Download to read offline
![evidence documents elaborated through this initiative and the examples of cases can be reviewed at http:
/www.paho.org/CDMEDIA/FCHGTZ/docsregionalesdocs.htm.
The Networks of Buen Trato [Good Treatment] that function in several countries have been used to
improve the responses to the problem. This type of network includes government and non-governmental
entities and tries to strengthen the capacities and efficiency of each entity joining the effort. For example,
experiences such as the “Casa Hogar UNACARI” (meaning the “his house” in the Yaqui dialect) in
Hermosillo, Sonora, México, where nearly 200 boys and girls between the ages of 0 and 14 years old have
suffered violence or have been abandoned by their mothers and fathers, provides shelter and
comprehensive assistance that includes formal education, medical services, psychological support and
recreation, in addition to the search for adoptive parents who will provide them with an adequate education
and attention. (http://www.difson.gob.mx/Sitio/programas_menores.aspx?prog=pUNACARI).
Aware of the problem and for the need for information on the subject, in 2002 PAHO published the first
bibliographic compendium on child abuse and maltreatment which includes more than 700 references and
their respective summaries from publications from 1995 to 2000. Through the publication of this second
volume of the Bibliography on Child Abuse and maltreatment, the Units of Child and Adolescent Health and
Risk Assessment of PAHO wish continue contributing to the promotion of information and evidence on the
situation of the child abuse in the Region of the Americas. For this second edition, publications from the
years 2001 to 2005 have been compiled from MEDLINE, LILACS and other sources.
The first part of this publication concentrates on articles about the definition, signs, and symptoms of
various forms of abuse and maltreatment; the following section contains references on the detection,
diagnosis, and evaluation of the utility of these for providers who work with abused children; articles on
practices and interventions have been grouped in order to facilitate their search for decision makers and
researchers; publications on pornography and child sexual abuse, and other special topics such as street
children, displaced persons due to wars and conflicts are listed after a section on the effects of the abuse
and neglect, which includes publications on mental health, long-term effects of violence or abuse,
resiliency, and aggressive behaviors. The last section compiles publications on human rights, laws, ethics,
and policy. A list of Web pages is included at the end of the document.
This publication is for physicians, government institutions, and ministries of health, family, and child
protection, academics, professors, researchers, and providers. We hope that it will contribute to the health
and development of children, adolescents, and their families and provide additional support for efforts to
reach the United Nations Millennium Development Goals (MDGs).
Yehuda Benguigui Alberto Concha-Eastman.
Unit Chief Regional Advisor
Child and Adolescent Health Risk Assessment and Management
Family and Community Health Sustainable Development and
PAHO/WHO Environmental Health
PAHO/WHO
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Hettiaratchy S, Dziewulski P. ABC of burns: pathophysiology and types of
burns. BMJ 2004; 328(7453):1427-9.
Fetuga BM, Njokama FO, Olowu AO. Prevalence, types and demographic
features of child labour among school children in Nigeria. BMC Int Health
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intervention to improve infant sleep and maternal mood. BMJ 2002;
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Forbes A, Acland P. What is the significance of haemosiderin in the lungs of
deceased infants? Med Sci Law 2004; 44(4):348-52.
Huyer D. Childhood sexual abuse and family physicians. Can Fam Physician
2005; 51:1317-9, 1323-5.
Free MM. Cross-cultural conceptions of pain and pain control. Proc (Bayl
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Kamer B, Bieganski T, Filipiak-Miastkowska I, Raczynska J, Baranska D,
Czyzewska S. [Difficulties in diagnosis of battered child syndrome in infant].
Fries AB, Pollak SD. Emotion understanding in postinstitutionalized Eastern Pol Merkuriusz Lek 2004; 16(94):368-72.
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Kashner TM, Carmody TJ, Suppes T et al. Catching up on health outcomes:
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Kaysen D, Scher CD, Mastnak J, Resick P. Cognitive Mediation of Childhood
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![Drugs for the doctor's bag: 2--children. Drug Ther Bull I was addicted to everything. J Mich Dent Assoc 2004;
2005; 43(11):81-4. 86(10):26-8, 30-1.
Abstract: In September 2005, we published Drugs for
the doctor's bag: 1--Adults, recognising the fact that The implementation of the Fast Track program: an example
there is still a need for most GPs to carry well- of a large-scale prevention science efficacy trial. J
equipped bags, even though many have given up Abnorm Child Psychol 2002; 30(1):1-17.
responsibility for out-of-hours services. Here we Abstract: In 1990, the Fast Track Project was initiated
suggest medicines that a GP might want to have to evaluate the feasibility and effectiveness of a
available for use in an emergency or for the acute comprehensive, multicomponent prevention program
treatment of children and adolescents, updatingour targeting children at risk for conduct disorders in four
previous advice. As with adults, it is not our intention demographically diverse American communities
to imply that every GP must carry every drug (Conduct Problems Prevention Research Group
mentioned. Some of the drugs will probably only be [CPPRG], 1992). Representing a prevention science
used by rural GPs who do not have access to approach toward community-based preventive
immediate emergency care. Whenever a medicine is intervention, the Fast Track intervention design was
first mentioned, our suggested formulation is included based upon the available data base elucidating the
in brackets. Unless otherwise stated, the doses given epidemiology of risk for conduct disorder and
are all from the BNF for Children. We enclose with suggesting key causal developmental influences (R. P.
this issue a card summarising parenteral doses (for Weissberg & M. T. Greenberg, 1998). Critical
adults and children) of drugs for medical emergencies; questions about this approach to prevention center
this card includes the BNF table of ideal weight for around the extent to which such a science-based
age. program can be effective at (1) engaging community
members and stakeholders, (2) maintaining
Exposure. Court: HIV-positive hearsay did not prejudice intervention fidelity while responding appropriately to
trial outcome. AIDS Policy Law 2004; 19(15):6. the local norms and needs of communities that vary
widely in their demographic and cultural/ethnic
Exposure. HIV-positive sex offender loses character witness composition, and (3) maintaining community
challenge. AIDS Policy Law 2004; 19(3):6. engagement in the long-term to support effective and
sustainable intervention dissemination. This paper
Exposure. Predator label holds for HIV-positive offender. discusses these issues, providing examples from the
AIDS Policy Law 2005; 20(16):8. Fast Track project to illustrate the process of program
implementation and the evidence available regarding
A genetic defense against child abuse? Harv Ment Health the success of this science-based program at engaging
Lett 2003; 19(9):8. communities in sustainable and effective ways as
partners in prevention programming.
Global group launches U.S. human rights project. AIDS
Policy Law 2002; 17(20):1. In Asia, child mortality is not linked to women's autonomy
or religion. Int Fam Plan Perspect 2003; 29(4):195-6.
The hidden health trauma of child soldiers. Lancet 2004;
363(9412):831. [In children with psychiatrically ill parents the soul suffers].
Krankenpfl J 2004; 42(5-6):153-4.
HIV as weapon. Court upholds man's enhanced sentence for
HIV exposure. AIDS Policy Law 2005; 20(14):8. Index of suspicion. Pediatr Rev 2003; 24(3):99-105.
HIV infection: five face death if guilty. Nurs Times 2001; [Investigating sexual abuse of a child]. Duodecim 2001;
97(38):9. 117(2):224-34.
Notes: CORPORATE NAME: Finnish Association of
HIV testing order must be challenged at trial. AIDS Policy Child Psychiatrists
Law 2004; 19(4):7.
Learn to read the signs. Nurs Stand 2003; 17(51):16-7.
HIV testing order reversed for convicted sex offender. AIDS
Policy Law 2005; 20(20):6. Lecturer struck off after claiming child pornography was a
teaching aid. Nurs Times 2001; 97(34):5.
HIV testing upheld for man convicted of child sexual abuse.
AIDS Policy Law 2004; 19(10):3. Letting live, letting die. Bull Med Ethics 2004; (201):19-22.
Notes: GENERAL NOTE: KIE: KIE Bib: allowing to
Hospitals tap into database for pediatric intensive care. Data die/infants; allowing to die/legal aspects
Strateg Benchmarks 2002; 6(6):85-91.
Libyan HIV trial is postponed. Nurs Times 2001; 97(39):7.
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![expected negative effect on the odds of child death in based clinicians were significantly more likely to
both groups, while household SES predicts child address a variety of routine health care maintenance
survival only among Fulbe children. When variables topics including: diet (relative risk [RR]: 1.09), sleep
representing the educational and psychosocial (RR: 1.46), at least 1 psychosocial issue (RR: 1.42),
attributes of the mother are included, no effects are smoking in the home (RR: 15.68), lead risk assessment
detected in either group. Controlling for these factors, (RR: 106.54), exposure to domestic or community
the size of total, practical, cognitive and emotional violence (RR: 35.19), guns in the home (RR: 58.11),
networks are found to significantly increase the odds of behavioral or social developmental milestones (RR:
child survival among the Fulbe only. Compositional 2.49), infant sleep position (RR: 9.29), breastfeeding
variables, such as the extent to which natal kin, non-kin (RR: 1.99), poison control (RR: 3.82), and child safety
or husbands figure in a woman's network, nor the (RR: 1.29). Trends toward improved lead exposure,
degree to which networks are located within household vision, and hearing screening were seen; however,
yield any significant results for the Fulbe. Among differences were not significant. Users of the system
Bamanan women, however, the higher the proportion reported that its use had improved the overall quality of
of network members living in the household, the lower care delivered, was well-accepted by families, and
the odds of child death. The paper concludes by improved guidance quality; however, 5 of 7 users
discussing the methodological, conceptual and reported that eye-to-eye contact with patients was
practical implications of these findings. reduced, and 4 of 7 reported that use of the system
increased the duration of visits (mean: 9.3 minutes
Adams JA. Evaluating children for possible sexual abuse. longer). All users recommended continued use of the
Am Fam Physician 2001; 63(5):843-4, 846. system. CONCLUSION: Use of the EMR in this study
was associated with improved quality of care. This
Adams Larsen M, Tentis E. The art and science of experience suggests that EMRs can be successfully
disciplining children. Pediatr Clin North Am 2003; used in busy urban pediatric primary care centers and,
50(4):817-40, viii-ix. as recommended by the Institute of Medicine, must
Abstract: A practical guide to working with parents on play a central role in the redesign of the US health care
the discipline of their children is provided. Focus is system.
specific to provide a practical tool of useful how-to
information for the primary care provider who works Adamsbaum C, Rolland Y, Husson B. [Pediatric
with children and their families. This article focuses on neuroimaging emergencies.]. J Neuroradiol 2004;
basic principles and techniques that can be established 31(4):272-80.
within the office setting, so as to model for families, as Abstract: The notion of emergency with regards to
well as to teach to families for use at home. This article pediatric neuroimaging requires a strong knowledge of
also focuses on common applications to illustrate the clinical indications. In children under 2 years of age,
use of these techniques. Finally, the art of consultation head trauma requires a CT scan in case of repeated or
and referral is reviewed for situations that are assessed prolonged or rapidly increasing vomiting, focal signs,
to be above and beyond the call of the primary loss of consciousness, unusual behavior, seizures,
practitioner. clinical signs of skull fracture or polytrauma. The
"shaken baby syndrome" is usually suspected in case of
Adams WG, Mann AM, Bauchner H. Use of an electronic loss of consciousness or seizures before 8 months of
medical record improves the quality of urban pediatric age. The hematomas that are observed are subdural in
primary care. Pediatrics 2003; 111(3):626-32. location, diffuse and deeply located. Imaging is only
Abstract: OBJECTIVE: To evaluate the quality of mandatory for headache suggesting underlying space
pediatric primary care, including preventive services, occupying lesion: permanent or increasing pain,
before and after the introduction of an electronic nocturnal headache, headache during postural changes
medical record (EMR) developed for use in an urban or efforts, associated to seizures or abnormal
pediatric primary care center. METHODS: A pre- neurological examination. No imaging is indicated in
postintervention analysis was used in the study. The case of first epileptic seizure associated to normal
intervention was a pediatric EMR. Routine health care neurological examination and without any particular
maintenance visits for children <5 years old were context. The presence of trauma, intracranial
reviewed, and documentation during preintervention hypertension, persisting disturbances of consciousness
(paper-based, 1998) and postintervention visits or associated focal sign necessitates urgent
(computer-based, 2000) was compared. RESULTS: A neuroimaging. No imaging is indicated in case of
total of 235 paper-based visits and 986 computer-based typical febrile seizures, i.e. generalized, brief and
visits met study criteria. Twelve clinicians (all occurring between 1 and 5 years of age. Spinal cord
attendings or nurse practitioners) contributed an symptoms require immediate MRI evaluation. The
average of 19.4 paper-based visits (range: 5-39) and 7 most frequent tumor is neuroblastoma. In the absence
of these clinicians contributed an average of 141 of spinal tumor, brain abnormalities must be excluded
computer-based visits each (range: 61-213). Computer- (inflammatory disease). In neonates, CT scan or MRI
must be readily performed in case of seizures or loss of
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![intensive care unit, duration of hospitalization, and media with effusion. A case report and review of
need for rehabilitation. Findings were compared with audiological assessments in children with otitis media
the general pediatric population hospitalized for non- with effusion. J Laryngol Otol 2003; 117(4):307-9.
terror-related trauma within the same time period. Abstract: A case of a child with mannosidosis and
RESULTS: During the study period, 138 children were bilateral otitis media with effusion (OME) is reported
hospitalized for a terror-related injury and 8363 for a here along with some discussion of relevant literature
non-terror-related injury. The study group was to emphasize the need for age appropriate audiometric
significantly older (mean age: 12.3 years [standard assessment before and after insertion of grommets for
deviation: 5.1] v 6.9 years [standard deviation: 5.3]) glue ear (OME). There is a need for multidisciplinary
and sustained proportionately more penetrating injuries teamwork in the management of children with hearing
(54% [n = 74] vs 9% [n = 725]). Differences were also loss. If OME is treated surgically, age-appropriate
noted in the proportion of internal injuries to the torso hearing assessment is required before and after
(11% in the patients with terror-related trauma vs 4% insertion of grommets. The need for audiological
in those with non-terror-related injuries), open wounds assessments will be relevant even if children had
to the head (13% vs 6%), and critical injuries (Injury passed the newborn hearing screening test.
Severity Score of 25+; 25% vs 3%). The study group
showed greater use of intensive care unit facilities Aitken ME, Rowlands LA, Wheeler JG. Advocating for
(33% vs 8% in the comparison group), longer median children's health at the state level: lessons learned.
hospitalization time (5 days vs 2 days), and greater Arch Pediatr Adolesc Med 2001; 155(8):877-80.
need for rehabilitative care (17% vs 1%). Abstract: This article documents the successful
CONCLUSIONS: Terror-related injuries are more creation and promotion of a bill to fund a nurse home
severe than non-terror-related injuries and increase the visitation program for high-risk mothers in Arkansas. It
demand for acute care in children. illustrates several key factors in successful advocacy by
pediatricians working in an academic setting: a realistic
Ahmad Z, Balsamo LM, Sachs BC, Xu B, Gaillard WD. time commitment; a community needs assessment, data
Auditory comprehension of language in young assimilation, and review of existing resources; the
children: neural networks identified with fMRI. identification and incorporation of stakeholders; a
Neurology 2003; 60(10):1598-605. narrow focus on the area of greatest need; the backing
Abstract: OBJECTIVE: The organization of neuronal of political partners; and favorable opportunities to
systems that process language in young children is advance child health issues.
poorly understood. The authors used fMRI to identify
brain regions underlying auditory comprehension in Ajrouch KJ, Antonucci TC, Janevic MR. Social networks
healthy young children. METHODS: Fifteen right- among blacks and whites: the interaction between race
handed children (mean age 6.8 years) underwent fMRI and age. J Gerontol B Psychol Sci Soc Sci 2001;
at 1.5-T using blood oxygen level dependent 56(2):S112-8.
echoplanar imaging. They listened to stories with a Abstract: OBJECTIVES: This study examined the
reverse speech control condition. Group data were main and interactive effects of age and race on the core
analyzed with statistical parametric mapping. characteristics of social networks including size,
Individual subject data were analyzed with a region of frequency of contact, geographical proximity, and
interest approach based on t-maps. An asymmetry composition of network. METHODS: Respondents
index (AI = [(L-R)/(L+R)]) was calculated for each were drawn from a stratified probability sample of
region. RESULTS: Group analysis showed significant people aged 20-93 in the greater Detroit metropolitan
activation in the left middle temporal gyrus (Brodmann area. Approximately 30% of the sample were African
area [BA] 21) and left superior temporal gyrus (BA 22) American, and people aged 60 and older were over-
along the superior temporal sulcus extending back to sampled (n = 1.382). The authors used hierarchical
the angular gyrus (BA 39). Individual maps showed regression analysis to estimate the influence of race
lateralized activation in temporal regions (AI > 0.49 +/- and age on each component of social network,
0.39). There was minimal activation in the frontal lobe. controlling for marital status, gender, and education.
There were no significant correlations between age and An interaction term (Race x Age) was added to explore
regional AI. CONCLUSION: Networks for auditory the extent to which age moderates any detected race
language processing are regionally localized and differences. RESULTS: Older age was associated with
lateralized by age 5. These data may provide a means smaller, less frequently seen, and less proximal
to interpret language fMRI studies performed in networks that had a higher proportion of kin. Blacks
preparation for brain surgery, and may be employed to and Whites were similar with regard to proximity, but
investigate the effect of chronic disease states, such as Blacks had smaller networks, more contact with
epilepsy, on language organization during critical network members, and more family members in their
periods for plasticity. networks. Race differences in frequency of contact and
proportion of kin were moderated by age, such that the
Ahmmed AU, O'Halloran SM, Roland NJ, Starkey M, differences in these variables diminished with
Wraith JE. Hearing loss due to mannosidosis and otitis increasing age. DISCUSSION: A systematic analysis
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![mothers and their children recruited as part of the learning approach to gene-expression data
longitudinal Mater University Study of Pregnancy and classification. Artif Intell Med 2003; 28(1):75-87.
its outcomes (MUSP) carried out in Brisbane, Abstract: We investigate the use of perceptrons for
Australia, from 1981 to 1984. Data were collected classification of microarray data where we use two
prenatally and then postnatally at 6 months and at 5, datasets that were published in [Nat. Med. 7 (6) (2001)
14, and 21 years. A range of biologic, familial, and 673] and [Science 286 (1999) 531]. The classification
intrapersonal factors was considered. A series of problem studied by Khan et al. is related to the
logistic regression models with inverse probability diagnosis of small round blue cell tumours (SRBCT) of
weighting was used to explore pathways to problem childhood which are difficult to classify both clinically
drinking from adolescence to early adulthood. For and via routine histology. Golub et al. study acute
males and females, no association was found between myeloid leukemia (AML) and acute lymphoblastic
either birth factors or childhood factors and a lifetime leukemia (ALL). We used a simulated annealing-based
diagnosis of alcohol disorders at age 21 years. method in learning a system of perceptrons, each
Externalizing symptoms and maternal factors at age 14 obtained by resampling of the training set. Our results
years were significantly associated with alcohol are comparable to those of Khan et al. and Golub et al.,
problems. For youth aged 14 years, maternal moderate indicating that there is a role for perceptrons in the
alcohol consumption accounted for the highest classification of tumours based on gene-expression
percentage of attributable risk among those exposed. data. We also show that it is critical to perform feature
Results show that exposure to maternal drinking in selection in this type of models, i.e. we propose a
adolescence is a strong risk factor for the development method for identifying genes that might be significant
of alcohol problems in early adulthood. for the particular tumour types. For SRBCTs, zero
error on test data has been obtained for only 13 out of
Alber TS. [Chlamydia trachomatis and Neisseria 2308 genes; for the ALL/AML problem, we have zero
gonorrhoeae in sexually abused children in Jutland]. error for 9 out of 7129 genes that are used for the
Ugeskr Laeger 2003; 165(5):481; author reply 481. classification procedure. Furthermore, we provide
evidence that Epicurean-style learning and simulated
Albertyn R, Bickler SW, van As AB, Millar AJ, Rode H. annealing-based search are both essential for obtaining
The effects of war on children in Africa. Pediatr Surg the best classification results.
Int 2003; 19(4):227-32.
Abstract: There is no doubt that the effects of war Albrecht SA, Maloni JA, Thomas KK, Jones R, Halleran J,
extend to the most vulnerable members of society, Osborne J. Smoking cessation counseling for pregnant
including children. Although armed conflicts occur women who smoke: scientific basis for practice for
throughout the world, the African continent seems to AWHONN's SUCCESS project. J Obstet Gynecol
be a particular background for civil and international Neonatal Nurs 2004; 33(3):298-305.
wars. The aim of this study was to identify causes of Abstract: OBJECTIVES: To review the literature
conflict in Africa and to evaluate the effect of war on addressing smoking cessation in pregnant women. To
children and their health in order to make practical develop the project protocol for the Association of
recommendations to health care workers dealing with Women's Health, Obstetric and Neonatal Nurse's
children in the setting of war. All articles written in the (AWHONN) 6th research-based practice project titled
past 5 years concerning "war" and "children" were "Setting Universal Cessation Counseling, Education
identified by means of a literature search and internet and Screening Standards (SUCCESS): Nursing Care of
review. Contrary to common belief, the causes of Pregnant Women Who Smoke." To evaluate the
conflict are complicated and multi-factorial. The potential of systematic integration of this protocol in
effects of war on childhood are disastrous and include primary care settings in which women seek care at the
severe negative effects on general paediatric health preconception, pregnant, or postpartum stages.
status. Short-term recommendations for health care LITERATURE SOURCES: Computerized searches in
workers working with children in war include supply MEDLINE and CINAHL, as well as references cited in
of emergency medical infrastructures, basic health articles reviewed. Key concepts in the searches
care, rehabilitation and education. Long-term included low-birth-weight infants and effects of
recommendations include orchestrating the relief and prenatal smoking on the infant and the effects of
support efforts from both national governments and preconception and prenatal smoking cessation
international non-profit organisations and speeding up intervention on premature labor and birth weight.
of economic recovery. The causes of conflict in Africa LITERATURE SELECTION: Comprehensive articles,
are complex and unlikely to be resolved soon. The reports, and guidelines relevant to key concepts and
effects of war on children are horrendous in many published after 1964 with an emphasis on new findings
ways, but can be limited by providing timely and from 1996 through 2002. Ninety-eight citations were
appropriate health care. identified as useful to this review. LITERATURE
SYNTHESIS: Tobacco use among pregnant women
Albrecht A, Vinterbo SA, Ohno-Machado L. An Epicurean and children's exposure to tobacco use (secondhand
smoke) are associated with pregnancy complications
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![such as placental dysfunction (including previa or took their medication but rarely resulted in stopping
abruption), preterm labor, premature rupture of prophylaxis. Prescribed antimalarials were sometimes
membranes, spontaneous abortions, and decreased birth never given. Appropriate counseling on side effects
weight and infant stature. Neonates and children who and reasons for faithful administration should
are exposed to secondhand smoke are at increased risk accompany antimalarial prophylaxis.
for developing otitis media, asthma, other respiratory
disorders later in childhood; dying from sudden infant Alechnowicz K, Chapman S. The Philippine tobacco
death syndrome; and learning disorders. The "5 A's" industry: "the strongest tobacco lobby in Asia". Tob
intervention and use of descriptive statements for Control 2004; 13 Suppl 2:ii71-8.
smoking status assessment were synthesized into the Abstract: OBJECTIVE: To highlight revelations from
SUCCESS project protocol for AWHONN's 6th internal tobacco industry documents about the conduct
research-based practice project. CONCLUSIONS: The of the industry in the Philippines since the 1960s.
literature review generated evidence that brief, office- Areas explored include political corruption, health,
based assessment, client-specific tobacco counseling, employment of consultants, resisting pack labelling,
skill development, and support programs serve as an and marketing and advertising. METHODS:
effective practice guideline for clinicians. Systematic keyword Minnesota depository website
Implementation and evaluation of the guideline is searches of tobacco industry internal documents made
under way at a total of 13 sites in the United States and available through the Master Settlement Agreement.
Canada. RESULTS: The Philippines has long suffered a
reputation for political corruption where collusion
Albright TA, Binns HJ, Katz BZ. Side effects of and between state and business was based on the exchange
compliance with malaria prophylaxis in children. J of political donations for favourable economic policies.
Travel Med 2002; 9(6):289-92. The tobacco industry was able to limit the effectiveness
Abstract: BACKGROUND: We wanted to determine of proposed anti-tobacco legislation. A prominent
the frequency of side effects and compliance with scientist publicly repudiated links between active and
mefloquine and chloroquine used for antimalarial passive smoking and disease. The placement of health
prophylaxis in children 0 to 13 years compared with warning labels was negotiated to benefit the industry,
side effects in same-age children taking prophylactic and the commercial environment allowed it to
chloroquine. METHODS: Subjects and treatment were capitalise on their marketing freedoms to the fullest
identified by retrospective medical record review for potential. Women, children, youth, and the poor have
children < or = 13 years not on other medications who been targeted. CONCLUSION: The politically laissez
visited a travel clinic between November 1997 and faire Philippines presented tobacco companies with an
January 2000. Parents were interviewed via telephone environment ripe for exploitation. The Philippines has
in January through March 2000 regarding compliance seen some of the world's most extreme and
and side effects. RESULTS: We reviewed 286 records controversial forms of tobacco promotion flourish.
and contacted 190 of 286 parents (66%). Of these, 177 Against international standards of progress, the
(93%) parents had first-hand knowledge about the Philippines is among the world's slowest nations to
child's compliance with the medication regimen and take tobacco control seriously.
were interviewed. Subjects were 47% male (median
age 6.3 years), contacted a median of 12.4 months Alemi F, Haack M, Nemes S. Statistical definition of
(range 2.8 to 28 months) following their clinic visit. Of relapse: case of family drug court. Addict Behav 2004;
these, 148 (84%) were prescribed mefloquine, and 29, 29(4):685-98.
chloroquine with 77% (136/177) taking the prescribed Abstract: At any point in time, a patient's return to drug
antimalarial. Most children (30 of 41 [73%]) not use can be seen either as a temporary event or as a
receiving their prophylaxis traveled unprotected to return to persistent use. There is no formal standard for
endemic area. Sixteen subjects (12% of those taking distinguishing persistent drug use from an occasional
antimalarials) reported side effects. Eleven of 115 relapse. This lack of standardization persists although
subjects (10%) who took mefloquine, and 5 of 22 the consequences of either interpretation can be life
subjects (23%) who took chloroquine reported a side altering. In a drug court or regulatory situation, for
effect. Side effects for mefloquine included diarrhea, example, misinterpreting relapse as return to drug use
anorexia, vivid dreams, headache, changes in sleep, could lead to incarceration, loss of child custody, or
hallucinations, and vomiting with 2 subjects stopping loss of employment. A clinician who mistakes a client's
mefloquine after seeking medical care. Side effects for relapse for persistent drug use may fail to adjust
chloroquine were headache, nausea, and changes in treatment intensity to client's needs. An empirical and
sleep. No child stopped taking chloroquine. Groups standardized method for distinguishing relapse from
reporting or not reporting a side effect were similar for persistent drug use is needed. This paper provides a
gender, age, travel destination, antimalarial prescribed, tool for clinicians and judges to distinguish relapse
and elapsed time from clinic visit to telephone contact. from persistent use based on statistical analyses of
CONCLUSIONS: Side effects from antimalarial drug patterns of client's drug use. To accomplish this, a
administration occurred in 10 to 23% of patients who control chart is created for time-in-between relapses.
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![Alter MJ. Do patients who fail to complete a hepatitis A or Aman MG, De Smedt G, Derivan A, Lyons B, Findling RL.
hepatitis B vaccination series have to restart it? Cleve Double-blind, placebo-controlled study of risperidone
Clin J Med 2003; 70(3):234. for the treatment of disruptive behaviors in children
with subaverage intelligence. Am J Psychiatry 2002;
Altshuler SJ. Drug-endangered children need a collaborative 159(8):1337-46.
community response. Child Welfare 2005; 84(2):171- Notes: CORPORATE NAME: Risperidone Disruptive
90. Behavior Study Group
Abstract: The United States is facing an epidemic of Abstract: OBJECTIVE: The short-term efficacy and
the use of methamphetamine drugs. Child welfare has safety of risperidone in the treatment of disruptive
not yet addressed the needs of the children living in so- behaviors was examined in a well-characterized cohort
called "meth homes." These children are endangered of children with subaverage intelligence. METHOD: In
not only from the chemicals involved, but also from this 6-week, multicenter, double-blind, parallel-group
parental abuse and neglect. Communities are study of 118 children (aged 5-12 years) with severely
recognizing the need for interagency collaboration to disruptive behaviors and subaverage intelligence (IQ
address the consequences of this epidemic. Spokane, between 36 and 84, inclusive), the subjects received
Washington, has created a Drug-Endangered Children 0.02-0.06 mg/kg per day of risperidone oral solution or
Project, whose mission is to implement a collaborative placebo. The a priori primary efficacy measure was the
response among law enforcement, prosecutorial, change in score from baseline to endpoint on the
medical, and social service professionals to the needs conduct problem subscale of the Nisonger Child
of drug-endangered children. This article presents the Behavior Rating Form. RESULTS: The risperidone
findings from the evaluation of the first year of the group showed significantly greater improvement than
project, including a baseline assessment of the needs of did the placebo group on the conduct problem subscale
drug-endangered children and the extent of of the Nisonger Child Behavior Rating Form from
community-based collaboration achieved. This article week 1 through endpoint (change in score of -15.2 and
makes recommendations for future community-based -6.2, respectively). Risperidone was also associated
partnerships to improve the well-being of drug- with significantly greater improvement than placebo on
endangered children. all other Nisonger Child Behavior Rating Form
subscales at endpoint, as well as on the Aberrant
Alvarado BE, Zunzunegui MV, Delisle H. [Validation of Behavior Checklist subscales for irritability,
food security and social support scales in an Afro- lethargy/social withdrawal, and hyperactivity; the
Colombian community: application on a prevalence Behavior Problems Inventory aggressive/destructive
study of nutritional status in children aged 6 to 18 behavior subscale; a visual analogue scale of the most
months]. Cad Saude Publica 2005; 21(3):724-36. troublesome symptom; and the Clinical Global
Abstract: We conducted a cross-sectional study on 193 Impression change score. The most common adverse
mothers of children 6 to 18 months of age in an effects reported during risperidone treatment were
African-Colombian community, with the objectives: headache and somnolence. The extrapyramidal
(1) to adapt and validate the Community Childhood symptom profile of risperidone was comparable to that
Hunger Identification Project scale, the DUKE-UNC- of placebo. Mean weight increases of 2.2 kg. and 0.9
11 social support scale, and the Quebec Longitudinal kg occurred in the risperidone and placebo groups,
Study of Child Development (QLSCD) partner support respectively. CONCLUSIONS: Risperidone was
scale, and (2) to identify any existent relationship effective and well tolerated for the treatment of
between nutritional status in infancy and both food severely disruptive behaviors in children with
insecurity and social support. We determined construct subaverage IQ.
validity using factor analysis and theoretical models-
based non-parametric correlations. Length-for-age and Ambalavanan N, Carlo WA. Comparison of the prediction
weight-for-length Z-results were calculated. Factor of extremely low birth weight neonatal mortality by
analyses reduced the hunger scale to one factor, the regression analysis and by neural networks. Early Hum
DUKE-UNC-11 scale to two factors, and the QLSCD Dev 2001; 65(2):123-37.
scale to one factor. The Cronbach's alpha test ranged Abstract: AIMS: To compare the prediction of
between 0.70 and 0.90. Both food insecurity and social mortality in individual extremely low birth weight
support scales were correlated with mother's social (ELBW) neonates by regression analysis and by
conditions, and social support was positively associated artificial neural networks. STUDY DESIGN: A
with social networks and mother's self-perceived health database of 23 variables on 810 ELBW neonates
status. Food insecurity, emotional-social support, and admitted to a tertiary care center was divided into
partner's negative support were associated with lower training, validation, and test sets. Logistic regression
height-to-age and therefore a higher ratio of chronic and neural network models were developed on the
malnutrition. The study supports the appropriateness of training set, validated, and outcome (mortality)
the instruments to measure the expressed concepts. predicted on the test set. Stepwise regression identified
significant variables in the full set. Regression models
and neural networks were then tested using data sets
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![school officials for July 1, 1994, through June 30, same primary genetic changes, segregated together,
1999. A case was defined as a homicide, suicide, legal suggesting that pathogenetically important regulatory
intervention, or unintentional firearm-related death of a networks remain conserved despite numerous passages.
student or nonstudent in which the fatal injury occurred Moreover, primary leukemias cosegregated with cell
(1) on the campus of a public or private elementary or lines carrying identical genetic rearrangements, further
secondary school, (2) while the victim was on the way supporting that critical regulatory pathways remain
to or from such a school, or (3) while the victim was intact in hematopoietic cell lines. Transcriptional
attending or traveling to or from an official school- signatures correlating with clinical subtypes/primary
sponsored event. MAIN OUTCOME MEASURES: genetic changes were identified and annotated based on
National estimates of risk of school-associated violent their biological/molecular properties and chromosomal
death; national trends in school-associated violent localization. Furthermore, the expression profile of
deaths; common features of these events; and potential tyrosine kinase-encoding genes was investigated,
risk factors for perpetration and victimization. identifying several differentially expressed members,
RESULTS: Between 1994 and 1999, 220 events segregating with primary genetic changes, which may
resulting in 253 deaths were identified; 202 events be targeted with tyrosine kinase inhibitors. The
involved 1 death and 18 involved multiple deaths identified conserved signatures are likely to reflect
(median, 2 deaths per multiple-victim event). Of the regulatory networks of importance for the transforming
220 events, 172 were homicides, 30 were suicides, 11 abilities of the primary genetic changes and offer
were homicide-suicides, 5 were legal intervention important pathogenetic insights as well as a number of
deaths, and 2 were unintentional firearm-related deaths. targets for future rational drug design.
Students accounted for 172 (68.0%) of these deaths,
resulting in an estimated average annual incidence of Andersson N, Cockcroft A, Ansari N et al. Household cost-
0.068 per 100 000 students. Between 1992 and 1999, benefit equations and sustainable universal childhood
the rate of single-victim student homicides decreased immunisation: a randomised cluster controlled trial in
significantly (P =.03); however, homicide rates for south Pakistan. BMC Public Health 2005; 5:72.
students killed in multiple-victim events increased (P Abstract: BACKGROUND: Household decision-
=.047). Most events occurred around the start of the makers decide about service use based largely on the
school day, the lunch period, or the end of the school costs and perceived benefits of health interventions.
day. For 120 (54.5%) of the incidents, respondents Very often this leads to different decisions than those
reported that a note, threat, or other action potentially imagined by health planners, resulting in under-
indicating risk for violence occurred prior to the event. utilisation of public services like immunisation. In the
Homicide offenders were more likely than homicide case of Lasbela district in the south of Pakistan, only
victims to have expressed some form of suicidal one in every ten children is immunised despite free
behavior prior to the event (odds ratio [OR], 6.96; 95% immunisation offers by government health services.
confidence interval [CI], 1.96-24.65) and been bullied METHODS/DESIGN: In 32 communities
by their peers (OR, 2.57; 95% CI, 1.12-5.92). representative of Lasbela district, 3344 households
CONCLUSIONS: Although school-associated violent participated in a baseline survey on early child health.
deaths remain rare events, they have occurred often In the 18 randomly selected intervention communities,
enough to allow for the detection of patterns and the we will stimulate discussions on the household cost-
identification of potential risk factors. This information benefit equation, as measured in the baseline. The
may help schools respond to this problem. reference (control) communities will also participate in
the three annual follow-up surveys, feedback of the
Andersson A, Eden P, Lindgren D et al. Gene expression general survey results and the usual health promotion
profiling of leukemic cell lines reveals conserved activities relating to immunisation, but without
molecular signatures among subtypes with specific focussed discussion on the household cost-benefit
genetic aberrations. Leukemia 2005; 19(6):1042-50. equations. DISCUSSION: This project proposes
Abstract: Hematologic malignancies are characterized knowledge translation as a two-way communication
by fusion genes of biological/clinical importance. that can be augmented by local and international
Immortalized cell lines with such aberrations are today evidence. We will document cultural and contextual
widely used to model different aspects of barriers to immunisation in the context of household
leukemogenesis. Using cDNA microarrays, we cost-benefit equations. The project makes this
determined the gene expression profiles of 40 cell lines information accessible to health managers, and
as well as of primary leukemias harboring 11q23/MLL reciprocally, makes information on immunisation
rearrangements, t(1;19)[TCF3/PBX1], effects and side effects available to communities. We
t(12;21)[ETV6/RUNX1], t(8;21)[RUNX1/CBFA2T1], will measure the impact of this two-way knowledge
t(8;14)[IGH@/MYC], t(8;14)[TRA@/MYC], translation on immunisation uptake.
t(9;22)[BCR/ABL1], t(10;11)[PICALM/MLLT10],
t(15;17)[PML/RARA], or inv(16)[CBFB/MYH11]. Andrade LO, Bareta IC, Gomes CF, Canuto OM. Public
Unsupervised classification revealed that health policies as guides for local public policies: the
hematopoietic cell lines of diverse origin, but with the experience of Sobral-Ceara, Brazil. Promot Educ 2005;
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![Suppl 3:28-31. disorders being 54% for attention-deficit/hyperactivity
Abstract: The accelerated urbanisation process that disorder, 77% for conduct disorder, 41% for
Brazil has gone through in the last 50 years has given oppositional defiant disorder, 57% for anxiety disorder
rise to daunting challenges for public managers, 57, 60% for depressive disorder 60, 63% for illicit drug
especially in terms of local public policy management abuse, and 58% for regular alcohol use. Internalizing
for the building of "healthy cities". In Sobral, a disorders (depressive disorders, anxiety disorders and
municipality of 173,000 inhabitants in Ceara in the phobias) were more prevalent in the female subsample.
North-eastern region of Brazil, a number of municipal There was no significant difference in the prevalence
policies were initiated beginning in 1997, many in of illicit drug abuse between genders. There were more
partnership with the federal and state governments. male than female adolescents on parole and failure to
They were inspired by the vision of a healthy and comply with the sentence was significantly more
equitable city and were marked by strategic planning frequent in females. The high prevalence of
and the implementation of intersectoral projects. This psychopathology suggested by this study indicates the
article lays out some of the actions and their results, need for psychiatric treatment as part of the prevention
including an increase in the public supply of drinking of juvenile delinquency or as part of the sentence.
water from 65% to 97% of households; an increase in However, treatment had never been available for 93%
sewage networks from 7% to 65%; an increase in of the sample in this study.
public refuse collection from 42% to 90%; the
expansion of green areas; the construction of nine Andreassen M, Lajer M, Lau M, Moesgaard K, Poulsen S,
kilometres of bicycle paths; the universalisation of Ramsing P. [Recovered memories--agreed and
integral health care through the Family Health Strategy disagreed]. Ugeskr Laeger 2004; 166(48):4394.
through a network with specialised out-patient and
hospital services; and a 148% increase in the number of Andronikou S, Bertelsmann J. CT scanning--essential for
children enrolled in primary school. These initiatives conservative management of paediatric blunt
also resulted in the improvement of quality of life abdominal trauma. S Afr Med J 2002; 92(1):35-8.
indicators, including a reduction in infant mortality
from 61.4 to 19.0 per thousand live births, a drop in the Andrzejak RG, Widman G, Lehnertz K, Rieke C, David P,
mortality rate from traffic accidents from 33.40 per Elger CE. The epileptic process as nonlinear
100,000 inhabitants in 2001 to 15.25 in 2003; and a deterministic dynamics in a stochastic environment: an
jump in literacy rates among children in the first cycle evaluation on mesial temporal lobe epilepsy. Epilepsy
of primary school from 40 to 90.7%. In the present Res 2001; 44(2-3):129-40.
article, the authors describe some of the successful Abstract: The theory of deterministic chaos addresses
strategies and projects initiated between 1997 and simple deterministic dynamics in which nonlinearity
2003, and discuss how this experience could be gives rise to complex temporal behavior. Although
reproduced in other communities across Brazil and biological neuronal networks such as the brain are
around the world. highly complicated, a number of studies provide
growing evidence that nonlinear time series analysis of
Andrade RC, Silva VA, Assumpcao FB Jr. Preliminary data brain electrical activity in patients with epilepsy is
on the prevalence of psychiatric disorders in Brazilian capable of providing potentially useful diagnostic
male and female juvenile delinquents. Braz J Med Biol information. In the present study, this analysis
Res 2004; 37(8):1155-60. framework was extended by introducing a new
Abstract: The aim of the present investigation was to measure xi, designed to discriminate between nonlinear
study the prevalence of psychiatric disorders in a deterministic and linear stochastic dynamics. For the
sample of delinquent adolescents of both genders and evaluation of its discriminative power, xi was extracted
to compare the prevalence between genders. A total of from intracranial multi-channel EEGs recorded during
116 adolescents (99 males and 17 females) aged 12 to the interictal state in 25 patients with unilateral mesial
19 on parole in the State of Rio de Janeiro were temporal lobe epilepsy. Strong indications of nonlinear
interviewed using the screening interview based on the determinism were found in recordings from within the
Schedule for Affective Disorders and Schizophrenia epileptogenic zone, while EEG signals from other sites
for School-Age Children -- Present and Lifetime mainly resembled linear stochastic dynamics. In all
(KSADS-PL). Data were collected between May 2002 investigated cases, this differentiation allowed to
and January 2003. Of 373 male and 58 female retrospectively determine the side of the epileptogenic
adolescents present in May 2002 in the largest zone in full agreement with results of the presurgical
institution that gives assistance to adolescents on parole workup.
in the city of Rio de Janeiro, 119 subjects were
assessed (three of them refused to participate). Their Angeles-Llerenas A, Bello MA, Dirce G, Salinas MA.
average age was 16.5 years with no difference between [Argentina, Brazil and Mexico. Biomedical research
genders. The screening interview was positive for and the defense of a single standard of attention in
psychopathology for most of the sample, with the developing countries]. Rev Invest Clin 2004;
frequencies of the suggested more prevalent psychiatric
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![56(5):675-85. critically new findings in this area. RECENT
Abstract: In the Helsinki Declaration, which FINDINGS: Research reviews and new studies
established the ethical principles for research with continue to highlight the burden of unidentified and
human subjects, article 5 states, "...concern about the hence untreated psychopathology among children
well-being of human beings should always come attending primary care. Expression of parental concern
before the interests of science and of society..." appears to provide important help in improving
Research proposals should include this commitment, recognition. Shared protocols have been developed for
both in developed and developing countries. In primary care use for clinical conditions such as
countries like Argentina, Brazil and Mexico, much of attention deficit hyperactivity disorder, but adherence
the population experience situations of great injustice, to protocols is still limited. Randomized controlled
including a lack of equal access to health care. In some trials have shown the feasibility and efficacy of
cases, sectors of the pharmaceutical industry may see suitably adapted therapeutic interventions for
these deficiencies as offering opportunities for carrying adolescent depression in primary healthcare and in
out research and achieving economic profits, educational settings. Surveys indicate a significant
something which carries the risk of perpetuating and amount of child and adolescent mental health work by
even intensifying the unjust situations and violations of social services in countries such as the UK, and attest
human rights--these population groups already suffer to the usefulness of protocols to attend to children in
from. This situation implies the need for commitment foster care. The new role of primary mental health
to and ethical reflection upon human rights related to worker has the potential to help support the interface
health. Agreements are needed between the actors between primary and specialist child and adolescent
involved in health research: sources of funding, mental health services. SUMMARY: There is
researchers, public policy makers, and the study increased interest in further clarifying and enhancing
subjects themselves, in order to protect the latter's the role of primary care child and adolescent mental
rights, including continuity of medical treatment for health services.
research subjects, when necessary.
Annas GJ. Conjoined twins--the limits of law at the limits of
Angelides S. Historicizing affect, psychoanalyzing history: life. N Engl J Med 2001; 344(14):1104-8.
pedophilia and the discourse of child sexuality. J Notes: GENERAL NOTE: KIE: Annas, George J
Homosex 2003; 46(1-2):79-109. GENERAL NOTE: KIE: 22 refs.
Abstract: Within the last two decades in Australia, GENERAL NOTE: KIE: KIE Bib: informed
Britain, and the United States, we have seen a veritable consent/minors; patient care/minors
explosion of cultural panic regarding the problem of
pedophilia. Scarcely a day passes without some Annas GJ. Extremely preterm birth and parental authority to
mention in the media of predatory pedophiles or refuse treatment--the case of Sidney Miller. N Engl J
organized pedophile networks. Many social Med 2004; 351(20):2118-23.
constructionist historians and sociologists have Notes: GENERAL NOTE: KIE: 13 refs.
described this incitement to discourse as indicative of a GENERAL NOTE: KIE: KIE Bib: allowing to
moral panic. The question that concerns me in this die/infants; resuscitation orders; treatment
article is: If this incitement to discourse is indicative of refusal/minors
a moral panic, to what does the panic refer? I begin by
detailing, first, how social constructionism requires Annas GJ. The right to health and the nevirapine case in
psychoanalytic categories in order to understand the South Africa. N Engl J Med 2003; 348(8):750-4.
notion of panic, and second, how a psychoanalytic Notes: GENERAL NOTE: KIE: 20 refs.
reading of history might reveal important unconscious GENERAL NOTE: KIE: KIE Bib: AIDS; health
forces at work in the current pedophilia "crisis" that our care/foreign countries; health care/rights
culture refuses to confront. Here, I will suggest a
repressed discourse of child sexuality is writ large. I Annas GJ. Testing poor pregnant patients for cocaine--
will argue that the hegemonic discourse of pedophilia physicians as police investigators. N Engl J Med 2001;
is contained largely within a neurotic structure and that 344(22):1729-32.
many of our prevailing responses to pedophilia Notes: GENERAL NOTE: KIE: Annas, George J
function as a way to avoid tackling crucial issues about GENERAL NOTE: KIE: 19 refs.
the reality and trauma of childhood sexuality. GENERAL NOTE: KIE: KIE Bib: prenatal injuries
Ani C, Garralda E. Developing primary mental healthcare Anthuber S, Hepp H. [Child and adolescent gynecology.
for children and adolescents. Curr Opin Psychiatry Introduction to the focal topic 'Child and adolescent
2005; 18(4):440-4. gynecology']. Gynakol Geburtshilfliche Rundsch 2003;
Abstract: PURPOSE OF REVIEW: Governmental 43(3):129-30.
initiatives to enhance child and adolescent mental Abstract: Valuable knowledge from the subspecialty of
healthcare are giving renewed impetus to work in child and adolescent gynecology is of considerable
primary care. This review identifies and discusses
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![importance for the clinically active pediatrician and consists of a written and a clinical component. Each
gynecologist. Focal topics such as sexual violence to candidate at the clinical component sees one long case
children and young adults, undesired pregnancies and and two short cases. OBJECTIVES: To assess the
pregnancy termination should not only be made known views of the bystanders regarding their sick children
in the media, but also to specialists, so that successful participating at a clinical examination, and to evaluate
prevention and treatment can be carried out. the children's perceptions of the clinical component.
Furthermore, endocrinological problems and genital METHODS: An interviewer-administered
malformations in adolescence should be detectable and questionnaire was discussed separately with the
treatable. participating children and their bystanders at the final
year examination in paediatrics of the Faculty of
Aouina H, El Gharbi L, Fakhfakh R et al. [Smoking Medicine, Colombo, in 1999. RESULTS: 116 patients
cessation program in Tunisia: experience of a participated at the clinical examination in paediatrics.
respiratory service.]. Int J Tuberc Lung Dis 2002; 107 (92%) of the bystanders were the children's
6(12):1123-7. mothers. Informed consent had not been obtained for
Abstract: A tobacco cessation programme was recently use in the examination from 59 (51%) of the children's
introduced into medical practice in Tunisia. The mothers. Seven (6%) were not satisfied with the way
medical staff in the pulmonary disease ward at Charles their children were handled by the candidates, and 25
Nicolle Hospital, Tunis, has been the first to implement (21.5%) showed concern about the number of
such a programme for people motivated to quit candidates examining their child. Bystanders who
smoking. This programme has been run for 3 years in participated at the long cases were inconvenience more
the respiratory disease out-patient department. It acts than those in the short cases. 34 children above the age
essentially against psychological and pharmacological of 5 years were also interviewed. An explanation
dependence on tobacco. The results obtained were very regarding the examination had not been given to 31
encouraging: 298 smokers have participated in this (92%) of them. Six children (17%) said they were
programme. The global success rate at 12 months of examined for too long. A majority of the bystanders
tobacco withdrawal was about 25% for people who welcomed the payments received and all of them were
were followed up, and 17% for the whole sample. satisfied with the medical students' conduct and
Medical help for smoking cessation should be more politeness. All of them agreed that this form of clinical
widely promoted in Tunisia to increase the number of examination was a good method of evaluating a
smokers who consult and improve the quality of student's professional competence. CONCLUSIONS:
medical intervention. Several aspects of the clinical component of the final
examination in paediatrics for medical undergraduates
Appelbaum PS. Law & psychiatry: Third-party suits against need to be improved to minimise the inconvenience
therapists in recovered-memory cases. Psychiatr Serv experienced by the children and their parents.
2001; 52(1):27-8.
Arana E, Marti-Bonmati L, Bautista D, Paredes R.
Appelbaum PS. The 'quiet' crisis in mental health services. [Diagnosis of calvarial lesions. Feature selection by
Health Aff (Millwood) 2003; 22(5):110-6. neural network and logistic regression]. Neurocirugia
Abstract: The failure of insurers and managed care (Astur) 2003; 14(5):377-84.
organizations to reimburse providers of mental health Abstract: OBJECTIVES: To establish the minimun set
services for the costs of care has led to a crisis in of features needed in the diagnosis of calvarial lesions
access to these services. Using the situation in using computed tomography (CT) and to assess the
Massachusetts as a case example, this paper explores accuracy of logistic regression (LR) and artificial
the impact of this defunding. Unable to sustain neural networks (NN) for their diagnosis. MATERIAL
continued losses, hospitals are closing psychiatric AND METHODS: 167 patients with calvarial lesions
units, and outpatient services are contracting or closing as the only known disease were enrolled. The clinical
altogether. The situation has been compounded by the and CT data were used for LR and NN models. Both
withdrawal of many practitioners from managed care models were tested with the jacknife method. The final
networks and cuts in public-sector mental health results of each model were compared using the area
services. Unless purchasers demand effective coverage under ROC curves (A 2 ). RESULTS: The lesions were
of mental health treatment, mental health services will 73.1 % benign and 26.9% malignant. There was no
likely continue to wither away. statistically significant difference between LR and NN
in differentiating malignancy. In characterizing the
Arachchi JK, Sumanasena SP, de Silva KS. Clinical histologic diagnoses, NN was statistically superior to
examination in paediatrics at final MBBS: views of LR. Important NN features needed for malignancy
children and their parents. Ceylon Med J 2003; classification were age and edge definition, and for the
48(1):12-4. histologic diagnoses matrix, marginal sclerosis and
Abstract: INTRODUCTION: The final examination in age. CONCLUSIONS: A minimum four features is
paediatrics for medical undergraduates in Sri Lanka needed to diagnose these lesions, not being important
patients' symptoms. NNs offer wide possibilities over
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![statistics for the calvarial lesions study besides a of domestic violence.
superior diagnostic performance.
Argyropoulos C, Nikiforidis GC, Theodoropoulou M et al.
Arana E, Marti-Bonmati L, Bautista D, Paredes R. Mining microarray data to identify transcription factors
Qualitative diagnosis of calvarial metastasis by neural expressed in naive resting but not activated T
network and logistic regression. Acad Radiol 2004; lymphocytes. Genes Immun 2004; 5(1):16-25.
11(1):45-52. Abstract: Transcriptional repressors controlling the
Abstract: RATIONALE AND OBJECTIVES: To expression of cytokine genes have been implicated in a
simplify the diagnostic features used by an artificial variety of physiological and pathological phenomena.
neural network compared with logistic regression (LR) An unknown repressor that binds to the distal NFAT
in the diagnosis of calvarial metastasis with computed element of the interleukin-2 (IL-2) gene promoter in
tomography and analyze their accuracy. MATERIALS naive T-helper lymphocytes has been implicated in
AND METHODS: Twenty-one of 167 patients with autoimmune phenomena and has emerged as a
calvarial lesions were found to have metastasis. potentially important factor controlling the latency of
Clinical and computed tomography data were used for HIV-1. The aim of this paper was the identification of
LR and neural network models. Both models were this repressor. We resorted to public microarray
tested with the leave-one-out method. The final results databases looking for DNA-binding proteins that are
of each model were compared using the area under present in naive resting T cells but are downregulated
receiver operating characteristic curve (Az). when the cells are activated. A Bayesian data mining
RESULTS: The neural network identified metastasis statistical analysis uncovered 25 candidate factors. Of
significantly more successfully than LR with an Az of the 25, NFAT4 and the oncogene ets-2 bind to the
0.9324 +/- 0.0386 versus 0.9192 +/- 0.0373, P = .01. common motif AAGGAG found in the HIV-1 LTR and
The most important features selected by the LR and IL-2 probes. Ets-2 binding site contains the three G's
neural network were age and edge definition. that have been shown to be important for binding of the
CONCLUSION: Neural networks offer wide unknown factor; hence, we considered it the likeliest
possibilities over statistics for the study of calvarial candidate. Electrophoretic mobility shift assays
metastases other than their minimum clinical and confirmed cross-reactivity between the unknown
radiologic features for diagnosis. repressor and anti-ets-2 antibodies, and cotransfection
experiments demonstrated the direct involvement of
Arcos E, Uarac M, Molina I, Repossi A, Ulloa M. [Impact of Ets-2 in silencing the IL-2 promoter. Designing
domestic violence on reproductive and neonatal experiments for transcription factor analysis using
health]. Rev Med Chil 2001; 129(12):1413-24. microarrays and Bayesian statistical methodologies
Abstract: BACKGROUND: Domestic violence can provides a novel way toward elucidation of gene
have an important influence on mother and child control networks.
health. AIM: To assess the consequences of remote and
actual, emotional or physical, domestic violence on the Arie S. WHO takes up issue of child abuse. BMJ 2005;
reproductive and newborn health in pregnant women. 331(7509):129.
MATERIAL AND METHODS: A longitudinal
epidemiological observation from an Urban Primary Ariza AJ, Greenberg RS, Unger R. Childhood overweight:
Health Care Center from Valdivia, Chile, in 1998. Two management approaches in young children. Pediatr
cohorts were studied: Pregnant women that Ann 2004; 33(1):33-8.
experienced domestic violence (index group) and Abstract: Management of overweight in young children
pregnant women not exposed to domestic violence may be our best opportunity for confronting the
(control group). Women were followed during nationwide epidemic of childhood obesity. Doing so
pregnancy and at labor. The newborn was also will require all health care providers to improve their
assessed. RESULTS: The index group had a higher identification, assessment, and guidance on this issue.
relative risk (RR) for impending abortion (RR 1.44, As a group, we must make it a priority to obtain height
95% confidence interval (CI): 1.07-1.93), hypertensive and weight measurements on every child and to
syndrome of pregnancy (RR 1.5, 95% CI: 1.18-1.96), interpret them correctly. We must be comprehensive in
intrahepatic cholestasis (RR 1.5, 95% CI: 1.1-1.94). our medical investigation in order to uncover
Women that experienced violence during pregnancy identifiable causes and recognize comorbidities. Most
had a higher risk of urinary tract infection (RR 2.88, of all, we must motivate families, as a whole, to
95% CI: 1.28-6.43), intrauterine growth retardation confront this issue with us by increasing physical
(RR 3.7, 95% CI: 1.77-7.93) and intrahepatic activity, decreasing sedentary behaviors, and
cholestasis. Newborns from the index group had lower improving eating practices. As health professionals in a
weight, size and gestational age. CONCLUSIONS: society that is not yet poised to fight this epidemic, we
Domestic violence is associated with hypertension must lead the way.
during pregnancy and intrauterine growth retardation.
The incorporation of bio-psychological evaluation and Armour KL, Callister LC. Prevention of triplets and higher
monitoring systems could attenuate the consequences
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![genes. CONCLUSION: Progress in understanding the 15(4):961-9.
mechanisms involved has not been straightforward and Abstract: The purpose of this study was to devise a
many inconsistencies have arisen. In order to take paradigm that stimulates attention using a frequency-
advantage of the potential for progress that stems from based analysis of the data acquired during a motor task.
the genetic findings it will be important to draw upon a Six adults (30-40 years of age) and one child (10 years)
variety of approaches and experimental paradigms. A were studied. Each subject was requested to attend to
functional genomic approach to ADHD means that "start" and "stop" commands every 20 s alternatively
investigation of gene function is carried out at various and had to respond with the motor task every second
levels of analysis, not only at the level of molecular time. Attention was stimulated during a block-
and cellular function but also at the level of designed, motor paradigm in which a start-stop
psychological processes, neuronal networks, commands cycle produced activation at the fourth
environmental interactions and behavioural outcomes. harmonic of the motor frequency. We disentangled the
motor and attention functions using statistical analysis
Assel MA, Landry SH, Swank PR, Steelman L, Miller- with subspaces spanned by vectors generated by a
Loncar C, Smith KE. How do mothers' childrearing truncated trigonometric series of motor and attention
histories, stress and parenting affect children's frequency. During our auditory-motor paradigm, all
behavioural outcomes? Child Care Health Dev 2002; subjects showed activation in areas that belong to an
28(5):359-68. extensive attention network. Attention and motor
Abstract: BACKGROUND: Information is needed to functions were coactivated but with different
understand the role of low to moderate levels of frequencies. While the motor-task-related areas were
mothers' emotional stress and child characteristics (i.e. activated with slower frequency than attention, the
prematurity) on parenting behaviours and their impact activation in the attention-related areas was enhanced
on children's behaviour that might be deemed every time the subject had to start or end the motor
'challenging' but not 'disordered'. METHODS: The task. We suggest that although a simple block-
direct and indirect relations of maternal childrearing designed, auditory-motor paradigm stimulates the
history and emotional stress, and observed parenting attention network, motor preparation, and motor
practices when children were 3 years of age on 4-year inhibition concurrently, a frequency-based analysis can
child behavioural outcomes was examined in a sample distinguish attention from motor functions. Due to its
of low-income families with a term (n=112) or preterm simplicity the paradigm can be valuable in studying
(n=180) child. Parenting practices included displays of children with attention deficit disorders.
warmth and restrictiveness when interacting with their
children. Child outcomes at 4 years included Aszodi I. [Contribution to the publication "Sexual crimes
observation of social initiations with their mothers and against minors" by Roland Csorba et al.]. Orv Hetil
maternal report of social and attentional problems. 2004; 145(44):2260; author reply 2260-1.
RESULTS: A Structural Equation Model building
approach guided by specific hypotheses indicated that Ateah CA, Parkin CM. Childhood experiences with, and
preterm as compared to full-term children had more current attitudes toward, corporal punishment. Can J
maternal reported social and attentional problems but Commun Ment Health 2002; 21(1):35-46.
did not differ in observed social initiating skills. Abstract: The purpose of the present study was to
Greater negative maternal childrearing history determine, in a Canadian sample, the extent to which
indirectly influenced social initiating skills through its corporal or physical punishment use continues,
direct influence on maternal emotional stress. Greater personal experiences, and current attitudes. Of the 436
maternal emotional stress directly influenced mothers' participants, 75% reported receiving physical
parenting that, in turn, directly influenced social punishment as children. Approximately 40% of
initiating. Prematurity and a more negative childrearing participants agreed that corporal punishment is
history had a direct negative influence on the maternal necessary as a means of discipline. Since parental
report of social and attentional behavioural outcomes. attitude toward physical punishment has been
CONCLUSIONS: These findings delineate the effects determined to be an important predictor in its use with
of prematurity and maternal parenting on the behaviour children, the authors recommend that parent education
of 4-year-old-children and extend current knowledge of programming must include information related to its
the influence of parental emotional stress on parenting. risks.
Even milder levels can negatively influence parenting,
and in turn, contribute to children's less well developed Atinmo T. Nutritional problems of Africa--the future of a
social skills. The issues raised in this study could help continent: an overview. Forum Nutr 2003; 56:281-2.
with the identification and prioritization of medical and
psychological services. August GJ, Hektner JM, Egan EA, Realmuto GM,
Bloomquist ML. The early risers longitudinal
Astrakas LG, Teicher M, Tzika AA. Activation of attention prevention trial: examination of 3-year outcomes in
networks using frequency analysis of a simple aggressive children with intent-to-treat and as-intended
auditory-motor paradigm. Neuroimage 2002;
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![deviations in the development of the vermis was the testing refusal were being in a monogamous
most sensitive morphological indicator of the effects of relationship for foreign-born women (41%) and already
prenatal alcohol exposure. It was seen in every being tested for U.S.-born women (65%).
diagnostic group including children who had been
exposed during only the first trimester of pregnancy. Azar ST, Cote LR. Sociocultural issues in the evaluation of
the needs of children in custody decision making. What
Avery JK. Informed consent lacking? J Ark Med Soc 2005; do our current frameworks for evaluating parenting
101(12):356-7. practices have to offer? Int J Law Psychiatry 2002;
25(3):193-217.
Avidan V, Hersch M, Armon Y et al. Blast lung injury:
clinical manifestations, treatment, and outcome. Am J Azar ST, Nix RL, Makin-Byrd KN. Parenting schemas and
Surg 2005; 190(6):927-31. the process of change. J Marital Fam Ther 2005;
Abstract: BACKGROUND: Blast lung injury (BLI) is 31(1):45-58.
a major cause of morbidity after terrorist bomb attacks Abstract: Parents' childrearing behaviors are guided by
(TBAs) and is seen with increasing frequency schemas of the caregiving role, their functioning in that
worldwide. Yet, many surgeons and intensivists have role, what children need in general, and what their own
little experience treating BLI. Jerusalem sustained 31 children are like in particular. Sometimes, however,
TBAs since 1983, resulting in a local expertise in parenting schemas can be maladaptive because they are
treating BLI. METHODS: A retrospective study of too rigid or simple, involve inappropriate content, or
clinical and radiologic characteristics, management, are dominated by negative affect. In this article, we
and outcome of victims of TBAs sustaining BLI who describe parenting schemas and provide an overview of
were admitted to ICU during December 1983 to empirical work documenting the characteristics of
February 2004. Long-term outcome was determined by maladaptive parenting schemas. We review how
a telephone interview. RESULTS: Twenty-nine intervention practices common to multiple therapeutic
patients met inclusion criteria. Hypoxia and pulmonary approaches (cognitive-behavior therapy, family
infiltrates in chest x-ray were sine qua non for the therapy, parent training, attachment-based
diagnosis. Seventy-six percent required mechanical interventions, and psychoanalytic parent-infant
ventilation, all within 2 hours of admission. One psychotherapy) attempt to modify schemas to promote
patient died. Seventy-six percent had no long-term more optimal functioning among parents. We highlight
sequelae. CONCLUSIONS: Most patients with how research in cognitive science may explain, in part,
significant BLI injury require mechanical ventilation. treatment effectiveness.
Late deterioration is rare. Death because of BLI in
patients who survived the explosion is unusual. Timely Bach KP, Schouten-van Meeteren AY, Smit LM,
diagnosis and correct treatment result in excellent Veenhuizen L, Gemke RJ. [Intracranial hemorrhages in
outcome. infants: child abuse or a congenital coagulation
disorder?]. Ned Tijdschr Geneeskd 2001; 145(17):809-
Aynalem G, Mendoza P, Frederick T, Mascola L. Who and 13.
why? HIV-testing refusal during pregnancy: Abstract: In children with head injuries the severity of
implication for pediatric HIV epidemic disparity. AIDS the neurological symptoms should concord with the
Behav 2004; 8(1):25-31. patient's history and signs of neurotrauma on
Abstract: To identify characteristics of pregnant examination. Discrepancies between the
women who refuse HIV testing and determine (hetero)anamnesis and physical examination on the one
predictive factors and the reasons for refusal, we hand and neurological findings on the other may
conducted face-to-face interviews of pregnant women indicate child abuse. The presence of both old and new
at prenatal clinics of public and private hospitals. We intracranial haemorrhages in the absence of
found 8% (n=65) of 826 pregnant women interviewed proportional trauma is generally considered as
refused HIV testing. In bivariate analysis, foreign-born evidence for child abuse. However, these symptoms
pregnant women residing in Los Angeles County were may also be the first manifestation of a congenital
twice more likely to refuse HIV testing than U.S.-born coagulation disorder. Three children, two girls aged 8
pregnant women (odds ratio [OR] = 1.97, 95% and 5 months and a boy aged 6 months were presented
confidence interval [CI] 1.11-3.49, p <.05). In a with alarming neurological symptoms due to
multivariate stepwise logistic regression model intracranial haemorrhages without external signs of
analysis, variables that were independent predictors of head trauma. The first girl had 'shaken baby' syndrome
HIV testing refusal during pregnancy were being while the other 2 had congenital coagulation disorders
foreign-born (OR = 2.11, 95% CI 1.07-4.38), not (haemophilia B and factor V deficiency, respectively).
receiving general information about HIV (OR = 7.48, All three recovered, the last two with remaining one-
95% CI 1.86-30.01), and not receiving specific sided neurological deficits. Child abuse and congenital
information about HIV and pregnancy (OR = 3.54, coagulation disorders may present with similar
95% CI 1.91-6.57). The most common reasons for neurological symptoms and radiological findings. In
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![these patients coagulation tests are mandatory and--if carries unacceptably high mortality. MATERIAL AND
abnormal--enable early substitution of deficits and METHODS: We reviewed our experience with
prevent inappropriate suspicion or accusation of childhood trauma due to battered child syndrome in our
caretakers. hospital to learn the extent, circumstances,
presentations, and consequences of this kind of events.
Bachanas PJ, Morris MK, Lewis-Gess JK et al. Our hospital is the most important center for
Psychological adjustment, substance use, HIV traumatized child care in Mexico. RESULTS: After our
knowledge, and risky sexual behavior in at-risk study, mild trauma due to child abuse accounted for 35
minority females: developmental differences during and major trauma accounted for 50 cases. In the former
adolescence. J Pediatr Psychol 2002; 27(4):373-84. group, 10 patients with fractures were observed; 21
Abstract: OBJECTIVE: To assess developmental were male patients. Children were abused by father or
differences in the psychological functioning, substance stepfather in the 21 cases, and by the mother in six.
use, coping style, social support, HIV knowledge, and There was delay in seeking immediate medical
risky sexual behavior of at-risk, minority adolescent attention treatment in all patients. In the second group,
girls; to assess developmental differences in there were ruptures of small bowel in 27, of the colon
psychosocial correlates of risky sexual behavior in in four patients, pancreas in three, and esophagus in
older and younger adolescents. METHOD: Participants two. Lung, pleura, bladder, spleen and other anatomic
included 164 minority teens, ages 12-19, who were structures also were affected. Five patients died.
receiving medical care in an adolescent primary care Similarity between the two patient groups studied
clinic. Teens completed measures of psychological indicates both the widespread nature of child abuse and
adjustment, substance use, coping style, social support, the need to suspect this diagnosis whenever a child is
religious involvement, and HIV knowledge and present with unexplained shock or peritonitis, specially
attitudes. In addition, they answered questions if there is anemia or bilious emesis. Delay in diagnosis
regarding their sexual history, family situation, school contributed to mortality.
status, and psychiatric and legal history. RESULTS:
Younger teens (ages 12-15) reported more symptoms Baggens CA. The institution enters the family home: home
of depression and earlier sexual debuts than older teens visits in Sweden to new parents by the child health care
(ages 16-19). However, older teens reported nurse. J Community Health Nurs 2004; 21(1):15-27.
significantly more substance use and were more likely Abstract: The purpose of this study is to investigate
to have been pregnant and to have contracted a interactional patterns in the dialogue that occurs during
sexually transmitted disease (STD) than younger teens. home visits of the nurse to new parents, to find out
Older teens also reported more religious involvement whether there are similarities between home visits and
and using more adaptive coping strategies than younger visits to the child health care centers, and to discuss
teens. Developmental differences in the correlates of this in relation to what is emphasized as important in
risky behaviors were also found between younger and home visits. Audiotaped conversations of encounters
older teens. Specifically, conduct problems and during 5 home visits to new parents and interviews
substance use were significantly associated with risky with parents and nurses were collected and analyzed
sexual behavior for younger teens, but not for older qualitatively. Results show that the interactions were
teens. Similarly, younger teens whose peers were orchestrated by the nurse, and operated on an agenda
engaging in risky behaviors reported engaging in more that was task-oriented. The interaction was dominated
risky sexual behaviors; however, these same relations by the nurse, and thus was asymmetrical. It seemed that
were not found for older teens. CONCLUSIONS: the nurse was attentive to what the parents brought up
Young minority adolescents exhibiting conduct in the discussions and responded to their worries very
problems and using substances seem to be at highest thoroughly, in accordance with the ideology. However,
risk for contracting HIV and STDs as a result of risky sometimes the parents were not even involved in the
sexual behavior. Prevention interventions should target nurse's activities.
teens in high-risk environments during late elementary
school or early middle school to encourage teens to Bailey BN, Delaney-Black V, Hannigan JH, Ager J, Sokol
delay intercourse, practice safer sex, and avoid drug RJ, Covington CY. Somatic complaints in children and
and alcohol use. An interdisciplinary model of care in community violence exposure. J Dev Behav Pediatr
primary care settings is clearly indicated to provide 2005; 26(5):341-8.
these services to at-risk youths. Abstract: Somatic complaints of children in primary
care settings often go unexplained despite attempts to
Baeza-Herrera C, Garcia-Cabello LM, Dominguez-Perez determine a cause. Recent research has linked violence
ST, Atzin-Fuentes JL, Rico-Mejia E, Mora-Hernandez exposure to stress symptomatology and associated
F. [Battered child syndrome. Surgical implications]. somatic problems. Unknown, however, is whether
Cir Cir 2003; 71(6):427-33. specific physical symptom complaints can be
Abstract: INTRODUCTION: Major trauma, specially attributed, at least in part, to violence exposure. Urban
abdominal and thoracic trauma due to child abuse is a African-American 6- and 7-year-old children (N =
serious, but fortunately infrequent problem which 268), residing with their biological mothers, recruited
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![before birth, and without prenatal exposure to hard than 5 years of age in a rural area of the Republic of
illicit drugs participated. Children and mothers were Guinea. Bull World Health Organ 2001; 79(1):28-32.
evaluated in our hospital-based research laboratory, Abstract: OBJECTIVES: To assess the ability of
with teacher data collected by mail. Community mothers in a rural area of the Republic of Guinea to
violence exposure (Things I Have Seen and Heard), identify fever in their children, and to estimate the
stress symptomatology (Levonn), and somatic proportion of children who received antimalarial drugs.
complaints (teacher-and self-report items) were METHODS: Children under 5 years of age in 41
assessed. Additional data collected included prenatal villages were selected by a two-step cluster sampling
alcohol exposure, socioeconomic status, domestic technique. During home visits we examined the
violence, maternal age, stress, somatic complaints and children and questioned their mothers about the child's
psychopathology, and child depression, abuse, and symptoms and treatment. FINDINGS: Of 784 children
gender. Community violence witnessing and examined, 23% were febrile and more than half of
victimization were associated with stress symptoms (r them also had a positive smear result for Plasmodium.
= .26 and .25, respectively, p < .001); violence Mothers reported 63% of children with a temperature >
victimization was related to decreased appetite (r = .16, or = 37.5 degrees C as sick. Among all children
p < .01), difficulty sleeping (r = .21, p < .001), and reported as feverish by their mother, 55% had a normal
stomachache complaints (r = .13, p < .05); witnessed temperature (< 37.5 degrees C). In contrast, a
violence was associated with difficulty sleeping (r = temperature > or = 37.5 degrees C was found in 38% of
.13, p < .05) and headaches (r = .12, p < .05). All children identified as sick but afebrile by their mother
associations remained significant after control for and in 13% of children considered healthy. Among
confounding. Community violence exposure accounted febrile children, 18% were given chloroquine at home
for 10% of the variance in child stress symptoms, and or had consulted at the health centre or a dispensary.
children who had experienced community violence CONCLUSION: In areas where malaria is endemic,
victimization had a 28% increased risk of appetite recognition of fever and its presumptive treatment with
problems, a 94% increased risk of sleeping problems, a antimalarial drugs is an essential part of the strategy of
57% increased risk of headaches, and a 174% increased the World Health Organization (WHO) to reduce the
risk of stomachaches. Results provide yet another morbidity due to this disease. This population study
possibility for clinicians to explore when treating these shows that mothers often failed to identify fever in
physical symptoms in children. their children and to consult or to provide antimalarial
treatment. Without great efforts to improve home care,
Bailey C, Pain R. Geographies of infant feeding and access it is unlikely that the morbidity and mortality due to
to primary health-care. Health Soc Care Community malaria in young children will be greatly reduced.
2001; 9(5):309-17.
Abstract: Although the benefits of breastfeeding to Baird JK, Owusu Agyei S, Utz GC et al. Seasonal malaria
mother and infant are now well established, within attack rates in infants and young children in northern
Britain initiation rates are low and have changed little Ghana. Am J Trop Med Hyg 2002; 66(3):280-6.
since 1980. This is despite many health promotion Abstract: The incidence density of infection and
initiatives aiming to increase breastfeeding. In this disease caused by Plasmodium falciparum in children
paper we discuss some of the findings of an aged six to 24 months living in the holoendemic Sahel
exploratory qualitative research study of infant feeding of northern Ghana was measured during the wet and
decisions in Newcastle upon Tyne, England, where dry seasons of 1996 and 1997. At the beginning of each
health professionals are actively seeking to increase season, a cohort composed of 259 and 277 randomly
local breastfeeding initiation and duration rates. Our selected children received supervised curative therapy
findings suggest that for health promotion initiatives to with quinine and Fansidar and primaquine for those
be effective across all social groups, there needs to be with normal glucose-6-phosphate dehydrogenase
(i) a socio-cultural understanding of different social activity. The 20 weeks of post-therapy follow-up
groups' access to and interpretation of pre- and consisted of three home visits weekly and examination
postnatal formal breastfeeding support health services, of Giemsa-stained blood films once every two weeks.
and (ii) more appreciation of how mothers' informal Blood films were also taken from children brought to
support networks impact on their access to, clinic with illness. The incidence density of parasitemia
interpretation and use of formal breastfeeding support. after radical cure was 4.7 infections/person-year during
the dry season and 7.1 during the wet season (relative
Bailey R, Rhee KB. Reach Out and Read: promoting risk = 1.51, 95% confidence interval [CI] = 1.25-1.81;
pediatric literacy guidance through a transdisciplinary P = 0.00001). Although the mean parasitemia count at
team. J Health Care Poor Underserved 2005; time of reinfection in the dry season (3,310/microl)
16(2):225-30. roughly equaled that in the wet season (3,056/microl; P
= 0.737), the risk ratio for parasitemia > 20,000/microl
Bailo Diallo A, De Serres G, Beavogui AH, Lapointe C, during the wet season was 1.71 (95% CI = 1.2-2.4; P =
Viens P. Home care of malaria-infected children of less 0.0025). The risk ratio for parasitemia > 20,000/microl
with fever during the wet season was 2.45 (95% CI =
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![of children admitted to hospital with NAHI in as health advocates. Service participants were
Scotland. RESULTS: Twenty-five children were predominately African American families. All
enrolled and 68% of children were neurologically participants were low-income and resided in inner-city
abnormal at an average follow-up of 59 months. A neighborhoods with high unemployment, high teen
wide range of abnormalities and outcomes was seen. birth rates, violent crime, and deteriorated
Speech and language difficulties were present in 64% neighborhoods. Outcomes for the first 666 participants
including autistic spectrum disorder. Cranial nerve are compared to a previous home-visiting program that
abnormalities were present in 20%. Visual deficits and used only nurses. Participant retention rates were
epilepsy compounded learning difficulties in 25% of equivalent overall and significantly higher in the first
survivors. Consent for follow-up was more likely to be months of the REACH-Futures program. There were
obtained where the perpetrator was known. two infant deaths during the course of the study, a
CONCLUSIONS: The spectrum and degree of severity lower death rate than the previous program or the city.
of neurological abnormalities in survivors of NAHI is Infant health problems and developmental levels were
extremely variable, with the majority of these children equivalent to the prior program and significantly more
being moderate or severely abnormal. These children infants were fully immunized at 12 months. The
require the support of a multi-disciplinary team in the authors conclude that the use of community workers as
community. Further study regarding the process of a part of the home-visiting team is as effective as the
follow-up, where complex medicolegal issues exist, are nurse-only team in meeting the needs of families at
needed in order to facilitate maximum neurological high risk of poor infant outcomes. This approach is of
development. national interest because of its potential to achieve the
desired outcomes in a cost-effective manner.
Barnea A, Rassis A, Zaidel E. Effect of neurofeedback on
hemispheric word recognition. Brain Cogn 2005; Barnes L. Afghanistan. Midwifery Today Int Midwife 2005;
59(3):314-21. (75):14-6.
Abstract: We applied SMR/theta neurofeedback (NF)
training at central sites of 20 Israeli children aged 10- Barnes L, Risko W, Nethersole S, Maypole J. Integrating
12 years, half boys and half girls. Half of the subjects complementary and alternative medicine into pediatric
received C3 training and the other half C4 training, training. Pediatr Ann 2004; 33(4):256-63.
consisting of 20 half-hour sessions. We assessed the Abstract: The Center for Pediatric Integrative Medical
effects of training on lateralized lexical decision in Education and Boston Healing Landscape Project
Hebrew. The lateralized lexical decision test reveals an represent diverse approaches to integrative medicine
independent contribution of each hemisphere to word and its practice. The relationship and collegial
recognition (Barnea, Mooshagian, & Zaidel, 2003). collaboration between the two programs illustrates the
Training increased accuracy and sensitivity. It extent to which they complement one another. Both
increased left hemisphere (LH) specialization under recognize the importance of curriculum geared to
some conditions but it did not affect interhemispheric different levels of learners and of interventions
transfer. Training did affect psycholinguistic introduced across the full curriculum. Both use case-
processing in the two hemispheres, differentially at C3 based learning, although each focuses on different
and C4. Training also increased hemispheric kinds of CAM and different case models. The Center
independence. There were surprising sex differences in for Pediatric Integrative Medical Education promotes
the effects of training. In boys, C4 training improved interactive didactics with hands-on, direct experiential
LH accuracy, whereas in girls C3 training improved learning. The BHLP applies active-learning pedagogy,
LH accuracy. The results suggest that the lateralized through experiential learning and its teaching case
NF protocol activates asymmetric hemispheric control model. Both programs understand that, given the
circuits which modify distant hemispheric networks ongoing interaction among medical students, residents,
and are organized differently in boys and girls. fellows, and faculty, each group's training in CAM
must reinforce the others for a larger system to change.
Barnes-Boyd C, Fordham Norr K, Nacion KW. Promoting
infant health through home visiting by a nurse- Barnow S, Lucht M, Freyberger HJ. [Alcohol problems in
managed community worker team. Public Health Nurs adolescence with reference to high risk children of
2001; 18(4):225-35. alcoholic parents. Results of a family study in
Abstract: This article describes the Resources, Mecklenburg Vorpommern]. Nervenarzt 2002;
Education and Care in the Home program (REACH- 73(7):671-9.
Futures), an infant mortality reduction initiative in the Abstract: In earlier studies, children of alcoholics
inner city of Chicago built on the World Health (COAs) reported more alcohol and drug problems and
Organization (WHO) primary health care model and higher levels of maladaptive behaviour and psychiatric
over a decade of experience administering programs to distress than non-COAs. However, increased exposure
reduce infant mortality through home visits. The to drugs and alcohol among COAs does not fully
program uses a nurse-managed team, which includes explain this phenomenon. In our family-based study
community residents selected, trained, and integrated
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![of abuse and violence; sex differences in the exposure and the need to review policies and
prevalence of anxiety and depressive disorders; and procedures regarding child abuse reporting. Child
gender bias in research and in clinical practice. General Welfare 2001; 80(2):275-96.
internists need to keep these factors in mind in Abstract: Research on the outcomes of drug-exposed
obtaining the clinical history, understanding the children evinces elevated developmental risks from the
meaning and significance that symptoms hold for each interaction of subtle biological vulnerabilities and
patient, and providing symptom relief. compromised parenting. States, however, have
generally not reviewed the procedures and policies they
Bartels A, Zeki S. The neural correlates of maternal and developed in the early 1990s when there was less
romantic love. Neuroimage 2004; 21(3):1155-66. research and experience with these children. At that
Abstract: Romantic and maternal love are highly time the gravest risks related to perinatal substance
rewarding experiences. Both are linked to the exposure seemed to be excessively punitive treatment
perpetuation of the species and therefore have a closely of mothers by over-zealous criminal justice
linked biological function of crucial evolutionary prosecutors. This article clarifies policy options for
importance. Yet almost nothing is known about their reporting and serving children who are born testing
neural correlates in the human. We therefore used positive for controlled substances and also calls for
fMRI to measure brain activity in mothers while they strengthening existing state policies regarding child
viewed pictures of their own and of acquainted abuse reporting and response.
children, and of their best friend and of acquainted
adults as additional controls. The activity specific to Barton C, Finlay F. Bruising in preschool children with
maternal attachment was compared to that associated to special needs. Arch Dis Child 2005; 90(12):1318;
romantic love described in our earlier study and to the author reply 1318.
distribution of attachment-mediating neurohormones
established by other studies. Both types of attachment Bartsch C, Risse M, Nagelmeier IE, Weiler G. [Deaths in
activated regions specific to each, as well as preschool and school age--a retrospective analysis from
overlapping regions in the brain's reward system that a medicolegal point of view]. Arch Kriminol 2004;
coincide with areas rich in oxytocin and vasopressin 214(1-2):30-6.
receptors. Both deactivated a common set of regions Abstract: At the Department of Legal Medicine in
associated with negative emotions, social judgment and Giessen all forensic autopsies from the years 1990 until
'mentalizing', that is, the assessment of other people's 2001 were investigated under the aspect of "death in
intentions and emotions. We conclude that human preschool and school age between 3 and 16 years of
attachment employs a push-pull mechanism that age." Out of 69 deaths 19% were due to a natural and
overcomes social distance by deactivating networks 81% to an unnatural cause of death. Both groups (3 to
used for critical social assessment and negative 6 and 7 to 16 years of age) were analyzed
emotions, while it bonds individuals through the retrospectively with regard to age and circumstances of
involvement of the reward circuitry, explaining the death and compared with the literature. The purpose of
power of love to motivate and exhilarate. the differentiating evaluation is to furnish ideas how to
prevent violent deaths of children.
Bartels V. [Crisis intervention in child sexual abuse]. Prax
Kinderpsychol Kinderpsychiatr 2005; 54(6):442-56. Barzegari M, Ghaninezhad H, Mansoori P, Taheri A,
Abstract: The impact of sexual abuse on children's Naraghi ZS, Asgari M. Computer-aided dermoscopy
development of attachment behaviour is especially for diagnosis of melanoma. BMC Dermatol 2005; 5:8.
disastrous when the abuse happens early in childhood, Abstract: BACKGROUND: Computer-aided
and when it lasts over a long period of time, and in case dermoscopy using artificial neural networks has been
the abuser is closely related to the child. These early reported to be an accurate tool for the evaluation of
traumatic experiences regularly result in damages to pigmented skin lesions. We set out to determine the
the mental, physical and emotional development of a sensitivity and specificity of a computer-aided
child. The main task of youth welfare is to protect dermoscopy system for diagnosis of melanoma in
children against maltreatment. For being able to do so Iranian patients. METHODS: We studied 122
it is significant to emphasize a scientific approach to pigmented skin lesions which were referred for
the hypothesis-based risk evaluation and the diagnostic evaluation or cosmetic reasons. Each lesion
conceptualization of intervention. In order to come to a was examined by two clinicians with naked eyes and
sound conclusion the agencies and professionals all of their clinical diagnostic considerations were
involved in a case of child abuse have to collaborate recorded. The lesions were analyzed using a
professionally. Potential misunderstandings between microDERM dermoscopy unit. The output value of the
the collaborating partners in this procedure will be software for each lesion was a score between 0 and 10.
discussed, as well as the way out of the labyrinth. All of the lesions were excised and examined
histologically. RESULTS: Histopathological
Barth RP. Research outcomes of prenatal substance examination revealed melanoma in six lesions.
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![the telehealth network had a major impact on the conventional injuries and concomitant nerve agent
delivery of paediatric cardiac care, improving access to intoxication. Anesthesiology 2002; 97(4):989-1004.
subspecialty services across the province. Notes: CORPORATE NAME: Department of
Anesthesiology and Critical Care Medicine, Tel Aviv
Bellotti T, Luo Z, Gammerman A, Van Delft FW, Saha V. Sourasky Medical Center and the Sackler Faculty of
Qualified predictions for microarray and proteomics Medicine
pattern diagnostics with confidence machines. Int J
Neural Syst 2005; 15(4):247-58. Benda BB. Gender differences in life-course theory of
Abstract: We focus on the problem of prediction with recidivism: a survival analysis. Int J Offender Ther
confidence and describe a recently developed learning Comp Criminol 2005; 49(3):325-42.
algorithm called transductive confidence machine for Abstract: This study of 300 women and 300 men
making qualified region predictions. Its main graduates of a boot camp finds that there are
advantage, in comparison with other classifiers, is that noteworthy gender differences in predictors of tenure
it is well-calibrated, with number of prediction errors in the community without criminal recidivism in a 5-
strictly controlled by a given predefined confidence year follow-up. The Cox proportional hazards models
level. We apply the transductive confidence machine to show that urban residence, childhood and recent
the problems of acute leukaemia and ovarian cancer abuses, living with a criminal partner, selling drugs,
prediction using microarray and proteomics pattern stress, depression, fearfulness, and suicidal thoughts
diagnostics, respectively. We demonstrate that the are stronger positive predictors of recidivism for
algorithm performs well, yielding well-calibrated and women than for men. Men are more likely to return to
informative predictions whilst maintaining a high level prison because of criminal peer associations, carrying
of accuracy. weapons, alcohol abuse, and aggressive feelings. Job
satisfaction and education lengthen time in the
Belsito KM, Law PA, Kirk KS, Landa RJ, Zimmerman AW. community more for men than women, whereas the
Lamotrigine therapy for autistic disorder: a number of children and relationships are more
randomized, double-blind, placebo-controlled trial. J important to tenure in the community for women. The
Autism Dev Disord 2001; 31(2):175-81. implications for the findings for theory are discussed.
Abstract: In autism, glutamate may be increased or its
receptors up-regulated as part of an excitotoxic process Benda BB. Life-course theory of readmission of substance
that damages neural networks and subsequently abusers among homeless veterans. Psychiatr Serv
contributes to behavioral and cognitive deficits seen in 2004; 55(11):1308-10.
the disorder. This was a double-blind, placebo- Abstract: This study examined outcomes of 310 female
controlled, parallel group study of lamotrigine, an and 315 male homeless veterans who were admitted to
agent that modulates glutamate release. Twenty-eight a Department of Veterans Affairs inpatient program for
children (27 boys) ages 3 to 11 years (M = 5.8) with a dual diagnoses of a substance use disorder and another
primary diagnosis of autistic disorder received either mental illness. Participants were surveyed to determine
placebo or lamotrigine twice daily. In children on gender differences for types of transforming
lamotrigine, the drug was titrated upward over 8 weeks experiences and for types of abuse as predictors of
to reach a mean maintenance dose of 5.0 mg/kg per readmission within two years. Predictors were selected
day. This dose was then maintained for 4 weeks. primarily from life-course theory and were analyzed
Following maintenance evaluations, the drug was with Cox's proportional hazards model. Transforming
tapered down over 2 weeks. The trial ended with a 4- experiences, such as enhanced ego identity and
week drug-free period. Outcome measures included spiritual well-being, attenuated the effects of childhood
improvements in severity and behavioral features of abuses, combat exposure, and depression for both
autistic disorder (stereotypies, lethargy, irritability, genders. Transforming experiences also reduced the
hyperactivity, emotional reciprocity, sharing pleasures) risk of readmission that was associated with aggression
and improvements in language and communication, for men and abuse that occurred either in the military
socialization, and daily living skills noted after 12 or recently for women.
weeks (the end of a 4-week maintenance phase). We
did not find any significant differences in Benecke M, Rodriguez y Rowinski M. [Luis Alfredo
improvements between lamotrigine or placebo groups Garavito Cubillos: criminal and legal aspects of serial
on the Autism Behavior Checklist, the Aberrant homicide with over 200 victims]. Arch Kriminol 2002;
Behavior Checklist, the Vineland Adaptive Behavior 210(3-4):83-94.
scales, the PL-ADOS, or the CARS. Parent rating Abstract: This is the first scientific report on the crimes
scales showed marked improvements, presumably due of the homosexual paedophile sadist Luis Alfredo
to expectations of benefits. Garavito Cubillos, based on a research stay of the
authors in Columbia, and including discussions with
Ben Abraham R, Rudick V, Weinbroum AA. Practical the investigators, and the offender. Between 1992 and
guidelines for acute care of victims of bioterrorism: 1999, Garavito killed more than 200 children in the
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![hemisphere seizure foci compared to normal volunteers shame.
using a fMRI reading comprehension task.
METHODS: Fifty patients with complex partial Berliner L, Hyman I, Thomas A, Fitzgerald M. Children's
epilepsy, aged 8 to 56 years and 33 normal volunteers, memory for trauma and positive experiences. J Trauma
aged 7 to 34 had fMRI (1.5 T) and neuropsychological Stress 2003; 16(3):229-36.
testing. Participants silently named an object described Abstract: Characteristics of children's memory for a
by a sentence compared to a visual control. Data were trauma and for a positive event were compared and
analyzed with region of interest (ROI) analysis based relationships of memory characteristics to trauma
on t maps for inferior frontal gyrus (IFG), midfrontal symptoms examined in 30 children who experienced a
gyrus (MFG), and Wernicke area (WA). Regional traumatic event. Results revealed that memories for
asymmetry indices (AIs) were calculated [(L - R)/(L + trauma tended to have less sensory detail and
R)]; AI > 0.20 was deemed left dominant and AI < 0.20 coherence, yet have more meaning and impact than did
as atypical language. RESULTS: Left hemisphere memories for positive experiences. Sexual traumas,
focus patients had a higher likelihood of atypical offender relationship, and perceived life threat were
language than right hemisphere focus patients (21% vs associated with memory characteristics. Few
0%, chi2 < 0.002). Left hemisphere focus patients, relationships between memory characteristics and
excluding those with atypical language, had lower trauma symptoms were found. Therapist ratings of
regional AI in IFG, MFG, and WA than controls. Right child memory characteristics were correlated with
hemisphere focus patients were all left language some child trauma memory characteristic reports.
dominant and had a lower AI than controls in WA and These results are consistent with other studies. Possible
MFG, but not for IFG. AI in MFG and WA were explanations include divided attention during the
similar between left hemisphere focus/left language traumatic event and cognitive avoidance occurring
patients and right hemisphere focus patients. Patients after the event.
activated more voxels than healthy volunteers. Lower
AIs were attributable to greater activation in right Bernard-Opitz V, Kwook KW, Sapuan S. Epidemiology of
homologous regions. Less activation in the right-side autism in Singapore: findings of the first autism survey.
WA correlated with better verbal memory performance Int J Rehabil Res 2001; 24(1):1-6.
in right focus/left hemisphere-dominant patients, Abstract: The report describes the results of a survey
whereas less strongly lateralized activation in IFG conducted on 176 parents of children with autism in
correlated better with Verbal IQ in left focus/left Singapore. The ages of the children ranged from 3 to
hemisphere-dominant patients. CONCLUSIONS: 12 years. The survey focused on the child's
Patients had lower asymmetry indices than healthy background, behaviour problems and skill profile, the
controls, reflecting increased recruitment of home and school situation as well as the linguistic and
homologous right hemisphere areas for language social background. It was noted that the Singapore
processing. Greater right hemisphere activation may population confirms the international distribution
reflect greater cognitive effort in patient populations, regarding a predominance of boys over girls and a low
the effect of epilepsy, or its treatment. Regional incidence of birth complications. A positive trend
activation patterns reflect adaptive efforts at recruiting noted was the fact that 60% of the children were
more widespread language processing networks that diagnosed before the age of 3 years. Discussion focuses
are differentially affected based on hemisphere of on possible risk factors and psychosocial adversities for
seizure focus. autism such as a high frequency of caregivers who are
foreign maids, the use of multiple languages and the
Berlin L. Errors of omission. AJR Am J Roentgenol 2005; high level of punitive educational practices. The
185(6):1416-21. possible influence of psychosocial deprivation on child
development is discussed.
Berlin L. Iodine-131 and the pregnant patient. AJR Am J
Roentgenol 2001; 176(4):869-71. Bernstein AE. Interview criteria for assessing allegations of
sexual abuse in children and adults. J Am Acad
Berliner L. Shame in child maltreatment: contributions and Psychoanal Dyn Psychiatry 2004; 32(2):399.
caveats. Child Maltreat 2005; 10(4):387-90.
Abstract: This special section is a collection of papers Berntsen D, Rasmussen SR, Smith SF, Willadsen J.
that investigates the role of shame in children with [Problematic report about recovered memories].
abuse histories. Relationships are found between Ugeskr Laeger 2004; 166(41):3623.
abuse-specific shame or general shame proneness and a
variety of outcomes. However, the relationships are not Berntsen D, Smith SF, Rasmussen SR, Willadsen J.
consistent. The utility of these findings will be [Recovered memories]. Ugeskr Laeger 2004;
enhanced by studies that use common measurement 166(36):3116; author reply 3116-7.
approaches and address similar outcomes, as well
specific tests of intervention approaches that target Berntsson LT, Kohler L. Quality of life among children aged
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![2-17 years in the five Nordic countries. Comparison formulas within 30 d postpartum [relative risk (RR) =
between 1984 and 1996. Eur J Public Health 2001; 2.27; 95% confidence interval (CI) = 1.82-2.82];
11(4):437-45. breastfeeding of a previous child for less than 6 mo
Abstract: BACKGROUND: The aim of the study was (RR = 1.64; 95% CI = 1.32-2.02); delay in the first
to analyse children's quality of life (QoL) in the five mother-child contact for over 90 min (RR = 1.50; 95%
Nordic countries from 1984 to 1996, a period in which CI = 1.17-1.93); mother's having completed primary or
major economic recessions occurred. METHODS: The partially completed secondary education (RR = 1.40;
study design was cross-sectional based on a random 95% CI = 1.01-1.92) or completed secondary education
sample of 3000 children in each country, aged 2 to 17 or higher (RR = 1.59; 95% CI = 1.14-2.22);
years, totalling 15,000 in 1984 and 15,000 in 1996. The primiparous mother (RR = 1.39; 95% CI = 1.12-1.74)
data were collected by mailed questionnaires. QoL was and; the mother recalling having been breastfed for less
analysed for three spheres of life: external, than 6 mo (RR = 1.27; 95% CI = 1.01-1.61).
interpersonal, personal including both factual and CONCLUSIONS: The purpose of strategies to promote
perceived variables. The external sphere represented breastfeeding should be to eliminate inappropriate care
the socio-economic conditions for the child's family, practices, such as delay in the first mother-child
the interpersonal sphere the structure and the function contact, as well as reducing the impact of other factors
of the child's social networks and the personal sphere leading to the introduction of artificial milk. Moreover,
the psychological well-being of the child. RESULTS: mothers need more and better support from
The total QoL for Nordic children from 1984 to 1996 professionals and peers.
increased, but there were differences in the
development of QoL between the countries. The Berry M, Cash SJ, Mathiesen SG. Validation of the
objective QoL became better, at the same time the Strengths and Stressors Tracking Device with a child
subjective QoL worsened, except in Denmark and welfare population. Child Welfare 2003; 82(3):293-
Iceland. The external QoL became better, whereas the 318.
interpersonal QoL was nearly unchanged but there Abstract: The Strengths and Stressors Tracking Device
were differences in the development between countries. (SSTD) is a rapid assessment measure of family well-
The personal QoL worsened slightly except for being that assesses the particular strengths and needs of
children in Iceland. The ranking between countries families at intake to help guide case planning and
changed. Danish children had the highest subjective evaluate the effectiveness of treatment. The device
and Norwegian children the highest objective and assesses families from an ecological perspective in the
external QoL. Swedish children had the highest domains of environmental conditions, social support,
personal QoL. Children 7-12 years had the highest caregiver skills, and child well-being, and may be used
QoL. Girls had a tendency to higher QoL in all ages. at multiple points during treatment to assess change.
CONCLUSION: Nordic children still enjoy a high SSTD has high internal consistency in all domains,
standard of living in spite of economic constraints, and distinguishes between physical abuse and neglect, and
the prerequisites for a high QoL are fulfilled. Further is sensitive to specific changes made by families across
research is suggested for clarifying the complex the duration of treatment.
background of these results.
Berry RM. Informed consent law, ethics, and practice: from
Berra S, Sabulsky J, Rajmil L, Passamonte R, Pronsato J, infancy to reflective adolescence. HEC Forum 2005;
Butinof M. Correlates of breastfeeding duration in an 17(1):64-81.
urban cohort from Argentina. Acta Paediatr 2003; Notes: GENERAL NOTE: KIE: KIE Bib: informed
92(8):952-7. consent
Abstract: AIM: To analyse factors associated with the
duration of breastfeeding in a representative cohort of Bertrand D. Staying abreast of the benefits of nursing. J Natl
mothers and children, including socio-demographic Med Assoc 2003; 95(2):107-8.
and cultural characteristics, breastfeeding antecedents,
perinatal factors and perinatal healthcare practices. Bess G, Allen J, Deters PB. The evaluation life cycle: a
METHODS: The study was conducted in the city of retrospective assessment of stages and phases of the
Cordoba, between 1993 and 1998. Mother-child circles of care initiative. Am Indian Alsk Native Ment
binomials from all public and private hospitals were Health Res 2004; 11(2):30-41.
asked to participate. Follow-up consisted of home Abstract: A life cycle metaphor characterizes the
visits at 30 d, 6, 12, 24, 36, 48 and 50 mo. Information evolving relationship between the evaluator and
was obtained on 650 healthy newborns. Cessation of program staff. This framework suggests that common
breastfeeding during the first 24 mo of life was developmental dynamics occur in roughly the same
analysed using the Kaplan-Meier method, and factors order across groups and settings. There are stage-
associated with weaning were studied using Cox's specific dynamics that begin with Pre-History, which
proportional risk regression. RESULTS: The median characterize the relationship between the grantees and
duration of breastfeeding was 4 mo. Factors associated evaluator. The stages are: (a) Pre-History, (b) Process,
with weaning were: the introduction of artificial
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![and 727 patients presented in 1996-97 and 1999-2000, psychological harm) can be distinguished from
respectively. The median number of cases treated per secondary victimization (devaluation and mistrust in
surgeon was 4 (1997, range 1-26) and 4 (2000, 1-23) the social environment). The degree of negative health
and per radiotherapist was 10 (1-51) and 19 (1-70). For outcomes depends on risk factors like previous abuse,
all 'nontemporal' standards, the overall standard severity of the violent act, and lack of social support.
increased, without reaching minimum high targets, Prevention must aim at changes of societal conditions
while most 'waiting times' increased. Overall 2-year that enhance sexual aggression and the establishment
survival was 64.1% in 1997 and 65.1% in 2000. There of programs for men and women at risk in which
was no difference in survival between networks (range techniques of control of sexual aggression, attenuation
56-68, 1997, log-rank test 4.1, P=0.4; 62-69, 2000, log- and inhibition can be learnt.
rank test 1.26, P=0.69). Patients assessed by a
multidisciplinary clinic exhibited improved survival Black J, Zenel JA. Child abuse by intentional iron poisoning
(1997: P=0.1; 2000: hazard ratio 0.7, P=0.02), as did presenting as shock and persistent acidosis. Pediatrics
those with a pretreatment chest X-ray (hazard ratio 0.7, 2003; 111(1):197-9.
P=0.03). Despite an increased incidence, standards for Abstract: A case of intentional iron poisoning
the process of care for patients with head and neck presented to our hospital. The patient's persistent
cancer improved between 1996 and 2000, while acidosis and the team's observation of maternal
waiting times increased and 2-year survival rates indifference indicated the diagnosis. This case should
remained unaltered. Two out of five networks alert physicians to a potential source for intentional
demonstrated centralisation of services between audits. poisoning that is present in most homes with young
Being seen in a multidisciplinary clinic correlated infants.
strongly with patient survival.
Black MM, Sazawal S, Black RE, Khosla S, Kumar J,
Bish JP, Ferrante SM, McDonald-McGinn D, Zackai E, Menon V. Cognitive and motor development among
Simon TJ. Maladaptive conflict monitoring as evidence small-for-gestational-age infants: impact of zinc
for executive dysfunction in children with chromosome supplementation, birth weight, and caregiving
22q11.2 deletion syndrome. Dev Sci 2005; 8(1):36-43. practices. Pediatrics 2004; 113(5):1297-305.
Abstract: Using an adaptation of the Attentional Abstract: OBJECTIVE: Infants who are born small for
Networks Test, we investigated aspects of executive gestational age (SGA) are at risk for developmental
control in children with chromosome 22q11.2 deletion delays, which may be related to deficiencies in zinc, an
syndrome (DS22q11.2), a common but not well essential trace metal, or to deficiencies in their ability
understood disorder that produces non-verbal cognitive to elicit caregiver responsiveness (functional isolation
deficits and a marked incidence of psychopathology. hypothesis). The objective of this study was to evaluate
The data revealed that children with DS22q11.2 at 6 and 10 months of age the impact of a 9-month
demonstrated greater difficulty than controls in supplementation trial of 5 mg of zinc on the
locating and processing target items in the presence of development and behavior of infants who were born
distracters. Importantly, children with DS22q11.2 SGA and to evaluate infants' ability to elicit responsive
showed a deficit in the ability to monitor and adapt to caregiver behavior. METHODS: A randomized,
stimulus conflict. These data provide evidence of controlled trial of zinc supplementation was conducted
inadequate conflict adaptation in children with among 200 infants in a low-income, urban community
DS22q11.2, a problem that is also present in in Delhi, India. Infants were recruited when they were
schizophrenia. The findings of specific executive full term (>36 weeks) and SGA (birth weight <10th
dysfunction in this group may provide a linkage percentile weight-for-gestational age). Infants were
between particular genetic abnormalities and the randomized to receive daily supplements of a
development of psychopathology. micronutrient mix (folate, iron, calcium, phosphorus,
and riboflavin) with or without 5 mg of zinc sulfate.
Bitzer J. [Sexual aggression against girls and adult women-- The supplement was administered by field workers
causes and consequences]. Ther Umsch 2005; daily from 30 days to 9 months of age. At 6 and 10
62(4):217-22. months, infant development and behavior were
Abstract: The causes of sexual aggression are multiple. measured in a clinical setting using the Bayley Scales
Bioevolutionary rooted behavioral dispositions (sexual of Infant Development II. Caregiver responsiveness,
aggressiveness of men as a reproductive strategy) are observed on an Indian version of the Home
enforced by specific male dominated structures of Observation for Measurement of the Environment
society and socially determined stereotypes of female scale, was measured during a home visit at 10 months.
roles which deter women from self determination of During both the clinic and home visits, caregivers
their sexuality; these macrosocial factors combine with reported on their infant's temperament. RESULTS:
individual conditions of socialization, in which There were no direct effects of zinc supplementation
violence plays an important role. With respect to the on the infants' development or behavior at either 6 or
consequences of sexual aggression primary 10 months. In a subgroup analysis among the zinc-
victimization (the trauma itself with physical and supplemented infants, lower birth weight infants were
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![instrumental aggression shown by persons with disturbances frequently found among IBS patients, and
developmental psychopathy. of the possible role of early abuse in IBS. A review of
the psychosocial treatments for IBS finds strong
Blair Y, Macpherson LM, McCall DR, McMahon AD, evidence to support the efficacy of hypnotherapy,
Stephen KW. Glasgow nursery-based caries cognitive therapy, and brief psychodynamic
experience, before and after a community psychotherapy. The research relating RAP to IBS is
development-based oral health programme's briefly reviewed, as is the research on its psychological
implementation. Community Dent Health 2004; treatment. Cognitive-behavioral therapy that combines
21(4):291-8. operant elements and stress management has the
Abstract: OBJECTIVE: To develop and evaluate NHS- strongest support as a treatment for RAP.
based strategies likely to improve dental health and
reduce inequalities in pre-5-year-old's oral health in Blandon-Gitlin I, Pezdek K, Rogers M, Brodie L. Detecting
Greater Glasgow, Scotland, by ecological study of deception in children: an experimental study of the
community-based oral health promotion programmes effect of event familiarity on CBCA ratings. Law Hum
in two of the area's most socio-economically deprived Behav 2005; 29(2):187-97.
communities. BASIC RESEARCH DESIGN: Abstract: The CBCA is the most commonly used
Following an initial health service-based Oral Health deception detection. technique worldwide. Pezdek et al.
Needs Assessment (OHNA) in a severely deprived (2004) used a quasi-experimental design to assess
community, culturally relevant dental health promotion children's accounts of a traumatic medical procedure;
interventions were initiated with multidisciplinary CBCA ratings were higher for descriptions of familiar
collaborative networks. Ecological studies to monitor than unfamiliar events. This study tested this effect
dental health involved cross-sectional caries using an experimental design and assessed the joint
epidemiology of nursery children aged 36-59 months at effect of familiarity and veracity on CBCA ratings.
baseline (1995/96), after two (1997/98) and four years Children described a true or a fabricated event. Half
(1999/00), in the G22 (pilot) and G33 post code areas. described a familiar event; half described an unfamiliar
These areas had similar socio-economic status (SES), event. Two CBCA-trained judges rated transcripts of
i.e. severe social deprivation. RESULTS: At the outset, the descriptions. CBCA scores were more strongly
mean dmft scores in the pilot area for the age groups influenced by the familiarity than the actual veracity of
36-47 months and 48-59 months were respectively 3.9 the event, and CBCA scores were significantly
(95% CI 2.8 5.1) and 5.9 (95% CI 5.1-6.8), with the correlated with age. CBCA results were compared with
proportions of caries-free children being 38% and 17%, results from other measures. Together with the results
respectively. Reductions in mean dmft of 46% for the of K. Pezdek et al. (2004) these findings suggest that in
36-47 month-olds and 37% for the 48-59 month-olds its current form, CBCA is of limited utility as a
occurred in the pilot public health programme area credibility assessment tool.
over the four-year period; the proportions of caries-free
children increased to 51% and 40%, respectively. Blank D. [Injury control from the perspective of contextual
During the first two years of the programme, increases pediatrics]. J Pediatr (Rio J) 2005; 81(5 Suppl):S123-
in the mean dmft of 36-47 month- and 48-59 month- 36.
olds in the G33 (comparator) area were recorded. Abstract: OBJECTIVE: To describe the relationship
However, this trend was reversed significantly two between injury control and contextual pediatrics.
years later following the introduction of a similar SOURCES OF DATA: Quasi-systematic review of
community development-based caries-prevention MEDLINE, SciELO and LILACS databases, using
programme. CONCLUSION: While not being able to combinations of the words contextual, community,
attribute causation, a programme of community injury, accident and violence; and non-systematic
development to promote the dental health of pre-school review of book chapters and classic articles.
children residing in two socio-economically SUMMARY OF THE FINDINGS: Safety depends on
disadvantaged areas of Glasgow was associated with the interaction of family habits, cultural patterns and
significant improvements in the dental health of these surroundings. Contextual pediatrics sees the child, the
pre-school populations. family, and the community as a continuum; health
diagnosis (sequential observation of problems and
Blanchard EB, Scharff L. Psychosocial aspects of assets) is one of its cornerstones. Changing
assessment and treatment of irritable bowel syndrome intrapersonal factors for injuries requires the use of
in adults and recurrent abdominal pain in children. J both passive and active strategies. Family and cultural
Consult Clin Psychol 2002; 70(3):725-38. risk factors for injury: home overcrowding, moving,
Abstract: This article presents a selective review of poverty, and young, illiterate and unemployed parents.
psychosocial research on irritable bowel syndrome The main neighborhood factors: material deprivation
(IBS) in adults and on a possible developmental and traffic. Cultural factors: illiteracy, unsafe products,
precursor, recurrent abdominal pain (RAP), in children. lack of mass transportation, handguns, workplaces
For IBS the authors provide a summary of without safety rules, faulty community organization,
epidemiology, of the psychological and psychiatric lack of communication between social sectors,
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![individualized, prenatal and postnatal, lactation for further pathologic characterization (cellular and
consultant intervention resulted in increased architectural). Three pathologic groups were identified:
cumulative intensity of breastfeeding up to 52 weeks. type I; architectural disorganization with/without giant
DESIGN: The randomized, nonblinded, controlled trial neurons, type IIA; architectural disorganization with
recruited women from prenatal care. Baseline prenatal dysmorphic neurons, and type IIB; architectural
interviews covered demographic data and breastfeeding disorganization, dysmorphic neurons, and balloon cells
experience, intention, and knowledge. Interviews at 1, (BCs). The focal histopathologic subtypes of MCDs in
2, 3, 4, 6, 8, 10, and 12 months after birth collected cortical tissue resected were then retrospectively
data on weekly feeding patterns, infant illness, and correlated with in situ extraoperative ECoG patterns.
infant health care use. SETTING: Two community RESULTS: Cortical areas with histopathologic subtype
health centers serving low-income, primarily Hispanic IIA showed significantly higher numbers of slow
and/or black women. PARTICIPANTS: The analytic repetitive spike pattern in comparison with
sample included 304 women (intervention: n = 145; histopathologic type I (p = 0.007) and normal
control: n = 159) with > or = 1 postnatal interview. pathology (p = 0.002). The ictal onset came mainly
INTERVENTION: Study lactation consultants from cortical areas with histopathologic type IIA (nine
attempted 2 prenatal meetings, a postpartum hospital of 15 patients). None of the seizures originated from
visit, and/or home visits and telephone calls. Control neocortical areas that showed BC-containing MCD
subjects received the standard of care. OUTCOME (type IIB). CONCLUSIONS: This study shows that
MEASURES: Cumulative breastfeeding intensity at 13 areas containing BCs are less epileptogenic than are
and 52 weeks, based on self-reports of weekly feeding, closely located dysplastic regions. These results
on a 7-level scale. RESULTS: The intervention group suggest a possible protective effect of BCs or a severe
was more likely to breastfeed through week 20 (53.0% disruption in the neuronal networks in BCs containing
vs 39.3%). Exclusive breastfeeding rates were low and dysplastic lesions. Further studies are needed to
did not differ according to group. In multivariate elucidate the nature and the potential role(s) of balloon
analyses, control subjects had lower breastfeeding cells in MCD-induced epileptogenicity.
intensity at 13 weeks (odds ratio [OR]: 1.90; 95%
confidence interval [CI]: 1.13-3.20) and 52 weeks (OR: Booth JR, Burman DD, Meyer JR, Gitelman DR, Parrish
2.50; 95% CI: 1.48-4.21). US-born control subjects had TB, Mesulam MM. Development of brain mechanisms
lowest breastfeeding intensity at 13 weeks (OR: 5.22; for processing orthographic and phonologic
95% CI: 2.43-11.22) and 52 weeks (OR: 5.25; 95% CI: representations. J Cogn Neurosci 2004; 16(7):1234-49.
2.44-11.29). There were no significant differences in Abstract: Developmental differences in the
breastfeeding intensity among the US-born neurocognitive networks for lexical processing were
intervention, foreign-born intervention, and foreign- examined in 15 adults and 15 children (9- to 12-year-
born control groups. CONCLUSIONS: This "best- olds) using functional magnetic resonance imaging
practices" intervention was effective in increasing (fMRI). The lexical tasks involved spelling and
breastfeeding duration and intensity. Breastfeeding rhyming judgments in either the visual or auditory
promotion should focus on US-born women and modality. These lexical tasks were compared with
exclusive breastfeeding. nonlinguistic control tasks involving judgments of line
patterns or tone sequences. The first main finding was
Boonyapisit K, Najm I, Klem G et al. Epileptogenicity of that adults showed greater activation than children
focal malformations due to abnormal cortical during the cross-modal lexical tasks in a region
development: direct electrocorticographic- proposed to be involved in mapping between
histopathologic correlations. Epilepsia 2003; 44(1):69- orthographic and phonologic representations. The
76. visual rhyming task, which required conversion from
Abstract: PURPOSE: Malformations due to abnormal orthography to phonology, produced greater activation
cortical development (MCDs) are common pathologic for adults in the angular gyrus. The auditory spelling
substrates of medically intractable epilepsy. The in situ task, which required the conversion from phonology to
epileptogenicity of these lesions as well as its relation orthography, also produced greater activation for adults
to histopathologic changes remains unknown. The in the angular gyrus. The greater activation for adults
purpose of this study was to correlate the cellular suggests they may have a more elaborated posterior
patterns of MCDs with the expression of focal cortical heteromodal system for mapping between
epileptogenicity as assessed by direct extraoperative representational systems. The second main finding was
electrocorticographic (ECoG) recordings by using that adults showed greater activation than children
subdural grids. METHODS: Fifteen patients with drug- during the intra-modal lexical tasks in the angular
resistant focal epilepsy due to pathologically confirmed gyrus. The visual spelling and auditory rhyming did not
MCD who underwent subdural electrode placement for require conversion between orthography and
extraoperative seizure localization and cortical phonology for correct performance but the adults
mapping between 1997 and 2000 were included in the showed greater activation in a system implicated for
study. Areas of interictal spiking and ictal-onset this mapping. The greater activation for adults suggests
patterns were identified and separated during surgery that they have more interactive convergence between
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![representational systems during lexical processing. highlights how important it is for expectant mothers
and new mothers to be confirmed in their mothering
Booth JR, Burman DD, Meyer JR et al. Larger deficits in role. Nurses in the maternity and child health services
brain networks for response inhibition than for visual have an important task to support people in becoming
selective attention in attention deficit hyperactivity and being parents, with regard to their emotional state.
disorder (ADHD). J Child Psychol Psychiatry 2005; There is a need for more resources within these
46(1):94-111. services for establishing parent groups, including
Abstract: BACKGROUND: Brain activation groups for fathers. This could improve parents'
differences between 12 control and 12 attention deficit physical, psychological and emotional health, and
hyperactivity disorder (ADHD) children (9- to 12-year- decrease their need for health and social services.
olds) were examined on two cognitive tasks during
functional magnetic resonance imaging (fMRI). Borowsky IW, Mozayeny S, Stuenkel K, Ireland M. Effects
METHOD: Visual selective attention was measured of a primary care-based intervention on violent
with the visual search of a conjunction target (red behavior and injury in children. Pediatrics 2004;
triangle) in a field of distracters and response inhibition 114(4):e392-9.
was measured with a go/no-go task. RESULTS: There Abstract: OBJECTIVE: Although many major health
were limited group differences in the selective attention care organizations have made recommendations
task, with control children showing significantly regarding physicians' roles in preventing youth
greater intensity of activation in a small area of the violence, the efficacy of violence prevention strategies
superior parietal lobule region of interest. There were in primary care settings remains to be empirically
large group differences in the response inhibition task, tested. METHODS: We conducted a randomized,
with control children showing significantly greater controlled trial to evaluate the effects of an office-
intensity of activation in fronto-striatal regions of based intervention on children's violent behaviors and
interest including the inferior, middle, superior and violence-related injuries. Children 7 to 15 years of age
medial frontal gyri as well as the caudate nucleus and who presented at 8 pediatric practices and scored
globus pallidus. CONCLUSION: The widespread positive on a brief psychosocial screening test (n =
hypoactivity for the ADHD children on the go/no-go 224) were randomly assigned to an intervention group
task is consistent with the hypothesis that response (clinicians saw the screening test results during the
inhibition is a specific deficit in attention deficit visit and a telephone-based parenting education
hyperactivity disorder. program was made available to clinicians as a referral
resource for parents) or a control group (clinicians did
Borg E. The legal status of the fetus. Can Nurse 2005; not see the screening test results). RESULTS:
101(8):19. Compared with control subjects, at 9 months after
study enrollment, children in the intervention group
Borjesson B, Paperin C, Lindell M. Maternal support during exhibited decreases in aggressive behavior (adjusted
the first year of infancy. J Adv Nurs 2004; 45(6):588- mean difference: -1.71; 95% confidence interval [CI]: -
94. 2.89 to -0.53), delinquent behavior (adjusted mean
Abstract: BACKGROUND: Mental health problems difference: -0.71; 95% CI: -1.28 to -0.13), and attention
among children and adolescents are becoming more problems (adjusted mean difference: -1.02; 95% CI, -
visible and some research indicates that they are 1.77 to -0.26) on the Child Behavior Checklist.
increasing. Several studies suggest that social support Children in the intervention group had lower rates of
counteracts the increasing risk of ill-health in families parent-reported bullying (adjusted odds ratio: 4.43;
with children. However, there is a lack of studies which 95% CI: 1.87-10.52), physical fighting (adjusted odds
focus on the support that expectant mothers and parents ratio: 1.79; 95% CI: 1.11-2.87), and fight-related
might need. AIM: The aim of the study was to describe injuries requiring medical care (adjusted odds ratio:
mothers' experiences of pregnancy, labour and 4.70; 95% CI: 1.33-16.59) and of child-reported
homecoming, support needs, and sources of support in victimization by bullying (adjusted odds ratio: 3.23;
their role as parents. METHODS: One hundred and 95% CI: 1.96-5.31). CONCLUSIONS: A primary care-
twenty-two mothers participated in the study by based intervention that includes psychosocial screening
answering a questionnaire consisting of 37 questions. and the availability of a parenting education resource
Data were analysed using descriptive statistics, chi- can decrease violent behavior and injury among
square tests and content analysis. FINDINGS: Mothers youths.
of infants had a great need to talk about their
experiences of labour soon afterwards and over the Bosch X. Spain makes plans to combat sex tourism. Lancet
following months. Most of the mothers had generally 2004; 363(9408):542.
received support from their partners. However, in some
situations, other people in their networks, and Bosschaart AN, Bilo RA. [Child abuse--the approach in the
maternity and child health services had been more hospital]. Ned Tijdschr Geneeskd 2005; 149(29):1605-
supportive than partners. DISCUSSION: The study 7.
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![Abstract: It is estimated that at least 50,000 children Bostock L. Pathways of disadvantage? Walking as a mode
are victims of child abuse each year in The of transport among low-income mothers. Health Soc
Netherlands. Approximately 40 of these children die. Care Community 2001; 9(1):11-8.
Doctors, in cooperation with other disciplines, have a Abstract: Research shows that lack of car ownership is
role in signalling child abuse in hospitals. Education associated with poorer health. It is often assumed that
must improve and enhance the knowledge and skills in the reason for this observed relationship is that access
this field. Hospital directors should facilitate education to a car--or not--reflects access to household assets.
to achieve and maintain this knowledge and enable it to Consequently, lack of car ownership is used as a
be put into practice. Better signalling procedures will standard marker of low socio-economic status.
result in quicker and more adequate treatment of these However, little attention has been paid to the
children. The number of fatal cases will then decrease experience of carlessness in the context of
as well. disadvantaged lives. This paper argues that "no access
to a car" is not only an indicator of low socio-economic
Bosshard G, Nilstun T, Bilsen J et al. Forgoing treatment at status but of walking as a mode of transport. These
the end of life in 6 European countries. Arch Intern arguments are illustrated by data from a study of 30
Med 2005; 165(4):401-7. low-income mothers with young children. Although
Notes: CORPORATE NAME: European End-of-Life walking is promoted as both an excellent and
Consortium inexpensive form of exercise, these data suggest that
GENERAL NOTE: KIE: 23 refs. reliance on walking can have negative effects on the
GENERAL NOTE: KIE: KIE Bib: allowing to die welfare of families. The paper draws on qualitative
Abstract: BACKGROUND: Modern medicine provides data to describe the ways in which carlessness restricts
unprecedented opportunities in diagnostics and access to health and social care resources such as food
treatment. However, in some situations at the end of a shops, health-care services and social networks. It also
patient's life, many physicians refrain from using all explores the impact of walking on the well being of
possible measures to prolong life. We studied the mothers and their day-to-day relationships with
incidence of different types of treatment withheld or children. This is compounded by walking through areas
withdrawn in 6 European countries and analyzed the that are neglected and depressed. The paper concludes
main background characteristics. METHODS: Between that strategies to reduce social exclusion must
June 2001 and February 2002, samples were obtained recognise the contradictory health effects of walking
from deaths reported to registries in Belgium, and aim to regenerate the physical fabric of social
Denmark, Italy, the Netherlands, Sweden, and housing estates as well as improve public transport
Switzerland. The reporting physician was then sent a options.
questionnaire about the medical decision-making
process that preceded the patient's death. RESULTS: Bostrom BA. In re A (children): in the Royal Courts of
The incidence of nontreatment decisions, whether or Justice (England). Issues Law Med 2001; 17(2):183-
not combined with other end-of-life decisions, varied 93.
widely from 6% of all deaths studied in Italy to 41% in Notes: GENERAL NOTE: KIE: KIE Bib: patient
Switzerland. Most frequently forgone in every country care/minors; treatment refusal/minors
were hydration or nutrition and medication, together Abstract: HELD: The proposed operation to separate
representing between 62% (Belgium) and 71% (Italy) conjoined twins resulting in the death of one of the
of all treatments withheld or withdrawn. Forgoing twins is lawful. Although Mary's death is foreseeable
treatment estimated to prolong life for more than 1 as an inevitable consequence of the operation, the
month was more common in the Netherlands (10%), invasive surgery is intended and necessary to save
Belgium (9%), and Switzerland (8%) than in Denmark Jodie's life. Mary's death is not a purpose or intention
(5%), Italy (3%), and Sweden (2%). Relevant of the surgery, and she will die only because her body,
determinants of treatment being withheld rather than on its own, was never viable.
withdrawn were older age (odds ratio [OR], 1.53; 95%
confidence interval [CI], 1.31-1.79), death outside the Bostrom BA. Miller v. HCA, Inc. Issues Law Med 2003;
hospital (death in hospital: OR, 0.80; 95% CI, 0.68- 19(2):171-3.
0.93), and greater life-shortening effect (OR, 1.75; 95% Notes: GENERAL NOTE: KIE: KIE Bib: allowing to
CI, 1.27-2.39). CONCLUSIONS: In all of the die/infants; informed consent/minors
participating countries, life-prolonging treatment is
withheld or withdrawn at the end of life. Frequencies Botash AS. From curriculum to practice: implementation of
vary greatly among countries. Low-technology the child abuse curriculum. Child Maltreat 2003;
interventions, such as medication or hydration or 8(4):239-41.
nutrition, are most frequently forgone. In older patients
and outside the hospital, physicians prefer not to Botkin JR. Preventing exploitation in pediatric research. Am
initiate life-prolonging treatment at all rather than stop J Bioeth 2003; 3(4):31-2.
it later. Notes: GENERAL NOTE: KIE: 8 refs.
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![GENERAL NOTE: KIE: KIE Bib: human and home visits by a midwife; women in the hospital-
experimentation/informed consent; human based care group were hospitalised for four to five
experimentation/minors days. MAIN OUTCOME MEASURES: Breastfeeding
28 days postpartum, women's views of their care and
Boulard G. The meth menace: battling the fast-paced spread readmission to hospital. RESULTS: Women in the
of methamphetamine may mean attacking it from home-based care group had shorter hospital stays (65
several fronts. State Legis 2005; 31(5):14-8. vs 106 hours, P < 0.001) and more midwife visits (4.8
vs 1.7, P < 0.001) than women in the hospital-based
Boulet MC, Ethier LS, Couture G. [Life events and trauma care group. Prevalence of breastfeeding at 28 days was
in chronic negligent mothers]. Sante Ment Que 2004; similar between the groups (90%vs 87%, P= 0.30), but
29(1):221-42. women in the home-based care group reported fewer
Abstract: The present study examines more closely the problems with breastfeeding and greater satisfaction
chronic behaviors of maltreating mothers. Events that with the help received. There were no differences in
these mothers have experienced during childhood are satisfaction with care, women's hospital readmissions,
examined, experiences including abuse, placement, postnatal depression scores and health status scores. A
separation, bereavement, rejection, neglect, lack of higher percentage of neonates in the home-based care
love and role reversal. Signs of unresolved trauma group were readmitted to hospital during the first six
found in the discourse of mothers, such as dissociation, months (12%vs 4.8%, P= 0.004). CONCLUSIONS: In
are also studied. It is proposed that negligent mothers low risk pregnancies, early discharge from hospital and
from the chronic group will evoke more negative midwife visits at home after delivery is an acceptable
experiences and/or more intense negative experiences alternative to a longer duration of care in hospital.
which occurred during childhood than the mothers Mothers' preferences and economic considerations
from the transitory group. The chronic group will also should be taken into account when choosing a policy of
show more signs of dissociation. From a six years postnatal care.
follow-up study, a sample of 20 mothers was recruited
from the Child Protection Services, including the cases Boy A, Salihu HM. Intimate partner violence and birth
of 10 chronic maltreating mothers and 10 transitory outcomes: a systematic review. Int J Fertil Womens
maltreating mothers. Two main measures were used: Med 2004; 49(4):159-64.
the Child Abuse Potential Inventory (CAPI) and the Abstract: OBJECTIVE: There is a lack of
Adult Attachment Interview (AAI) (Main et Goldwyn, comprehensive information on the relationship between
1998). The experiences from childhood and complete domestic physical and emotional violence and
discourse in AAI were analysed with the method used pregnancy outcomes. Accordingly, we undertook this
by Main et Goldwyn (1998). Non parametric analysis systematic review of the literature to examine the
indicate that mothers from the chronic group evoke evidence on the association between physical and
more negative and very negative childhood experiences emotional abuse and pregnancy outcomes. STUDY
than the mothers from the transitory group. Content DESIGN AND METHOD: A comprehensive literature
analysis show that chronic maltreating mothers relate search was carried out using pertinent key words that
having gone through more potentially traumatic events would retrieve any research article pertaining to the
such as foster care placements, separations and abuse. topic. This was supplemented by cross-referencing of
The analysis of the Adult Attachment Interview the articles. A total of 296 articles were found; case
according to Main and Goldwyn's system demonstrate reports and articles that failed to satisfy the study
that the majority of the chronic maltreating mothers inclusion criteria were removed and 30 articles were
have two times more unresolved traumas. included in the review. RESULTS: Overall, adverse
pregnancy outcomes, including low birth weight,
Boulvain M, Perneger TV, Othenin-Girard V, Petrou S, maternal mortality and infant mortality are
Berner M, Irion O. Home-based versus hospital-based significantly more likely among abused than
postnatal care: a randomised trial. BJOG 2004; nonabused mothers. Abused pregnant mothers present
111(8):807-13. more often than nonabused mothers with kidney
Abstract: OBJECTIVE: To compare a shortened infections, gain less weight during pregnancy, and are
hospital stay with midwife visits at home to usual more likely to undergo operative delivery. Fetal
hospital care after delivery. DESIGN: Randomised morbidity, such as low birth weight, preterm delivery,
controlled trial. SETTING: Maternity unit of a Swiss and small size for gestational age are more frequent
teaching hospital. POPULATION: Four hundred and among abused than nonabused gravidas. The risk for
fifty-nine women with a single uncomplicated maternal mortality is three times as high for abused
pregnancy at low risk of caesarean section. mothers. Black abused mothers are 3-4 times as likely
METHODS: Women were randomised to either home- to die as their white counterparts. Unmarried victims
based (n= 228) or hospital-based postnatal care (n= are also three times as likely to die as married abused
231). Home-based postnatal care consisted of early mothers. Intimate partner violence is also responsible
discharge from hospital (24 to 48 hours after delivery) for increased fetal deaths in affected pregnancies
(about 16.0 per 1000). CONCLUSION: Intimate
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![interactions between young "hard to manage" children of an 8-month center- and home-based prevention
and their mothers. J Abnorm Child Psychol 2002; program for preschoolers at high risk for conduct
30(2):103-12. problems. We report immediate program effects on
Abstract: Thirty preschoolers rated as "hard to manage" observed and self-rated parenting practices and
on Goodman's (R. Goodman, 1997) Strengths and observed child behavior with peers. Ninety-nine
Difficulties Questionnaire (SDQ), and a group of preschool-age siblings of adjudicated youths and their
matched control children were observed and recorded families were randomly assigned to an enhanced
on audiotape at home, interacting with their mothers version of the Incredible Years Series (Webster-
(Time 1). At the 18-month follow-up home visits Stratton, 1989; n = 50) or to a no-intervention control
(Time 2), the children and mothers were filmed across condition (n = 49). In an intent-to-treat design, the
4 observation settings. Mother-child interactions were intervention yielded significant effects on negative
rated on affect, control, responsiveness and parenting, parental stimulation for learning, and child
"connectedness" of communication. At Time 1, social competence with peers. Improvements in
mothers of the "hard to manage" group used more negative parenting, stimulation for learning, and child
negative control and engaged in fewer connected social competence support the potential of the
conversations than did mothers in the control group. At intervention to prevent later conduct problems in high-
Time 2, mothers of the "hard to manage" group risk children.
displayed higher levels of negative control and lower
levels of positive control. These results are discussed in Brotman LM, Klein RG, Kamboukos D, Brown EJ, Coard
terms of the importance of examining connected SI, Sosinsky LS. Preventive intervention for urban,
communication and different observation contexts low-income preschoolers at familial risk for conduct
when examining dyadic mother-child interactions. problems: a randomized pilot study. J Clin Child
Adolesc Psychol 2003; 32(2):246-57.
Brosnan CA, Upchurch SL, Meininger JC, Hester LE, Abstract: Conducted a pilot study to test the feasibility
Johnson G, Eissa MA. Student nurses participate in of a prevention program for promoting parenting in
public health research and practice through a school- families of preschoolers at high risk for behavior
based screening program. Public Health Nurs 2005; problems. Risk status was based on a family history of
22(3):260-6. antisocial behavior and residence in a low-income,
Abstract: Obesity has reached epidemic proportions urban community. Thirty preschoolers (ages 21/2 to 5)
among children in minority populations, placing them and their parents were randomly assigned to a 1-year,
at risk for diabetes and hypertension. The importance home- and clinic-based intervention or to a no-
of educating a generation of nurses who have the intervention control condition. Despite families'
knowledge, skills, and passion to address this public multiple risk factors, high rates of attendance and
health need is crucial to the profession and to satisfaction were achieved. Relative to controls,
America's health. This article describes the use of a intervention parents were observed to be significantly
Community Partnership Model to frame baccalaureate more responsive and use more positive parenting
nursing students' (B.S.N.) service learning within the practices. Results support the feasibility of engaging
context of a research study to screen middle- and high- high-risk families in an intensive prevention program.
school students for health risks. The missions of The meaningful changes achieved in parenting suggest
education, research, and practice are linked together in that a preventive approach is promising for families
the model by three processes: evidence-based practice, with multiple risk factors.
service learning, and scholarly teaching. The aim of the
project was early identification of obesity, Brouh Y, Paut O, Lena G, Paz-Paredes A, Camboulives J.
hypertension, and type 2 diabetes and their predictors [Shaken baby syndrome: improvement of cerebral
in a high-risk student population, between 12 and 19 blood flow velocity after a subdural external derivation
years of age. Early evidence indicates that the model is in a six-month old infant]. Ann Fr Anesth Reanim
feasible and effective for directing student learning and 2002; 21(8):676-80.
addressing public health problems in the community. Abstract: The shaken baby syndrome is a severe form
of child abuse. The intracranial injuries are associated
Bross DC. Protecting children from maltreatment in a with a high morbidity and mortality rates. A 6 month-
hospital setting. Child Abuse Negl 2001; 25(12):1551- old healthy infant presented at home a
3. cardiorespiratory arrest. After a cardiopulmonary
resuscitation, radiological survey showed sub-dural
Brotman LM, Gouley KK, Chesir-Teran D, Dennis T, Klein haematomas and retinal haemorrhages, without a
RG, Shrout P. Prevention for preschoolers at high risk history of trauma. The diagnosis of shaken baby
for conduct problems: immediate outcomes on syndrome was made. Despite medical management and
parenting practices and child social competence. J Clin a fontanelle tap, clinical signs of intracranial
Child Adolesc Psychol 2005; 34(4):724-34. hypertension worsened. Transcranial Doppler
Abstract: This study investigated the immediate impact examination found the cerebral blood flow velocities to
be decreased while the pulsatility index was increased.
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![who do not respond adequately to monotherapy, but identification of communities with disparate oral health
because there is virtually no research to establish safety needs, problems, and resources; and (3) effective
and effectiveness of such strategies, careful monitoring presentation of community-specific oral health survey
is needed. data to community leaders, stakeholders, and decision
makers.
Brugge D, Carranza L, Steinbach S, Wendel A, Hyde J.
Environmental management of asthma at Brummer S. Streamlined support. Centralized desktop
Massachusetts managed care organizations. J Public management improves IT service at an Atlanta-based
Health Manag Pract 2001; 7(5):36-45. children's healthcare system. Health Manag Technol
Abstract: Asthma management staff at eight 2004; 25(4):22-4.
Massachusetts managed care organizations (MCOs)
were interviewed to learn the extent of inclusion of Brunod R, Cazenave B, Angele C. [Outcome of small girls,
environmental prevention strategies in their asthma victims of incest]. Rev Med Suisse Romande 2001;
disease management policies. Six of the plans had 121(7):513-6.
formal asthma disease management programs, all
reported to be based on the National Heart Lung and Bryan E. The impact of multiple preterm births on the
Blood Institute guidelines, but none followed these family. BJOG 2003; 110 Suppl 20:24-8.
guidelines in their entirety. Three MCOs provided for Abstract: Multiple births are important contributors to
home visits that included addressing environmental the preterm and low birthweight population and the
factors for severe asthmatics. Despite the limited role numbers of twin births have been steadily rising since
that MCOs appear to play in environmental prevention the early 1980s in all developed countries. This is
of asthma, the authors identify opportunities and largely due to the increased use of ovulation induction
encourage efforts to expand these programs. and multi-embryo transfer in the treatment of
subfertility. Parents of preterm twins have been shown
Bruguera M, Sanchez Tapias JM. [Viral hepatitis in to be less responsive to their infants than those with
immigrants and in adopted children. A problem of singletons. Parental stress with twins has also been
unknown magnitude in Spain]. Med Clin (Barc) 2001; demonstrated by the higher incidence of maternal
117(15):595-6. depression and of child abuse in multiple birth families.
Furthermore, siblings of twins are more likely to have
Brumley DE, Hawks RW, Gillcrist JA, Blackford JU, Wells behaviour problems. Mortality and long-term
WW. Successful implementation of community water morbidity rates are greatly increased amongst multiple
fluoridation via the community diagnosis process. J birth children. The problems of the single surviving
Public Health Dent 2001; 61(1):28-33. twin and the unaffected co-twin of a disabled child are
Abstract: OBJECTIVES: This paper describes the often underestimated as is the complexity of the
community diagnosis process and how it was used to bereavement of parents who still have surviving
implement community water fluoridation in Tennessee. multiples. Addressing the cause of the epidemic of
METHODS: Public health dental staff developed a iatrogenic multiple births is likely to be the single most
survey instrument to collect community-specific data effective way to reduce the number of preterm infants
on the oral health status of schoolchildren. Key survey and the long-term problems to which they are prone.
findings were presented to county health councils who
were determining and prioritizing the health needs of Brzozowska A. [Child maltreatment as a risk factor for
their communities. RESULTS: Community-specific suicidal behavior--a literature review]. Psychiatr Pol
data showed higher caries levels in children without 2004; 38(1):29-36.
access to an optimally fluoridated community water Abstract: Based on a review of studies done in the last
supply. Presentation of local survey findings to county 20 years the author presents recent knowledge on the
health councils resulted in fluoridation being a high- possible relationship between child maltreatment and
priority health issue in several counties. With health suicidal behaviour in childhood, adolescence and
council support, opposition to fluoridation by utility adulthood.
district officials was overcome when decision makers
were challenged with local survey findings. The Buchanan GR, Journeycake JM, Adix L. Severe chronic
community diagnosis process resulted in the successful idiopathic thrombocytopenic purpura during childhood:
fluoridation of six community water systems serving a definition, management, and prognosis. Semin Thromb
total of 33,000 residents. CONCLUSIONS: The Hemost 2003; 29(6):595-603.
community diagnosis approach was successful in Abstract: Chronic idiopathic thrombocytopenic purpura
implementing community water fluoridation in (ITP) can be categorized as mild, moderately severe, or
geographic areas historically opposed to this public severe. Severe chronic ITP during childhood is a rare
health measure. The success of these fluoridation disorder characterized by clinically significant
initiatives was attributed to: (1) current, community- mucocutaneous hemorrhage, usually in the setting of
specific assessments of children's oral health; (2) marked thrombocytopenia. It can cause substantial
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![Bushman BJ, Bonacci AM. Violence and sex impair used to identify 266 children at high risk for ADHD.
memory for television ads. J Appl Psychol 2002; Parents completed standardized instruments assessing
87(3):557-64. network structure and function, DSM-IV diagnoses of
Abstract: Participants watched a violent, sexually disruptive disorders, caregiver strain, and treatment
explicit, or neutral TV program that contained 9 ads. receipt, and children self-reported internalizing
Participants recalled the advertised brands. They also symptoms. Relationships were examined with analysis
identified the advertised brands from slides of of variance and multivariate prediction, adjusting for
supermarket shelves. The next day, participants were sociodemographic characteristics, psychopathology,
telephoned and asked to recall again the advertised and parental strain. RESULTS: Network characteristics
brands. Results showed better memory for people who varied by race and socioeconomic status (SES), but not
saw the ads during a neutral program than for people by child gender. African-American and disadvantaged
who saw the ads during a violent or sexual program parents reported smaller network sizes, but more
both immediately after exposure and 24 hr later. frequent contact and higher levels of support than their
Violence and sex impaired memory for males and white and high-SES counterparts. High levels of
females of all ages, regardless of whether they liked instrumental support lowered the odds of ADHD
programs containing violence and sex. These results treatment during the 12 months before (OR =.7, p
suggest that sponsoring violent and sexually explicit <.001) and after (OR =.7, p <.001) the network
TV programs might not be a profitable venture for assessment interview. In contrast, parental strain
advertisers. increased the likelihood of ADHD treatment during
both periods. CONCLUSIONS: Clinicians should
Bussen S, Rehn M, Haller A, Weichert K, Dietl J. [Genital anticipate high levels of caregiver strain and low levels
findings in sexually abused prepubertal girls]. Zentralbl of instrumental support among their patients' parents
Gynakol 2001; 123(10):562-7. and address the potential high need for respite care in
Abstract: Genital findings in sexually abused treatment plans.
prepubertal girls.Childhood sexual abuse is defined as
the involvement of dependent, developmentally Busza J, Castle S, Diarra A. Trafficking and health. BMJ
immature children and adolescents in sexual activities 2004; 328(7452):1369-71.
that they do not fully comprehend, to which they are
unable to give informed consent or that violate the Butchart A, Engstrom K. Sex- and age- specific relations
social taboos of family roles. Essential to the diagnosis between economic development, economic inequality
of sexual abuse is an awareness of the problem and and homicide rates in people aged 0-24 years: a cross-
acknowledgement of its manifestations. The evaluation sectional analysis. Bull World Health Organ 2002;
of the sexually abused girl usually is performed in a 80(10):797-805.
pediatric and adolescent gynecology outpatient Abstract: OBJECTIVE: To test whether relations
department. Thus, the gynecologist will be part of a between economic development, economic inequality,
multidisciplinary approach to the problem and will and child and youth homicide rates are sex- and age-
need to be competent in the basic skills of history specific, and whether a country's wealth modifies the
taking, physical examination, selection of laboratory impact of economic inequality on homicide rates.
tests und differential diagnosis. Findings secondary to METHODS: Outcome variables were homicide rates
sexual abuse are often subtle. Acute tears or bruisings around 1994 in males and females in the age ranges 0-
are rare, because force is seldom part of sexual acts 4, 5-9, 10-14, 15-19 and 20-24 years from 61 countries.
committed against a child. A vaginal opening of greater Predictor variables were per capita gross domestic
than 5 mm is not common and may indicate vaginal product (GDP), GINI coefficient, percentage change in
penetration. An intact hymen not necessarily exclude per capita gross national product (GNP) and female
vaginal intercourse. Lack of physical evidence never economic activity as a percentage of male economic
rules out abuse because sexual acts may leave no activity. Relations were analysed by ordinary least
physical findings. squares regression. FINDINGS: All predictors
explained significant variances in homicide rates in
Bussing R, Zima BT, Gary FA et al. Social networks, those aged 15-24. Associations were stronger for males
caregiver strain, and utilization of mental health than females and weak for children aged 0-9. Models
services among elementary school students at high risk that included female economic inequality and
for ADHD. J Am Acad Child Adolesc Psychiatry 2003; percentage change in GNP increased the effect in
42(7):842-50. children aged 0-9 and the explained variance in
Abstract: OBJECTIVE: This study explores whether females aged 20-24. For children aged 0-4, country
parental support networks vary by sociodemographic clustering by income increased the explained variance
factors among children at high risk for attention- for both sexes. For males aged 15-24, the association
deficit/hyperactivity disorder (ADHD) and whether with economic inequality was strong in countries with
network characteristics influence the receipt of mental low incomes and weak in those with high incomes.
health treatment for the child. METHOD: A school CONCLUSION: Relations between economic factors
district-wide, two-phase screening study design was and child and youth homicide rates varied with age and
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![sex. Interventions to target economic factors would based INT reported a trend toward lower total
have the strongest impact on rates of homicide in parenting distress compared with caregivers of children
young adults and late adolescent males. In societies who received SC with no home visits.
with high economic inequality, redistributing wealth
without increasing per capita GDP would reduce Byard RW, Donald TG. Initial neurologic presentation in
homicide rates less than redistributions linked with young children sustaining inflicted and unintentional
overall economic development. fatal head injuries. Pediatrics 2005; 116(6):1608;
author reply 1608-9.
Bute M. Congenital heart disease and treatment options.
Case Manager 2004; 15(2):56-8; quiz 59. Byock I. The ethics of loving care. Health Prog 2004;
85(4):12-9, 57.
Butler-Sloss DE. The role of the law in the care of sick Notes: GENERAL NOTE: KIE: 31 refs.
children. Med Sci Law 2003; 43(2):93-7. GENERAL NOTE: KIE: KIE Bib: terminal care
Butler-Sloss E, Hall A. Expert witnesses, courts and the law. Byrne MW. Conducting research as a visiting scientist in a
J R Soc Med 2002; 95(9):431-4. women's prison. J Prof Nurs 2005; 21(4):223-30.
Abstract: Incarcerated populations have disparities in
Butz AM, Pulsifer M, Marano N, Belcher H, Lears MK, health risks and illness conditions meriting study, but
Royall R. Effectiveness of a home intervention for the history of prison research is marred by unethical
perceived child behavioral problems and parenting conduct. Ethical participation strategies are discussed
stress in children with in utero drug exposure. Arch in the context of studies implemented by the author in a
Pediatr Adolesc Med 2001; 155(9):1029-37. state prison system. This study used ethnographic
Abstract: OBJECTIVE: To determine if a home-based approaches, observed adherence to federal and
nurse intervention (INT), focusing on parenting institutional review board regulations and corrections
education/skills and caregiver emotional support, department directives, and maintained continuous
reduces child behavioral problems and parenting stress communication with vested interests to provide entry
in caregivers of in utero drug-exposed children. and long-term access for studies on female prisoners
DESIGN: Randomized clinical trial of a home-based and their civilian infants. A culture clash between the
INT. SETTINGS: Two urban hospital newborn punitive restrictive environment that serves the
nurseries; homes of infants (the term infant is used custody-control-care mission of corrections systems
interchangeably in this study with the term child to and the open inquiry environment needed for conduct
denote those from birth to the age of 36 months); and a of health research exists. Federal regulations protect
research clinic in Baltimore, Md. PARTICIPANTS: In prisoners as human subjects but additional vigilance
utero drug-exposed children and their caregivers (N = and communication by researchers are required.
100) were examined when the child was between the Gaining and maintaining access to prison inmates for
ages of 2 and 3 years. Two groups were studied: nursing research are leadership challenges that can be
standard care (SC) (n = 51) and INT (n = 49). met within the caring and collaborative paradigm of
INTERVENTION: A home nurse INT consisting of 16 nursing.
home visits from birth to the age of 18 months to
provide caregivers with emotional support and Caan W. GP involvement in child protection. Br J Gen Pract
parenting education and to provide health monitoring 2002; 52(481):678.
for the infant. MAIN OUTCOME MEASURES:
Scores on the Child Behavior Checklist and the Cackett P, Fleck B, Mulhivill A. Bilateral fourth-nerve palsy
Parenting Stress Index. RESULTS: Significantly more occurring after shaking injury in infancy. J AAPOS
drug-exposed children in the SC group earned t scores 2004; 8(3):280-1.
indicative of significant emotional or behavioral Abstract: The shaken baby syndrome is a serious form
problems than did children in the INT group on the of child abuse that typically results in serious short-
Child Behavior Checklist Total (16 [31%] vs 7 [14%]; and long-term neurological sequelae. Isolated cranial
P =.04), Externalizing (19 [37%] vs 8 [16%]; P =.02), nerve palsies have been reported after shaking injuries
and Internalizing (14 [27%] vs. 6 [12%]; P =.05) scales in infants. We report a child with bilateral fourth
and on the anxiety-depression subscale (16 [31%] vs. 5 cranial nerve palsy that developed after a shaking
[10%]; P =.009). There was a trend (P =.06) in more injury.
caregivers of children in the SC group reporting higher
parenting distress than caregivers of children in the Cadoret RJ, Langbehn D, Caspers K et al. Associations of
INT group. CONCLUSIONS: In utero drug-exposed the serotonin transporter promoter polymorphism with
children receiving a home-based nurse INT had aggressivity, attention deficit, and conduct disorder in
significantly fewer behavioral problems than did in an adoptee population. Compr Psychiatry 2003;
utero drug-exposed children receiving SC (P =.04). 44(2):88-101.
Furthermore, those caregivers receiving the home- Abstract: Prior studies of the Iowa Adoption cohorts
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![discussing newborn health checks with a pregnant our country's medical system. Opportunities to teach
woman and her partner. Response. N Z Bioeth J 2003; students to recognize and address these disparities
4(1):36-8. abound within medical education. Participatory
Notes: GENERAL NOTE: KIE: KIE Bib: informed training and educational action projects can prepare
consent/minors; mass screening learners to lead us toward a more just and egalitarian
medical system with the potential to change the context
Campos-Outcalt D. How does HIPAA affect public health of family and community in which we care for patients.
reporting? J Fam Pract 2004; 53(9):701-4. However, systematic commitment from educational
programs is necessary to produce activated clinicians,
Canabarro ST, Eidt OR, Aerts DR. [Pediatric injuries at teachers, and researchers to achieve these changes.
home]. Rev Gaucha Enferm 2004; 25(2):257-65.
Abstract: Physical trauma occurred at home with Caniano DA. Ethical issues in the management of neonatal
children from zero to six years of age is a descriptive surgical anomalies. Semin Perinatol 2004; 28(3):240-5.
study outlining an epidemiologic case series that aims Abstract: This article provides a framework for
at characterising trauma and the situations in which it thinking about three areas in neonatal surgery that
occurs. Subjects were 120 individuals legally contain potential moral and ethical concerns for
responsible for hospitalized children of the mentioned pediatric surgeons and the parents of a newborn and/or
age in the second semester of 2002. The study detected fetus with a surgical anomaly. The utilization of life-
the necessity of implanting an information system in sustaining therapy for neonates has made survival
ambulatory care units and hospitals in order to get possible for many infants with serious birth defects.
knowledge about several relevant variables, as sorts, Sometimes the use of these treatments is problematic in
frequency, circumstances and causes for the traumas. terms of their actual benefit to the infant and the
The necessity of an educational approach to prevention potential for enhancing their future quality of life.
was also strongly evidenced. Second, the prenatal diagnosis of congential anomalies
has made counseling of the prospective parents a
Canahuati J, Joya de Suarez MJ. Supporting breastfeeding: routine part of pediatric surgical practice and raises the
current status and future challenges. Child Welfare issue of how best to advise and support a couple whose
2001; 80(5):551-62. fetus has a significant birth defect. Finally, pediatric
Abstract: Although breastfeeding is an optimal source surgeons have a responsibility to their patients and
of nutrition that promotes the health and development society to provide the highest quality of care. This may
of infants, rates of breastfeeding have been declining. involve participation in multi-institutional clinical
International conventions and strategies, such as the trials, so that the optimal care of a surgical neonate
Innocenti Declaration and the 10 Steps to Successful with a congenital or acquired condition is ascertained
Breastfeeding, are helping to educate society about the by rigorous prospective research evaluation.
benefits of breastfeeding and to create supports for
mothers and their children, but advocacy and education Canino IA, Inclan JE. Culture and family therapy. Child
are still needed Adolesc Psychiatr Clin N Am 2001; 10(3):601-12.
Abstract: Children and families constitute an ever-
Candib LM, Gelberg L. How will family physicians care for increasing culturally diverse group in this country.
the patient in the context of family and community? Together with incentives in multicultural education and
Fam Med 2001; 33(4):298-310. the evidence of the impact of different cultural values
Abstract: Difficulties caring for patients in the context in the media, these groups have become more visible,
of family and community stem from problems of more complex, and harder to study. Culture is defined
power and vulnerability. Patients are disempowered in as dynamic and expressive of shared values and
relation to physicians and to the medical care system. behaviors. Cultural patterns may be situation specific
Physicians are disempowered in their ability to provide and change according to contextual demands (rural
comprehensive relationship-centered care to versus urban youth) or may be population specific (the
individuals and families because of economic culture of gay youth versus heterosexual youth). Some
constraints on medical care and limits on continuity of people also ascribe to cultural beliefs, but these do not
care. Individual patients are also vulnerable to abuses necessarily translate to behaviors. Families and their
of power within their families because of physical and children vary in their level of acculturation and
sexual abuse; the recognition of such abuses and developmentally vary in their level of ethnic
appropriate interventions for them requires awareness identification. Child-rearing patterns and parenting
of the gender ideology that underlies interpersonal approaches are constantly in flux, as are gender roles
abuses of power. Families and communities can be and, increasingly, religious affiliations. Clinicians are
disempowered because of vulnerabilities related to challenged to treat these families and often find the
race, ethnicity, poverty, and homelessness. The cultural dissonance with their own native culture and
additive effects of these vulnerabilities have created theoretical approaches as obstacles for the appropriate
health disparities that are a hallmark of inequities in assessment and treatment interventions. As the field of
family therapy has developed, so have culturally
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![sensitive and competent approaches in the field of Cannon A. Rome: can we talk? US News World Rep 2002;
mental health. These approaches must be integrated 132(14):23-4.
into the multiplicity of other factors that define
normality and psychopathology and be studied further Capaldi DM, Conger RD, Hops H, Thornberry TP.
in the context of their relevance and efficacy for special Introduction to special section on three-generation
groups of children and families who suffer with studies. J Abnorm Child Psychol 2003; 31(2):123-5.
specific disorders. In the meantime, cultural awareness Abstract: Interest in lifespan research and cross-
and competence will continue to help clinicians generational associations in parenting practices and
understand better the impact of values and patterns in child behaviors has grown rapidly in recent years. The
family cycles, family organization, child-rearing four papers presented in this journal test three key
practices, and the expression of symptoms in family intergenerational research questions regarding
systems. intergenerational continuities for externalizing
behaviors, using different 3-generational samples.
Canivet C. [Infant crying--a safety risk?]. Lakartidningen
2005; 102(23):1805-7. Capaldi DM, Pears KC, Patterson GR, Owen LD. Continuity
Abstract: A Dutch study is described, in which the of parenting practices across generations in an at-risk
occurrence of potentially detrimental parental actions sample: a prospective comparison of direct and
induced by infant crying were assessed and thereafter mediated associations. J Abnorm Child Psychol 2003;
related to various factors, including the parents' 31(2):127-42.
judgment that the crying was "excessive". commentary Abstract: A prospective model of parenting and
in the same Lancet issue questions whether this might externalizing behavior spanning 3 generations (G1, G2,
be interpreted as a "blaming of the victim" process. and G3) was examined for young men from an at-risk
Official Swedish and international statistics on child sample of young adult men (G2) who were in
abuse, especially a recent UNICEF report, are approximately the youngest one third of their cohort to
summarized. The co-occurrence of spouse and child become fathers. It was first predicted that the young
abuse is briefly discussed. Southall and co-workers' men in G2 who had children the earliest would show
report on covert video recordings of life threatening high levels of antisocial behavior. Second, it was
child abuse is related, as well as some of the public predicted that G1 poor parenting practices would show
reactions following it, and a proposed new both a direct association with the G2 son's subsequent
categorization of child abuse. parenting and a mediated effect via his development of
antisocial and delinquent behavior by adolescence. The
Cannell J, Hudson JI, Pope HG Jr. Standards for informed young fathers had more arrests and were less likely to
consent in recovered memory therapy. J Am Acad have graduated from high school than the other young
Psychiatry Law 2001; 29(2):138-47. men in the sample. Findings were most consistent with
Notes: GENERAL NOTE: KIE: KIE Bib: fraud and the interpretation that there was some direct effect of
misconduct; informed consent; mental health parenting from G1 to G2 and some mediated effect via
Abstract: Malpractice suits against therapists for either antisocial behavior in G2.
instilling or recovering false memories of sexual abuse
have increased in the last few years and some of the Capone A Jr. Lens-sparing vitreous surgery for infantile
awards have been large. Failure to give informed amblyogenic vitreous hemorrhage. Retina 2003;
consent, that is, failing to inform patients concerning 23(6):792-5.
the risk of recovering false memories, is one of the Abstract: PURPOSE: To report on a series of infants
main allegations increasingly made against therapists with amblyogenic vitreous and/or subinternal limiting
in recovered memory cases. In the landmark case on membrane hemorrhage managed by lens-sparing
informed consent, Canterbury v. Spence fashioned a vitrectomy. DESIGN: Retrospective case series
standard of disclosure that focused on how material the studying retinal attachment status and visual acuity.
potential warnings were to the patient's decision and RESULTS: Eleven eyes sustained vitreous hemorrhage
specifically stated the standard would be set by the law, as a consequence of shaken baby syndrome, 1 due to
not by the profession. The court ruled that the "risk or hyaloidal canal hemorrhage extending into the vitreous,
cluster of risks" must be disclosed to the patient in a 1 due to Terson syndrome, 1 due to birth trauma, and 2
manner that meets the patient's "informational needs." due to a presumed coagulation disorder. Age of the
A review of relevant literature shows that a substantial patients at the time of surgery ranged from 2 to 23
body of information existed by the early 1990s that months (age adjusted for prematurity). Follow-up
warned psychotherapists about the risk of false reports ranged from 7 to 81 months (mean, 28 months). Ten
of sexual and physical abuse. This article concludes eyes had visual improvement. Two infants with shaken
that the "risk or cluster of risks" that must be disclosed baby syndrome had bilateral nonrecordable flash visual
to a patient recovering repressed memories in evoked potential before surgery; one eye of one infant
psychotherapy should have included warnings about had a better than expected visual outcome after
recovering false memories. surgery. One eye sustained a retinal tear without
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![detachment. One eye in an infant with severe shaken sufficient support system is discussed.
baby syndrome and traumatic retinopathy developed a
total rhegmatogenous retinal detachment with Carlson GA, Mick E. Drug-induced disinhibition in
proliferative vitreoretinopathy. CONCLUSIONS: psychiatrically hospitalized children. J Child Adolesc
Infantile amblyogenic vitreous hemorrhage may be Psychopharmacol 2003; 13(2):153-63.
effectively managed by lens-sparing vitreous surgery. Abstract: OBJECTIVE: To examine rates and
Visual outcome of shaken baby syndrome may be predictors of drug-induced behavioral disinhibition
limited as a consequence of structural damage to the (DIBD) in psychiatrically hospitalized children.
retina, optic nerve, or posterior visual pathways. METHODS: DIBD was examined in 267 children
psychiatrically hospitalized for at least 4 weeks. Age,
Carbaugh SF. Family teaching toolbox. Preventing shaken gender, diagnosis, and medication were covariates.
baby syndrome. Adv Neonatal Care 2004; 4(2):118-9. DIBD was defined as dramatic increase in aggression
identified by increased time-outs while on medicaton.
Cardona M, Garcia HI, Giraldo CA et al. [Homicides in RESULTS: Twenty (7.5%) children met our criteria.
Medellin, Colombia, from 1990 to 2002: victims, Attention deficit hyperactivity disorder, pervasive
motives and circumstances]. Cad Saude Publica 2005; developmental disorder, and selective serotonin
21(3):840-51. reuptake inhibitor use appeared to increase the risk, and
Abstract: In Medellin, Colombia, homicide has been older age and stimulant use decreased the risk of
the first cause of morbidity and mortality for 20 years. DIBD. However, it was often difficult to distinguish
Medellin has the highest homicide rates of all major true DIBD from the behavioral fluctuations of these
cities in Latin America. This study describes the disturbed children. Fifteen percent of children
victims, motives, and circumstances in homicides in subsequently improved on the same regimen, 40%
Medellin from 1990 to 2002. The period included improved when the offending drug was stopped and
55,365 homicides, of which 1,394 were randomly another treatment was started, and the remainder had
studied. Of this sample, 93.6% (95%CI: 92.2%-94.8%) adverse response to many medications.
were males, 77.0% (95%CI: 75.0%-79.5%) less than CONCLUSIONS: DIBD is a complex phenomenon
35 years of age, one-fourth had consumed alcohol, and that does not lend itself to simple conclusions and
nine out of ten were killed with firearms. The main requires further study.
motives were revenge and armed robbery. 37.0%
(95%CI: 34.0%-41.0%) of the victims lived in the Carlson M. What the nuns didn't know. Could they have
lowest socioeconomic stratum of the city. uncovered abuse? Not in a culture that kept them in the
Characteristics of homicides in Medellin have dark. Time 2002; 159(15):84.
remained unchanged since the 1980s, when the most
violent period in the city's history began. The most Caroli M, Argentieri L, Cardone M, Masi A. Role of
heavily affected groups are young males who live and television in childhood obesity prevention. Int J Obes
die in poor neighborhoods, and the murders are Relat Metab Disord 2004; 28 Suppl 3:S104-8.
individual acts that leave no wounded behind. Abstract: OBJECTIVE: To assess the role of television
as tool for childhood obesity prevention. METHOD:
Carey LK, Nicholson BC, Fox RA. Maternal factors related Review of the available literature about the relationship
to parenting young children with congenital heart between television and childhood obesity, eating habits
disease. J Pediatr Nurs 2002; 17(3):174-83. and body shape perception. RESULTS: The reviewed
Abstract: The purpose of this study was to compare the studies showed the following: television watching
early child-rearing practices between mothers of young replaces more vigorous activities; there is a positive
children with congenital heart disease (CHD) and correlation between time spent watching television and
mothers of healthy children. In addition, maternal being overweight or obese on populations of different
stress, parental developmental expectations, and the age; obesity prevalence has increased as well as the
early behavioral and emotional development of their number of hours that TV networks dedicate to children;
children were explored. Maccoby's (1992) socialization during the last 30 y, the rate of children watching
theory emphasizing the reciprocal nature of mother- television for more than 4 h per day seems to have
child interactions provided the framework for this increased; children are exposed to a large number of
study. Findings from quantitative self-report measures important unhealthy stimulations in terms of food
and videotaped parent-child interactions showed a intake when watching television; over the last few
remarkable similarity between mothers of children with years, the number of television food commercials
CHD and mothers of healthy children. In contrast, targeting children have increased especially when it
qualitative data revealed important differences with comes to junk food in all of its forms; the present use
mothers of CHD children reporting high levels of of food in movies, shows and cartoons may lead to a
vigilance with their children. The important role of misconception of the notion of healthy nutrition and
promoting the principle of normalization among stimulate an excessive intake of poor nutritional food;
mothers of children with CHD and ensuring a and obese subjects shown in television programmes are
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![Cavet J, Sloper P. The participation of children and young Cerasoli G, Zondini M, Pocecco M. Home care for diabetic
people in decisions about UK service development. children: keeping children out of hospital. Acta
Child Care Health Dev 2004; 30(6):613-21. Biomed Ateneo Parmense 2003; 74 Suppl 1:41-4.
Abstract: BACKGROUND: The involvement of Abstract: This article examines how home care for
children and young people in decisions regarding diabetic children resident in the Azienda Sanitaria
service development is well supported in government Locale (Local Health Centre) of Cesena is organised. It
policy and underpinned by the UN Convention on the outlines the tasks the Diabetes Health Visitor Nurse
Rights of the Child. Information on the extent, nature carries out, the times and ways of execution, and the
and outcomes of children and young people's methods for analysing the effectiveness of the service.
participation can inform further development in this Finally, some of the results achieved through the
area. METHODS: Systematic literature searches, plus activation of this new service have been included,
contact with professional networks, were used to gather among which the fact that the average number of days
and review evidence on children and young people's a child is kept in hospital at the clinical onset of
participation. RESULTS: There is a rapidly developing diabetes has dropped from 10 to 5.
body of information describing and analysing
innovative practices in this field. However, there is also Cespedes-Londono JE, Jaramillo-Perez I, Castano-Yepes
a smaller, but substantial, amount of evidence RA. [The impact of social security system reform on
demonstrating the limited extent of current health services equity in Colombia]. Cad Saude Publica
involvement. A good deal of guidance is now available 2002; 18(4):1003-24.
about how to promote the involvement of children and Abstract: To evaluate the impact on access to, and use
young people. However, the basis of this advice is not of, health services in Colombia's new national health
always clear, and more evidence about children's views insurance system, the authors compared two cross
and their experience of participation in public decision- sections of the population: before (1993) and after
making is required. Issues identified as barriers to (1997), with the approval of Act 100, creating the
change included adult attitudes and intransigence, lack General System for Social Security in Health (SGSSS).
of training for key adults, lack of clarity leading to Two equity indicators were assessed: concentration
tokenism, the nature of organizations (i.e. their curves (CC) and concentration indices (CI),
formality, complexity, bureaucracy and internal summarizing the distribution of access to health care
politics) and the short-term nature of much funding. and utilization of health care services provided by the
The evidence suggests that good practice includes a SGSSS according to income deciles. Between 1993
listening culture among staff, clarity, flexibility, and 1997, the CI for access to insurance halved from
adequate resources, skills development and training for 0.34 to 0.17; simultaneously, coverage increased from
staff and participating children and young people, 23% to 57%, especially among the poorest segments of
inclusion of marginalized groups, feedback and the population, where it increased from 3.7% to 43.7%
evaluation. There is only limited evidence that children as a result of subsidies provided by local governments.
and young people's involvement in public decision- The CI for utilization of health care services did not
making leads to more appropriate services, although vary significantly. Increased disease prevalence and
there is evidence that participating children and young utilization of services among the insured, due to biased
people benefit in terms of personal development and selection of risks and moral hazards, were also
that staff and organizations learn more about their documented. These findings suggest a positive impact
views. CONCLUSIONS: The value of the participation by the Reform on inequalities in access to health care
of children and young people in public decision- insurance; however, a similar effect on inequities in
making is now well accepted, and is recognized in the utilization of health services is not clear.
standards set in the Children's National Service
Framework. However, there is an urgent need for Ceylan A, Ertem M, Korukluoglu G et al. An epidemic
internal and external evaluations of children's caused by measles virus type D6 in Turkey. Turk J
involvement. Pediatr 2005; 47(4):309-15.
Abstract: In this study, the extent of measles outbreak
Celia F. Cutaneous anthrax: an overview. Dermatol Nurs was investigated in the Idil and Cizre counties of
2002; 14(2):89-92. Sirnak Province. New cases determined in patients who
Abstract: The recent acts of bioterrorism have raised applied to primary care clinics and those detected
new questions about this uncommon disease. Clinicians during home visits were evaluated. In 2001, a total of
are puzzled as to why some of the victims exposed to 2,143 cases reported in Sirnak Province were signified
Bacillus anthracis spores developed the cutaneous form as a probable outbreak. Three hundred and thirty-three
of the disease and others the inhalational form. Despite patients in Cizre and 219 patients in Idil applied to the
these questions, cutaneous anthrax remains relatively primary care clinics. Of the cases, in Cizre 8.4%
simple to treat effectively. The real clinical challenge (n=28) and in Idil 6.4% (n=14) were infants aged nine
lies in the diagnosis, especially being able to months and younger who had not yet been vaccinated.
distinguish it from a spider bite. Totally, 17 new cases (8 in Cizre and 9 in Idil) in the
exanthema phase were determined during home visits
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![affect children's emotional and behavioral adjustment. polio vaccine, OPV, is administered as a drop often on
Although treatments to reduce psychological morbidity a lump of sugar placed in the child's mouth. Given
following disasters are needed, it has been difficult to multiple times, the vaccine may protect a child for life!.
conduct treatment research in postdisaster In this essay, the Nigerian scenario serves as a case
environments because of the sensitivity of victims to study of community involvement and trust in
perceived intrusiveness and exploitation. OBJECTIVE: international humanitarian policy. The underlying
To evaluate the efficacy of a public health--inspired causes of the rebellion and its long term impact on
intervention combining school-based screening and immunization programs in the region as well around
psychosocial treatment to identify and treat children the world are of interest and relevance to students,
with persistent disaster-related trauma symptoms. teachers and practitioners of public health.
DESIGN: To identify children with continued high
levels of trauma-related symptoms 2 years after a Chen JQ, Han P, Dunne MP. [Child sexual abuse: a study
major disaster, we conducted a community-wide among 892 female students of a medical school].
school-based screening of disaster-exposed public Zhonghua Er Ke Za Zhi 2004; 42(1):39-43.
elementary school children. Children with the highest Abstract: OBJECTIVE: This study was designed to
levels of trauma-related symptoms were randomly ascertain the prevalence of child sexual abuse (CSA)
assigned to 1 of 3 consecutively treated cohorts. among female students of a medical school and to
Children in the cohorts awaiting treatment served as explore the impact of CSA on the mental health and
wait-list controls. Within each cohort, children were health related risk behaviors of the victims being
randomly assigned to either individual or group sexually abused and to provide useful reference for
treatment to allow comparison of the efficacy of the 2 CSA prevention. METHODS: A cross-sectional survey
treatment modalities. SETTING: All 10 public was carried out among 892 female students from a
elementary schools on the island of Kauai (one of the medical school by anonymous self-administered
Hawaiian Islands) 2 years after Hurricane Iniki. questionnaire during Oct. 2002. The questionnaire used
PARTICIPANTS: All 4258 children in second through for this study mainly included (1) general demographic
sixth grade were screened. The 248 children with the information; (2) sexual experiences; (3) 12 forms of
highest levels of psychological trauma symptoms were CSA. In this study, cases of CSA were defined as those
selected for treatment. INTERVENTION: Children who answered positively to one or more of the 12
were randomly assigned to either individual or group questions relating to childhood sexual experiences
treatment provided by specially trained school-based (including non-physical contact CSA and physical
counselors. Treatment comprised 4 sessions. MAIN contact CSA) occurring before age 16 with a person
OUTCOME MEASURES: The Kauai Reaction when a child did not want to. (4) Center for
Inventory, a self-report measure of trauma symptoms, Epidemiologic Studies (CES)-Depression Scale; (5)
and the Child Reaction Inventory, a semistructured Self Esteem Scale; (6) Risk Behaviors; (7) Health
clinical interview for posttraumatic stress disorder status' self-evaluation. Survey procedures were
symptoms. RESULTS: After treatment, children designed to protect students' privacy by allowing
reported significant reductions in self-reported trauma- anonymous and voluntary participation. Students were
related symptoms. This symptom reduction was seated separately, completed the self-administered
maintained at the 1-year follow-up. Clinical interviews questionnaire in their classrooms during a regular class
also indicated that treated children had fewer trauma period. Respondents were encouraged to participate in
symptoms compared with untreated children. this survey, but given the sensitive nature of the
CONCLUSIONS: School-based community-wide subject, they could skip portion of the questionnaire if
screening followed by psychosocial intervention seems they were not comfortable with the questions. The
to effectively identify and reduce children's disaster- completed questionnaires were sealed in envelopes by
related trauma symptoms and may facilitate students themselves (the envelope was distributed with
psychological recovery. While group and individual questionnaire at the same time), and then collected
treatments did not differ in efficacy, fewer children together. Data were analysed by using the Statistical
dropped out of the group treatment. This approach may Package for the Social Sciences software. Frequency,
be applicable to screening and treating children percentage, Chi-square test and t-test of statistics were
exposed to a variety of large-scale disasters. used to analyze the CSA prevalence and explore the
influence of CSA on mental health of students.
Chen C. Rebellion against the polio vaccine in Nigeria: RESULTS: Among 892 female students, 25.6%
implications for humanitarian policy. Afr Health Sci reported having experienced CSA (any one of 12 forms
2004; 4(3):205-7. non-physical contact and physical contact CSA) before
Abstract: Polio eradication has been top on the agenda the age of 16 years. The median age at first episode
of various international humanitarian organizations was 12 years. Comparing the rates of CSA of female
since 1988. Caused by a virus that enters through the students in different parents' education level, between
mouth, poliomyelitis attacks the nervous system, and one-child in a family and more than one-child in a
can lead to irreversible paralysis or death. Children family, among rural area, county and city, there were
under five years of age are most at risk, and the oral no significant differences. Compared to the students
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![educated and more working class. The size of the RO Chu SY, Barker LE, Smith PJ. Racial/ethnic disparities in
and the number of years that the religious leader had preschool immunizations: United States, 1996-2001.
been with the RO were the strongest predictors of the Am J Public Health 2004; 94(6):973-7.
RO's interest in participating in the project. These data Abstract: OBJECTIVES: We examined current
will be helpful in recruiting community organisations racial/ethnic differences in immunization coverage
into health promotion programmes. rates among US preschool children. METHODS: Using
National Immunization Survey data from 1996 through
Christianson A, Modell B. Medical genetics in developing 2001, we compared vaccination coverage rates between
countries. Annu Rev Genomics Hum Genet 2004; non-Hispanic White, non-Hispanic Black, Hispanic,
5:219-65. and Asian preschool children. RESULTS: During the
Abstract: Since Watson & Crick's 1953 description of 6-year study period, the immunization coverage gap
the structure of DNA, significant progress has been between White and Black children widened by an
achieved in the control of congenital disorders, most of average of 1.1% each year, and the gap between White
which has benefited industrialized countries. Little and Hispanic children widened by an average of 0.5%
advantage accrued to developing nations, most of each year. The gap between White and Asian children
which in the same time frame achieved a significant narrowed by an average of 0.8% each year.
epidemiological transition, resulting in congenital CONCLUSIONS: Racial/ethnic disparities in
disorders attaining public health significance. The preschool immunization coverage rates have increased
burden of congenital disorders in these lower-resource significantly among some groups; critical
countries is high and they need to develop medical improvements in identifying, understanding, and
genetic services. We present a new pragmatic approach addressing race/ethnicity-specific health care
for the care and prevention of congenital disorders in differences are needed to achieve the Healthy People
these countries, pioneered initially by the World Health 2010 goal of eliminating disparities.
Organization.
Chung S, Shannon M. Hospital planning for acts of terrorism
Chronis AM, Lahey BB, Pelham WE Jr, Kipp HL, Baumann and other public health emergencies involving children.
BL, Lee SS. Psychopathology and substance abuse in Arch Dis Child 2005; 90(12):1300-7.
parents of young children with attention- Abstract: In today's world the increased potential of
deficit/hyperactivity disorder. J Am Acad Child terrorist attacks places unique burdens and
Adolesc Psychiatry 2003; 42(12):1424-32. consequences on health care workers. Hospitals and
Abstract: OBJECTIVE: To compare the prevalence of hospital personnel must now be prepared to react
psychological disorders in parents of young children immediately to such events. They must also implement,
with and without attention-deficit/hyperactivity in advance, policies to protect their own health care
disorder (ADHD) and comorbid disruptive behavior personnel while providing care to victims. In this
disorders (DBD). METHOD: Subjects included 98 review, we discuss the four major forms of mass
three- to seven-year-old children with DSM-IV ADHD casualty terrorism (biological, chemical, nuclear, and
(68 with ADHD and comorbid oppositional defiant or thermomechanical) including clinical signs and
conduct disorder [ADHD+ODD/CD]) and 116 non- symptoms for each, the impact on health care
ADHD comparison children recruited in 1995-96 personnel, and special considerations for children. We
during the first wave of a longitudinal study. Biological will then outline key principles of hospital preparation
mothers were administered interviews to assess ADHD with regard to paediatrics in anticipation of such
and DBD in their children and mood, anxiety, and emergencies.
substance use disorders in themselves. In addition, they
were queried about symptoms of childhood ADHD and Chvetzoff G, Garnier M, Perol D et al. Factors predicting
DBD, and antisocial personality disorder in themselves home death for terminally ill cancer patients receiving
and their children's biological fathers. RESULTS: hospital-based home care: the Lyon comprehensive
Child ADHD was associated with increased rates of cancer center experience. J Pain Symptom Manage
maternal and paternal childhood ADHD relative to 2005; 30(6):528-35.
comparison children. Child ADHD+ODD/CD was Abstract: This study aimed to determine factors
associated with maternal mood disorders, anxiety favoring home death for cancer patients in a context of
disorders, and stimulant/cocaine dependence, and coordinated home care. A retrospective study was
paternal childhood DBD. Mothers of children with conducted among patients followed up by the home
ADHD+ODD/CD also reported increased drinking care coordinating unit of the cancer center of Lyon.
problems in their children's fathers. CONCLUSIONS: The main endpoint was place of death. Univariate
These findings indicate that many young children with analysis included general characteristics (age, gender,
ADHD, particularly those with comorbid ODD/CD, rural or urban residence, disease), Karnofsky Index
require comprehensive services to address both their (KI), type of care at referral (chemotherapy, palliative
ADHD and the mental health needs of their parents. care, or other supportive care), and coordinating
medical oncologist (MCO) home visits. Significant
factors were used in a logistic regression analysis. Of
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![Abstract: Antipsychotic medications are increasingly suggests ways pediatricians can enhance fathers'
used in adolescents for a variety of psychiatric caregiving involvement by offering specific, culturally
difficulties, including psychosis, bipolar disorder, and sensitive advice and how pediatricians might change
aggression. Weight gain is a significant side effect of their office practices to support and increase fathers'
neuroleptics, which may limit adolescents' compliance active involvement in their children's care and
with these medications. This report presents a case of development.
significant weight loss while on olanzapine, with a
body mass index (BMI) falling from 25 to 19.5 during Coles J. Doing retrospective child sexual abuse research
8 months of treatment. Possible mechanisms for this safely and ethically with women: is it possible? Two
effect are discussed. perspectives. Monash Bioeth Rev 2004; 23(2):S50-9.
Notes: GENERAL NOTE: KIE: 26 fn.
Cohen MH, Kemper KJ, Stevens L, Hashimoto D, Gilmour GENERAL NOTE: KIE: KIE Bib: behavioral
J. Pediatric use of complementary therapies: ethical research/special populations
and policy choices. Pediatrics 2005; 116(4):e568-75.
Abstract: OBJECTIVE: Many pediatricians and parents Colgrove J, Bayer R. Could it happen here? Vaccine risk
are beginning to integrate use of complementary and controversies and the specter of derailment. Health Aff
alternative medical (CAM) therapies with conventional (Millwood) 2005; 24(3):729-39.
care. This article addresses ethical and policy issues Abstract: Controversy over vaccine safety has achieved
involving parental choices of CAM therapies for their high visibility over the past decade. At the same time,
children. METHODS: We conducted a literature search however, levels of coverage for routinely
to assess existing law involving parental choice of recommended childhood vaccines in the United States
CAM therapies for their children. We also selected a are at their highest ever. We examine this apparent
convenience sample of 18 states of varying sizes and paradox. We consider the ways in which concerns over
geographic locations. In each state, we inquired within vaccine safety have emerged and diffused through the
the Department of Health and Human Services whether popular media, legislative hearings, and Internet-based
staff were aware of (1) any internal policies concerning activism. As a case study, we review the controversy
these issues or (2) any cases in the previous 5 years in over the alleged connection between autism and the
which either (a) the state initiated proceedings against measles-mumps-rubella (MMR) vaccine and consider
parents for using CAM therapies for their children or why it had a dramatic effect on the vaccine's
(b) the department received telephone calls or other acceptance in Great Britain but virtually none in the
information reporting abuse and neglect in this domain. United States.
We asked the American Academy of Pediatrics and the
leading CAM professional organizations concerning Collin-Vezina D, Cyr M. [Current understanding about
any relevant, reported cases. RESULTS: Of the 18 intergenerational transmission of child sexual abuse].
state Departments of Health and Human Services Child Abuse Negl 2003; 27(5):489-507.
departments surveyed, 6 reported being aware of cases Abstract: OBJECTIVE: The aim of this article is to
in the previous 5 years. Of 9 reported cases in these 6 review what is currently understood about
states, 3 involved restrictive dietary practices (eg, intergenerational transmission of child sexual abuse
limiting children variously to a watermelon or raw (CSA). METHOD: CSA transmission is discussed first
foods diet), 1 involved dietary supplements, 3 involved from the point of view of men CSA survivors who
children with terminal cancer, and 2 involved religious become sexually abusive, and then from the
practices rather than CAM per se. None of the perspective of mothers who survived CSA whose
professional organizations surveyed had initiated children have been sexually abused. Mechanisms that
proceedings or received telephone calls regarding may help us understand how CSA is transmitted from
abuse or neglect concerning parental use of CAM one generation to another are described. More
therapies. CONCLUSIONS: Pediatric use of CAM specifically, focus is given to those mechanisms that
therapies raises complex issues. Clinicians, hospitals, might differentiate CSA survivors who break the cycle
state agencies, courts, and professional organizations of abuse from those who perpetuate it. RESULTS: In
may benefit from a policy framework to help guide light of the research reviewed, it seems that the
decision making. transmission of CSA is far from inevitable, since one-
third of sexually abusive men and half of sexually
Coleman WL, Garfield C. Fathers and pediatricians: abused children's mothers mentioned having been
enhancing men's roles in the care and development of sexually abused in their childhood. Because of the
their children. Pediatrics 2004; 113(5):1406-11. retrospective method used in many studies, causal links
Notes: CORPORATE NAME: American Academy of could not be established. However, some mechanisms
Pediatrics Committee on Psychosocial Aspects of have been proposed in order to better understand the
Child and Family Health phenomenon of CSA. Severity of abuse, attachment
Abstract: Research substantiates that fathers' relationships with parental figures, as well as
interactions with their children can exert a positive dissociative symptoms that follow the abuse were
influence on their children's development. This report
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![use. The importance of evaluating the generalizability Concha-Eastman A, Espitia VE, Espinosa R, Guerrero R.
of research-supported interventions to community [Epidemiology of homicides in Cali, Colombia, 1993-
settings is highlighted and recommendations for future 1998: six years of a population-based model]. Rev
research are offered. Panam Salud Publica 2002; 12(4):230-9.
Abstract: OBJECTIVES: To demonstrate the
Comtois KA, Tisdall WA, Holdcraft LC, Simpson T. Dual usefulness of an effective and timely information
diagnosis: impact of family history. Am J Addict 2005; model, underscore the seriousness of the problem of
14(3):291-9. homicides, and point out the need to apply this type of
Abstract: Psychiatric outpatients with severe and model as well as comprehensive prevention projects,
persistent mental illness and a current or past substance such as Desarrollo, Seguridad y Paz (DESESPAZ).
use disorder (N = 89) were interviewed. Information From 1993 to 1998, 11 457 homicides were registered
from the Family Informant Schedule and Criteria was in Cali, Colombia, through an epidemiological
configured in three ways to capture the degree of surveillance model established under DESESPAZ by
familial substance abuse: biological parents only, all the mayor's office in Cali. METHODS: Beginning in
first-degree biological relatives, and all caregivers. All January 1993, a work group organized by DESESPAZ
three configurations predicted the severity of lifetime reviewed and standardized the variables that different
drug abuse on the Inventory of Drug Use institutions gathered about the victims, their assailants,
Consequences, controlling for any gender and non- and the facts surrounding each case, and issued a
substance-related Axis I diagnosis. Differences in weekly summary bulletin for the mayor and other local
means represent low to very low substance abuse authorities. RESULTS: Between 1983 and 1994, the
severity for those without family history and low to homicide rate increased from 23 to 124 per 100 000
medium severity for those with family history. The inhabitants. Subsequently, rates went down in 1995,
clinical implications are discussed. 1996, and 1997 to 112, 102, and 86,1 per 100 000,
respectively, and again rose slightly in 1998 to 88 per
Conaglen HM. Sexual content induced delay: a 100 000. Even though people of all ages, including
reexamination investigating relation to sexual desire. children under 5, have been victims of violence, the
Arch Sex Behav 2004; 33(4):359-67. most affected group is that of men between the ages of
Abstract: This article reports the utility of an 20 and 34. The ratio of men to women has varied from
information processing approach to examine whether 14.3:1 to 9.2:1. In terms of numbers, percentages, and
there is a relationship between sexual content induced rates, low-income groups are the most seriously
delay and levels of sexual desire as determined by self- affected, although the highest-income groups have had
report questionnaires. We tested this idea using a rates as high as 160 per 100 000. A firearm was used in
partial replication of the J. H. Geer and H. S. Bellard over 80% of homicides, and the crime was most often
(1996) protocol demonstrating sexual content induced committed at night and on a weekend. A suspect was
delay (SCID) in responding to sexual versus neutral identified in only a few cases (8% to 21%). The
words. In addition, the experiment examined whether bivariate analysis revealed a positive association with
SCID was different in people with varying levels of alcohol consumption by the victim, as well as with the
sexual desire. It was hypothesized that persons with use of firearms by the assailant (OR: 3.1; 95% CI: 2.6
low levels of sexual desire might respond more slowly to 3.6). Cases that occurred during a fight between
to sexual word cues than others. Words with equal individuals or during group fighting showed an
frequency of usage and similar word length were association with the use of a sharp weapon and with
chosen from among those used in the Geer and Bellard alcohol consumption by the victim (OR: 1.9; 95% CI:
study. The experiment was conducted with 171 1.4 to 2.6). CONCLUSIONS: A map shows the
volunteers who completed sexual desire questionnaires, homicide distribution by neighborhood, and the
lexical decision making tasks, and word ratings. The benefits of a population-based surveillance model are
SCID effect was demonstrated by both men and discussed, particularly their usefulness for identifying
women in the study with no significant variation risk factors and the measures that can be applied to
between the sexes. In accordance with prediction, it prevent and control this form of violence.
was found that persons with lower levels of sexual
desire responded more slowly to sexual stimuli than Conger RD, Wallace LE, Sun Y, Simons RL, McLoyd VC,
other participants, and rated sexual words as less Brody GH. Economic pressure in African American
familiar, less acceptable, and less positive emotionally families: a replication and extension of the family
to them. These findings have implications for stress model. Dev Psychol 2002; 38(2):179-93.
understanding how emotional content contributes to Abstract: This study of 422 two-caregiver African
SCID. They also suggest that further exploration of American families, each with a 10-11-year-old focal
these ideas, perhaps using other stimulus modalities, child (54% girls), evaluated the applicability of the
may be helpful in advancing understanding of family stress model of economic hardship for
responses to sexual cues, and the potential implications understanding economic influences on child
that may have in better understanding sexual desire. development in this population. The findings generally
replicated earlier research with European American
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![prenatal tobacco exposure a risk factor for early employment at the time of follow-up were associated
adolescent smoking? A follow-up study. Neurotoxicol with higher life satisfaction both 1 and 2 years after
Teratol 2005; 27(4):667-76. injury. Motor independence at rehabilitation discharge
Abstract: Recent reports indicate a relation between was also associated at 1 year. Current social integration
prenatal tobacco exposure (PTE) and offspring and the absence of depressed mood were associated at
smoking. Many of these reports have been 2 years. Life satisfaction was relatively stable between
retrospective or have not included important variables years. Change that did occur was associated with
such as other prenatal substance exposures, maternal marital status and depressed mood 2 years after injury.
and child psycho-social characteristics, mother's CONCLUSIONS: Life satisfaction after TBI seems to
current smoking, and friends' smoking. No prior study be related to attaining healthy and productive lifestyles.
has examined the timing of PTE. In this prospective Future research should investigate other factors that
study of a birth cohort of 567 14-year-olds, we affect life satisfaction to increase prediction and
examined the relation between trimester-specific PTE, appreciate all influences on subjective well being after
offspring smoking, and other correlates of adolescent TBI.
smoking. Average age of the adolescents was 14.8
years (range: 13.9-16.6 years), 51% were female, 54% Cortese MM, Diaz PS, Samala U et al. Underimmunization
were African-American. Data on maternal tobacco and in Chicago children who dropped out of WIC. Am J
other substance use were collected both prenatally and Prev Med 2004; 26(1):29-33.
postnatally, 51% of the mothers were prenatal smokers Abstract: BACKGROUND: The Special Supplemental
and 53% smoked when their children were 14 years. Nutrition Program for Women, Infants, and Children
PTE in the third trimester significantly predicted (WIC) serves a large proportion of Chicago infants, but
offspring smoking (ever/never, smoking level, age of some discontinue participation before age 1 year. To
onset) when demographic and other prenatal determine if children who remained active at WIC
substances were included in the analyses. PTE immunization-linked sites after their first birthday were
remained a significant predictor of the level of more likely to be immunized by ages 19 and 25 months
adolescent smoking when maternal and child than those who dropped out, a retrospective cohort
psychological characteristics were added to the model. study was conducted. METHODS: Four Chicago WIC
When more proximal measures of the child's smoking sites that used monthly voucher pick-up were chosen.
were included in the model, including mother's current Children born from July 1, 1997 to September 30, 1997
smoking and friends' smoking, PTE was no longer who attended these sites were eligible (N=1142). The
significant. Significant predictors of adolescent cohort was divided into two groups: (1) active group
smoking at age 14 were female gender, Caucasian race, (46%), who had a WIC visit on or after their first
child externalizing behavior, maternal anxiety, and birthday; and (2) inactive group (54%), who had their
child depressive symptoms. Although direct effects of last WIC visit before their first birthday. Children were
PTE on offspring smoking behavior have previously enrolled through home visits. RESULTS: The records
been reported from this study and by others, by early- for 200 children were analyzed. By age 19 months, 65
adolescence, this association is not significant after (84%) of 77 active children had received one dose of
controlling for the more proximal covariates of measles-mumps-rubella vaccine (MMR), compared to
adolescent smoking such as mother's current smoking 82 (67%) of 123 inactive children (risk ratio [RR]=1.3;
and peer smoking. 95% confidence interval [CI], 1.1- 1.5). By age 25
months, 64 (83%) active children had received four
Corrigan JD, Bogner JA, Mysiw WJ, Clinchot D, Fugate L. doses of diphtheria-tetanus-pertussis vaccine (DTP),
Life satisfaction after traumatic brain injury. J Head one MMR, and three doses of Haemophilus influenzae
Trauma Rehabil 2001; 16(6):543-55. type b vaccine (Hib), compared with 64 (52%) inactive
Abstract: OBJECTIVE: To investigate correlates of life children (RR=1.6; 95% CI, 1.3-2.0). CONCLUSIONS:
satisfaction after traumatic brain injury (TBI). In this cohort, children active in WIC after their first
DESIGN: Prospective, longitudinal study of patients birthday were more likely to be immunized by ages 19
with TBI studied 1 and 2 years after injury. SETTING: and 25 months, compared with those who were no
A specialized inpatient TBI rehabilitation unit in a longer active. Chicago children who drop out of WIC
midwestern academic medical center. SUBJECTS: may represent those at highest risk for
Two hundred eighteen consecutive patients admitted underimmunization and may require special strategies
for rehabilitation, at least 14 years of age, with a to improve coverage.
primary diagnosis of TBI, consented to participate, and
interviewed 1 and/or 2 years after injury (112 Cory CZ, Jones BM. Can shaking alone cause fatal brain
interviewed both years, 58 at year 1 only, 48 at year 2 injury? A biomechanical assessment of the Duhaime
only). MAIN OUTCOME MEASURES: Satisfaction shaken baby syndrome model. Med Sci Law 2003;
With Life Scale. RESULTS: Stepwise multiple 43(4):317-33.
regressions accounted for statistically significant, but Abstract: A biomechanical model of a one-month old
small, proportions of variance. Not having a preinjury baby was designed and tested by Duhaime and co-
history of substance abuse and having gainful workers in 1987 in an attempt to assess the
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![domestic violence, and institutionalization predicted The case was submitted to English law by the hospital,
separations, but homelessness was the most important and the operation permitted against the parents' wishes.
predictor, equivalent in size to 1.9 other risk factors. I consider the relationship between the legal decision
We infer that policies regarding child welfare and and the moral reasons adduced in its support, reasons
substance abuse treatment should be changed to reduce gaining their force against the framework of much
unnecessary placements. Studies of homeless children mainstream normative ethical theory. I argue that in a
who remain with families may be biased if separated few morally dilemmatic situations, such a legalistic-
children are excluded. theoretical approach cannot plausibly accommodate
certain irreducible and ineliminable features of the
Cowan FM, Langhaug LF, Mashungupa GP et al. School ethical experience of any concrete individual
based HIV prevention in Zimbabwe: feasibility and implicated in the situation, and that this failure partly
acceptability of evaluation trials using biological undermines its self-appointed role of guiding such an
outcomes. AIDS 2002; 16(12):1673-8. individual's conduct. For example, the problem as
Notes: CORPORATE NAME: Regai Dzive Shiri experienced by the judge and by the parents might not
Project be the same problem at all, and some of their respective
Abstract: OBJECTIVE: To determine the feasibility reasons may be mutually unintelligible or impotent. I
and acceptability of conducting a community certainly do not argue for a rejection of law or of moral
randomized trial (CRT) of an adolescent reproductive theory; I merely challenge their implicit claim to
health intervention (ARHI) using biological measures comprehensiveness and their fixation with an idealised
of effectiveness. SETTING: Four secondary schools and putatively universal rationality modelled on
and surrounding communities in rural Zimbabwe. converging scientific enquiry. Finally, I claim that at
METHODS: Discussions were held with pupils, least in the twins' case there may be insufficient
parents, teachers and community leaders to determine normative robustness to the conclusions reached, or
acceptability. A questionnaire and urine sampling indeed reachable, by the court in a situation where
survey was undertaken among Form 1 and 2 pupils. intuitions and moral reasons pull in fundamentally
Studies were undertaken to inform likely participation incommensurable directions; as such, there may be
and follow up in a future CRT. A community survey of room for an acknowledgement of the spiritual, through
16-19-year-olds was conducted to determine levels of a humble abstention from making a decision--which is
secondary school attendance and likely HIV prevalence not to be confused with deciding to do nothing.
at final follow up in the event of a trial. RESULTS:
Form 1 and 2 pupils aged 12-18 years (n = 723; median Coyer SM. Mothers recovering from cocaine addiction:
age, 15 years) participated in the research. Prevalences factors affecting parenting skills. J Obstet Gynecol
of HIV, Chlamydia and gonorrhoea were 3.6% [95% Neonatal Nurs 2001; 30(1):71-9.
confidence interval (CI), 2.3-5.3%], 0.4% (95% CI, Abstract: OBJECTIVE: To identify factors that may
0.1-1.3%) and 1.9% (95% CI, 1.0-3.3%) respectively. influence parenting by mothers who are recovering
There was poor correlation between biological from cocaine addiction. DESIGN: Exploratory
evidence of sexual experience and questionnaire descriptive, with in-depth unstructured interviews.
responses, due to concerns about confidentiality. Only SETTING: Interviews were conducted in the woman's
13% (95% CI, 4-27%) of those infected with HIV home or in a treatment center. PARTICIPANTS: A
and/or a sexually transmitted disease admitted to convenience sample of 11 women recovering from
having had sex. In the community survey of 573 cocaine addiction who were mothers of children 3
adolescents aged 16-19 years, 6.6% (95% CI, 3.9- years of age and younger. RESULTS: A content
10.3%) of females and 5.1% (95% CI, 2.9-8.2%) of analysis was used to analyze the interview data. Two
males were HIV positive. High participation and themes, personal/psychologic factors and
retention rates are achievable within a trial in this environmental/contextual factors, and four subthemes
setting. CONCLUSIONS: It is acceptable and feasible emerged. They identify issues that may affect parenting
to conduct randomized trials to establish the by mothers being treated for cocaine addiction.
effectiveness of ARHIs. However, self-reported Subthemes included low self-esteem, difficulty
behavioural outcomes will probably be biased, developing a maternal identity, isolation from friends
emphasizing the importance of using externally and family, and chronic life stress. CONCLUSION:
validated biological outcome measures to determine This study provides a better understanding of the
effectiveness. sources contributing to vulnerability in the parenting
role for mothers recovering from cocaine addiction and
Cowley C. The conjoined twins and the limits of rationality will assist nurses in providing care for these mothers
in applied ethics. Bioethics 2003; 17(1):69-88. and their children.
Notes: GENERAL NOTE: KIE: 24 fn.
GENERAL NOTE: KIE: KIE Bib: patient care/minors Craig M. Perinatal risk factors for neonaticide and infant
Abstract: In this article I consider the case of the homicide: can we identify those at risk? J R Soc Med
surgical separation of conjoined twins resulting in the 2004; 97(2):57-61.
immediate and predictable death of the weaker one.
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![permissive eating, and child food preparation. Internal Cunha AJ, dos Santos SR, Martines J. Integrated care of
consistencies were adequate to high, but test-re-test childhood disease in Brazil: mothers' response to the
correlations often were low. Children also completed recommendations of health workers. Acta Paediatr
questionnaires on FJV availability and accessibility in 2005; 94(8):1116-21.
the home, and food records for 2 days in the classroom. Abstract: AIM: To describe the process of follow-up in
Parental modeling, peer normative beliefs and FV primary care facilities where the Integrated
availability were significantly correlated with FJV Management of Childhood Illness (IMCI) strategy was
consumption. Further research with these scales is implemented. IMCI was developed by WHO and
warranted. UNICEF as an integrated approach to manage sick
children under 5 y of age and aims to reduce mortality
Culverwell T. The parent's perspective. Proc Nutr Soc 2005; and morbidity. METHODS: From August 2001 to
64(3):339-43. February 2002, 229 sick children who had a health
Abstract: The present paper gives an insight from a condition included in the IMCI case management
parent's perspective into the roles of health guidelines were seen in six family healthcare facilities
professionals and service providers in the daily in Brazil. We analysed the care provided to 153
management of a child with complex needs that children who were recommended for a 2- or 5-d
include enteral feeding. It focuses on the case of a 9- follow-up visit. Children who did not return were
year-old boy and discusses some aspects of his visited and assessed at home. RESULTS: Only 87
diagnosis and treatment, and the support received. It children (56.9%) timely returned for follow-up: 70 had
highlights the need for a multi-agency approach based improved, eight presented the same health conditions,
around the child, in which parents are consulted, the five were worse and four had a new problem. The main
opinions of professionals from the different disciplines reasons given for not returning for follow-up were: the
are valued by other professionals and professionals do child had improved (35.1%) and other family priorities
not issue conflicting advice but share knowledge before (47.4%). Home visits showed that, although most
giving advice. There should be national accessibility to children had improved (n=49), some had a new health
support services and a standardised training problem and one child was sick enough to be referred.
programme for carers. Better communication between Prescription of antibiotics was associated with
parents, carers, health professionals and service increased probability of returning for a follow-up visit
providers and working together can reduce the stress (RR =1.64 [1.22-2.20], p=0.001). CONCLUSION:
for the patient and carer, and put less strain on much- Adherence to follow-up was just over 50%, mostly
needed resources. because the condition had already resolved, but some
children were still sick and needed intervention.
Cummings EM, Goeke-Morey MC, Papp LM. Everyday Training on counselling on the recognition of danger
marital conflict and child aggression. J Abnorm Child signs and when to return for a follow-up visit must be
Psychol 2004; 32(2):191-202. reinforced.
Abstract: Children's immediate aggressive responding
to exposure to marital conflict was examined. Cunningham CE, McHolm A, Boyle MH, Patel S.
Participants were 108 families with 8- to 16-year-old Behavioral and emotional adjustment, family
children (53 boys, 55 girls), with diary records of functioning, academic performance, and social
children's reactions to marital conflict in the home relationships in children with selective mutism. J Child
completed by 103 mothers (n = 578 records) and 95 Psychol Psychiatry 2004; 45(8):1363-72.
fathers (n = 377 records) during a 15-day period. Child Abstract: This study addressed four questions which
responses to analog presentations of marital conflict parents of children with selective mutism (SM)
tactics were also obtained. Exposure to destructive frequently ask: (1) Is SM associated with anxiety or
conflict tactics and negative parental emotionality oppositional behavior? (2) Is SM associated with
increased the likelihood of aggressive behavior in parenting and family dysfunction? (3) Will my child
children when they witnessed marital conflict, whereas fail at school? and (4) Will my child make friends or be
constructive conflict tactics and positive parental teased and bullied? In comparison to a sample of 52
emotionality decreased the probability of aggression. community controls, 52 children with SM were more
Conflict topics presumed to be threatening to the child anxious, obsessive, and prone to somatic complaints. In
(child- or marital-related) also heightened the contrast, children with SM were less oppositional and
likelihood of aggression. Aggressive responding to evidenced fewer attentional difficulties at school. We
conflict in both home and laboratory predicted found no group differences in family structure,
externalizing behavior problems. Fathers' and mothers' economic resources, family functioning, maternal
separate diary reports, and child responses to analog mood difficulties, recreational activities, or social
presentation of conflict, provided generally consistent networks. While parents reported no differences in
findings. An exposure hypothesis for marital conflict as parenting strategies, children with SM were described
an influence on child aggression is discussed. as less cooperative in disciplinary situations. The
academic (e.g., reading and math) and classroom
cooperative skills of children with SM did not differ
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![the initiation of ictal events in FCD tissue coincided sounds were repeated, giving 100 cases that were
with the occurrence of GABAA receptor-dependent randomly distributed on a compact disc. Four
interictal events leading to [K+]o elevations that were cardiologists assessed and categorised the cases as
larger than those seen during the interictal period. having "no murmur", "innocent murmur", or
Finally, by testing the effects induced by baclofen on "pathological murmur", recorded the assessment time
epileptiform events generated by FCD and MTLE per case, their degree of certainty, and whether they
slices, we discovered that the function of GABAB recommended referral. RESULTS: On average, 2.1
receptors (presumably located at presynaptic inhibitory minutes were spent on each case. The mean sensitivity
terminals) was markedly decreased in FCD tissue. and specificity were 89.7% and 98.2% respectively,
Thus, epileptiform synchronization leading to in vitro and the inter-observer and intra-observer variabilities
ictal activity in the human FCD tissue is initiated by a were low (kappa 0.81 and 0.87), respectively. A total
synchronizing mechanism that paradoxically relies on of 93.4% of cases with a pathological murmur and
GABAA receptor activation causing sizeable increases 12.6% of cases with an innocent murmur were
in [K+]o. This mechanism may be facilitated by the recommended for referral. CONCLUSION:
decreased ability of GABAB receptors to control Telemedical referral of patients with heart murmurs for
GABA release from interneuron terminals. remote assessment by a cardiologist is safe and saves
time. Skilled auscultation is adequate to detect patients
Daane DM. Child and adolescent violence. Orthop Nurs with innocent murmurs.
2003; 22(1):23-9; quiz 30-1.
Abstract: Although the juvenile violent crime rate has Dahl S, Hauff E. [Treatment of psychologically traumatised
decreased steadily during the past 5 years, the problem patients]. Tidsskr Nor Laegeforen 2003; 123(23):3437;
of violence and violence-related behaviors in the lives author reply 3437-8.
of our children and adolescents remains. The incidence
of violent victimization against children and violence Dake JA, Price JH, Telljohann SK. The nature and extent of
and violence-related behavior by today's youth is bullying at school. J Sch Health 2003; 73(5):173-80.
related to a variety of factors. Exposure to violence in Abstract: In elementary schools, the prevalence of
the home, school, community, or video games and bullying ranges from 11.3% in Finland to 49.8% in
other entertainment significantly influences aggressive Ireland. The only United States study of elementary
behaviors among children and adolescents. Other students found that 19% were bullied. Bullying
childhood violence predictors include alcohol and drug behavior declines as students progress through the
use, gender, and low self-esteem. The childhood grades. School bullying is associated with numerous
violence risk indicators have implications for child and physical, mental, and social detriments. A relationship
adolescent violence prevention and intervention also exists between student bullying behavior and
programs. Nurses who recognize dangerous and school issues such as academic achievement, school
potentially dangerous behavior in children and bonding, and absenteeism. Prevention of school
adolescents are better able to provide violence bullying should become a priority issue for schools.
prevention and intervention services and referrals to The most effective methods of bullying reduction
children at risk or in danger. Because orthopaedic involve a whole school approach. This method includes
nurses often see adolescents who have already assessing the problem, planning school conference
sustained injury from violence, identification of those days, providing better supervision at recess, forming a
at risk is particularly important. bullying prevention coordinating group, encouraging
parent-teacher meetings, establishing classroom rules
Dahl LB, Hasvold P, Arild E, Hasvold T. Heart murmurs against bullying, holding classroom meetings about
recorded by a sensor based electronic stethoscope and bullying, requiring talks with the bullies and victims,
e-mailed for remote assessment. Arch Dis Child 2002; and scheduling talks with the parents of involved
87(4):297-301; discussion 297-301. students. Finally, this review suggests further studies
Abstract: BACKGROUND: Heart murmurs are needed to help ameliorate the bullying problem in US
common in children, and they are often referred to a schools.
specialist for examination. A clinically innocent
murmur does not need further investigation. The Dalton R. Journal will publish accused scientist's work.
referral area of the University Hospital is large and Nature 2001; 409(6820):548.
sparsely populated. A new service for remote
auscultation (telemedicine) of heart murmurs in Daniell C. Veterinarians and SPCAs: an essential
children was established where heart sounds and short partnership. Can Vet J 2002; 43(3):188-90.
texts were sent as an attachment to e-mails. AIM: To
assess the clinical quality of this method. METHODS: Dannetun E, Tegnell A, Hermansson G, Giesecke J. Parents'
Heart sounds from 47 patients with no murmur (n = 7), reported reasons for avoiding MMR vaccination. A
with innocent murmurs (n = 20), or with pathological telephone survey. Scand J Prim Health Care 2005;
murmurs (n = 20) were recorded using a sensor based 23(3):149-53.
stethoscope and e-mailed to a remote computer. The
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![cortical plasticity in the injured brain and its relevance population. The lower gingival and vestibular oral
to neurologic rehabilitation. We suggest that imaging mucosa was chosen as the study area. The blood vessel
techniques are important tools in identifying cortical area was determined, and the oral vascular networks
regions underlying functional reorganization. were characterized by analyzing their complexity (D, at
Furthermore, detection of such areas might become a two scales: D 1-46, D 1-15), tortuosity (Dmin), and
basis for specific training promoting the optimal randomness (L-Z) of the vascular loops. Infants with
reorganization of cortical networks to enhance motor BPD showed a significantly lower blood vessel area as
control. well as a higher vascular network complexity (D 1-46,
D 1-15, and L-Z) than control subjects (p < 0.0001).
de Boer J. Chips help diagnosis of childhood cancers. Trends Our findings provide a new early clinical sign in BPD
Cell Biol 2001; 11(8):323. and stress the importance of an early disorder in the
oral mucosal vascularization process in the disease
De Felice C, Bianciardi G, Parrini S, Laurini RN, Latini G. pathogenesis.
Congenital oral mucosal abnormalities in true
umbilical cord knots. Biol Neonate 2004; 86(1):34-8. De Giorgio F, De Mercurio D, Vetrugno G, Abbate A.
Abstract: OBJECTIVE: The pathogenesis and clinical Shaken-baby syndrome: a challenging diagnosis. Med
significance of true umbilical cord knots remain Sci Law 2005; 45(2):182-3.
controversial. Here, we tested the hypothesis of the
presence of congenital oral mucosal changes in de Oliveira MI, Camacho LA, Tedstone AE. Extending
newborns with true umbilical cord knots. STUDY breastfeeding duration through primary care: a
DESIGN: Seven consecutive infants with true systematic review of prenatal and postnatal
umbilical cord knots and 50 gestational age- and sex- interventions. J Hum Lact 2001; 17(4):326-43.
matched controls were enrolled. The proportion of oral Abstract: This literature review provides an overview
frenulum abnormalities and the two-dimensional of the effectiveness of strategies and procedures used
vascular network geometry [fractal dimension, D, at to extend breastfeeding duration. Interventions carried
two scales: D(1-46), and D(1-15), with the relative out during pregnancy and/or infant care conducted in
Lempel-Ziv complexity, (L-Z)], were analyzed. primary health care services, community settings, or
RESULTS: Infants with true umbilical cord knots hospital clinics were included. Interventions covering
showed significantly higher proportions of mandibular only the delivery period were excluded. Interventions
frenulum agenesis compared to controls (p = that were most effective in extending the duration of
0.000006). The oral vascular networks of these infants breastfeeding generally combined information,
exhibited a significantly higher D(1-46) and D(1-15) (p guidance, and support and were long term and
< 0.0001, respectively), and higher L-Z values (p < intensive. During prenatal care, group education was
0.0001) than control networks. CONCLUSION: These the only effective strategy reported. Home visits used
findings indicate the presence of significant congenital to identify mothers' concerns with breastfeeding, assist
oral mucosal changes in newborn infants with true with problem solving, and involve family members in
umbilical cord knots, thus suggesting a previously breastfeeding support were effective during the
unrecognized association between true umbilical cord postnatal period or both periods. Individual education
knots and a subclinical extracellular matrix disorder. sessions were also effective in these periods, as was the
combination of 2 or 3 of these strategies in
de Felice C, Latini G, Parrini S et al. Oral mucosal interventions involving both periods. Strategies that
microvascular abnormalities: an early marker of had no effect were characterized by no face-to-face
bronchopulmonary dysplasia. Pediatr Res 2004; interaction, practices contradicting messages, or small-
56(6):927-31. scale interventions.
Abstract: An abnormal pulmonary vasculature has been
reported as an important component of de San Lazaro C, Harvey R, Ogden A. Shaking infant
bronchopulmonary dysplasia (BPD). We tested the trauma induced by misuse of a baby chair. Arch Dis
hypothesis of an early abnormal vascular network Child 2003; 88(7):632-4.
pattern in infants with BPD. Fifteen infants with BPD Abstract: A 2 month old infant presented with bilateral
(nine boys and six girls; gestational age 27.5 +/- 2.0 subdural haemorrhages and bilateral subhyaloid
wk; birth weight 850 +/- 125 g) and 15 sex- and haemorrhage. The parent admitted to forceful bouncing
gestational age-matched infants (nine boys and six of the child in a baby rocker. Experiments showed that
girls; gestational age 27.6 +/- 2.6 wk; birth weight 865 violent rocking in the chair could produce extreme
+/- 135 g) were examined on postnatal days 1 and 28. alternating acceleration/deceleration forces in excess of
BPD infants showed a significantly higher prevalence those induced by shaking alone. Such handling could
of histologic chorioamnionitis (p = 0.009), as well as not be interpreted as accidental mismanagement and
higher intubation duration (p = 0.0004), oxygen the abusive nature of the process was graphically
supplementation (p < 0.0001), and initial illness shown in video recordings of the experiment.
severity (p = 0.0002) than the BPD-negative Prosecution resulted in a conviction for cruelty, and a
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![primarily responsible for negative outcomes. evidence; look to other clinical sources for best
OBJECTIVE: To examine the relationship between practice ideas; evaluate what you have; and make a
violence exposure and trauma-related distress and decision to maintain the status quo, gather more data,
standardized test performance among early school-aged or change practice. This clinical project is an example
urban children, controlling for important potential of the collaborative, interdisciplinary nature of EBP,
confounders. DESIGN: A total of 299 urban first-grade and it is also an example of the collaborative work
children and their caregivers were evaluated using self- among differently skilled nurses. In this instance, a
report, interview, and standardized tests. MAIN clinically based nurse identified a practice problem and
OUTCOME MEASURES: The child's IQ (Wechsler recruited a nurse researcher to help design, analyze,
Preschool and Primary Scale of Intelligence--Revised) and evaluate the findings from an interview study. The
and reading ability (Test of Early Reading Ability, results are being implemented via nursing leadership to
second edition) were the outcomes of interest. change practice.
RESULTS: After controlling for confounders (child's
gender, caregiver's IQ, home environment, Demaurex CG, Geyer-Smadja I, Ansermet F. [Role of
socioeconomic status, and prenatal exposure to secondary prevention in a specialized consultation for
substance abuse) violence exposure was related to the sexual abuse and negligence]. Rev Med Suisse
child's IQ (P =.01) and reading ability (P =.045). Romande 2001; 121(7):507-12.
Trauma-related distress accounted for additional
variance in reading ability (P =.01). Using the derived DeMause L. The evolution of childrearing. J Psychohist
regression equation to estimate effect sizes, a child 2001; 28(4):362-451.
experiencing both violence exposure and trauma-
related distress at or above the 90th percentile would be DeMause L. The evolution of the psyche and society. J
expected to have a 7.5-point (SD, 0.5) decrement in IQ Psychohist 2002; 29(3):238-85.
and a 9.8-point (SD, 0.66) decrement in reading
achievement. CONCLUSION: In this study, exposure Denison R. HIV is a magnifying glass. WORLD 2001;
to violence and trauma-related distress in young (124):3.
children were associated with substantial decrements in
IQ and reading achievement. Denning AS, Tuttle LK, Bryant VJ, Walker SP, Higgins JR.
Ascertaining women's choice of title during pregnancy
Delavier-Fosse S. [Role of the pediatric psychiatrist at the and childbirth. Aust N Z J Obstet Gynaecol 2002;
hearing of young victims]. Soins Pediatr Pueric 2001; 42(2):125-9.
(200):38-9. Abstract: METHODS: A questionnaire was
administered to 958 women attending the antenatal
Dell'Orfano S. The meaning of spiritual care in a pediatric clinic at Mercy Hospital for Women, Melbourne, to
setting. J Pediatr Nurs 2002; 17(5):380-5. ascertain their choice of title during pregnancy
Abstract: In the previous issue of the Journal of Midwifery, nursing and medical staff (376 in total)
Pediatric Nursing, one type of evidence-based practice were also invited to respond to a similar questionnaire.
(EBP) format was provided for potential nurse scholars RESULTS: The response rate was 73.6% from the
who utilize the EBP process [MacPhee, M. (2002). survey of all women who were overwhelmingly in
Journal of Pediatric Nursing, 17(4);313-20]. There are, favour of being called 'patient' as their first choice
however, many potential formats to present evidence- (34%), followed by 'other' (20%) and then 'mother'
based clinical practice innovations. I am eager to work (19%). Virtually all women requesting 'other' wished to
with nurses who have been involved in promoting be called by their name. Women wishing to be called
evidence-based nursing practice. The Journal of 'patient' for first choice did not significantly differ from
Pediatric Nursing will use this column as a forum for the remainder of the study group in age, gestation,
sharing evidence-based clinical practice innovations, number of previous pregnancies, or number of
such as case studies, clinical teaching exemplars, and children. When women from the Family Birth Centre
interdisciplinary programs highlighting collaborative (FBC) were analysed as a separate group, they had a
practice among nurses and other health care clear preference to be called 'other' (unanimously, by
professionals. Please contact me at their name) than the general antenatal population (odds
maura80521@yahoo.com for editorial advice and ratio (OR) 5.1; 95% confidence interval (CI) 3.1, 8.3; p
assistance. The following article is a clinical < 0.0001). The staff survey, with a response rate of
contribution from a nurse on the Neurosurgery- 84%, also demonstrated that 'patient' was the most
Rehabilitation Unit of The Children's Hospital, Denver. popular first choice for patient title. Medical staff were
This evidence-based clinical project evolved from a significantly more likely to choose 'patient' (OR 4.2,
nurse's recognition of the importance of spiritual care 95% CI 2.3, 7.7; p < 0.0001), though the term 'patient'
for families of children with serious brain injuries. It is was the preferred choice of all staff.
an example of how an EBP formula can facilitate
change and innovation. Start with a clinical problem; Denninghoff KR, Knox L, Cunningham R, Partain S.
get help; look to the literature for best research
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![Emergency medicine: competencies for youth violence past 12 months was 10.4% (95% confidence interval
prevention and control. Acad Emerg Med 2002; [CI], 9.7%-11.1%), 22.6% (95% CI, 21.6%-23.6%),
9(9):947-56. and 3.9% (95% CI, 3.4%-4.4%), respectively. Thirty-
Abstract: By any standard one wishes to apply, the eight percent of asthmatic subjects had visited the
impact of violence on the health and safety of the emergency department or have been hospitalized, and
public is significant. The expression of violence among 50% reported lost school days and workdays. Seventy-
children in the United States has increased significantly six percent of sampled asthmatic patients were
during the modern era. Homicide and suicide are the considered to be atopic. CONCLUSIONS: The burden
second and third leading causes of death in youths 15- of disease and societal consequences of allergic entities
24 years of age. The emergency department (ED) is a in urban settings in countries such as Colombia are of
common site for the care of these victims, and because concern but are largely ignored, perhaps because of the
victims often become assailants, the emergency care misconception that these diseases are of public health
provider needs to know the epidemiology, treatment, importance only in industrialized nations.
and methods for prevention of youth violence in order
to curtail the cycle. A multidisciplinary task force was Dennis TA, Brotman LM. Effortful control, attention, and
convened by the Centers for Disease Control and aggressive behavior in preschoolers at risk for conduct
Prevention (CDC)-funded Southern California Center problems. Ann N Y Acad Sci 2003; 1008:252-5.
of Academic Excellence on Youth Violence Prevention Abstract: This work examines distinct aspects of
and the Keck School of Medicine at the University of effortful control and attention predicted aggression in a
Southern California to define competencies for health group of children at elevated risk for the development
professionals in youth violence prevention and control. of conduct problems. Results suggested that behavioral
Three levels of competence were identified: the inhibition, rather than attentional control, best
generalist level, which should be obtained by all health predicted maternal reports of child aggressive
professionals; the specialist level, which should be behaviors.
obtained by health professionals such as emergency
medicine providers, who frequently work with Deodhar J. Telemedicine by email--experience in neonatal
populations affected by violence; and a third, or scholar care at a primary care facility in rural India. J Telemed
level, to be acquired by health professionals who wish Telecare 2002; 8 Suppl 2:20-1.
to become experts not only in the care, but also in Abstract: During an 18-month study period,
research and advocacy. This article reports the details teleconsultations were conducted by email between a
of this group's efforts and applies them to emergency neonatal intensive care unit at an urban teaching
care provider education. These competencies should hospital in western India and a rural primary care
shape the development of curricula for the span of centre 40 km away. There were email consultations
emergency medical training from emergency medical about 182 newborn babies; these consultations
services scholastic training to postgraduate continuous comprised 309 messages sent from the primary care
medical education. centre and 272 messages from the teaching hospital.
The average reply time was 11.3 h. Thirty-eight babies
Dennis R, Caraballo L, Garcia E et al. Asthma and other were referred to the intensive care unit at the teaching
allergic conditions in Colombia: a study in 6 cities. hospital after these consultations. The remaining 144
Ann Allergy Asthma Immunol 2004; 93(6):568-74. babies were managed at the primary care centre.
Abstract: BACKGROUND: No detailed information is Telemedicine helped in the diagnosis, referral,
available on the burden and impact of allergic diseases treatment and follow-up of patients. The cost of the
simultaneously for adults and children in Colombia and email service was estimated to be Rs12,000 and the
most Latin American countries. OBJECTIVES: To savings in avoided transfer were estimated to be
investigate the prevalence of asthma, allergic rhinitis, Rs546,000, a cost-benefit ratio of 1:45.
and atopic dermatitis symptoms in 6 cities in
Colombia; to measure patient expenses and school days DePompei R, Frye D, DuFore M, Hunt P. Traumatic Brain
and workdays lost; to describe disease severity; and to Injury Collaborative Planning Group: a protocol for
determine levels of total and specific IgE in asthmatic community intervention. J Head Trauma Rehabil 2001;
subjects. METHODS: A multistage stratified random 16(3):217-37.
sample selection of schools with subjects aged 5 to 18 Abstract: OBJECTIVE: The Traumatic Brain Injury
years in each city was used. Guardian subjects selected Collaborative Planning Group was formed in
were contacted, and home visits were arranged. December 1992 to address service gaps and better use
Subjects aged 1 to 4 years and older than 19 years were agencies and their programs to meet the specialized
also selected randomly by systematic sampling based needs of individuals with traumatic brain injury (TBI).
on the addresses of the subjects aged 5 to 18 years. SETTING: The group meetings served as the
Subjects with asthma symptoms were invited to interagency link between service providers for
provide a blood sample. RESULTS: Information was comprehensive planning and problem solving.
obtained from 6,507 subjects. The prevalence of OUTCOME MEASURES: This article focuses on the
asthma, rhinitis, and atopic dermatitis symptoms in the
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![the consequences of teen pregnancy. The teens also follows the EBP process of: (1) identifying a clinical
made several recommendations for enhancing the problem and stating a clinical question that focuses the
program. The findings suggest that simulated process; (2) doing a literature search for best research
experiences can be a powerful strategy for effective evidence; (3) using query techniques, such as phone
learning about complex decisions regarding the risks of calls and e-mails, to determine best clinical practice
sexual activity and the realities of parenting. among similar institutions; and (4) drawing a practice
conclusion-to accept the status quo, to instigate change
Didziokiene A, Zemaitiene N. [Psychological state of abused of practice, or to do more research. This project was an
children of risk group]. Medicina (Kaunas) 2005; interdisciplinary effort orchestrated by the surgical
41(1):59-66. programs nurses at Boston Children's Hospital.
Abstract: The aim of this study was to describe the
psychological peculiarities of physically abused DiFranza JR, Savageau JA, Rigotti NA et al. Development
schoolchildren of risk group. The survey was based on of symptoms of tobacco dependence in youths: 30
the data gathered using anonymous questionnaire. month follow up data from the DANDY study. Tob
Indicators, chosen for evaluation of psychological well- Control 2002; 11(3):228-35.
being of schoolchildren, were the following: loneliness, Abstract: OBJECTIVE: To determine if there is a
happiness, ability to make contacts and socialize with minimum duration, frequency or quantity of tobacco
peers, sense of coherence, self-esteem, and suicidal use required to develop symptoms of dependence.
tendencies. The sample of 211 schoolchildren, aged 10 DESIGN AND SETTING: A retrospective/prospective
to 16 year from seventeen Kaunas secondary schools longitudinal study of the natural history of tobacco
participated in the survey. The sampling was made on dependence employing individual interviews
the basis of lists of socially and pedagogically conducted three times annually in two urban school
neglected schoolchildren. It has been established that systems over 30 months. Detailed histories of tobacco
psychological well-being of physically abused use were obtained including dates, duration, frequency,
schoolchildren, in comparison with the ones not quantity, patterns of use, types of tobacco, and
abused, was worse. Physically abused children more symptoms of dependence. PARTICIPANTS: A cohort
often felt loneliness and unhappiness, found it more of 679 seventh grade students (age 12-13 years). MAIN
difficult to make friends, were more often OUTCOME MEASURES: The report of any of 11
characterized by low self-esteem and weak sense of symptoms of dependence. RESULTS: Among 332
coherence. The relationship between physical abuse subjects who had used tobacco, 40% reported
and suicidal tendencies was established; suicidal symptoms, with a median latency from the onset of
tendencies among physically abused schoolchildren monthly smoking of 21 days for girls and 183 days for
were six times more frequent than among those, who boys. The median frequency of use at the onset of
did not suffer violence (78.5% and 12.5%). Almost all symptoms was two cigarettes, one day per week. The
schoolchildren, attributed to the group with high risk report of one or more symptoms predicted continued
for suicide, were physically abused (29.0% and 1.9%, smoking through the end of follow up (odds ratio (OR)
respectively). 44, 95% confidence interval (CI) 17 to 114, p < 0.001).
CONCLUSIONS: Symptoms of tobacco dependence
Diehl D, Gray C, O'Connor G. The school community commonly develop rapidly after the onset of
council: creating an environment for student success. intermittent smoking, although individuals differ
New Dir Youth Dev 2005; (107):65-72, table of widely in this regard. Girls tend to develop symptoms
contents. faster. There does not appear to be a minimum nicotine
Abstract: A model of community-school partnerships is dose or duration of use as a prerequisite for symptoms
developing within a school district in Evansville, to appear. The development of a single symptom
Indiana. Based on a full-service community school strongly predicted continued use, supporting the theory
philosophy, the model started in one elementary school that the loss of autonomy over tobacco use begins with
in the Evansville-Vanderburgh School Corporation and the first symptom of dependence.
has expanded into a districtwide initiative called the
School Community Council. The council is made up of Dillard JP, Tluczek A. Information flow after a positive
over seventy community organizations and social newborn screening for cystic fibrosis. J Pediatr 2005;
service agencies working together to establish full- 147(3 Suppl):S94-7.
service schools as places of community and to enhance Abstract: OBJECTIVES: To provide a model of the
youth and family development. information processes instigated by a positive result on
a newborn screening for cystic fibrosis and to analyze
Difazio R. Creating a halo traction wheelchair resource their implications for future research. METHOD: We
manual: using the EBP approach. J Pediatr Nurs 2003; reviewed research conducted at Wisconsin and
18(2):148-52. elsewhere. RESULTS: We identified 6 distinct phases
Abstract: This article describes a clinically based of information flow. CONCLUSION: Although
project that used evidence-based practice (EBP). It continued attention to genetic counseling is clearly
warranted, research on information flow after newborn
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![reaction to trauma--an overview of conceptual issues to a control condition or the ATP intervention.
and neurobiological factors. Nord J Psychiatry 2005; Analyses focus on the longitudinal effects of the ATP
59(2):79-91. intervention on self-reported substance use through
Abstract: The discovery of trauma as an aetiological middle school and the 1st year of high school (Grades
factor in mental dissociation is more than a century old, 6, 7, 8, and 9). Levels of engagement in the selected
but neurobiological research in the last decade has and indicated interventions were somewhat less than
started to clarify a neurobiological basis that may shed expected. Despite relatively low levels of engagement,
light on the complex symptomatology observed in the intervention reduced initiation of substance use in
traumatized children. Dysfunctional stress responses, both at-risk and typically developing students. These
emotional-based style of functioning, hyperarousal, findings are discussed with respect to lessons learned
anxiety, irritability, impulsivity, disengaged attention about parent engagement, optimizing strategies for
and educational underachievement may thus begin to schoolwide implementation, and the promise of
be better understood. The aim of this overview is to embedding family interventions within the public
give an update on the concept of dissociation and the school ecology.
links to new neurobiological findings, hopefully to
reduce unawareness, wrong diagnostics or even neglect Dixon JK. Kids need clean air: air pollution and children's
of dissociative symptomatology by clinicians in child health. Fam Community Health 2002; 24(4):9-26.
and adolescent psychiatry in the Nordic countries. A Abstract: Air pollution affects children's health in many
systematic overview of studies of mental dissociation ways, including reduced lung function, increased
in children and adolescents published over the last morbidity, increased use of health care services, and
decade disclosed a total of 1019 references; 309 papers infant mortality. Information on the relationship of air
regarding the concept of dissociation, memory, trauma pollution and children's health is discussed, with a
and the neurobiological correlates were studied in focus on the diversity of research methods used to
detail. The assumption of a trauma-genic basis of understand this relationship. Decisions affecting air
dissociation is still most discussed in the literature. The quality ultimately are made through political and social
importance of other childhood trauma in addition to processes. Health care and health promotion
sexual abuse is outlined, focusing on childhood practitioners who are concerned about the health of
interpersonal trauma. Recent research on traumatized children should provide leadership for advocacy to
children and adolescents has demonstrated some promote environmental health in our communities.
permanent neurochemical as well as functional and
structural abnormalities in brain areas that are involved Dmitrieva OA. [Development of forensic medical expertise
in the integrative process of cognition and memory. of sexual conditions in men]. Sud Med Ekspert 2005;
This research begins to clarify the cerebral basis and 48(3):18-21.
mechanisms for the trauma-related dissociation Abstract: The necessity of new methodological
observed in dissociative (conversion) disorders, post- approaches in forensic medical examination of sexual
traumatic stress disorder (PTSD) and somatoform male conditions are discussed basing on the analysis of
disorders. New perspectives on the nature of questionnaire surveys of isolated groups of men and
subcortical processes linking the phenomena of forensic medical examinations of male victims accused
dissociation and traumatic experiences may have of sexual crimes. How to update expertise of sexual
important implications for the understanding of male conditions including investigations of anorectal
dissociative disorders in children and adolescents. They and erectile dysfunctions in shown.
may be regarded as complex environmentally induced
developmental, supporting the view that PTSD and Dmitrieva TN, Oades RD, Hauffa BP, Eggers C.
somatization disorders may be specific forms of Dehydroepiandrosterone sulphate and corticotropin
dissociative processes to be categorized together with levels are high in young male patients with conduct
dissociative (conversion) disorders as "trauma-related disorder: comparisons for growth factors, thyroid and
dissociative disorders". gonadal hormones. Neuropsychobiology 2001;
43(3):134-40.
Dishion TJ, Kavanagh K, Schneiger A, Nelson S, Kaufman Abstract: Childhood conduct disorder (CD) may
NK. Preventing early adolescent substance use: a originate in a stressful upbringing, and be associated
family-centered strategy for the public middle school. with unusual physical or sexual development and
Prev Sci 2002; 3(3):191-201. thyroid dysfunction. We therefore explored circulating
Abstract: The Adolescent Transitions Program (ATP) levels of hormones from adrenal, gonadal and growth
promotes student adjustment and reduces risk within a hormone axes associated with stress, aggression and
public school setting, focusing primarily on parenting development in 28 CD patients and 13 age-matched
practices using a tiered, multilevel prevention strategy. healthy children (10-18 years old). The CD group had
A description is given of the program, levels of higher levels of dehydroepiandrosterone sulphate
engagement, and intervention effects. Within each (DHEA-S), corticotropin (ACTH) and free tri-
school, multiethnic students (N = 672) and their iodothyronine (fT(3)) if under 14 years. There were no
families were randomly assigned at the individual level
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![practice and the referral rate to ophthalmologist and symptoms). All patients met DSM-IV criteria for a
diabetic specialists. Further quantitative and qualitative disruptive behavior disorder (oppositional defiant
studies are needed to explore the needs for support in disorder of conduct disorder) in addition to research
diabetes management in general practice in Europe. criteria. RESULTS: "Outer-directed irritability" most
clearly distinguished patients from controls (effect size
Donohoe M. The evidence base for shaken baby syndrome: 4.1) and did not correlate with other mood measures.
meaning of signature must be made explicit. BMJ Patients and controls showed no to minimal differences
2004; 329(7468):741; author reply 741. on internalizing symptoms. CONCLUSION:
Disruptive behavior disordered children and
Donohoe M. Evidence-based medicine and shaken baby adolescents characterized by outer-directed irritability
syndrome: part I: literature review, 1966-1998. Am J exist, can be identified, and should be further
Forensic Med Pathol 2003; 24(3):239-42. investigated, especially since they are potentially
treatable.
Donoso E. [Inequalities in infant mortality in Santiago]. Rev
Med Chil 2004; 132(4):461-6. Dopfner M, Rothenberger A, Sonuga-Barke E. Areas for
Abstract: BACKGROUND: Social and economical future investment in the field of ADHD: preschoolers
inequalities have an adverse effect on infant mortality. and clinical networks. Eur Child Adolesc Psychiatry
AIM: To test if the poorest communities of Santiago 2004; 13 Suppl 1:I130-5.
have the highest rates of infant mortalilty. MATERIAL Abstract: BACKGROUND: Two areas ripe for future
AND METHODS: Variables were obtained from the investment in the field of ADHD are identified. ADHD
year 2000 Vital Statistics yearbook and the National in the preschool years is a key area for future study and
Socioeconomic Characterization inquiry. Infant development. Many questions relating to its validity
mortality was correlated with the mean income of and diagnosis remain unanswered, although there is a
households, the population below the threshold of growing demand for treatment in daily practice. The
poverty and the unemployed population of the 32 lack of conformity of diagnosis and treatment of
municipalities of the Santiago Province. The ratio and children with ADHD in daily practice to international
the difference in mortality rates between the best-practice guidelines represent unsolved problems.
communities with the higher and lower incomes and Investment in ADHD networks connecting different
the attributable population risk for infant mortality in services and different professions across European
the Province of Santiago was calculated. RESULTS: nations may help to reduce these problems.
Infant mortality was positively correlated with the OBJECTIVE: To describe recent developments and
population below the threshold of poverty (r=0.383; future trends in relation to preschool ADHD and
p=0.03) and the unemployed population (r=0.437; ADHD clinical network. METHODS: Selective review
p=0.012) and inversely correlated with the mean and interpretation of empirical data. CONCLUSION:
household income (r=-0.522; p=0.002). Infant Further studies are required to disentangle the various
mortality in the poorest community was 2.2 times pathways into ADHD during preschool especially in
higher than in the richest one. The difference in rates relation to the background of early gene-environment
was 6.6/1000 live births. The attributable population interaction. This will improve the management of
risk determined that it is possible to reduce infant death preschoolers with ADHD especially in the area of
by 57.8%. CONCLUSIONS: In the Province of prevention and risk reduction. There will be an
Santiago, the poorest communities have the highest increasing demand for networks for the diagnosis and
infant mortality. treatment of children with ADHD.
Donovan SJ, Nunes EV, Stewart JW et al. "Outer-directed Dormitzer CM, Gonzalez GB, Penna M et al. The
irritability": a distinct mood syndrome in explosive PACARDO research project: youthful drug
youth with a disruptive behavior disorder? J Clin involvement in Central America and the Dominican
Psychiatry 2003; 64(6):698-701. Republic. Rev Panam Salud Publica 2004; 15(6):400-
Abstract: OBJECTIVE: To examine whether "outer- 16.
directed irritability," a mood construct from the adult Abstract: OBJECTIVE: To estimate the occurrence and
literature, characterizes a subgroup of disruptive school-level clustering of drug involvement among
behavior disordered children and adolescents school-attending adolescent youths in each of seven
previously shown to improve on divalproex, a mood countries in Latin America, drawing upon evidence
stabilizer. METHOD: A sample (N = 20) of disruptive from the PACARDO research project, a multinational
youth (aged 10-18 years) entering a divalproex collaborative epidemiological research study.
treatment study of temper and irritable mood swings METHODS: During 1999-2000, anonymous self-
was compared to normal controls (N = 18) on measures administered questionnaires on drug involvement and
of aggression/irritability directed against others related behaviors were administered to a cross-
(externalizing symptoms) and on aggression/ irritability sectional, nationally representative sample that
against self, anxiety, and depression (internalizing included a total of 12,797 students in the following
seven countries: Costa Rica (n = 1,702), the Dominican
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![just those designed to increase food availability) modulated inputs into a global percept and the ability
encouraged participation and increased attendance. to extract the resultant global percept from a noisy
Children thought that attending food programs kept environment.
them healthy, and helped them work harder in school.
Parents' pride was the main barrier to participation in Eftekhar B, Mohammad K, Ardebili HE, Ghodsi M,
programs; however, parents who were actively Ketabchi E. Comparison of artificial neural network
involved in program delivery did not feel stigmatized and logistic regression models for prediction of
accepting food. To encourage participation, nutrition mortality in head trauma based on initial clinical data.
professionals should collaborate with local residents to BMC Med Inform Decis Mak 2005; 5(1):3.
develop and implement community-based food Abstract: BACKGROUND: In recent years, outcome
programs. prediction models using artificial neural network and
multivariable logistic regression analysis have been
Edwards C, Dunham DN, Ries A. Our-component model for developed in many areas of health care research. Both
counseling clients with traumatic childhood abuse. these methods have advantages and disadvantages. In
Psychol Rep 2003; 93(1):143-50. this study we have compared the performance of
Abstract: To treat the effects of traumatic childhood artificial neural network and multivariable logistic
abuse effectively, we propose a model which regression models, in prediction of outcomes in head
incorporates information from neurophysiological, trauma and studied the reproducibility of the findings.
psychoeducational, cognitive, and social work METHODS: 1000 Logistic regression and ANN
literature. The four components of the model reflect the models based on initial clinical data related to the GCS,
broad range of explanations for pathology posed by tracheal intubation status, age, systolic blood pressure,
researchers and also support the breadth of respiratory rate, pulse rate, injury severity score and the
interventions available for use with survivors of outcome of 1271 mainly head injured patients were
childhood abuse. The model relies on individualized compared in this study. For each of one thousand pairs
assessment and treatment related to the physiological of ANN and logistic models, the area under the
response to abuse, faulty learning, cognitive and receiver operating characteristic (ROC) curves,
psychological problems, and social effects of abuse. Hosmer-Lemeshow (HL) statistics and accuracy rate
This model contributes to the literature by providing a were calculated and compared using paired T-tests.
comprehensive framework complementary to many RESULTS: ANN significantly outperformed logistic
theoretical orientations, is useful across the helping models in both fields of discrimination and calibration
disciplines, and appropriate in multidisciplinary but under performed in accuracy. In 77.8% of cases the
settings. area under the ROC curves and in 56.4% of cases the
HL statistics for the neural network model were
Edwards VT, Giaschi DE, Dougherty RF et al. superior to that for the logistic model. In 68% of cases
Psychophysical indexes of temporal processing the accuracy of the logistic model was superior to the
abnormalities in children with developmental dyslexia. neural network model. CONCLUSIONS: ANN
Dev Neuropsychol 2004; 25(3):321-54. significantly outperformed the logistic models in both
Abstract: Children with dyslexia and children fields of discrimination and calibration but lagged
progressing normally in reading performed several behind in accuracy. This study clearly showed that any
perceptual tasks to determine (a) the psychophysical single comparison between these two models might not
measures that best differentiate children with dyslexia reliably represent the true end results. External
from children with average reading abilities; (b) the validation of the designed models, using larger
extent of temporal processing deficits in a single, well- databases with different rates of outcomes is necessary
defined group of children with dyslexia; and (c) the co- to get an accurate measure of performance outside the
occurrence of visual and auditory temporal processing development population.
deficits in children with dyslexia. 4 of our 12
psychophysical tasks indicated differences in temporal Egle UT, Ecker-Egle ML, Nickel R, van Houdenhove B.
processing ability between children with dyslexia and [Fibromyalgia as a dysfunction of the central pain and
children with good reading skills. These included 2 stress response]. Psychother Psychosom Med Psychol
auditory tasks (dichotic pitch perception and FM tone 2004; 54(3-4):137-47.
discrimination) and 2 visual tasks (global motion Abstract: Fibromyalgia is often understood as a
perception and contrast sensitivity). The battery of 12 syndrome mainly characterised by widespread pain and
tasks successfully classified 80% of the children into tenderness and "unexplained" etiology and
their respective reading-level groups. Within the group pathogenesis. In the last years evidence is growing that
of children with dyslexia who had temporal processing biological as well as psychosocial stress play a
deficits, most were affected in either audition or vision; pathogenetic key-role. Beginning with the general
few children were affected in both modalities. The function and development of the stress response system
observed deficits suggest that impaired temporal the actual knowledge of its relationship with central
processing in dyslexia is most evident on tasks that pain-processing mechanisms is reviewed. Early
require the ability to synthesize local, temporally adverse childhood experiences can impair the function
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![of the stress system all over the lifespan. Subsequently, every three to four crashes. The total number of deaths
research evidence for the role of stress in the due to RTAs was significantly higher than was the
etiopathogenesis of fibromyalgia is summarised. number of deaths due to the use of firearms in
Psychological as well as psychobiological commission of robbery. Police reports relative to the
consequences are outlined. Finally, an integrative use of firearms during armed robberies indicate that of
model of fibromyalgia is proposed, which may put a total of the 652 victims who were killed, 348 (68.1%)
several pieces of a biopsychosocial puzzle together. were the armed robbers, 134 (26.2%) were bystanders,
This model offers an approach for the differentiation of and 29 (5.7%) were policemen. CONCLUSIONS: The
subgroups and a clinical orientation for developing an enormity of the problems of traumatic deaths from
adequate therapy for the individual patient. RTAs and armed robberies in a developing country has
been highlighted.
Egle UT, Hardt J, Nickel R, Kappis B, Hoffmann SO.
[Long-term effects of adverse childhood experiences - Ehlers CL, Wall TL, Garcia-Andrade C, Phillips E. Visual
Actual evidence and needs for research1/2]. Z P3 findings in Mission Indian youth: relationship to
Psychosom Med Psychother 2002; 48(4):411-34. family history of alcohol dependence and behavioral
Abstract: There is evidence from some prospective and problems. Psychiatry Res 2001; 105(1-2):67-78.
several retrospective studies that early biological and Abstract: Native Americans have some of the highest
psychosocial stress in childhood is associated with rates of alcohol abuse and dependence, yet risk factors
long-term vulnerability to various mental and physical for problem drinking remain relatively unknown. The
diseases. In the last few years research findings have amplitude of the P3 component of the event-related
accumulated on those emotional, behavioural and potential (ERP) has been suggested to be an index of
psychobiological factors which are responsible for the 'vulnerability to alcoholism', especially when it is
mediation of these lifelong consequences. They are the elicited by visual tasks in younger individuals. Visual
cause of an increased risk of somatization and other P3 tasks, however, have not been previously
mental disorders. Particularly anxiety, depression and investigated in Native American youth. One hundred
personality disorders often result in high-risk behaviour and four Mission Indian youth between the ages of 7
that itself is associated with physical disease and 13 years participated in the study. ERPs were
(cardiovascular disorders, stroke, viral hepatitis, type 2 collected using two visual target paradigms: a facial
diabetes, chronic lung diseases) as well as with discrimination and an estimation of line orientation
aggressive behaviour. A survey on the current task. Analyses of covariance revealed that participants
knowledge of how these various factors interact is with a first degree family history of alcoholism had
presented and a bio-psychopathological model of lower P3 component amplitudes in frontal leads to the
vulnerability is educed. Implications for future research facial discrimination task. Lower P3 amplitudes, in
are outlined and contrasted to actual political trends in posterior areas, were found in the line discrimination
Germany. task in children who scored above the 75th percentile
in delinquent behaviors on the Achenbach Child
Ehikhamenor EE, Ojo MA. Comparative analysis of Behavior Checklist. These findings are consistent with
traumatic deaths in Nigeria. Prehospital Disaster Med investigations in non-Indian populations demonstrating
2005; 20(3):197-201. that the late positive component of the event related
Abstract: INTRODUCTION: The number of deaths potential is sensitive to both familial history of alcohol
due to trauma from road traffic accidents (RTAs), and dependence as well as personal history of externalizing
from the use of firearms either for homicide or armed behaviors.
robbery, ethnic conflicts, and other events, such as
flooding, explosions from petroleum products, and Ehrensaft MK. Interpersonal relationships and sex
religious violence, is on the rise in Nigeria. This differences in the development of conduct problems.
preliminary study is a comparative analysis of the Clin Child Fam Psychol Rev 2005; 8(1):39-63.
frequency of deaths caused by RTAs and the deaths Abstract: This article investigates the role of
caused by the use of firearms during armed robbery. interpersonal relationships in shaping sex differences in
The study sought to identify the number of traumatic the manifestation, etiology, and developmental course
deaths caused by RTAs or armed robbery as well as the of conduct problems and their treatment needs. The
number of victims who sustained injuries in the process review examines whether: (1) Girls' conduct problems
of RTA or armed robberies. METHODS: An are more likely than boys' to manifest as a function of
indigenous, non-governmental organization (NGO) disrupted relationships with caretakers and peers; (2)
network was used to abstract data for the frequency of For girls more than for boys, the outcomes of conduct
RTAs associated with death or injuries and for deaths problems in adolescence and adulthood, and related
caused by armed robberies and was supplemented with treatment needs, are more likely to be a consequence of
data obtained from the Nigerian police. RESULTS: For the quality of interpersonal relationships with others,
RTAs, the victims included drivers, passengers, and particularly opposite-sex peers and partners. Evidence
pedestrians. In 3,032 cases of RTAs, the total number reviewed suggests that boys and girls share many
of deaths was 1,239 (29.1%): one Nigerian dies for similarities in their expression of conduct problems,
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![low level in discrete neighborhoods. Interventions partner and almost 90% had dependent children. In the
targeting HIV-endemic neighborhoods will be needed previous month, 17% had been assaulted and 35%
to further reduce HIV prevalence in this area. raped by clients. Unwanted pregnancy was common;
86% had had at least one abortion. Compared with
Elliott V. Speaking up for children. Interview by Catharine women in rural towns, township sex workers were
Sadler. Nurs Stand 2004; 18(19):59. younger (median age 22 vs. 26), saw more clients
(median 9 vs. 4 per week) and earned more from sex
Ells AL, Kherani A, Lee D. Epiretinal membrane formation work (up to 63-90 euros vs. 12 euros per week). Issues
is a late manifestation of shaken baby syndrome. J of alternative sources of income, safety for sex workers
AAPOS 2003; 7(3):223-5. and the conditions which create the necessity for sex
Abstract: Shaken baby syndrome is a constellation of work are vital to address. The question of number of
injuries resulting from the intentional shaking type clients and the nature of sex work have obvious
movement of a child who is usually younger than 3- implications for HIV/STI prevention policy.
years-old. This rapid acceleration-deceleration
movement of the head is responsible for lesions Elsig C, Schopper C, Anthony M, Gramigna R, Boker H.
attributed to shearing forces placed on the vitreoretinal [In-patient hypnotherapeutic trauma exposure for
structures and meningeal vessels across the dura. The posttraumatic stress disorder: a case report]. Psychiatr
ophthalmic findings include intraocular hemorrhages, Prax 2002; 29(2):97-100.
perimacular retinal folds, and peripheral retinoschisis Abstract: This paper describes the treatment of a
in the presence of intracranial injuries such as subdural patient with the diagnoses of a borderline personality
hematomas without obvious external signs of head disorder and posttraumatic stress disorder (DSM-IV
trauma. We describe a case of late development of an and ICD-10) within the setting of a psychiatric ward
epiretinal membrane in a child with a history of shaken spezializing in depression. For purposes of controlled
baby syndrome and propose a differential diagnosis list re-exposure to the patient's trauma, a hypnotherapeutic
for epiretinal membrane formation in the pediatric age method was chosen. A significant reduction of
group. symptoms, in particular the intrusions and the
hyperarousal, was observed. Of great importance in the
Elman JL. Connectionist models of cognitive development: successful outcome of this case is the integration of
where next? Trends Cogn Sci 2005; 9(3):111-7. hypnotherapy into a multi-dimensional treatment
Abstract: Over the past two decades, connectionist concept including group therapy, physical therapy and
models have generated a lively debate regarding the anxiety-reducing self-management therapy. This
underlying mechanisms of cognitive development. This approach facilitated the development of trust and
debate has in turn led to important empirical research security in the patient required for the hypnotherapeutic
that might not have occurred otherwise. More recently, intervention and minimized the splitting tendencies
advances in developmental neuroscience present a new specific to borderline patients. Further discussion is
set of challenges for modelers. In this article, I review centered on the difficulties arising in the context of an
some of the insights that have come from modeling emergency ward setting with its high intensity
work, focusing on (1) explanations for the shape of atmosphere encompassing the danger of
change; (2) new views on how knowledge may be retraumatization of this special group of patients.
represented; (3) the richness of experience. The article Finally several aspects of the clinical implications of
concludes by considering some of the new challenges this method are addressed.
and opportunities for modeling cognitive development.
Elster NR. HIV and art: reproductive choices and
Elmore-Meegan M, Conroy RM, Agala CB. Sex workers in challenges. J Contemp Health Law Policy 2003;
Kenya, numbers of clients and associated risks: an 19(2):415-30.
exploratory survey. Reprod Health Matters 2004; Notes: GENERAL NOTE: KIE: KIE Bib: AIDS;
12(23):50-7. reproductive technologies; selection for treatment
Abstract: In Kenya in 1999, an estimated 6.9% of
women nationally said they had exchanged sex for Eminson M, Jureidini J. Concerns about research and
money, gifts or favours in the previous year. In 2000 prevention strategies in Munchausen Syndrome by
and 2001, in collaboration with sex workers who had Proxy (MSBP) abuse. Child Abuse Negl 2003;
formed a network of self-help groups, we conducted an 27(4):413-20.
exploratory survey among 475 sex workers in four Abstract: There would seem to be three motives for
rural towns and three Nairobi townships, regarding research into Munchausen Syndrome by Proxy
where they worked, the number of clients they had and (MSBP) abuse; first to enhance treatment; second to
the risks they were exposed to. Participants were enhance our understanding of the psychopathology of
identified by a network of social contacts in the seven those who carry out the abuse; and third to find
centres. Most of the women (88%) worked from bars, interventions to prevent its occurrence. We will argue
hotels, bus stages and discos; 57% lived with a stable that only the first justification is valid. The second and
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![on the selection of the favourable method. preenrollment and 47% postenrollment. Among 2,519
contacts whose immunity status was susceptible or
Etiler N, Velipasaoglu S, Aktekin M. Risk factors for overall unknown, the vaccination start/finish rate was
and persistent diarrhoea in infancy in Antalya, Turkey: 45%/41%. Site-specific adjusted relative risks of
a cohort study. Public Health 2004; 118(1):62-9. household noncompliance compared with Texas were
Abstract: The aim of this study was to identify factors 2.14 (Michigan), 1.96 (Georgia), and 1.30
that influence the incidence of diarrhoea in infancy. (Connecticut). Mother's birth in the United States
The study was a prospective cohort study conducted in increased the relative risk of household noncompliance
two primary healthcare unit areas in Antalya, Turkey. (1.32). Home visits, implemented only in Texas, most
A total of 204 infants were followed until they were likely account for higher compliance rates in that state.
aged 1 year. Morbidity surveillance and anthropometric Findings may indicate that many perinatal programs
measurements were carried out by home visits every 2 could achieve higher overall rates of infant and contact
months. The average incidences were found to be 2.76 identification; pre- and postvaccination serologic
episodes per child-year for overall diarrhoea and 18.56 testing in contacts and infants, respectively; and
episodes per 100 child-years for persistent diarrhoea. contact hepatitis B vaccination.
Relative risks, confidence intervals and logistic
regression analyses were used to assess the Euler GL, Copeland JR, Rangel MC, Williams WW.
associations. For both overall diarrhoea and persistent Antibody response to postexposure prophylaxis in
episodes, increased risks were associated with having infants born to hepatitis B surface antigen-positive
an uneducated mother (RR=1.89 and 5.33, women. Pediatr Infect Dis J 2003; 22(2):123-9.
respectively) and a self-employed father (RR=1.89 and Abstract: BACKGROUND: Annually 20,000 infants
3.77, respectively). Among environmental factors, are born to hepatitis B surface antigen (HBsAg)-
living in a slum was associated with both overall positive US women. Without prophylaxis 30% risk
(RR=1.68) and persistent (RR=2.69) diarrhoea, chronic hepatitis B virus infection, and 25% of those
whereas living in a crowded house (RR=1.70), having risk dying from resulting liver cirrhosis or liver cancer
no kitchen (RR=2.27) or having an unhygienic toilet as adults. METHODS: We attempted to interview each
(RR=1.93) were found to be significant for overall HBsAg-positive pregnant woman reported to the health
episodes alone. Factors related to the infant were department between 1992 and 1997, to provide their
preterm birth (RR=1.64), low birth weight (RR=2.05), infants with immunoprophylaxis at birth and in the
and first breastfeed given more than 1 h after birth clinic or home and to serotest at 9 to 15 months of age.
(RR=1.64). Nutritional status was also associated with RESULTS: Of 879 women reported, 92% enrolled;
overall or persistent diarrhoea: underweight children 787 delivered 796 live infants; 91% of infants received
(RR=2.15, persistent diarrhoea only), stunted children hepatitis B immunoglobulin; 98, 95 and 89% received
(RR=1.67 and 2.14, respectively) or wasted children hepatitis B vaccine (HepB) Doses 1, 2 and 3,
(RR=1.54 and 3.20, respectively). By logistic respectively; and 80% were serotested. Of these 2.2%
regression analysis, both overall and persistent were HBsAg-positive and 97% had antibody to HBsAg
diarrhoea were found to be associated with mother's (anti-HBs) of > or =10 mIU/ml. Anti-HBs
education. concentrations measured in 504 infants were 10 to 99
mIU/ml (25%), 100 to 999 mIU/ml (43%) and > or
Euler GL, Copeland J, Williams WW. Impact of four urban =1000 mIU/ml (29%). Serotesting was less likely
perinatal hepatitis B prevention programs on screening among infants of mothers <20 years of age [odds ratio
and vaccination of infants and household members. (OR) 2.5]; white, non-Hispanic (OR 2.8); or with a
Am J Epidemiol 2003; 157(8):747-53. household income of <$15,000/year (OR 2.0). Lower
Abstract: During 1992-2000, the authors studied antibody titers were found when serotesting at 4 to 12
compliance with perinatal hepatitis B prevention months than at <4 months after HepB-3 (OR 1.8 to
recommendations, including vaccination of household 4.4), with HepB-3 receipt <6 months after HepB-2 (OR
contacts, at four metropolitan sites in Connecticut, 2.5) and when household income was <$15,000/year
Georgia, Texas, and Michigan. Demographic and (OR 2.1). CONCLUSIONS: Centralized case
hepatitis B-related knowledge, attitudes, practices, and management with home visits resulted in high rates of
barrier data were collected on pregnant women testing complete immunoprophylaxis and postvaccination
positive for hepatitis B surface antigen and on their testing among infants born to HBsAg-positive women.
infants, children, and household and sexual contacts. Perinatal immunoprophylaxis was immunogenic under
Generalized estimating equations with repeated routine public health use, with higher anti-HBs titers
measures in a multivariable model were used to obtain occurring in infants tested <4 months postvaccination.
adjusted relative risks of household noncompliance. In Because infants in households with low income had
1,458 households studied, 1,490 infants and 3,502 higher rates of nonprotective antibody responses, they
other contacts were identified. Among infants, may benefit from extra efforts to ensure that serotesting
vaccination start/finish rates were 92%/72%, and 73% is conducted postvaccination.
were serotested postvaccination. Prevaccination
serotesting rates among contacts were 22% Evander E, Holst H, Jarund A et al. Role of ventilation
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![complaints and depression in victims. J Pediatr 2004; study of stressful chilhood experiences]. Prax
144(1):17-22. Kinderpsychol Kinderpsychiatr 2003; 52(8):547-59.
Abstract: OBJECTIVES: To assess the association Abstract: A population-based analysis of over 17,000
between bullying behavior and a wide variety of middle-class American adults undergoing
psychosomatic health complaints and depression.Study comprehensive, biopsychosocial medical evaluation
design In a cross-sectional study, 2766 elementary indicates that three common categories of addiction are
school children age 9 to 12 years filled out a strongly related in a proportionate manner to several
questionnaire on bullying behavior and health specific categories of adverse experiences during
complaints. Three groups-bullied children, active childhood. This, coupled with related information,
bullies, and children who both bully and are bullied- suggests that the basic cause of addiction is
were compared with the group of children not involved predominantly experience-dependent during childhood
in bullying behavior. Subsequently, risks for and not substance-dependent. This challenge to the
psychosomatic symptoms and depression were usual concept of the cause of addictions has significant
calculated by means of odds ratios. RESULTS: Bully implications for medical practice and for treatment
victims had significantly higher chances for depression programs.
and psychosomatic symptoms compared with children
not involved in bullying behavior. Odds ratios were as Felitti VJ. [The relationship of adverse childhood
follows: headache, 3.0; sleeping problems, 2.4; experiences to adult health: Turning gold into lead]. Z
abdominal pain, 3.2; bed-wetting, 2.9; feeling tired, Psychosom Med Psychother 2002; 48(4):359-69.
3.4; and depression, 7.7. Children who actively bullied Abstract: The Adverse Childhood Experiences (ACE)
did not have a higher chance for most of the Study is a long term, in-depth analysis of over 17,000
investigated health symptoms. CONCLUSIONS: Being adult Americans, matching their current health status
bullied is strongly associated with a wide range of against adverse childhood experiences that occurred on
psychosomatic symptoms and depression. These average a half-century earlier. We found that such
associations are similar to the complaints known to be adverse childhood experiences are quite common
associated with child abuse. Therefore, when such although typically concealed and unrecognized; that
health complaints are presented, pediatricians and other they still have a profound effect a half century later,
health care workers should also be aware of the although now transmutated from psychosocial
possibility that a child is being bullied to take experience into organic disease; and that they are the
preventive measures. main determinant of the health and social well-being of
the nation. Our findings are of direct importance to the
Feldman R, Klein PS. Toddlers' self-regulated compliance to everyday practice of medicine and psychiatry because
mothers, caregivers, and fathers: implications for they indicate that much of what is recognized as
theories of socialization. Dev Psychol 2003; 39(4):680- common in adult medicine is the result of what is not
92. recognized in childhood. The ACE Study challenges as
Abstract: To compare children's socialized behavior to superficial the current conceptions of depression and
parents and nonparental agents, this study examined addiction, showing them to have a very strong dose-
self-regulated compliance to mothers and caregivers-- response relationship to antecedent life experiences.
an early form of internalization--in 90 toddlers, half of
whom were also observed with fathers. Adults were Felland L, Benoit AM. Communities play key role in
observed in play, teaching, and discipline sessions with extending public health insurance to children. Issue
the child and were interviewed on child-rearing Brief Cent Stud Health Syst Change 2001; (44):1-4.
philosophies. Child cognition and emotion regulation Abstract: Nearly all low-income children are now
were assessed, and naturalistic observations were eligible for public health insurance coverage through
conducted at child-care locations. Mean-level and rank- Medicaid or the State Children's Health Insurance
order stability were found in child compliance to the 3 Program (SCHIP), but millions of eligible children still
adults. Child emotion regulation and adult warm lack coverage. Increasingly, states have turned to local
control in a discipline situation were related to self- communities to assist with SCHIP outreach. The
regulated compliance to the mother, caregiver, and Center for Studying Health System Change's (HSC)
father. Compliance to parents correlated with parental recent site visits to 12 nationally representative
sensitivity and philosophies, and compliance to the communities found many organizations not
caregiver correlated with child cognition and social traditionally involved in public health insurance
involvement when child-care quality was controlled. activities--such as schools, employers and religious and
Maternal sensitivity and warm control discipline community groups--playing important outreach roles.
predicted compliance to the caregiver but not vice Local social service agencies, health departments and
versa. Results are consistent with theoretical positions providers also are helping children gain coverage. For
on the generalization of socialization from the mother policy makers seeking to increase enrollment, these
to nonmaternal agents. community efforts offer a valuable road map. Local
SCHIP outreach generally is considered successful but
Felitti VJ. [Origins of addictive behavior: evidence from a is costly. And, state budget shortfalls and reduced
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![for children and adolescents Day Hospitals, 62 new Ferris I Tortajada J, Berbel Tornero O, Ortega Garcia JA et
beds in long care residential units, development of al. [Risk factors for pediatric malignant bone tumors].
specific programmes for the homeless and gender- An Pediatr (Barc) 2005; 63(6):537-47.
based violence, a significant investment in information Abstract: INTRODUCTION: Cancer is the result of the
systems (450 new computers) and development of best interaction of two kinds of determinants: genetic
practice and operational guidelines. Mental health (endogenous) and environmental (exogenous). In the
system was put to the test with Madrid's March 11th last few decades, pediatric oncology as a whole has
terrorist attack. A Special Mental Health Plan for progressed, including knowledge of malignant osseous
Affected people was developed. DISCUSSION: Unlike tumors (MOT). Although advances have been made in
some European countries, public mental health service diagnostic and therapeutic aspects, little progress has
is the main heath care provider. There are no voluntary taken place in our knowledge of the risk factors
agencies bcollaborating with mental health care. involved in their etiopathogenesis. Objective: This
Continuity of care and coordination between all mental review has three objectives: a) to provide an update on
health resources is essential in service delivery. MOT-related risk factors in the child and adult
Increased demand of care for minor psychiatric population; b) to disseminate knowledge of the main
disorders, children and adolescent mental health care, MOT-related risk factors among our colleagues in
and implementation of rehabilitation and residential order to promote research into these factors, diagnosis
facilities for chronic patients are outstanding and future prevention, and c) to request help from our
challenges similar to those in other European capitals. colleagues in the Environment and Pediatric Cancer
Overall, the mental health system had successfully research project. MATERIAL AND METHODS: We
coped with last year's increased care demand after performed a systematic review of the literature
March 11th terrorist attack in Madrid. published in the last 30 years on risk factors implicated
in the etiopathogenesis of MOT, using Medline,
Ferreira AL. [Follow-up of child abuse victims: challenges Cancerlit, Science Citation Index and Embase. The
for the pediatrician]. J Pediatr (Rio J) 2005; 81(5 search profiles used were: pediatric/childhood
Suppl):S173-80. malignant bone tumors, pediatric/ childhood bone
Abstract: OBJECTIVE: To review practical questions cancer/neoplasm, osteosarcoma/bone sarcoma/Ewing's
about the initial assistance and follow-up of child abuse sarcoma and risk factors/etiology/epidemiology. The
victims and their families by pediatricians. SOURCES most interesting articles were selected and the most
OF DATA: A literature review was carried out using relevant references contained therein were retrieved.
the MEDLINE and LILACS databases, including the RESULTS: MOT represent 6-7 % of all pediatric
years 2000 to 2005. Some articles from past years and neoplasms. The most frequent types are osteosarcoma
books were included due to their importance. (OS) and Ewing's sarcoma (ES), representing 56 % and
SUMMARY OF THE FINDINGS: Initial assistance is 34 % respectively. OS-related risk factors are the
one of the most important actions by health following: a) previous osseous disease (Paget's
professionals for the protection of abused children in disease); b) familial-genetic factors (hereditary
different healthcare sectors (community, outpatient retinoblastoma, Li-Fraumeni syndrome, Rothmund-
clinics, emergency rooms and infirmary), and it is Thompson syndrome, Bloom syndrome, familial OS,
fundamental for the reduction of immediate and long- Diamond-Blackfan anemia); c) chemical factors
term negative consequences of violence. The protection (antineoplastic drugs); d) physical factors (ionizing
services cannot monitor all the families under their radiation); e) biologic factors; f) parental occupation,
responsibility and most child abuse cases are not even and g) other factors (artificial osseous implants and
reported to those institutions; therefore, regular follow- traumatisms). ES-related risk factors are the following:
up by a pediatrician is advisable. It is important to a) ethnic-cultural (Caucasian race); b) genetic factors;
provide the family with support and guidance until the c) parental occupation (herbicide, pesticide and
child is safe. The main challenges are: to be involved fertilizer exposure); d) maternal obstetric history, and
without causing more violence; to consider all the e) other factors (parental smoking and inguinal hernia).
family as the focus of attention, including the family CONCLUSIONS: Most causes of MOT are unknown.
members who have committed the assault, helping Based on different levels of scientific evidence, the
them to change inadequate behaviors; to develop main factors implicated in the etiopathogenesis of OS
specific abilities to carry out this work, which must be are: Paget's disease, hereditary retinoblastoma, Li-
multiprofessional, interdisciplinary and intersectoral. Fraumeni syndrome, antineoplastic drugs, and ionizing
CONCLUSIONS: Families face difficulties when their radiation. The main factors related to ES are:
children are abused and when the situation gains Caucasian race, parental occupation, parental smoking,
notoriety, demanding interventions from many and surgery for inguinal hernia. The main obstacles to
institutions. In this process, a pediatrician can guide greater knowledge of MOT-related factors are: a) their
and help them to guarantee the protection and healthy multiple origin; b) the low prevalence in the
development of their children. To overcome population; c) lack of environmental health training in
challenges, health professionals have to be technically pediatrics, and d) the low public and private investment
and emotionally prepared. in this research field.
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![Ferris i Tortajada J, Ortega Garcia JA, Garcia i Castell J, 64.5%: 68.6% among primary and 50.3% among
Lopez Andreu JA, Berbel Tornero O, Crehua Gaudiza secondary school pupils. Major economic activities
E. [Risk factors for neuroblastoma]. An Pediatr (Barc) included street trading (43.6%), selling in kiosks and
2005; 63(1):50-60. shops (25.4%) and farming (23.6%). No child was
Abstract: INTRODUCTION: NB is the most frequent involved in bonded labour or prostitution. Girls were
pediatric cancer arising in the sympathetic nervous more often involved in labour activities than boys
system and represents a serious healthcare challenge (66.8% versus 62.1%, p = 0.048): this difference was
because: 1) it is the most frequent neoplasm in the first most obvious with street trading (p = 0.0004). Most of
decades of life; 2) it biological behavior is the children (82.2%) involved in labour activities did
unpredictable (spontaneous regression, maturation to so on the instruction of one or both parents in order to
ganglioneuroma, and localized and metastasized contribute to family income. Children of parents with
variants); and 3) little is known about most of the risk low socio-economic status or of poorly educated
factors involved in its etiopathogenesis. The objective parents were significantly involved in labour activities
of this study was to disseminate knowledge of (p = 0.01 and p = 0.001 respectively). Child labour was
constitutional and environmental (physical, chemical, also significantly associated with increasing number of
biological and social) risk factors linked to the children in the family size (p = 0.002). A higher
development of neuroblastoma (NB), with various prevalence rate of child labour was observed among
levels of scientific evidence. To seek collaboration children living with parents and relations than among
among pediatricians in the research project those living with unrelated guardians. CONCLUSION:
"Environment and Pediatric Cancer". MATERIAL It is concluded that smaller family size, parental
AND METHODS: We performed a systematic review education and family economic enhancement would
of the literature published in the previous 25 years on reduce the pressure on parents to engage their children
risk factors for NB diagnosed in the first two decades in labour activities.
of life, using Medline, the Science Citation Index and
Embase. Search profiles were: Fiese BH, Wamboldt FS, Anbar RD. Family asthma
"neuroblastoma/childhood sympathetic nervous system management routines: connections to medical
neoplasms and risk factors/etiology/epidemiology". adherence and quality of life. J Pediatr 2005;
The most interesting articles and the most relevant 146(2):171-6.
references contained therein were selected. RESULTS: Abstract: OBJECTIVES: To develop a reliable
With greater or lesser scientific evidence, the following measure of asthma management routines and examine
risk factors increase the risk of developing NB: genetic its association with health care utilization, medical
factors; geographic factors; ethnic factors; adherence, and quality of life. STUDY DESIGN:
socioeconomic factors; infectious factors; physical Families (n = 153) with a child with asthma, drawn
factors; parental occupational exposure; gestational from two sites, participated in the study. Parents
factors; and perinatal and maternal factors. Preventive completed the Asthma Routines Questionnaire,
factors associated with a lower risk of developing NB Adherence to Clinical Trials interview, Functional
are breastfeeding and intake of vitamin supplements Severity of Asthma Questionnaire, and Caregiver
during pregnancy. CONCLUSIONS: The main barriers Quality of Life. Children completed the Pediatric
to the identification of evidence-based risk factors Quality of Life. Electronic monitoring of medication
involved in the development of NB are its complex use over a period of 12 months was available for
biology and clinical course, its relative rarity and the children at one study site. RESULTS: A principal
difficulty of performing epidemiological studies. component factor analysis revealed two dimensions to
Research on constitutional and environmental factors the Asthma Routines Questionnaire: Medication
involved in its etiopathogenesis should be stimulated. Routines and Routine Burden. Medication Routines
The best preventive strategy is to recommend were related to medical adherence and to health care
breastfeeding for more than 6 months. utilization. Routine Burden was related to caregiver
and child quality of life. CONCLUSIONS: The
Fetuga BM, Njokama FO, Olowu AO. Prevalence, types and Asthma Routine Questionnaire holds promise as a
demographic features of child labour among school reliable assessment of family practices related to
children in Nigeria. BMC Int Health Hum Rights 2005; medication use. The emotional burden of daily care can
5(1):2. be distinguished from medication use, which is more
Abstract: BACKGROUND: To determine the closely linked to adherence issues. Targeted questions
prevalence, types and demographic features of child during regular care may reveal family routine practices
labour among school children in Nigeria. METHODS: amenable to intervention.
A cross-sectional interview study of 1675 randomly
selected public primary and secondary school pupils Figueiredo B, Bifulco A, Paiva C, Maia A, Fernandes E,
aged 5 to less than 18 years was conducted in the Matos R. History of childhood abuse in Portuguese
Sagamu Local Government Area of Ogun State, parents. Child Abuse Negl 2004; 28(6):669-82.
Nigeria from October 1998 to September 1999. Abstract: OBJECTIVE: The study examines the self-
RESULTS: The overall prevalence of child labour was reported prevalence of childhood physical and sexual
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![abuse in a large sample of Portuguese parents. Finke L, Williams J, Ritter M et al. Survival against drugs:
METHOD: Nearly 1,000 parents (506 mothers and 426 education for school-age children. J Child Adolesc
fathers) were selected through public primary schools Psychiatr Nurs 2002; 15(4):163-9.
from the Northern area of Portugal. All completed the Abstract: PROBLEM: Alcohol and drug use of young
Portuguese version of the Childhood History school-age children continue to escalate.
Questionnaire (CHQ) [Journal of Family Violence 5 Comprehensive, effective interventions are needed to
(1990) 15]. RESULTS: Results show that the treat and prevent future alcohol and drug use.
prevalence of abuse was 73%, but more severe physical METHODS: The alcohol and drug use of 69 school-
abuse involving sequelae/injury was reported by 9.5%. age children participating in afterschool programs was
Most physical abuses began prior to age 13, with half explored; parents completed a family climate scale. An
continuing after age 13. No gender differences were investigator-developed educational program was
found for rates of physical abuse. However, among the evaluated for its effect on self-efficacy of the children
milder physical abuse without sequelae/injury, those to prevent drug and alcohol use. FINDINGS: Although
women who experienced "whipping" or family climate scales indicated functioning families,
"slapping/kicking" were more likely to do so from their 25% of the children indicated they have used drugs or
mothers than fathers. Among men who were alcohol and 49% indicated a possible problem with
"slapped/kicked" this was more likely to be from their alcohol or drugs being used at home by parents. A
fathers. Low rates of sexual abuse were found at 2.6% significant correlation with a child's self-efficacy and
with no gender or age differences. Lack of a supportive drug use was found. CONCLUSIONS: The educational
adult in childhood related to the more severe abuses, program taught children survival skills to resist the use
but only in adolescence. Portuguese rates of abuse were of alcohol and drugs. Children with a plan to resist the
consistently lower than those reported in USA and use of drugs were more likely not to use drugs.
Spanish studies using the CHQ. CONCLUSIONS: This
is the first retrospective, self-report study of childhood Finkelhor D. The legacy of the clergy abuse scandal. Child
abuse in a large sample of Portuguese parents and, Abuse Negl 2003; 27(11):1225-9.
even with a participation rate of 69%, shows lower
rates than in US and Spanish samples. Finkelstein N, Rechberger E, Russell LA et al. Building
resilience in children of mothers who have co-
Fikree FF, Pasha O. Role of gender in health disparity: the occurring disorders and histories of violence:
South Asian context. BMJ 2004; 328(7443):823-6. intervention model and implementation issues. J Behav
Health Serv Res 2005; 32(2):141-54.
Findling RL, Steiner H, Weller EB. Use of antipsychotics in Abstract: Historically, children of parents with co-
children and adolescents. J Clin Psychiatry 2005; 66 occurring substance abuse and mental health disorders
Suppl 7:29-40. and histories of violence/trauma have been overlooked
Abstract: The comparable efficacy and improved safety in behavioral health treatment systems. The Women,
of the atypical antipsychotics compared with the Co-occurring Disorders and Violence Study (WCDVS)
traditional antipsychotic agents in the treatment of was a 5-year initiative funded by the United States
schizophrenia and other disorders in adults have Substance Abuse and Mental Health Services
prompted the use of these agents in children and Administration (SAMHSA) that included a Children's
adolescents. The atypical antipsychotics are Study that explored the treatment needs of children of
increasingly being used in children and adolescents women with these multiple disorders. This article
with a variety of different psychiatric diagnoses, describes the development of the Children's Study
including schizophrenia, bipolar disorder, intervention that included clinical assessment, group
autism/pervasive developmental disorders, conduct intervention, and resource coordination/advocacy for
disorder, depression, anxiety disorders, tic disorders, children aged 5-10 to build resilience through
delirium, and eating disorders. Unfortunately, clinical increasing coping skills, improving interpersonal
use of these agents in pediatric patients has far relationships, and helping coalesce positive identity
exceeded the limited evidence from randomized and self-esteem. Innovative procedures, including the
controlled trials. This article reviews the available participation of consumer/survivor/recovering women
evidence from the published literature on the use of the and mothers, in the planning, implementation, and
atypical antipsychotics in children and adolescents with administrative applications of this intervention and
schizophrenia, bipolar disorder, and maladaptive study are also highlighted. It is recommended that
aggression associated with autism/pervasive programs begin to implement family-focused
developmental disorders and conduct integrated treatment approaches that can potentially
disorder/disruptive behavior disorders. increase protective factors for children affected by
parental mental illness, substance abuse, and violence.
Fine B. Being the voice for a child. Pediatr Ann 2004;
33(11):785-7. Fischer M, Barkley RA, Smallish L, Fletcher K. Young adult
follow-up of hyperactive children: self-reported
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![neurobiology of the orbitalfrontal cortex and its Fourneret P, Desombre H, de Villard R, Revol O. [Interest
protective inhibitory role in the temporal organization of propranolol in the treatment of school refusal
of behavior, the development of emotion regulation, anxiety: about three clinical observations]. Encephale
the development of the self, and experience-dependent 2001; 27(6):578-84.
reorganizing neocortical processes. The hypothesis Abstract: School refusal anxiety is a
being proposed is that the experience-dependent pathopsychological disorder which touches the young
maturation of the orbitalfrontal cortex in early abusive child, between 8 and 13 years. Even if the school
environments, characterized by discontinuity in dyadic refusal is studied for a long time, there is not still
socioaffective interactions between the infant and the consensus as for the specific definition of this disorder
caregiver, may be responsible for a pattern of lateral or on the best way of treating it. Nevertheless,
inhibition between conflicting subsets of self- accountable of long-lasting difficulties in school
representations which are normally integrated into a integration, its short and medium term consequences
unified self. The basic idea is that the discontinuity in are serious and well known: school desertion, mood
the early caretaking environment is manifested in the disorder and behavioral problems. Speed and quality of
discontinuity in the organization of the developing the medico-psychological and educational
child's self. interventions represent a important factor for evolution
and prognosis. Although, psychological interventions
Forsyth BW. Psychological aspects of HIV infection in remain essential, sometimes the interest of an
children. Child Adolesc Psychiatr Clin N Am 2003; associated psychotropic medication should be
12(3):423-37. discussed. This one can indeed either improve their
Abstract: Despite advances in the pharmaceutical results or supporting their installations. Despite more
treatment of HIV disease, there are still an increasing than twenty controlled trials in the pediatric population,
number of people living with the disease, and an no definitive psychopharmacological treatment data
increasing number of children and adolescents are exist for anxiety disorder in childhood and especially
personally affected by the epidemic. The psychological for school refusal disorder. The majority of the studies
effects on these children are significant and relate not stress as well the interest of benzodiazepines as
only to a parent's degree of illness and the threat of tricyclic antidepressants but without being able to
death but also to the association of the disease with specify the possible superiority of a chemical on the
substance abuse and the pervasive effects of the stigma other. On the other hand, the side effects of each one
that surround it. To intervene optimally on behalf of are well-documented, in particular for the
these children, programs must be multidisciplinary and benzodiazepines (potential abuse, sedation, potential
take a holistic approach to address specific social and desinhibition, mnemonic disorder), limiting thus their
psychological issues and ensure stability in a child's uses in child. In this work, we would like to emphasize
care giving. the interest of propranolol in the treatment of somatic
symptoms usually met in school refusal anxiety.
Fortunata B, Kohn CS. Demographic, psychosocial, and Although beta-blockers have been used in the treatment
personality characteristics of lesbian batterers. of neurovegetative symptoms associated with
Violence Vict 2003; 18(5):557-68. situational anxiety disorders, there is no controlled data
Abstract: Prevalence of domestic violence (DV) in and only some open data to guide pediatric use for
lesbian and heterosexual relationships appears to be anxiety disorders in children. Nevertheless, prescribed
similar. Despite this, few studies have examined factors with low posology and in substitution of
associated with DV in lesbian relationships, and even benzodiazepine, this medication enabled us in three
fewer have examined characteristics of lesbian severe clinical cases to shorter notably the time of
batterers. Demographic and psychosocial school rehabilitation. Well tolerated on the clinical
characteristics and personality traits were examined in level, with a greater efficiency on the somatic signs
100 lesbians in current relationships (33 Batterers and related to anxiety than benzodiazepines and with not
67 Nonbatterers). Results indicated that Batterers were having their side effects, this therapeutic can constitute
more likely to report childhood physical and sexual a significant support in the psychological treatment of
abuse and higher rates of alcohol problems. Results these children. However, these present results require
from the MCMI-III indicated that, after controlling for to be confirm by other observations, which will be lead
Debasement and Desirability indices, Batterers were perhaps to a controlled study.
more likely to report aggressive, antisocial, borderline,
and paranoid personality traits, and higher alcohol- France D. Battle of the faithful. Catholics are voicing hurt
dependent, drug-dependent, and delusional clinical and anger over the church's sexual-abuse crisis. Is the
symptoms compared to Nonbatterers. These results hierarchy listening? Newsweek 2002; 139(24):49.
provide support for social learning and
psychopathology theoretical models of DV and clinical France D. Confessions of a fallen priest. Newsweek 2002;
observations of lesbian batterers, and expand our 139(13):52-4, 56.
current DV paradigms to include information about
same-sex DV.
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![observed in the overall infant mortality rate has been providers in six cities. We then mailed a survey to a
matched by decreases in several disparities at the same random sample of private practice family physicians
time that it has been marred by increases in others. The and pediatricians and public health nurses who
data support the possibility that where you live has immunize children. The overall survey response rate
become an increasingly salient factor in determining was 77%, and the final sample size was 544.
the odds of infant mortality. High parity, low education RESULTS: Focus group findings indicated that parents
and unemployment status have also become more rarely refused vaccines but occasionally resisted
salient factors in predicting post neonatal infant specific vaccines. Parents who were unsure about
mortality risk in the more recent period as compared to vaccinating were open to discussions about vaccines
the earlier period. As Mexico's infant mortality rate with a trusted provider. Most of these parents agreed to
begins to stabilize in the near future, this research immunize after discussing concerns with their provider.
highlights the need to re-focus our research efforts on In a subsequent survey of providers, respondents
the causes and consequences of differential mortality estimated that they immunized a mean of 3536 (median
trends. 1560) children annually. The reported mean number of
refusals per 1000 children age >18 years immunized
Frankel G. Charismatic doctor at vortex of vaccine dispute: was 7.2 (median 0.4), with varicella vaccine being the
experts argue over findings, but specialist sees possible most commonly refused. Means did not vary by region
MMR link to autism. Washington Post 2004; A1, A20. or specialty. Providers indicated that fear of side effects
Notes: GENERAL NOTE: KIE: KIE Bib: heard about from media/word of mouth was the most
immunization commonly expressed reason for parents to refuse
vaccines (52%). Religious (28%) or philosophical
Franz HB. [Gynecologic injuries, management]. Kongressbd (26%) reasons or belief that the disease was not
Dtsch Ges Chir Kongr 2001; 118:632-4. harmful (26%) were less common reasons. Providers
Abstract: Accidental trauma to the female perineum is reported that few parents refused because of anti-
relatively rare and occurs most often in the 4- to 12- government sentiment (8%). CONCLUSIONS:
year-old age group. Vulva and vaginal trauma are the Providers indicate low vaccine refusal rates within
result of straddle injuries, accidental penetration, offices of traditional primary care providers and in
intercourse, sexual abuse and motor vehicle accidents. public health clinics. Strategies for efficient provider-
Injuries to the genitalia require typical surgical repair patient communication are needed to address parental
and, in association with anogenital or urogenital concerns about vaccines.
injuries, a multidisciplinary approach.
Fredriksson GE, Hogberg U, Lundman BM. Postpartum care
Franz R. Environmental dangers pose a threat to children's should provide alternatives to meet parents' need for
skin. Dermatol Nurs 2001; 13(4):308, 311. safety, active participation, and 'bonding'. Midwifery
2003; 19(4):267-76.
Fraser J. Victoria's story. Pract Midwife 2003; 6(8):4-5. Abstract: OBJECTIVE: To describe new parents'
choice of the type of maternity care they wanted to
Fraser J. When a simple 'yes' or 'no' is not enough. Pract receive, the family suite (FS) or an early discharge
Midwife 2005; 8(9):42-3. (ED), and to gain a better understanding of parents'
experiences of different postnatal care alternatives.
Freckelton I. Munchausen Syndrome bx proxy and criminal DESIGN: A qualitative study using semi-structured
prosecutions for child abuse. J Law Med 2005; interviews. The interviews were analysed by content
12(3):261-6. analysis. SETTING AND PARTICIPANTS: Eleven
couples and one mother, including both first-time and
Fredrickson DD, Davis TC, Arnould CL et al. Childhood experienced parents. Six families received care at a FS
immunization refusal: provider and parent perceptions. while the others chose an ED within 24 hours after
Fam Med 2004; 36(6):431-9. birth. MEASUREMENTS AND FINDINGS: The
Notes: GENERAL NOTE: KIE: 31 refs. postpartum period was experienced as an unpredictable
GENERAL NOTE: KIE: KIE Bib: immunization; time for new parents, when the need for safety,
treatment refusal/minors participation in decision-making, and 'bonding' was felt
Abstract: BACKGROUND AND OBJECTIVES: to be central and decisive to their choice of care. The
Parental concerns may contribute to immunization type of care that the parents felt best met their needs
refusals and low infant immunization rates. Little varied according to the mother's assessment of her own
knowledge is available about how often and why and the baby's health status, the parents' requirements
parents refuse immunizations for their children. This and experience and the way in which they, as parents,
study was conducted to estimate, based on reports from handled the opportunities and demands of different
health care providers and parents, the frequency of and environments. However, the opportunities for the
reasons for immunization refusal. METHODS: In parents to choose the form of care they considered best
1998, we conducted 32 focus groups of parents and for their family were limited. PRACTICAL
IMPLICATIONS: To best fulfil parents' wishes and
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![needs in postnatal care alternative care forms are While similarities and differences arose, universal
needed. Also, a way to treat the family as a whole on perspectives and practices emerged among the parents
an individual family basis must be found and parents of that are discussed as prevailing themes. Results suggest
newborn babies should be allowed to choose the form that the parents' struggle, systemic barriers, and the
of care they consider best. urban environment are the greatest challenges facing
families. Addressing these challenges will contribute to
Free MM. Cross-cultural conceptions of pain and pain establishment of truly equitable and effective
control. Proc (Bayl Univ Med Cent) 2002; 15(2):143-5. interventions for urban children, whether deaf or hard
Abstract: Pain is a ubiquitous feature of the human of hearing, their parents, and other family members.
experience. This paper presents an anthropology of
pain. Anthropology is defined as the cross-cultural and Freeman B, Iron Cloud-Two Dogs E, Novins DK, LeMaster
comparative study of human behavior. Pain can be PL. Contextual issues for strategic planning and
acute and episodic, and pain can be constant and evaluation of systems of care for American Indian and
uninterrupted. Acute pain, lasting for minutes or hours, Alaska Native communities: an introduction to Circles
is reported at some time by virtually all adults and by of Care. Am Indian Alsk Native Ment Health Res
most juveniles and is indicated by the cries and facial 2004; 11(2):1-29.
expressions of toddlers and infants. This universality of Abstract: This introduction to the evaluation
pain as a part of the human condition has been component of the Circles of Care initiative includes
established by the research of many biological, background on the nature of the initiative, Center for
physical, and social scientists. Ethnographers, Mental Health Services support for developing systems
physicians, and public health experts describe pain of care for youth with emotional disturbances, and an
complaints for a variety of modern, industrial societies overview of the systems of care approach. The
and traditional, undeveloped societies. Pain is the most prevalence, unique challenges, and the historical,
frequent complaint brought to the offices of physicians political, and cultural context of health care delivery
in North America, and it is a focus of attention in the for American Indian and Alaska Native peoples are
literate medical traditions of China, India, and Islamic also discussed.
cultures. Hence, the study of pain and the cultural
perceptions of pain are prominent foci of Freeman J. Mandatory abuse training--new developments for
anthropologists. Given that the goal of medicine is to an old law! Iowa Med 2002; 92(4):26-7.
offer medical care to all people who seek it, the
practice of modern medicine may be assisted by an Freeman M. Whose life is it anyway? Med Law Rev 2001;
exploration of the possibility of cultural differences in 9(3):259-80.
medical beliefs and practices in the multiethnic and Notes: GENERAL NOTE: KIE: Freeman, Michael
racially diverse patient populations today. GENERAL NOTE: KIE: 172 fn.
GENERAL NOTE: KIE: KIE Bib: patient care/minors
Freedman LP, Waldman RJ, de Pinho H, Wirth ME,
Chowdhury AM, Rosenfield A. Transforming health Fremy D. [Improving the medical treatment of minors who
systems to improve the lives of women and children. are victims of sexual assault or physical abuse: a
Lancet 2005; 365(9463):997-1000. receiving center and partnership between a psychiatric
hospital and university hospital]. Sante Publique
Freeman B, Dieterich CA, Rak C. The struggle for language: (Bucur) 2003; 15 Spec No:179-84.
perspectives and practices of urban parents with Abstract: The aim of the partnership is the
children who are deaf or hard of hearing. Am Ann Deaf establishment and operation of a centre open 24 hours a
2002; 147(5):37-44. day which receives and treats adults and underage
Abstract: Research is scarce on young children with victims of sexual assault and physical abuse coming
hearing impairments growing up in urban from the greater metropolitan area of Besancon. The
environments. A qualitative study was used to explore centre also provides the victims and their families with
and describe the perspectives and practices of these adapted forensic and psychotherapeutic assistance. The
children's parents. An ethnographic approach enabled mechanisms to carry out the project will be set out in a
documentation of parents' routines, daily activities, contract between the two hospitals, including the
thoughts (perceptions), and behaviors (practices). In- resources of the two institutions. The centre will fit into
depth interviews and observations were the primary the existing network of partners which is already
data sources. Data collection occurred within a 6- operational in Besancon. The role of the University of
month period. Research questions focused on efforts Besancon and the Faculty of Medicine will be to
parents make independently and with others (e.g., promote research in the field of physical abuse, its
educational staff, family members) to facilitate and causes and effects, and to train future physicians who
support their child's efforts to communicate and acquire will later be in charge of handling these types of cases
language. Nine parents, two grandparents, and six staff in their careers.
members disclosed their perspectives and practices.
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![approaches to caring, as most of the women who seek considered that when parents force food on their child,
midwifery care are healthy and require a health- this is a violation of the child's integrity. This view is
promotion model of care that may not easily lend itself based on the idea that such actions restrict the child's
to examination by scientists or clinicians. However, right to self-determination. In the participants'
when intervention is indicated to save the lives of opinions, when the child is forced to sleep well, this is
mother, baby, or both, those interventions must be not regarded as a violation of the child's integrity, but is
based on the best available evidence from a variety of perceived as support of the child's autonomy. An
sources leading to the most effective choices for action. underlying theoretical view may be that parents' time
The ICM Essential Competencies for Midwifery can be saved if the child becomes independent of the
Practice (2002) are based on evidence derived from a parents at as early an age as possible.
variety of quantitative and qualitative methodologies.
Expert clinical consensus may serve as to the best form Furman-Reznic M, Hiss J. Assessing child abuse. Isr Med
of evidence at certain points in the evolution of Assoc J 2003; 5(2):152; author reply 152.
knowledge. Every midwife needs to understand where
the gaps exist in supporting traditional practices that Furtado EF, Laucht M, Schmidt MH. [Psychological
have yet to be fully examined in a scientific manner. In symptoms in children of alcoholic fathers]. Z Kinder
summary, a multi-matrix or triangulated approach may Jugendpsychiatr Psychother 2002; 30(4):241-50.
be most appropriate to the delineation of evidence Abstract: OBJECTIVES: In spite of a growing interest
underpinning best midwifery practice. in recent years in epidemiological research on behavior
problems of children of alcoholics (COAs), few
Funk RR, McDermeit M, Godley SH, Adams L. prospective longitudinal child psychiatric studies have
Maltreatment issues by level of adolescent substance been conducted up to now. METHODS: In the
abuse treatment: the extent of the problem at intake and Mannheim Study of Risk Children, an ongoing
relationship to early outcomes. Child Maltreat 2003; prospective study of high risks, the data of 219 children
8(1):36-45. (26 COAs and 193 non-COAs) were analyzed from
Abstract: Differences in self-reported victimization and birth to the age of 11 years. Sociodemographic data,
outcomes for residential (n = 114) vs. outpatient (n = organic and psychosocial risk factors, the number and
73) substance abuse treatment samples were examined. severity of behavior problems, and the rate of
Repeated measures MANOVAs for victimization level expansive and introversive disorders have been
by level of care were performed on days of alcohol and investigated. RESULTS: The family status of the
marijuana use and substance-related problems. COAs was characterized by the father's lower level of
Residential treatment participants reported higher education as well as by socioeconomic difficulties and
prevalence of victimization and higher levels of general more numerous adverse life events. Other psychosocial
victimization but did not differ on acute (high) problems such as marital conflict and a lack of coping
victimization at intake. Analyses revealed a significant mechanisms were also more frequent in COA families.
interaction between follow-up outcomes and level of A significantly higher rate of expansive symptoms and
care for adolescents with acute intake victimization. disorders was found in children of alcoholic fathers
Adolescents placed in residential treatment were more from the age of two years on. CONCLUSIONS:
likely to reduce their days of alcohol and marijuana use Children of alcoholic fathers represent a group at risk
and past month substance-related problems at follow- for the early onset of psychiatric problems and are
up. Adolescents with low intake levels of victimization deserving of more attention in prevention and early
did not differ by level of care. Findings suggest that intervention programs.
clinicians must carefully weigh placement
recommendations for adolescents with maltreatment Gabris K, Tarjan I, Rozsa N. Dental trauma in children
histories and that researchers should study ways to presenting for treatment at the Department of Dentistry
increase outpatient treatment effectiveness for these for Children and Orthodontics, Budapest, 1985-1999.
adolescents. Dent Traumatol 2001; 17(3):103-8.
Abstract: Data on children with dental trauma who
Funkquist EL, Carlsson M, Nyqvist KH. Consulting on presented for treatment at the Department of Dentistry
feeding and sleeping problems in child health care: for Children and Orthodontics in Budapest over a
what is at the bottom of advice to parents? J Child period of 15 years were analysed. The WHO guidelines
Health Care 2005; 9(2):137-52. were used to classify the traumatic injuries. A total of
Abstract: The aim of this study was to investigate and 590 children were involved, 810 teeth being affected.
interpret ideas inherent in sleep and diet consultations Children aged 7-14 years made up 88% of the cohort.
concerning infants in Swedish child health services. The male:female ratio was 58:42. The
Data were obtained through semi-structured interviews permanent:primary ratio for the affected teeth was
of professionals employed in these services. A 90:10. The teeth most commonly affected were the
qualitative method with a phenomenological approach maxillary central incisors. In 70% of the cases, only
was applied to analyse the data. The results indicate one tooth was traumatised. The incidence of dental
that professionals have underlying conceptions. They
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![trauma peaked at 10 years of age. The most common weight at home by research assistants, masked to group
injury type observed was enamel-dentin crown allocation. RESULTS: No clinically important or
fracture. The decreasing sequence of frequency of statistically significant group differences were found in
etiological factors was playing, sports, falls, cycling, daily breastfeeding frequency (mean difference
road accidents and fighting. Of the accidents, 65% experimental minus control = 0.1 feeds [95%
occurred at school or at home. Seventy seven per cent confidence interval: -0.1-0.3]) or daily rate of infant
of the patients presented for medical care in the first 3 weight gain (-1.1 g [-2.5-0.3]) based on intention-to-
days after the accident. treat analyses. CONCLUSIONS: Follow-up by nurses
after short postpartum hospital stays, in either the home
Gadeyne E, Ghesquiere P, Onghena P. Longitudinal or a hospital-based clinic, of healthy infants discharged
relations between parenting and child adjustment in at <36 hours seems associated with satisfactory infant
young children. J Clin Child Adolesc Psychol 2004; breastfeeding outcomes.
33(2):347-58.
Abstract: We studied the predictive relations between Gago LC, Wegner RK, Capone A Jr, Williams GA.
reports of parenting behavior on the one hand and Intraretinal hemorrhages and chronic subdural
academic achievement and reported behavior problems effusions: glutaric aciduria type 1 can be mistaken for
of young children on the other hand. Data were shaken baby syndrome. Retina 2003; 23(5):724-6.
gathered for 352 children and their parents from
kindergarten to 2nd grade. The results indicated that in Gailhoustet L, Goulet O, Cachin N, Schmitz J. [Study of
the academic domain, low supportive and high psychological repercussions of 2 modes of treatment of
controlling parenting practices were modestly related adolescents with Crohn's disease]. Arch Pediatr 2002;
to poor subsequent math achievement. Children's 9(2):110-6.
externalizing and attention problem behavior was Abstract: No study has yet compared the respective
clearly predictive of high levels of control in mothers psychological impact of corticotherapy and enteral
and low levels of support in fathers. The combination nutrition in the treatment of Crohn's disease, and
of high parental support and control was especially especially, the psychological problems linked to the
associated with high levels of problem behavior. wearing of a nasogastric tube 24 hours a day. The goal
However, when previous parenting and child of this study was to collect comparative information
adjustment were taken into account, the magnitude of regarding the real-life experience and the feeling of
the predictive power of parenting for child adjustment, these two treatments. PATIENTS AND METHODS:
and of child adjustment for parenting, remained From September 1997 to February 1998 at the clinic of
limited. inflammatory bowel diseases of the hospital Necker-
Enfants malades, 51 patients aged 12 to 18 (average
Gagnon AJ, Dougherty G, Jimenez V, Leduc N. 15) participated in this study. Thirty [15 on
Randomized trial of postpartum care after hospital corticotherapy (CT); 15 on enteral nutrition (EN)]
discharge. Pediatrics 2002; 109(6):1074-80. answered a questionnaire inspired by a similar
Abstract: OBJECTIVE: Harmful effects of short Canadian questionnaire (Inflammatory Bowel Disease
postpartum hospital stays include dehydration and Questionnaire), and 21 passed Spielberger's anxiety
malnutrition of breastfed infants. These may be tests, Beck's depression tests and a psychological
prevented by adequate breastfeeding frequency; interview. RESULTS: Treatment: According to the 30
however, rigorous research to determine the relative questionnaires the appreciation of the therapeutic
effectiveness of various follow-up strategies in results was similar in the two treatments, the majority
supporting breastfeeding frequency is absent. This of patients respected their treatment (only one patient
study addressed the question, "Is there a difference in on EN ate secretly and two on CT stopped their
breastfeeding frequency or infant weight gain for corticotherapy). Of the 15 EN questionnaires: nine out
singleton infants discharged within 36 hours' of 15 patients responded well to the suspension of oral
postpartum who received either community nurse feeding, two were hungry, nine experienced cravings
(home visit) or hospital nurse (clinic) follow-up?" and ten avoided meals during their treatment. From a
METHODS: A randomized, controlled trial was cosmetic point of view, six/14 (43%) found it difficult
conducted at a university teaching hospital (3700 putting up with the nasogastric tube 24 hours a day,
births/y) and affiliated community health centers. A and eight/15 (53%) on CT found the facial swelling
consecutive sample of 586 healthy mother-infant pairs difficult to bear. According to the 21 psychological
were recruited from January 1997 to September 1998 interviews, eight patients deemed EN efficient, while
before discharge; 513 (87.5%) contributed data on 1 or only four felt the same about CT. Of the 11 EN
more outcomes. Forty-eight-hour postpartum telephone psychological interview, no adolescent patients were
contact and day 3 nurse contact in the home hungry, eight had cravings and nine avoided meals
(experimental) or at the hospital (control) were during their treatment, seven mentioned they felt
provided. The main outcomes measured were different and seven described how EN had upset the
breastfeeding frequency and infant weight gain family's routine. Nine (82%) talked about how difficult
assessed at 2 weeks' postpartum by maternal diary and it was to put up with the nasogastric tube 24 hours a
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![day from a cosmetic standpoint while eight/ten (80%) Gaillard WD, Pugliese M, Grandin CB et al. Cortical
on CT found the facial swelling difficult to live with. localization of reading in normal children: an fMRI
Seven complained that they had been the victims of language study. Neurology 2001; 57(1):47-54.
verbal abuse. Quality of life: According to the 30 Abstract: BACKGROUND: fMRI provides a
questionnaires, eight/15 patients on EN missed an noninvasive means of identifying the location and
average of 15 days of school against five/15 patients on organization of neural networks that underlie cognitive
CT, ten patients judged that EN restricted their daily functions. OBJECTIVE: To identify, using fMRI, brain
lives and nine mentioned the daily difficulties to wear a regions involved in processing written text in children.
tube 24 hours a day. Tests: Spielberger's test of anxiety METHODS: The authors studied nine normal right-
revealed that on average, the 11 patients on EN who handed native English-speaking children, aged 10.2
were interviewed suffered the first level of anxiety, years (range 7.9 to 13.3 years), with two paradigms:
while the ten patients on CT felt the second level. As reading Aesop's Fables and "Read Response Naming"
for the Beck's depression test, the 11 patients on NE (reading a description of an object that was then
suffered the first level of depression on average, while silently named). Data were acquired using blood
those on CT were subject to the second level. oxygen level-dependent fMRI. Group data were
CONCLUSION: This study demonstrated that EN was analyzed with statistical parametric mapping;
perceived as being more disruptive to patients daily individual data sets were analyzed with a region-of-
lives than CT and defines the difficulties linked to the interest approach from individual study t maps. The
suspension of oral feeding and the wearing of a naso- number of activated pixels was determined in brain
gastric tube. The study also describes the difficulties regions and an asymmetry index (AI = [L - R]/[L + R])
involved in coping with the side effects of CT, one calculated for each region. RESULTS: The authors
example being facial swelling which can be as found strong activation in the left middle temporal
unpleasant from a cosmetic point of view as wearing of gyrus and left midfrontal gyrus and variable activation
a naso-gastric tube. in left inferior frontal gyrus for both reading tasks in
the group analysis (z > 5.5 to 9.1). All subjects had
Gaillard WD, Balsamo LM, Ibrahim Z, Sachs BC, Xu B. strong left-sided lateralization for both tasks in
fMRI identifies regional specialization of neural middle/superior temporal gyrus, inferior frontal gyrus,
networks for reading in young children. Neurology and middle frontal gyrus (AI = 0.76 to 1.0 for t = 4).
2003; 60(1):94-100. Reading Fables activated twice as many pixels in
Abstract: BACKGROUND: fMRI allows mapping of temporal cortex as the Read Response Naming task;
neural networks underlying cognitive networks during activation in dorsolateral prefrontal cortex was similar
development, but few studies have systematically for both tasks. Small homologous right middle
examined children 7 and younger, in whom language temporal region activation was seen with reading a
networks may be more diffusely organized than in fable. CONCLUSIONS: The neural networks that
adults. OBJECTIVE: To identify neural networks process reading appear to be lateralized and localized
during early reading consolidation in young children. by middle to late childhood. Reading text paradigms
METHODS: The authors studied 16 normal, right- may prove useful for identifying frontal and temporal
handed, native English-speaking children with a mean language-processing areas and for determining
age of 7.2 years (range 5.8 to 7.9) with fMRI reading language dominance in children experiencing epilepsy
paradigms adjusted for reading level. Data were or undergoing tumor surgery.
acquired with the echoplanar imaging BOLD technique
at 1.5 T. Group data were analyzed with statistical Gaitatzis A, Purcell B, Carroll K, Sander JW, Majeed A.
parametric mapping (SPM-99); individual data sets Differences in the use of health services among people
were analyzed with a region of interest approach from with and without epilepsy in the United Kingdom:
individual study t maps (t = 4). The number of socio-economic and disease-specific determinants.
activated pixels in brain regions was determined and an Epilepsy Res 2002; 50(3):233-41.
asymmetry index (AI) ([L-R]/[L+R]) calculated for Abstract: We aim to examine the socio-economic,
each region. RESULTS: In group analysis the authors demographic and disease-specific determinants in the
found prominent activation in left inferior temporal use of health services by patients with epilepsy,
occipital junction and left fusiform gyrus (Brodmann compared to people without epilepsy. We used data
area [BA] 37), middle temporal gyrus (BA 21, 22), from the fourth national survey of morbidity in general
middle frontal gyrus (BA 44, 45), and the practice, carried out in 1991-1992. Overall mean
supplementary motor area. Activation was strongly annual number of consultations with general
lateralized in middle frontal gyrus and Wernicke areas practitioners, home visits and referrals to secondary
(AI 0.54, 0.62). Fourteen subjects had left-sided care per person were calculated for people with
language lateralization, one was bilateral, and one had epilepsy, stratified by age, sex and socio-economic
poor activation. CONCLUSIONS: The neural networks status. The proportion of patients consulting for certain
that process reading are strongly lateralized and diseases or disease groups were also calculated for
regionally specific by age 6 to 7 years. Neural patients with epilepsy. Results were compared to these
networks in early readers are similar to those in adults. in people without epilepsy, and rate ratios were
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![calculated. Patients with epilepsy consulted twice as OUTCOME MEASURES: Rates of early discharge
often, required three to four times more home visits, (<or=1-night stay after vaginal delivery and <or=3-
and were referred to secondary care three times more night stay after cesarean section) and untimely follow-
often than people without epilepsy, irrespective of age, up (no home or office visit within 2 days of early
sex and social class. Among patients with epilepsy, discharge). RESULTS: Overall, 49.4% of newborns
consultation rates and home visits were higher in were discharged early. Of these, 67.5% had untimely
females, older people and people from the manual follow-up. The odds of early discharge were greater
social classes. A higher proportion of patients with with lower incomes: the adjusted odds ratios (AORs)
epilepsy consulted for neoplasms, haematological and (with 95% confidence intervals) were 2.06 (1.50-2.83)
mental health disorders, dementia, stroke and for incomes <or=100% of poverty, 2.20 (1.65-2.93) for
gastrointestinal bleeding. Older age and low social incomes from 101%-200% of poverty, and 2.24 (1.63-
class were less strongly associated with health service 3.08) for incomes from 201%-300% of poverty.
utilisation than in people without epilepsy, indicating Untimely follow-up was more likely for infants of
that people with epilepsy lose much of the protective women with incomes <or=100% of poverty (AOR =
effect of young age and high social class on health. 1.89 [1.13-3.17]) and 201%-300% of poverty (AOR =
Factors contributing to the higher utilisation of health 1.78 [1.09-2.91]), Medicaid coverage (AOR = 1.73
services in people with epilepsy need to be studied [1.20-2.47]), Latina ethnicity (AOR = 1.47 [1.02-
further and their effects taken into account in the 2.14]), and non-English language (AOR = 1.72 [1.16-
organisation of health services for people with 2.55]). CONCLUSIONS: Despite an apparent decline
epilepsy. in short stays after legislation, many newborns--
particularly from lower-income families--continue to
Gajowy M, Simon W. [Child abuse, neglect and pregnancy be discharged early. Most newborns discharged early--
losses--combination and its psychological sequel]. particularly those with Medicaid and those from low-
Psychiatr Pol 2002; 36(6):911-27. income, Latina, and non-English-speaking homes--do
Abstract: The authors surveyed the literature focused not receive recommended follow-up. The most
on childhood mistreatment and pregnancy loss. They socioeconomically vulnerable newborns are receiving
present definitions and classifications of child abuse fewer postnatal services.
(emotional, verbal, physical, sexual), child neglect
(physical, emotional-intellectual) and pregnancy losses Galil A, Carmel S, Lubetzky H, Vered S, Heiman N.
(especially miscarriage and abortion). In the second Compliance with home rehabilitation therapy by
part of the paper a correlation between abuse and parents of children with disabilities in Jews and
pregnancy loss is displayed as well as a correlation Bedouin in Israel. Dev Med Child Neurol 2001;
between child abuse and neglect. The different kinds of 43(4):261-8.
pregnancy losses are viewed as similar in aspect of Abstract: Among key points in making progress and
psychological sequel, though their intensity and succeeding with a therapeutic programme for children
particular character depends on the mother's with disabilities is parental compliance with the regime
contribution to the loss of her child. In the last part, the for their child. The purpose of this study was to
consequences of the above correlation are discussed. evaluate factors influencing compliance with home
The clinical observations suggest, that abuse and therapy in the Jewish and Bedouin populations. Data
neglect experienced in childhood increases the were collected by structured questionnaires. A total of
probability of pregnancy loss in adulthood. On the 193 families participated (84% response rate) with
other hand, the loss of on unborn child is one of the children who ranged in age from 6 months to 6 years
factors causing child abuse and neglect. (mean age at first visit to the centre was 9.5 years in
Jews and 16.1 years in Bedouin). Compliance was
Galbraith AA, Egerter SA, Marchi KS, Chavez G, Braveman significantly lower among the Bedouin. Multivariate
PA. Newborn early discharge revisited: are California regression analysis showed that the strongest
newborns receiving recommended postnatal services? contributory factor in lack of compliance was being
Pediatrics 2003; 111(2):364-71. Bedouin. The second factor was intensity of
Abstract: CONTEXT: Responding to safety concerns, questioning destiny, indicating that parents with these
federal and state legislation mandated coverage of feelings may be less likely to comply with therapeutic
minimum postnatal stays and state legislation in regimes. Other factors which were associated with
California mandated coverage of follow-up after early compliance were parents' education and socioeconomic
discharge. Little is known about the postnatal services status: lower levels on these dimensions corresponded
newborns are receiving. OBJECTIVE: To describe with lower parental compliance. These results were
rates of early discharge and of timely follow-up for illuminated by a trial intervention programme for
early-discharged newborns. DESIGN AND SETTING: Bedouin families which involved telephone contact,
Retrospective, population-based cohort study using a translation facilities, and detailed explanations during
1999 postpartum survey in California. visits to the centre. Intervention increased the
PARTICIPANTS: A total of 2828 infants of mothers compliance rate of the Bedouin appointments with
with medically low-risk singleton births. MAIN specialists to 76% (91 of 120 appointments) thereby
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![reaching similar levels to those of the Jewish group. responsibility. Although the health visitors supported
These preliminary results indicate that the strong the principles underpinning Family Group
association between non-compliance and being Conferences, they were unsure about how to put theory
Bedouin may be due to factors of communication, and into practice. The need for more education and training
that the Bedouin are receptive to therapeutic was strongly supported to enable the model to move
interventions when communicated in their own from marginal to mainstream use. They also considered
language. that Family Group Conferences could threaten
interagency working, associated with issues relating to
Galinowski A. [Borderline personality disorder]. Encephale professional responsibility. CONCLUSIONS: The
2005; 31 Pt 2:S73-5. results identified training and procedural issues that
need to be addressed if Family Group Conferences are
Gallagher C. Initiating a pediatric office-based quality to be introduced successfully within mainstream child
improvement program. J Healthc Qual 2001; 23(2):4-9; protection practice. Insights from this study have led to
quiz 9-10, 52. inclusion of Family Group Conferences in the local
Abstract: This article describes a pediatric primary care child protection guidelines, with emphasis applied to
network's initiative to implement an office-based interdisciplinary working, empowerment of families
quality improvement (QI) program. First, network and professional staff, and education and training.
physicians determined their priorities for quality
improvement. Then primary care practitioners on the Galler JR, Waber D, Harrison R, Ramsey F. Behavioral
Quality Committee (QC), representing each local group effects of childhood malnutrition. Am J Psychiatry
practice, were educated about a physician-led QI 2005; 162(9):1760-1; author reply 1761.
process. The four steps of this process are as follows:
(1) Set quality aims, (2) determine measurements of Gandle EL. It sounds like child abuse--but is it? Am Fam
improvements, (3) generate ideas for change, and (4) Physician 2002; 65(2):330, 332, 334.
test changes. Next, the QC selected two initial projects-
-office preparedness for pediatric emergencies and Gansky SA. Dental data mining: potential pitfalls and
asthma management--and corresponding practical issues. Adv Dent Res 2003; 17:109-14.
subcommittees were formed. The pediatricians Abstract: Knowledge Discovery and Data Mining
identified QI practice changes they believed could be (KDD) have become popular buzzwords. But what
implemented successfully to make a measurable exactly is data mining? What are its strengths and
difference in children's healthcare. limitations? Classic regression, artificial neural
network (ANN), and classification and regression tree
Gallagher F, Jasper M. Health Visitors' experiences of (CART) models are common KDD tools. Some recent
Family Group Conferences in relation to child reports (e.g., Kattan et al., 1998) show that ANN and
protection planning: a phenomenological study. J Nurs CART models can perform better than classic
Manag 2003; 11(6):377-86. regression models: CART models excel at covariate
Abstract: AIMS AND BACKGROUND: The purpose interactions, while ANN models excel at nonlinear
of this study was to explore Health Visitors' covariates. Model prediction performance is examined
experiences of Family Group Conferences as part of with the use of validation procedures and evaluating
Child Protection Planning in Hampshire, England. The concordance, sensitivity, specificity, and likelihood
aim was to identify good practice, recognizing the ratio. To aid interpretation, various plots of predicted
challenges of the approach and enabling probabilities are utilized, such as lift charts, receiver
recommendations for improved collaboration to be operating characteristic curves, and cumulative
framed. The Family Group Conferences model is based captured-response plots. A dental caries study is used
on partnership, decision-making and family as an illustrative example. This paper compares the
involvement and presents an alternative to case performance of logistic regression with KDD methods
conferences. METHODS: A Husserlian of CART and ANN in analyzing data from the
phenomenological approach was adopted, using taped Rochester caries study. With careful analysis, such as
semi-structured interviews with four health visitors validation with sufficient sample size and the use of
who had experience of Family Group Conferences. proper competitors, problems of naive KDD analyses
Colaizzi's seven stages of phenomenological analysis (Schwarzer et al., 2000) can be carefully avoided.
were used. FINDINGS: The four key categories related
to the ability of the Family Group Conference model to Garbarino J, Bradshaw CP, Vorrasi JA. Mitigating the
empower families; the need for health visitors to effects of gun violence on children and youth. Future
receive appropriate education and training; Child 2002; 12(2):72-85.
organizational; and professional issues. Health visitors Abstract: Countless children and youth are exposed to
believed that Family Group Conferences could gun violence each year--at home, at school, in their
empower families, but they felt unprepared to attend. communities, or through the media. Gun violence can
Concerns were identified regarding confidentiality and leave lasting emotional scars on these children. This
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![article reviews research regarding the psychological administered by mail to parents, teenagers, and
effects of gun violence on children and youth, and teachers. RESULTS: Parents were more likely to rate
offers suggestions for how parents, school ELGA teenagers than control subjects as in the
administrators, and mental health workers can mitigate "abnormal" range for hyperactivity (8% vs 1%;
these negative effects. Children exposed to gun difference: 7%; (95% confidence interval [CI]: 2-12),
violence may experience negative short- and long-term peer relationship problems (19% vs 5%; difference:
psychological effects, including anger, withdrawal, 14%; 95% CI: 6-21), and emotional problems (18% vs
posttraumatic stress, and desensitization to violence. 7%; difference: 11%; 95% CI: 3-19), but not conduct
All of these outcomes can feed into a continuing cycle problems (10% vs 5%; difference: 5%; 95% CI: -1 to
of violence. Certain children may be at higher risk for 12)). Teachers reported a similar pattern. In contrast,
negative outcomes if they are exposed to gun violence. compared with control subjects, ELGA teenagers did
Groups at risk include children injured in gun violence, not rate themselves as having more problems with
those who witness violent acts at close proximity, those peers, hyperactivity, conduct, depression, or low self-
exposed to high levels of violence in their communities esteem. They reported more emotional problems but
or schools, and those exposed to violent media. less delinquency, alcohol, cannabis, and other drug use.
Parents, school administrators, and mental health CONCLUSIONS: Compared with mainstream
workers all can play key roles in protecting children classmates, children who are born extremely early
from gun violence and helping them overcome the continue to have higher levels of parent- and teacher-
effects of gun-related trauma. The authors recommend reported emotional, attentional, and peer problems well
a number of strategies that adults can adopt to help into their teens. However, despite these problems, they
children cope with gun violence, such as increasing do not show signs of more serious conduct disorders,
parental monitoring, targeting services to youth at risk delinquency, drug use, or depression.
of violent activity, and developing therapeutic
interventions to help traumatized young people. Gardner HB. Hypoxia leading to intracranial problems may
be a retinal haemorrhage. Neuropathol Appl Neurobiol
Garber M, Hunt SC, Arnold RM. Ask the ethicist: can an 2004; 30(2):192.
HIV-positive woman be forced to take medicine to
protect her fetus? Med Ethics (Burlingt, Mass) 2004; Gardner JM, Powell CA, Baker-Henningham H, Walker SP,
11(3):3, 12. Cole TJ, Grantham-McGregor SM. Zinc
Notes: GENERAL NOTE: KIE: 5 refs. supplementation and psychosocial stimulation: effects
GENERAL NOTE: KIE: KIE Bib: AIDS; fetuses; on the development of undernourished Jamaican
treatment refusal children. Am J Clin Nutr 2005; 82(2):399-405.
Abstract: BACKGROUND: Undernourished children
Garcia DP. Living without immunizations--a new growing have poor levels of development that benefit from
trend. J Ky Med Assoc 2005; 103(3):109-11. stimulation. Zinc deficiency is prevalent in
undernourished children and may contribute to their
Gardner F, Johnson A, Yudkin P et al. Behavioral and poor development. OBJECTIVE: We assessed the
emotional adjustment of teenagers in mainstream effects of zinc supplementation and psychosocial
school who were born before 29 weeks' gestation. stimulation given together or separately on the
Pediatrics 2004; 114(3):676-82. psychomotor development of undernourished children.
Notes: CORPORATE NAME: Extremely Low DESIGN: This was a randomized controlled trial with
Gestational Age Steering Group 4 groups: stimulation alone, zinc supplementation
Abstract: OBJECTIVES: To investigate behavioral and alone, both interventions, and control (routine care
emotional problems and positive adjustment of 15-to only). Subjects were 114 children aged 9-30 mo and
16-year-olds who were born at extremely low below -1.5 z scores of the National Center for Health
gestational age (ELGA), from the perspective of Statistics weight-for-age references who were recruited
parents, teachers, and teenagers. METHODS: from 18 health clinics. Clinics were randomly assigned
Prospective follow-up was conducted of birth cohorts, to receive stimulation or not; individual children were
with classroom control subjects. All infants who were randomly assigned to receive zinc or placebo. The
born before 29 weeks in 1983-1984 (mean gestational stimulation program comprised weekly home visits
age: 27 weeks) to mothers who resided in 3 regions of during which play was demonstrated and maternal-
the United Kingdom were studied. A total of 82% (179 child interactions were encouraged. The
of 218) of survivors were traced at age 15 to 16. The supplementation was 10 mg Zn as sulfate daily or
150 in mainstream school were compared with age- placebo. Development (assessed by use of the Griffiths
and gender-matched classroom control subjects (n = Mental Development Scales), length, and weight were
108). Behavioral and emotional problems, delinquency, measured at baseline and 6 mo later. Weekly morbidity
peer relations, self-esteem, and hobbies, were assessed histories were taken. RESULTS: Significant
by standardized, well-validated instruments, including interactions were found between zinc supplementation
the Strengths and Difficulties Questionnaire, and stimulation. Zinc benefited the developmental
quotient only in children who received stimulation, and
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![benefits from zinc to hand and eye coordination were mother-twins relationship. The impossibility to
greater in stimulated children. Zinc supplementation establish a dyadic relationship with each child creates
alone improved hand and eye coordination, and feelings of frustration and guilt. The risk of child abuse
stimulation alone benefited the developmental quotient, is increased in twins. The balanced psychoemotional
hearing and speech, and performance. Zinc development of twins requires parental attitudes
supplementation also reduced diarrheal morbidity but enhancing their individualization as opposed to their
did not significantly improve growth. CONCLUSION: "collectivization". The risk of prematurity is ten times
Zinc supplementation benefits development in increased in twins which increases the risks of
undernourished children, and the benefits are enhanced developmental disabilities. Considering that the
if stimulation is also provided. number of twin deliveries is rising in our country it is
important to be aware of the problems experienced by
Gardner JM, Walker SP, Powell CA, Grantham-McGregor the families and to improve the way material and
S. A randomized controlled trial of a home-visiting psychological help is provided to them.
intervention on cognition and behavior in term low
birth weight infants. J Pediatr 2003; 143(5):634-9. Garg VK, Agarwalla A, Agrawal S, Deb M, Khanal B.
Abstract: OBJECTIVES: To determine whether early Sexual habits and clinico-etiological profile of sexually
psychosocial intervention with low birth weight term transmitted diseases in Nepal. J Dermatol 2001;
(LBW-T) infants improved cognition and behavior and 28(7):353-9.
to compare LBW-T with normal birth weight (NBW) Abstract: A total of 100 patients giving histories
infants. STUDY DESIGN: A randomized controlled suggestive of sexually transmitted disease (STDs) and
trial was carried out in Kingston, Jamaica, with 140 attending the dermatology OPD at BPKIHS (B.P.
LBW-T infants (weight<2500 g). The intervention Koirala Institute of Health Sciences) in Nepal over a
comprised weekly home visits by paraprofessionals for period of one year from 1st July 1999 to 30th June
the first 8 weeks of life aimed at improving maternal- 2000 were included in this study. Out of 10,400 new
child interaction. LBW-T and 94 matched NBW dermatology cases, a total of 100 cases (0.96%) of
(weight 2500 to 4000 g) infants were recruited from the STDs were seen. Of these 73 were males, and the
main maternity hospital. Main outcome measures were majority (53%) were in the age group of 21-30 years.
problem solving (2 means-end tests: cover and support) Most of the patients were from Sunsari district (54%).
and 4 behavior ratings at 7 months. Analyses used were The most common profession (21%) was businessman
the t test for intervention effects and multiple followed by housewife (19%). The most common age
regression to compare LBW and NBW infants. for first sexual contact was 16 to 19 years (45%).
RESULTS: LBW-T intervened infants had higher Eleven percent had their first sexual contact at the age
scores than LBW-T control infants on the cover test of 15 or below 15 years. Premarital sexual exposure
(P<.05) and were more cooperative (P<.01) and happy was recorded in 17% of the unmarried males. There
(P<.05). LBW-T control infants had poorer scores on were only 3 homosexuals and 1 bisexual patient.
both the cover (P<.001) and support tests (P<.01), Multiple contacts were recorded in 55% of the patients.
vocalized less (P<.02), and were less cooperative The most common source of contact was a commercial
(P<.001), happy (P<.02), and active (P<.02) than NBW sex worker in 34.15%. Condoms were always used by
infants. LBW-T intervened infants had lower scores only 7%. The various types of sexually trasmitted
than NBW infants only on the support test (P<.05). diseases (STDs) were syphilis (31%) followed by
CONCLUSIONS: Early low-cost intervention can condylomata acuminata (16%), herpes genitalis (15%),
improve cognition and behavior of LBW-T infants in gonorrhoea (9%), and mixed infections (12%). Despite
developing countries. their varied sexual behavior, none of the patients were
HIV positive; however, it is always advisable to screen
Garel M, Chavanne-De Weck E, Blondel B. [Psychological all STD patients for HIV antibody.
consequences of twinship on the children and their
parents]. J Gynecol Obstet Biol Reprod (Paris) 2002; Garno JL, Goldberg JF, Ramirez PM, Ritzler BA. Impact of
31(1 Suppl):2S40-5. childhood abuse on the clinical course of bipolar
Abstract: This paper presents a synthesis about the disorder. Br J Psychiatry 2005; 186:121-5.
psychological consequences of twinship based on a Abstract: BACKGROUND: Few investigations have
review of the literature and on our clinical experience. examined the impact of childhood trauma, and domains
During pregnancy, delivery and the immediate post- of childhood abuse, on outcome in bipolar disorder.
partum, mothers experience physical and psychological AIMS: To evaluate the prevalence and subtypes of
difficulties linked with increased medical risks for childhood abuse reported by adult patients with bipolar
themselves and for the children. The twins mortality is disorder and relationship to clinical outcome.
high before and after delivery. Grieving for one twin METHOD: Prevalence rates of childhood abuse were
creates particular problems for parents. During first retrospectively assessed and examined relative to
months after hospital discharge mothers encounter illness complexity in a sample of 100 patients at an
material and emotional stress. They are caused by academic specialty centre for the treatment of bipolar
overload of mothering tasks and the specificity of disorder. RESULTS: Histories of severe childhood
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![test these hypotheses, while controlling for self- specific avoidable causes. The use of three reference
reported delinquency, friends' delinquency, and values (the mean, the quintile with the greatest SEDI,
individual as well as family characteristics. METHOD: and the optimal empirical reference value) makes it
The sample included 756 boys first assessed when they possible to measure gaps that could be avoided. The
attended kindergarten in disadvantaged areas of ratio of the lowest SEDI quintile to the empirical
Montreal. Gang membership was assessed at the ages optimal reference value was 2.1 for AM, 2.0 for PYLL,
of 14, 15 and 16 years. Delinquency and drug use data 1.7 for infant mortality, and 1.5 for HCAMR.
were collected from self-reports and court files at the CONCLUSIONS: These results, which are consistent
same ages. RESULTS: Gang members displayed far with those found in previous published sources,
higher rates of delinquent behaviour and drug use than estimate the magnitude and pattern of variations among
non-gang members. The results support the facilitation communes. The results also provide information, based
model for transient gang members (i.e., youths in a on data for 1992, with which to start monitoring health
gang during only one of the three periods considered) inequalities among small geographic areas, which were
and the enhancement model for stable gang members communes in this particular case. Although
(i.e., youths in a gang for at least two of the periods interventions for promoting equity tend to focus
considered), for person and property offences. The exclusively on communes having lower socioeconomic
association between gang membership and delinquency development and higher rates of avoidable mortality,
persisted after introducing the control variables. reducing the latter implies a two-pronged approach:
Additional analyses showed that the effect associated prioritizing interventions targeting underprivileged
with belonging to a gang was beyond that of simply communes so as to foster equity, while attempting to
having delinquent friends. CONCLUSION: Preventing cover the majority of communes in an effort to prevent
the creation and participation in such gangs should avoidable mortality.
reduce the frequency of antisocial behaviour during
adolescence. Gautier T, Droit-Volet S. Attention and time estimation in 5-
and 8-year-old children: a dual-task procedure. Behav
Gattini C, Sanderson C, Castillo-Salgado C. [Using different Processes 2002; 58(1-2):57-66.
indicators of preventable mortality as an approach to Abstract: This experiment tested the effect of a dual-
measuring health inequalities in Chilean task on time reproduction in 5- and 8-year-olds.
municipalities]. Rev Panam Salud Publica 2002; Children had to reproduce a stimulus duration lasting
12(6):454-61. for 6 or 12 s, during which they either did or did not
Abstract: OBJECTIVES: To analyze differences in perform a concurrent non-temporal task (i.e. picture
avoidable mortality among communes in Chile, using naming) both in low (LA) and high (HA) attentional
different indicators as an operational approach to demand conditions. The results showed that children
estimating health inequalities. METHODS: Small area reproduced shorter durations in the dual-task than in
variation analysis in a sample of 117 of all 335 Chilean the single-task condition, whatever the duration value
communes that existed in 1992. By using secondary used. However, this shortening effect was greater in the
data, we developed and compared some avoidable- 5-year-olds than in the 8-year-olds. Furthermore, in the
mortality indicators, such as potential years of life lost 5-year-olds, temporal reproductions were significantly
(PYLL), avoidable mortality (AM) (based on shorter in both dual-tasks (LA or HA) than in the
background and criteria drawn from the literature), single-task, whereas, in the 8-year-olds, differences
health care avoidable mortality (HCAMR), and life reached significance only between the HA dual-task
expectancy. A socioeconomic development index and the single-task. In the non-temporal task, the
(SEDI) was also developed. The scope of the variation proportion of naming errors was also greater in the
was estimated through the weighted variation dual-task than in the single-task, especially under high
coefficient, the Gini coefficient, the ratio between the attentional demand, but it did not significantly differ
values for the quintiles at both extremes of the SEDI between the two age groups tested.
distribution, and the ratio of the lowest SEDI quintile
to the group of municipalities having a SEDI greater Gauvin S, Le Moullec Y, Bremont F et al. Relationships
than 0.90 (optimal empirical reference value). The between nitrogen dioxide personal exposure and
socioeconomic pattern of variations was examined ambient air monitoring measurements among children
through concentration curves and by comparing in three French metropolitan areas: VESTA study.
communal quintiles based on their SEDI. RESULTS: Arch Environ Health 2001; 56(4):336-41.
The various avoidable-mortality indicators used Abstract: In epidemiological studies, investigators have
showed an inverse and statistically significant routinely used ambient air concentrations, measured by
correlation with socioeconomic development, as well air-quality monitoring networks, to assess exposure of
as with the profile of the various SEDI quintiles and subjects. When there is great spatial variability of
with the majority of specific causes of avoidable ambient air concentrations or when there are specific
mortality. The distribution profile of AM indicators indoor exposures, this approach may yield substantial
among SEDI communal quintiles reflects the same exposure misclassification and distort the associations
tendency, along with most of the mortality from between exposure and the health endpoints of interest.
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![multidisciplinary collaboration and advance the study (200):8-9.
of human milk and lactation.
Getahun H. Marriage through abduction ('Telefa') in rural
Gereda JE, Klinnert MD, Price MR, Leung DY, Liu AH. north west Ethiopia. Ethiop Med J 2001; 39(2):105-12.
Metropolitan home living conditions associated with Abstract: A community based cross sectional study was
indoor endotoxin levels. J Allergy Clin Immunol 2001; conducted in a rural district of North West Ethiopia
107(5):790-6. between February and April 1997 to determine the
Abstract: BACKGROUND: Household endotoxin magnitude of marriage through abduction ('Telefa') and
exposure in allergy and asthma has been gaining identify problems associated with it. Randomly
attention for its dual potential to exacerbate these selected and currently married 1,168 women were
conditions in individuals with established disease and interviewed. The prevalence of marriage through
to abrogate atopy before disease onset. OBJECTIVE: abduction was 6.2% (72/1168). All the abductions
We sought to better understand the home reported were only once in lifetime during the first
environmental and lifestyle factors influencing house marriage. The median age at first marriage of abducted
dust endotoxin levels. METHODS: From the homes of women was 13 years with a range of 13 (Minimum = 7
86 infants with wheeze in metropolitan Denver, and Maximum 20). About two third (66.7%) of
Colorado, house dust endotoxin (detected with a abducted women had been married more than once in
standardized Limulus Amebocyte Lysate assay) and their life time. Following a multivariate analysis in a
common indoor allergen (Fel d 1, Can f 1, Der p 1, Der logistic regression model abducted women were likely
f 1, and Bla g 1) contents were quantified. to be victims of abortion [Adjusted OR (95% CI) =
Comprehensive home environment and lifestyle 1.71 (1.10-3.05)], marital instability [Adjusted OR
questionnaires were completed during home visits by (95% CI) = 1.87 (1.10-3.18)], rape [Adjusted OR (95%
trained study staff and parents. RESULTS: House dust CI) = 7.77 (3.78-15.95)] and domestic violence
endotoxin levels were associated with only 2 home [Adjusted OR (95% CI) = 1.69 (1.11-2.81)]. The
environmental features: animals in the home and the recognition of the magnitude and the associated health
presence of central air conditioning. The strongest problems of marriage through abduction (Telefa) is
positive associations were found with animals in the important. Appropriate strategies that address the
home. Interestingly, the homes without cats or other health needs of abducted women must be designed.
animals revealed a negative correlation between house Enforcing the judiciary system to discourage this
dust Fel d 1 and endotoxin (P =.03). Central air harmful practice and empowerment of young girls and
conditioning, especially during months of typical use, rural women is needed.
was associated with lower house dust endotoxin levels.
No significant associations between house dust Ghazvini A, Mullis RL. Center-based care for young
endotoxin levels and home dampness, number of children: examining predictors of quality. J Genet
household inhabitants or young children, cleaning Psychol 2002; 163(1):112-25.
frequency, or presence of tobacco smokers in the home Abstract: The authors collected information from
were found. CONCLUSIONS: Indoor endotoxin caregivers, trained observers, and parents to investigate
exposure can be increased by the presence of animals quality elements in child-care programs designed for
in the home and decreased with central air young children in center-based settings. Participants
conditioning. In some homes without animals, where were 75 parents of children aged 15 to 36 months and
allergen exposure adequate for sensitization still their caregivers from 13 child-care centers in a
occurs, there are lower levels of house dust endotoxin. southeastern state. Observers collected indicators of
Therefore in homes without animals, factors that program quality and process and structural quality
influence allergen and endotoxin levels in house dust indicators, including adult-child ratio, group size, use
probably differ. Households with detectable allergen of planned activities, use of child-designated space,
levels but low endotoxin levels may provide a housekeeping activities, and caregiver-child
predisposing environment for animal allergen interactions. Participants responded to questions
sensitization. regarding their child-rearing beliefs, social support
networks, perceived stress levels, and demographic
Germain A. Reproductive health and human rights. Lancet characteristics. The best predictors of higher quality
2004; 363(9402):65-6. care and sensitive caregiver-child interaction in centers
Notes: GENERAL NOTE: KIE: 17 refs. were specialized caregiver training, higher adult-child
GENERAL NOTE: KIE: KIE Bib: reproduction ratios, use of planned activities, and less perceived
stress by caregivers. Implications of these findings are
Gerressu M, French RS. Using the Internet to promote discussed.
sexual health awareness among young people. J Fam
Plann Reprod Health Care 2005; 31(4):267, 269-70. Ghetti S, Alexander KW, Goodman GS. Legal involvement
in child sexual abuse cases. Consequences and
Gervaise S. [Seeds of violence]. Soins Pediatr Pueric 2001; interventions. Int J Law Psychiatry 2002; 25(3):235-51.
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![catheterisation in children with congenital heart income, inner-city neighborhoods. PARTICIPANTS:
disease. Altogether 3666 surgical procedures and 1828 First- and second-year pediatric residents and their
therapeutic catheterisations were performed. Central patient-parent dyads. INTERVENTIONS: Parents in
tracking of mortality identified 469 deaths, 194 the standard-intervention group received safety
occurring within 30 days and 275 later. Forty two of counseling and referral to the children's safety center
the 194 deaths within 30 days were detected by central from their pediatrician. Parents in the enhanced-
tracking but not by volunteered data. For surgery intervention group received the standard services plus a
overall, survival at 30 days was 94.9%, falling to home-safety visit by a community health worker.
91.2% at one year; this effect was most marked for OUTCOMES: Home observers assessed the following
infants. For therapeutic catheterisation survival at 30 safety practices: reduction of hot-water temperature,
days was 99.1%, falling to 98.1% at one year. Survival poison storage, and presence of smoke alarms, safety
of individual centres or individual operators did not gates for stairs, and ipecac syrup. RESULTS: The
differ from the national average after benchmark prevalence of safety practices ranged from 11% of
procedures. CONCLUSIONS: Independent data parents who stored poisons safely to 82% who had a
validation is essential for accurate survival analysis. working smoke alarm. No significant differences in
One year survival gives a more realistic view of safety practices were found between study groups.
outcome than traditional perioperative mortality. However, families who visited the children's safety
Currently no detectable difference exists in survival center compared with those who did not had a
between any of the 13 UK tertiary congenital heart significantly greater number of safety practices (34%
disease centres, but confidence intervals for small vs 17% had > or 3). CONCLUSIONS: Home visiting
centres are wide, limiting our power to detect was not effective in improving parents' safety practices.
underperformance from analysis of a single year's data. Counseling coupled with convenient access to reduced-
Appropriately resourced, focused national audit is cost products appears to be an effective strategy for
capable of accurate data collection on which promoting children's home safety.
nationwide, long term quality control can be based.
Gigantesco A, Camuffo M, Mirabella F, Morosini P.
Giedd JN. The anatomy of mentalization: a view from [Parental evaluation of child and adolescent mental
developmental neuroimaging. Bull Menninger Clin health services: a multicentric study]. Ann Ist Super
2003; 67(2):132-42. Sanita 2005; 41(4):501-13.
Abstract: The capacity for mentalization emerges from Abstract: A self-completed questionnaire for routinely
developmental changes in the physical structure of the assessing parents' opinions on the quality of care in
brain. Although pediatric imaging studies have not child and adolescent mental health services was
directly addressed the process of mentalizing, general developed. A reliability study was performed, and the
principles of brain development may shed light on the questionnaire was then introduced in the practice of 5
neurobiology of mentalization. Increases in white services. Parents' opinions were evaluated, and specific
matter, which speeds communication between brain aspects of services more associated with the overall
cells, growing complexity of neuronal networks opinion were investigated. Very good results were
suggested by gray matter changes, and environmentally observed in the reliability study. Parents had critical
sensitive plasticity are all essential aspects in a child's opinions about the availability of the rehabilitative
ability to mentalize and maintain the adaptive equipment, emergency management, and linkage
flexibility necessary for healthy transition into among different types of services. The judgement
adulthood. about health outcomes was the most important
predictor of the overall opinion on the quality of
Gielen AC, McDonald EM, Wilson ME et al. Effects of services. Because of its user-friendliness, the
improved access to safety counseling, products, and questionnaire may be particularly suitable for routine
home visits on parents' safety practices: results of a use.
randomized trial. Arch Pediatr Adolesc Med 2002;
156(1):33-40. Gilgoff D. A settlement in Boston. US News World Rep
Abstract: OBJECTIVE: To present the results of an 2003; 135(9):28.
intervention trial to enhance parents' home-safety
practices through pediatric safety counseling, home Gill D. Ethical principles and operational guidelines for
visits, and an on-site children's safety center where good clinical practice in paediatric research.
parents receive personalized education and can Recommendations of the Ethics Working Group of the
purchase reduced-cost products. DESIGN: Confederation of European Specialists in Paediatrics
Pediatricians were randomized to a standard- or an (CESP). Eur J Pediatr 2004; 163(2):53-7.
enhanced-intervention group. Parents of their patients Notes: CORPORATE NAME: Ethics Working Group
were enrolled when the patient was 6 months or of the Confederation of European Specialists in
younger and observed until 12 to 18 months of age. Paediatrics
SETTING: A hospital-based pediatric resident Abstract: A child has the full right of protection of
continuity clinic that serves families living in low-
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![were compared: children with (a) invisible friends, (b) Glick S. [Child abuse--undiagnosed]. Harefuah 2002;
companions who were personified objects (e.g., dolls), 141(10):879-82, 931, 930.
and (c) no imaginary companion. Results indicated that Abstract: We present the case of a 2 1/2 year old child
children differentiated the relationships in their social brought to the emergency room by his mother, a nurse
networks according to provisions. Parent-child at that hospital, and her companion, because of a
relationships afforded instrumental help and siblings fractured clavicle. Over the next 14 days the child was
were associated with conflict. Provisions of real and seen by a variety of physicians in different sites (3
imaginary friendships were similar, although imaginary different emergency rooms, pediatricians' offices,
friends were preferred as objects of nurturance. Results orthopedic clinics) for various injuries. Each individual
imply that 4-year-old children have developed injury was treated separately, and the diagnosis of a
differentiated relationship schemas and that those of battered child syndrome was not entertained. The child
children with invisible friends may be particularly was not undressed completely and numerous clues to
distinct. the diagnosis went undetected. A greater sensitivity to
the diagnosis of child abuse is essential. More careful
Glew GM, Fan MY, Katon W, Rivara FP, Kernic MA. history-taking, more thorough physical examination
Bullying, psychosocial adjustment, and academic and better interinstitutional communication are
performance in elementary school. Arch Pediatr essential if child abuse is to be detected in its earliest
Adolesc Med 2005; 159(11):1026-31. phases.
Abstract: BACKGROUND: Over the past decade,
concerns about bullying and its role in school violence, Glowinski AL, Bucholz KK, Nelson EC et al. Suicide
depression, and health concerns have grown. However, attempts in an adolescent female twin sample. J Am
no large studies in the United States have examined the Acad Child Adolesc Psychiatry 2001; 40(11):1300-7.
prevalence of bullying during elementary school or its Abstract: OBJECTIVE: To examine suicide attempts in
association with objective measures of school an epidemiologically and genetically informative youth
attendance and achievement. OBJECTIVE: To sample. METHOD: 3,416 Missouri female adolescent
determine the prevalence of bullying during elementary twins (85% participation rate) were interviewed from
school and its association with school attendance, 1995 to 2000 with a telephone version of the Child
academic achievement, disciplinary actions, and self- Semi-Structured Assessment for the Genetics of
reported feelings of sadness, safety, and belonging. Alcoholism, which includes a detailed suicidal
DESIGN: Cross-sectional study using 2001-2002 behavior section. Mean age was 15.5 years at
school data. SETTING: Urban, West Coast public assessment. RESULTS: At least one suicide attempt
school district. PARTICIPANTS: Three thousand five was reported by 4.2% of the subjects. First suicide
hundred thirty (91.4%) third, fourth, and fifth grade attempts were all made before age 18 (and at a mean
students. MAIN OUTCOME MEASURE: Self- age of 13.6). Major depressive disorder, alcohol
reported involvement in bullying. RESULTS: Twenty- dependence, childhood physical abuse, social phobia,
two percent of children surveyed were involved in conduct disorder, and African-American ethnicity were
bullying either as a victim, bully, or both. Victims and the factors most associated with a suicide attempt
bully-victims were more likely to have low history. Suicide attempt liability was familial, with
achievement than bystanders (odds ratios [ORs], 0.8 genetic and shared environmental influences together
[95% confidence interval (CI), 0.7-0.9] and 0.8 [95% accounting for 35% to 75% of the variance in risk. The
CI, 0.6-1.0], respectively). All 3 bullying-involved twin/cotwin suicide attempt odds ratio was 5.6 (95%
groups were significantly more likely than bystanders confidence interval [CI] 1.75-17.8) for monozygotic
to feel unsafe at school (victims, OR, 2.1 [95% CI, 1.1- twins and 4.0 (95% CI 1.1 -14.7) for dizygotic twins
4.2]; bullies, OR, 2.5 [95% CI, 1.5-4.1]; bully-victims, after controlling for other psychiatric risk factors.
OR, 5.0 [95% CI, 1.9-13.6]). Victims and bully-victims CONCLUSIONS: In women, the predisposition to
were more likely to report feeling that they don't attempt suicide seems usually to manifest itself first
belong at school (ORs, 4.1 [95% CI, 2.6-6.5] and 3.1 during adolescence. The data show that youth suicide
[95% CI, 1.3-7.2], respectively). Bullies and victims attempts are familial and possibly influenced by
were more likely than bystanders to feel sad most days genetic factors, even when controlling for other
(ORs 1.5 [95% CI, 1.2-1.9] and 1.8 [95% CI, 1.2-2.8], psychopathology.
respectively). Bullies and bully-victims were more
likely to be male (ORs, 1.5 [95% CI, 1.2-1.9] and 3.0 Glowinski AL, Jacob T, Bucholz KK, Scherrer JF, True W,
[95% CI, 1.3-7.0], respectively). CONCLUSIONS: Heath AC. Paternal alcohol dependence and offspring
The prevalence of frequent bullying among elementary suicidal behaviors in a children-of-twins study. Drug
school children is substantial. Associations between Alcohol Depend 2004; 76 Suppl:S69-77.
bullying involvement and school problems indicate this Abstract: INTRODUCTION: In substance abusing
is a serious issue for elementary schools. The research families, sources of familial comorbidity are potentially
presented herein demonstrates the need for evidence- confounded by genetic-environmental (GE) interplays.
based antibullying curricula in the elementary grades. The children-of-twins (COT) design can be used to
elucidate the association of a parental trait and an
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![aspects of this issue, medical experts adopt their own on youth victimization, crime and delinquency in
rules for insulin regimen specification and dose Alberta conducted by the Canadian Research Institute
adjustment. This paper investigates the application of a for Law and the Family in collaboration with
neural network approach for the development of a researchers from the University of Alberta. The survey
prototype system for knowledge classification in this included 2,001 youth attending Grades 7 to 12 in
domain. The system will further facilitate decision public and Catholic schools in selected urban and rural
making for diabetic patient management by insulin areas in the province. Analyses focus on self-reported
administration. In particular, a generating algorithm for past-year delinquency. Statistically significant results
learning arbitrary classification is employed. The were found for relationships between extent of
factors participating in the decision making were delinquency and gender, grade level, psychosocial
among other diabetes type, patient age, current problems (as measured by conduct, hyperactivity, and
treatment, glucose profile, physical activity, food emotional problems), and extent of past-year
intake, and desirable blood glucose control. The victimization. For low/moderate delinquency, females
resulting system was trained with 100 cases and tested were comparable to males, and even reported slightly
on 100 patient cases. The system proved to be higher rates for low/moderate violence-related
applicable to this particular problem, classifying delinquency. Younger students were more likely to
correctly 92% of the testing cases. indicate engaging in violence-related delinquency,
while older students were more likely to report
Gold J, Bugg G. Alberta law confining child prostitutes property-related delinquent acts. Overall, Grade 9
upheld. Can HIV AIDS Policy Law Rev 2001; 6(1- students had the highest rates of delinquency. For
2):34-5. personal characteristics, a high score on conduct
Abstract: The Alberta Court of Queen's Bench has problems was most strongly correlated with
determined that the Alberta Protection of Children moderate/high delinquency. The relationship between
Involved in Prostitution Act is not in violation of the high levels of delinquency and victimization was
Constitution. This decision overturns the ruling of the stronger for violence-related delinquency than for
Provincial Court, which held that the Act infringes the property-related delinquency.
rights articulated in sections 7, 8, and 9 of the Charter.
Gomez-Dantes O, Gomez-Jauregui J, Inclan C. [Equity and
Golombok S, MacCallum F, Goodman E, Rutter M. fairness in the Mexican health system reform]. Salud
Families with children conceived by donor Publica Mex 2004; 46(5):399-416.
insemination: a follow-up at age twelve. Child Dev Abstract: OBJECTIVE: To assess the equity and
2002; 73(3):952-68. fairness of the Mexican health system reform that
Abstract: Growing public awareness of the use of occurred in the late 1990's. MATERIAL AND
donor insemination (DI) to enable infertile couples to METHODS: The Mexican reform process was
become parents has been accompanied by increasing evaluated using the benchmark-system designed by
concern regarding the potentially negative Daniels et al. This benchmark system was adapted to
consequences for family relationships and child the Mexican setting by adding specific indicators. A
development. Findings are presented from a documentary review of the Mexican reform process
prospective study of the quality of parenting and was conducted to score its performance for each
psychological adjustment of DI children at age 12. benchmark. RESULTS: Except for housing and
Thirty-seven DI families, 49 adoptive families, and 91 nutrition components, the reform included few actions
families with a naturally conceived child were related to health determinants. For health care, the
compared on standardized interview and questionnaire main reform initiatives were those related to extending
measures administered to mothers, fathers, children, the coverage of essential health services and
and teachers. The differences between DI families and decentralizing health care provision to the states.
the other family types reflected greater expressive Reform initiatives included few activities related to fair
warmth of DI mothers toward their children and less financing, tiering, emphasis on second and third level
involvement in the discipline of their children by DI care, accountability, and transparency.
fathers. The DI children were well adjusted in terms of CONCLUSIONS: The late nineties reform of the
their social and emotional development. The findings Mexican health system had some positive effect on
are discussed with respect to the secrecy surrounding access of the poor to health care and administrative
DI and the imbalance in genetic relatedness between efficiency, but little impact on fair financing, quality of
the parents and the child. care, and democratic governance. The English version
of this paper is available at:
Gomes JT, Bertrand LD, Paetsch JJ, Hornick JP. Self- http://www.insp.mx/salud/index.html.
reported delinquency among Alberta's youth: findings
from a survey of 2,001 junior and senior high school Gonzalez de Dios J. [Neonatal neurology decision-making
students. Adolescence 2003; 38(149):75-91. starting from systematic reviews of Cochrane
Abstract: This article draws on data from a 1999 survey Collaboration]. Rev Neurol 2005; 40(8):453-9.
Abstract: INTRODUCTION: Cochrane Collaboration
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![professionals use knowledge as a resource to influence strategies to work on the prevention of infant
the policy process. Other actors (e.g. managers and psychopathological disorders as well as the parenting
municipalities) use formal power, money or 'initiative' process. The aspects on early development on children
as their main resources. Powerful actors put forward are specially emphasized describing the interventions
less scientific knowledge than actors in dependent to promote the development and the care of the
positions. Individual actors with a combined scientific protective factors, the resilience, as well as to approach
and political frame of reference put forward knowledge the risk factors. This is illustrated threw a clinical case.
most frequently, especially in complex networks with
many actors, more than one powerful actor, more than Gostin LO. AIDS in Africa among women and infants: a
one arena, more than one dominant resource and more human rights framework. Hastings Cent Rep 2002;
than one dominant frame of reference. CONCLUSION: 32(5):9-10.
The use of scientific knowledge in school health care Notes: GENERAL NOTE: KIE: 16 refs.
policy-making processes can and must be improved. GENERAL NOTE: KIE: KIE Bib: AIDS
Liaison officers can bridge the gap between doctors
and policymakers, especially in complex policy Gottdiener WH. Psychoanalysis and schizophrenia: three
networks. They combine a scientific and a political responses to Martin Willick. J Am Psychoanal Assoc
frame of reference and act upon scientific knowledge 2002; 50(1):314-6; author reply 316-9.
as a resource in their efforts to influence the policy-
making process. Gottlieb G, Halpern CT. A relational view of causality in
normal and abnormal development. Dev Psychopathol
Gormally L. The Maltese conjoined twins. Second Opin 2002; 14(3):421-35.
(Chic) 2001; (8):36-52. Abstract: An understanding of developmental
Notes: GENERAL NOTE: KIE: Gormally, Luke phenomena demands a relational or coactive concept of
GENERAL NOTE: KIE: 21 fn. causality, as opposed to a conceptualization that
GENERAL NOTE: KIE: KIE Bib: patient care/minors assumes that singular causes can act in isolation. In this
article we present a developmental psychobiological
Gorman-Smith D, Tolan PH, Henry DB et al. Predictors of systems view of relational (bidirectional, coactional)
participation in a family-focused preventive causality, in which it is proposed that developmental
intervention for substance use. Psychol Addict Behav outcomes are a consequence of at least two specific
2002; 16(4 Suppl):S55-64. components of coaction from the same or different
Abstract: This study reports patterns of involvement in levels of a developmental system. The levels are
a family-focused preventive intervention, Schools and genetic, neural, behavioral, and environmental; the
Families Educating (SAFE) Children, targeting early latter level includes the cultural, social, and physical
predictors of risk for delinquency and drug use among aspects of an organism's environment. We show the
175 African American and Latino first-grade children applicability of this view to the understanding of the
living in economically disadvantaged inner-city development of normal and abnormal behavioral and
neighborhoods. Three empirically derived patterns psychological phenotypes through illustrations from
emerged: joiners, responders, and minimal responders. the existing animal and human literature. Finally, we
Joiners were immediately responsive and enthusiastic discuss future possibilities and potential stumbling
and participated fully. Responders attended fully only blocks in the implementation of a more fully realized
after extensive effort was made to recruit and retain bidirectional, coactional perspective in developmental
them. However, once engaged, they attended fully and psychopathological research.
participated with enthusiasm. Minimal responders
attended a few sessions sporadically even with Gou Z, Fyfe C. A canonical correlation neural network for
extensive, ongoing effort to engage them. Ethnicity, multicollinearity and functional data. Neural Netw
marital status, parental antisocial behavior, economic 2004; 17(2):285-93.
and loss stressors, monitoring, and child's depression Abstract: We review a recent neural implementation of
and hyperactivity were significant discriminators of Canonical Correlation Analysis and show, using ideas
group membership. suggested by Ridge Regression, how to make the
algorithm robust. The network is shown to operate on
Gorodisch R. [Endemic social exclusion and early data sets which exhibit multicollinearity. We develop a
development: "made in Chacarita"]. Vertex 2004; second model which not only performs as well on
15(56):115-20. multicollinear data but also on general data sets. This
Abstract: My aim is to introduce in this article a project model allows us to vary a single parameter so that the
that two foundations are developing in Chacarita, a network is capable of performing Partial Least Squares
neighborhood in Buenos Aires City, heading to provide regression (at one extreme) to Canonical Correlation
help and support to adolescent parents under social Analysis (at the other)and every intermediate operation
deprivation conditions and/or undergoing emotional between the two. On multicollinear data, the parameter
problems. It is an action project embracing different setting is shown to be important but on more general
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![centered maternity care were categorized as issues in and malnutrition among the displaced population in
coordination of services among health caregivers, South Darfur and reinforces the need to mount
patient-health caregiver relationships and systems, and appropriate and timely humanitarian responses.
access to services. Facilitators of family-centered
maternity care were identified as perceived response to Grandi C, Cernadas JC. [Neonatal networks]. J Pediatr (Rio
high-risk patients, health-related support outside the J) 2004; 80(5):431; author reply 431-2.
hospital, and special resources. Narratives, or personal
stories told by the women, were used to illustrate Grant B, Wallace JG, Hobson RA, Craig BG, Mulholland
barriers and facilitators. CONCLUSIONS: Education HC, Casey FA. Telemedicine applications for the
about family-centered maternity care is vitally regional paediatric cardiology service in Northern
important for health caregivers. In clinical situations, Ireland. J Telemed Telecare 2002; 8 Suppl 2:31-3.
each childbearing woman and her family should be Abstract: The regional paediatric cardiology centre in
treated as if they are extraordinary. In this way, Northern Ireland has a telemedicine network linking
practitioners can alter routines that cause the woman the neonatal units of three district general hospitals
and her family to lose individualized care. using ISDN and IP-compliant equipment. We have
previously reported the use of ISDN transmission at
Grandesso F, Sanderson F, Kruijt J, Koene T, Brown V. 128 kbit/s for remote echocardiography. In a series of
Mortality and malnutrition among populations living in 61 patients, a total of 59 transmitted scans were of
South Darfur, Sudan: results of 3 surveys, September sufficient diagnostic quality to confirm or exclude the
2004. JAMA 2005; 293(12):1490-4. presence of major congenital heart disease (CHD).
Abstract: CONTEXT: Mass violence against civilians There were three diagnostic errors (7%). Subsequently,
in the west of Sudan has resulted in the displacement of we have examined the use of ISDN transmission at 384
more than 1.5 million people (25% of the population of kbit/s. Echocardiographic studies were carried out on
the Darfur region). Most of these people are camped in 21 patients and all were followed up. Fourteen patients
142 settlements. There has been increasing (67%) had CHD confirmed. There were two diagnostic
international concern about the health status of the errors (10%). Our experience of transmitting live
displaced population. OBJECTIVE: To perform rapid echocardiographic images suggests that ISDN at 384
epidemiological assessments of mortality and kbit/s provides the optimum balance between the
nutritional status at 3 sites in South Darfur for relief clarity of the transmitted images and costs. We expect
efforts. DESIGN, SETTING, AND PARTICIPANTS: that IP videoconferencing will offer similar quality but
In August and September 2004, mortality surveys were at a lower running cost, and are currently assessing it in
conducted among 137,000 internally displaced persons a pilot study. All sites within our network will remain
(IDPs) in 3 sites in South Darfur (Kass [n = 900 capable of ISDN transmission until the efficacy and
households], Kalma [n = 893 households], and reliability of IP transmission has been demonstrated in
Muhajiria [n = 900 households]). A nutritional survey a controlled trial. The clinical telemedicine service has
was performed concomitantly among children aged 6 led to the earlier diagnosis of and instigation of
to 59 months using weight for height as an index of appropriate treatment for CHD.
acute malnutrition (Kass [n = 894], Kalma [n = 888],
and Muhajiria [n = 896]). A questionnaire detailing Gray C. Pediatricians taking new look at corporal-
access to food and basic services was administered to a punishment issue. CMAJ 2002; 166(6):793.
subset of households (n = 210 in each site). MAIN
OUTCOME MEASURES: Crude and under 5-year Gray DE. Gender and coping: the parents of children with
mortality rates and nutritional status of IDPs in Kass, high functioning autism. Soc Sci Med 2003; 56(3):631-
Kalma, and Muhajiria, South Darfur. RESULTS: 42.
Crude mortality rates, expressed as deaths per 10,000 Abstract: Gender is a concept that is frequently
per day, were 3.2 (95% confidence interval [CI], 2.2- discussed in the literature on stress, coping and illness.
4.1) in Kass, 2.0 (95% CI, 1.3-2.7) in Kalma, and 2.3 Research has reported that women are more vulnerable
(95% CI, 1.2-3.4) in Muhajiria. Under 5-year mortality than men are to stressful events and use different
rates were 5.9 (95% CI, 3.8-8.0) in Kass, 3.5 (95% CI, strategies to cope with them. Furthermore, it is often
1.5-5.7) in Kalma, and 1.0 (95% CI, 0.03-1.9) in asserted that these gender-based differences in coping
Muhajiria. During the period of displacement covered may partially explain the differential impact of stressful
by our survey in Muhajiria, violence was reported to be events on men and women. Unfortunately, much of this
responsible for 72% of deaths, mainly among young research has equated gender with sex and failed to
men. Diarrheal disease was reported to cause between contextualise the experience of illness and coping. This
25% and 47% of deaths in camp residents and mainly paper presents a qualitative analysis of the role of
affected the youngest and oldest age groups. Acute gender and coping among parents of children with high
malnutrition was common, affecting 14.1% of the functioning autism or Asperger's syndrome in an
target population in Kass, 23.6% in Kalma, and 10.7% Australian sample. It attempts to analyse the different
in Muhajiria. CONCLUSION: This study provides meanings of the disability for mothers and fathers and
epidemiological evidence of the high rates of mortality
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![of clinic referral for early conduct problems: variable- from US census data. 2) A prospective cohort of 88
and person-oriented approaches. Dev Psychopathol infants < or = 90 days of age who had been treated for
2001; 13(2):255-76. unintentional head trauma in an urban pediatric
Abstract: The current study utilized both variable- and emergency department (ED) was studied.
person-oriented analyses to examine correlates of early Circumstances of injury and gender-related differences
disruptive behavior problems. Participants included 80 in these circumstances were assessed. RESULTS: In
preschool boys referred to a child psychiatry clinic and the NPTR database, 600 of 1072 (56%) (95%
diagnosed with oppositional defiant disorder (with or confidence interval [CI] 0.53, 0.59) infants < or = 90
without attention-deficit hyperactivity disorder) and 80 days of age were boys (P =.001). In the ED cohort, 54
case-matched normal comparison boys. The study of 88 (62%) (95% CI 0.50, 0.72) subjects were boys (P
examined four domains of correlates: vulnerable child =.06). In virtually all of the cases described, subjects
characteristics, poor parenting practices, insecure appeared to be passive participants in the injury. The
attachment, and adverse family ecology. Results most commonly reported circumstances of injury were
indicated that the combination of these factors provided the following: "child left alone on furniture and fell" (n
relatively high sensitivity (81%) and specificity (85%), = 39) or "parent dropped child" (n = 27). Boys
clearly differentiating referred from comparison boys. accounted for 20 (74%) of the subjects in the "parent
A dramatic increase in clinic status occurred when dropped child" group (P =.04). CONCLUSIONS: Boys
three or more factors were present, and specific outnumber girls among infants less than 3 months of
combinations of factors were differentially predictive age with unintentional head trauma. These young
of conduct problems. However, no correlates were infants appear to be passive participants in their
found to be either necessary or sufficient for clinic injuries, which indicates that differences in parenting
status. By maintaining the integrity of individual cases, practices may account for the observed gender
person-oriented analyses were able to answer different differences.
questions than more traditional variable-oriented
analyses. Discussion focuses on the value of person- Greenham SL, Stelmack RM. Event-related potentials and
oriented analyses for understanding heterogeneous picture-word naming: effects of attention and semantic
clinical groups. relation for children and adults. Dev Neuropsychol
2001; 20(3):619-38.
Greene K, Bogo M. The different faces of intimate violence: Abstract: Event-related potentials (ERPs) were
implications for assessment and treatment. J Marital recorded from children, 9 to 13 years of age, while they
Fam Ther 2002; 28(4):455-66. named words and pictures. The words and pictures
Abstract: Current research about violence in intimate were presented individually and in superimposed
relationships suggests that at least two qualitatively picture-word pairs in which the meaning of the words
distinct types of violence exist. This new knowledge and pictures was either congruent, semantically
challenges the dominant conceptualization of intimate associated, or incongruent. Both words and pictures
violence as solely a manifestation of patriarchal male elicited large amplitude negative waves (N450) at
dominance. Following a review of the research and anterior electrode sites. The amplitude of this N450
analysis of illustrative clinical examples, a conceptual wave was larger for individually presented pictures
framework is presented that assists couple therapists in than for words. N450 amplitude was also larger when
answering three salient questions: What type of naming pictures than when naming words in the
violence am I most likely to be working with? How can superimposed arrays, an effect that is attributed to
I assess the differences between types of violence? And differences in attentional demand required to name
how might I proceed with treatment for different types pictures rather than to exogenous stimulus
of violence? characteristics. No significant effects of semantic
incongruity were observed. These ERP waveforms for
Greenes DS, Wigotsky M, Schutzman SA. Gender children differ from those observed for adults who
differences in rates of unintentional head injury in the exhibited positive amplitude waves to individually
first 3 months of life. Ambul Pediatr 2001; 1(3):178- presented pictures and who also exhibited semantic
80. incongruity effects.
Abstract: OBJECTIVES: To assess for gender
differences in rates of unintentional head injury in Gregory W. Reviving truth and trust. Time 2002;
infants less than 3 months of age, to assess the 159(24):58-60.
circumstances of injury in these patients, and to look
for gender-related differences in these circumstances. Gregory W. "There will be guidance." Interview by David
METHODS: Two separate databases were analyzed. 1) France. Newsweek 2002; 139(17):39.
The National Pediatric Trauma Registry (NPTR) was
queried for all patients < or = 90 days of age who had Greicius MD. Neuroimaging in developmental disorders.
been diagnosed with unintentional head trauma Curr Opin Neurol 2003; 16(2):143-6.
between 1990 and 1999. The proportion of males was Abstract: PURPOSE OF REVIEW: This review
compared to the expected proportion of 51%, derived
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![considers the role of neuroimaging in developmental before and after the 2002 ceasefire. Malnutrition deaths
disorders by highlighting recent studies in two distinct, reflect the extent of the food crisis affecting this
but overlapping, developmental disorders: autism and population. Timely humanitarian assistance must be
fragile X syndrome. RECENT FINDINGS: After a made available to all populations in such conflicts.
decade of conflicting results in neuroimaging studies of
autism, recent studies have provided some convergent Greiner T, Sachs M, Morrison P. The choice by HIV-
data. One well-replicated finding is that autistic positive women to exclusively breastfeed should be
subjects have larger brains. Further, this enlargement, supported. Arch Pediatr Adolesc Med 2002; 156(1):87-
present as early as 3 years of age, appears to represent 8.
accelerated growth in infancy and may be followed by
slowed growth in late childhood. Other findings are Grekin ER, Brennan PA, Hammen C. Parental alcohol use
discussed but considered preliminary in the absence of disorders and child delinquency: the mediating effects
converging evidence or replication studies. Recent of executive functioning and chronic family stress. J
work in fragile X syndrome suggests aberrant fronto- Stud Alcohol 2005; 66(1):14-22.
striatal and fronto-parietal networks and relates these Abstract: OBJECTIVE: This study examines the
abnormalities "forward" to behavior and "backward" to relationship between parental alcohol use disorders
decreased protein expression. SUMMARY: As the (AUDs) and child violent and nonviolent delinquency.
field of neuroimaging has matured, it has revealed its It also explores the mediating effects of executive
promise as a safe, reliable, in-vivo tool in the study of functioning and chronic family stress on the parental
developmental disorders. By insisting on larger, more AUD/child delinquency relationship. METHOD:
homogeneous patient groups and longitudinal rather Participants were 816 families with children (414 boys
than cross-sectional studies, the field is poised to fulfill and 402 girls) born between 1981 and 1984 at Mater
its ultimate role of linking defects in molecular biology Misericordiae Mother's Hospital in Brisbane, Australia.
to aberrant behavior. Parents and children completed semistructured
interviews, questionnaires and neuropsychological tests
Grein T, Checchi F, Escriba JM et al. Mortality among that assessed parental alcohol use, family psychiatric
displaced former UNITA members and their families in history, chronic family stress, child delinquency and
Angola: a retrospective cluster survey. BMJ 2003; child executive functioning. RESULTS: Paternal (but
327(7416):650. not maternal) AUDs predicted child violent and
Abstract: OBJECTIVE: To measure retrospectively nonviolent delinquency. Executive functioning
mortality among a previously inaccessible population mediated the relationship between paternal AUDs and
of former UNITA members and their families violent delinquency, whereas family stress mediated
displaced within Angola, before and after their arrival the relationship between paternal AUDs and both
in resettlement camps after ceasefire of 4 April 2002. violent and nonviolent delinquency.
DESIGN: Three stage cluster sampling for interviews. CCONCLUSIONS: Results support a biosocial
Recall period for mortality assessment was from 21 conceptualization of the paternal AUD/delinquency
June 2001 to 15-31 August 2002. SETTING: Eleven relationship. They suggest that paternal AUDs may be
resettlement camps over four provinces of Angola (Bie, associated with child executive functioning and family
Cuando Cubango, Huila, and Malange) housing 149 stress, which may in turn lead to child delinquency.
000 former UNITA members and their families.
PARTICIPANTS: 900 consenting family heads of Greydanus DE, Pratt HD, Richard Spates C, Blake-Dreher
households, or most senior household members, AE, Greydanus-Gearhart MA, Patel DR. Corporal
corresponding to an intended sample size of 4500 punishment in schools: position paper of the Society
individuals. MAIN OUTCOME MEASURES: Crude for Adolescent Medicine. J Adolesc Health 2003;
mortality and proportional mortality, overall and by 32(5):385-93.
period (monthly, and before and after arrival in camps). Notes: CORPORATE NAME: SAM 2002-2003 Ad
RESULTS: Final sample included 6599 people. The Hoc Corporal Punishment Committee
390 deaths reported during the recall period
corresponded to an average crude mortality of 1.5/10 Gribomont AC. [Traumatic vitreous-retinal hemorrhage in
000/day (95% confidence interval 1.3 to 1.8), and, infants]. Bull Soc Belge Ophtalmol 2001; (281):5-11.
among children under 5 years old, to 4.1/10 000/day Abstract: After a short review of the non-traumatic, and
(3.3 to 5.2). Monthly crude mortality rose gradually to rare, causes of vitreoretinal hemorrhages in infants, we
a peak in March 2002 and remained above emergency analyze the 4 situations where a traumatic hemorrhage
thresholds thereafter. Malnutrition was the leading can be found: accidental head trauma, which has to be
cause of death (34%), followed by fever or malaria very severe and is then an unfrequent etiology, head
(24%) and war or violence (18%). Most war victims trauma in child abuse or the so-called "shaken baby
and people who had disappeared were women and syndrome", which is the most frequent cause, and
children. CONCLUSIONS: This population of where we point out the key role of the ophthalmologist
displaced Angolans experienced global and child in the diagnosis and the prognostic evaluation, the
mortality greatly in excess of normal levels, both
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![insufficient to unambiguously detect OA events in the current parent-child relationship. In addition, the
sleeping infants. domestic and international adoptees' behavior is more
similar than it is different. The study highlights the
Gross E, Burr CK. HIV counseling and testing in pregnancy. importance of helping families understand how early
N J Med 2003; 100(9 Suppl):21-6; quiz 67-8. negative experiences are associated with behavior
difficulties. Results suggest that families may have
Grossman DC. Computer simulation: a powerful tool for similar need for social and medical services, regardless
injury control. Arch Pediatr Adolesc Med 2001; of the country of origin of adoption.
155(9):992-3.
Gruber KJ, Fleetwood TW. In-home continuing care
Grote A. [Traction retinal detachment, optic atrophy, apallic services for substance use affected families. Subst Use
syndrome after shaking trauma in an infant]. Misuse 2004; 39(9):1379-403.
Ophthalmologe 2002; 99(4):295-8. Abstract: The role of in-home work with substance use
Abstract: INTRODUCTION: Ophthalmological affected family members has great potential for
examinations are important in children with suspected addressing family and personal issues that are often not
shaken baby and/or battered child syndrome. Retinal well addressed by continuing care interventions that
and epiretinal haemorrhages can indicate non- involve limited contact with the family and the impact
accidental injuries. We observed a case of extensive alcohol and other drug "abuse" has on the family
retinal hemorrhages, edema of the optic disc followed environment. This article reviews the importance of
by development of optic atrophy, neovascularisation involving the family in the recovery process and offers
and tractional retinal detachment over the course of comparative advantages of an in-home visitation
months. CASE REPORT: A 6-week-old infant with no approach for assisting the substance user with
history of systemic disease or trauma was admitted to maintaining substance use avoidance, reintegrating
the children's hospital because of a disorder of with the family, and addressing unresolved family
consciousness, respiratory insufficiency, taut fontanel issues affecting children and spousal relationships.
and dilated pupils with sluggish reaction to light. A
subdural haematoma was diagnosed. Ophthalmological Gruber KJ, Fleetwood TW, Herring MW. In-home
examination showed no signs of trauma in the anterior continuing care services for substance-affected
segment. Ophthalmoscopy revealed extensive retinal families: the bridges program. Soc Work 2001;
haemorrhages and swollen optic nerve heads. During 46(3):267-77.
the next months optic atrophy, subretinal fibrosis at the Abstract: Addressing substance abuse in families is an
posterior pole, neovascularisation at the optic disc and important concern for the social work field. This article
non-rhegmatogenous retinal detachment developed. presents a preliminary view of a continuing care
The child is in a persistent vegetative state. substance abuse recovery services program designed to
DISCUSSION: Non-accidental injuries can cause assist the substance-affected family. The intervention
direct trauma and indirect traumatic sequelae. Retinal approach is a blended model of substance abuse
haemorrhages, especially in conjunction with recovery work and family preservation. Services are
unexplained trauma or changes of consciousness directed at helping substance-abusing parents with
should arouse suspicion of shaken baby syndrome. The "recovering" their role with their families, developing
ophthalmologist should emphasize this and strongly support for their recovery work, and helping them gain
recommend further investigation if not previously the education and skills they need for effective
undertaken. parenting, supportive family involvement, and
avoidance of drugs and alcohol. The program focuses
Groza V, Ryan SD. Pre-adoption stress and its association on helping substance abusers and their families achieve
with child behavior in domestic special needs and relapse prevention by addressing functioning in four
international adoptions. Psychoneuroendocrinology domains: individual actions and cognitions, individual
2002; 27(1-2):181-97. recovery actions, family actions and cognitions, and
Abstract: This article presents data from studies of family recovery actions. The article presents two case
children adopted through the United States public child examples to highlight the efficacy of the intervention
welfare system and children adopted internationally model and the general positive effect continuing care
from Romania. The article summarizes the data on: a). services are having on substance-affected families.
behavior problems as they relate to Romanian adoptees
from a cross-sectional study, b). behavior problems for Grundell E. Tissue typing for bone marrow transplantation:
a sample of children adopted through the United States an ethical examination of some arguments concerning
public child welfare system from a cross-sectional harm to the child. Monash Bioeth Rev 2003; 22(4):45-
study, and c). a comparison of children's behavior for 55.
these two groups. Results indicate that the most Notes: GENERAL NOTE: KIE: 48 fn.
significant predictor of children's behavior is a negative GENERAL NOTE: KIE: KIE Bib: organ and tissue
pre-adoptive history of abuse or institutionalization and donation; prenatal diagnosis; reproduction
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![ulnar nerves of 59 patients to interpret data. The data of decrease in the number of children hospitalised for
the patients were diagnosed by the neurologists as 19 injuries sustained in the home environment, it is not
patients were normal, 20 patients had neuropathy and possible to determine if this is a 'real' change or a result
20 patients had myopathy. The amount of FFT of other factors affecting the data. While children
coefficients had been reduced by using principal continue to be killed and injured as a result of
components analysis (PCA). This would facilitate preventable incidents in the home environment, injury
calculation and storage of EMG data. PCA coefficients prevention strategies should be continued and
were applied to multilayer perceptron (MLP) and strengthened.
support vector machine (SVM) and both classified
systems of performance values were computed. Gumpert CH. [Assessment of children's reliability in
Consequently, the results show that SVM has high connection with sexual abuse. A complex interplay
anticipation level in the diagnosis of neuromuscular between the judicial system and expert witnesses].
disorders. It is proved that its test performance is high Lakartidningen 2002; 99(24):2734-8.
compared with MLP.
Gunn VL, Hickson GB, Cooper WO. Factors affecting
Guler NF, Kocer S. Use of support vector machines and pediatricians' reporting of suspected child
neural network in diagnosis of neuromuscular maltreatment. Ambul Pediatr 2005; 5(2):96-101.
disorders. J Med Syst 2005; 29(3):271-84. Abstract: OBJECTIVE: To identify factors associated
Abstract: In this study the performance of support with pediatricians' decision not to report suspected
vector machine (SVM)and back-propagation neural child maltreatment. DESIGN: A survey was distributed
network were applied to analyze the classification of to a random sample of pediatricians in a single state.
the electromyogram (EMG) signals obtained from Participants were asked if they had ever suspected
normal, neuropathy and myopathy subjects. By using child abuse or neglect but did not report. In addition,
autoregressive (AR) modeling, AR coefficients were all were asked to list all the considerations that
obtained from EMG signals. Moreover, the support pediatricians incorporate into their decisions not to
vector machine and artificial neural network (ANN) report. RESULTS: One hundred ninety-five
were used as base classifiers. The AR coefficients were pediatricians completed the survey (56% of those
benefited as inputs for SVM and ANN. Besides, these eligible). Twenty-eight percent of respondents stated
coefficients were tested both in ANN and SVM. The that they had considered reporting an incident of
results show that SVM has high anticipation level in suspected child maltreatment but had chosen not to.
the diagnosis of neuromuscular disorders. It is proved Providers who had chosen not to report were more
that its test performance is high compared with ANN. likely to be men (P = .006), to have been in practice
longer (P = .001), to have reported more cases (P =
Gulliver P, Dow N, Simpson J. The epidemiology of home .001), to have been deposed (P = .001) or to have
injuries to children under five years in New Zealand. testified (P = .01) in child maltreatment cases, and to
Aust N Z J Public Health 2005; 29(1):29-34. have been threatened with lawsuit (P = .02) than were
Abstract: OBJECTIVE: This paper describes the pediatricians who had never declined to report.
epidemiology of injuries sustained by children under Multivariate logistic regression demonstrated that male
five in the home. METHODS: Cases were selected gender (odds ratio [OR] 2.18; 95% confidence interval
from the New Zealand Health Information Service [CI] 1.05-4.49), years in practice (OR 1.23; 95% CI
public hospital morbidity and mortality data, and 1.05-1.44), and experience reporting (OR 1.28; 95% CI
included all 0-4 year olds where the place of injury 1.02-1.60) were all independently associated with
occurrence was classified as 'home'. The circumstances decisions not to report. Respondents who had declined
of injury were coded according to the Supplementary to report were more likely to cite lack of knowledge
Classifications of External Causes of Injury and about reporting laws and process (P = .05) and poor
Poisoning (E-codes) of the International Classifications experiences with child service agencies (P = .03) as
of Diseases. Age-specific rates of death or reasons for not reporting than were their counterparts
hospitalisation due to injury were calculated using the who had never declined to report suspected
population of 0-4 year olds in New Zealand for each maltreatment. CONCLUSIONS: Many barriers exist to
year as the denominator. RESULTS: The rate of death reporting suspected maltreatment. Specific educational
from an injury sustained at home between 1989 and interventions may be helpful in eliminating barriers to
1998 was 13 per 100,000 population per year. The reporting.
main causes of death were suffocation, submersion,
homicide and fire. The rate of hospitalisation in Gupta A, Rani M, Mittal AK, Dikshit PC. A study of
children aged 0-4 years from an injury sustained in the homicidal deaths in Delhi. Med Sci Law 2004;
home between 1989 and 2000 was 737 per 100,000 44(2):127-32.
population per year. The most frequently recorded Abstract: A meticulous post-mortem review was
causes of hospitalisation were falls, scalds, poisonings undertaken in the department of forensic medicine at
and cut/piercing incidents. CONCLUSION AND the Maulana Azad Medical College (MAMC) to find
IMPLICATIONS: Although there has been an apparent
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![identified as heterosexual were at particular risk. Abstract: We described a case of shaken-baby
Attachment theory can guide interventions by syndrome with multiple chronic subdural hematomas.
informing how individuals experience relationships and A 10-month-old male baby was admitted to our
manage developmental transitions. hospital because of loss of consciousness and
convulsions. CT scan revealed an acute subarachnoid
Haas F. Bereavement care: seeing the body. Nurs Stand hemorrhage extending into the interhemispheric fissure
2003; 17(28):33-7. and supracerebellar space. The patient was treated
Abstract: BACKGROUND: Generally, it is now conservatively, and discharged from the hospitaL Two
accepted that the long-term outcomes are better for months after ictus, a baby was admitted to our hospital
those who are able to see the body of a loved one as it with general fatigue. CT scan demonstrated multiple
helps people who are grieving to come to terms with chronic subdural hematomas. Burr hole irrigation and
the death. CONCLUSION: While the evidence drainage brought about complete disappearance of
indicates that seeing the body of a loved one helps the these lesions. Retrospectively, it was found that these
grieving process, a recent study into bereavement multiple subdural hematomas were due to shaken-baby
reactions following neonatal deaths gives disturbing syndrome. Shaken-baby syndrome is a form of child
evidence to the contrary, so while it may usually be abuse that can cause significant head injury, and
good practice to encourage viewing, this may be subdural hematoma is the most common manifestation.
potentially damaging to new parents who have lost a It is well known that the outcome of shaken-baby
baby. syndrome is generally not good. It is important to
suspect shaken-baby syndrome when a chronic
Haddad HM. Munchausen syndrome by proxy. subdural hematoma is seen in a baby.
Ophthalmology 2004; 111(2):407; author reply 407.
Hagele DM. The impact of maltreatment on the developing
Hadders-Algra M. Early brain damage and the development child. N C Med J 2005; 66(5):356-9.
of motor behavior in children: clues for therapeutic
intervention? Neural Plast 2001; 8(1-2):31-49. Haggerty RJ. Index of suspicion. Pediatr Rev 2003;
Abstract: The Neuronal Group Selection Theory 24(8):276-83.
(NGST) could offer new insights into the mechanisms
directing motor disorders, such as cerebral palsy and Haggman-Laitila A. Early support needs of Finnish families
developmental coordination disorder. According to with small children. J Adv Nurs 2003; 41(6):595-606.
NGST, normal motor development is characterized by Abstract: AIMS: This study describes the early needs
two phases of variability. Variation is not at random for support that families with small children have in the
but determined by criteria set by genetic information. context of their own life situations. The study
Development starts with the phase of primary population consisted of Finnish families (n = 551) who
variability, during which variation in motor behavior is participated in a project titled 'Families with Children'
not geared to external conditions. At function-specific (1996-2001). The project supplemented the existing
ages secondary variability starts, during which motor public services. The information provided by the study
performance can be adapted to specific situations. In was utilized in supporting families and developing
both forms, of variability, selection on the basis of family work in seven experimental areas. METHODS:
afferent information plays a significant role. From the The data were collected between 1997 and 2000 using
NGST point of view, children with pre- or perinatally family service plans and client reports. The data were
acquired brain damage, such as children with cerebral analysed with inductive content analysis and using the
palsy and part of the children with developmental SPSS software (version 7.5). FINDINGS: The families
coordination disorder, suffer from stereotyped motor needed support in the areas of parenthood, upbringing
behavior, produced by a limited repertoire or primary and child care, marital problems and social support
(sub)cortical neuronal networks. These children also networks. The need for early support was also
have problems in selecting the most efficient neuronal connected to health problems of the children or the
activity, due to deficits in the processing of sensory parents, problems with work or studies, unemployment,
information. Therefore, NGST suggests that problems in economic or living conditions, or family
intervention in these children at early age should aim at crises. In addition to support, the families searched for
an enlargement of the primary neuronal networks. With help from family workers in disputes over child
increasing age, the emphasis of intervention could shift custody and visitation rights, intoxicant abuse and
to the provision of ample opportunities for active violence, and problems in adjusting to society. Each
practice, which might form a compensation for the family had 4-5 needs for early support.
impaired selection. CONCLUSIONS: The results demonstrate that families
with small children have many needs for which they
Haga S, Ishido K, Inada N, Sakata S. [Multiple chronic seek help when there are available services
subdural hematoma in shaken-baby syndrome]. No supplementing the existing public services. The
Shinkei Geka 2004; 32(8):845-8. information provided by the study can be utilized in
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![onset of regular tobacco use is as predictive of lifetime Abstract: Toys placed in the bed or microenvironment
drug use and depressive disorders as it is of alcohol use of infants in the neonatal intensive care unit (NICU)
disorders [Alcohol.: Clin. Exp. Res. 23 (1999) 513.]. demonstrate high rates of colonization (92%). As with
This finding, which paralleled findings regarding early other fomites, toys may be one potential source of
onset of alcohol use [J. Subst. Abuse 10 (1998) 59.], nosocomial infection (NI). This project critically
suggested that early regular use of any drug might evaluated the practice of placing toys in the
simply be an indicator of risk for a constellation of microenvironment of critically ill infants by using the
problem behaviors. The purpose of the present study is Iowa Model of Evidence-Based Practice to Promote
to test this hypothesis as well as to study the strength Quality Care. With the model as a guide for decision
and patterns of associations among these problem making, the existing evidence was explored using a
behaviors already present among youth. The results systematic review of the literature, case studies,
will permit description of more precise profiles to scientific principles, theory, and expert opinion. A
identify groups of children at risk. METHODS: Using comprehensive review of the literature did not clearly
data for respondents aged 12-16 from the Third identify a causal relationship between toys in the NICU
National Health and Nutrition Examination Survey microenvironment and NI. Levels of evidence
(NHANES III), descriptive statistics were calculated suggesting an association between toys and NI were
and logistic regression models were estimated. determined to be moderately strong and consistent. A
RESULTS: Descriptive analyses indicated that in plausible relationship between the practice of placing
comparison with those who never smoked, or who toys in the beds of NICU patients and risk for infection
simply experimented, early-onset regular smokers, both was found. These findings prompted a pilot practice
those who began at age 13 or younger and those who change, eliminating toys in the NICU, to test the
did so between 14 and 16, were those most likely to potential impact of this intervention. Pre- and
use alcohol and other drugs as well as have school postintervention infection rates were compared. NI
problems and early sexual experiences culminating in rates decreased from 4.6 to 1.99 per 1,000 patient days
pregnancy. Multivariate logistic regression analyses over a 6-month evaluation period. Although this
were conducted to assess the associations among these decrease was not statistically significant, it was the
high-risk behaviors. IMPLICATIONS: These results lowest rate recorded in 5 years. Ongoing evaluation of
support the hypothesis that early onset of smoking is NI rates is in progress. Individual NICUs must
but an indicator of a syndrome of problem behaviors determine if the evidence warrants a practice change in
already in place during childhood. They also suggest their setting.
that the significance of an age onset variable may differ
depending on the age of the sample used. As follow-up Hanrahan LP, Anderson HA, Busby B et al. Wisconsin's
data are collected, we expect to learn much about the environmental public health tracking network:
natural course of the distinct risk groups identified in information systems design for childhood cancer
the analyses by studying longitudinally this nationally surveillance. Environ Health Perspect 2004;
representative group of early adolescents. 112(14):1434-9.
Abstract: In this article we describe the development of
Hanna JN, Symons DJ, Lyon MJ. A measles outbreak in the an information system for environmental childhood
Whitsundays, Queensland: the shape of things to cancer surveillance. The Wisconsin Cancer Registry
come? Commun Dis Intell 2002; 26(4):589-92. annually receives more than 25,000 incident case
Abstract: This report describes a small outbreak of reports. Approximately 269 cases per year involve
measles that occurred in the Whitsunday region, north children. Over time, there has been considerable
Queensland, in July to August 2002. With one community interest in understanding the role the
exception, all the cases were deliberately unvaccinated environment plays as a cause of these cancer cases.
because their parents were conscientious objectors to Wisconsin's Public Health Information Network (WI-
vaccination. It is suggested that this pattern of measles PHIN) is a robust web portal integrating both Health
outbreaks, with most cases being not preventable Alert Network and National Electronic Disease
because of conscientious objection, will become Surveillance System components. WI-PHIN is the
increasingly recognised in the future. information technology platform for all public health
surveillance programs. Functions include the secure,
Hannesdottir H. [Early prevention and Mental Health automated exchange of cancer case data between
Service for children and adolescents. Laeknabladid public health-based and hospital-based cancer
2003; 89(4):295. registrars; web-based supplemental data entry for
Notes: .] environmental exposure confirmation and hypothesis
testing; automated data analysis, visualization, and
Hanrahan KS, Lofgren M. Evidence-based practice: exposure-outcome record linkage; directories of public
examining the risk of toys in the microenvironment of health and clinical personnel for role-based access
infants in the neonatal intensive care unit. Adv control of sensitive surveillance information; public
Neonatal Care 2004; 4(4):184-201, quiz 202-5. health information dissemination and alerting; and
information technology security and critical
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![infrastructure protection. For hypothesis generation, processes, possibly due to involvement of frontal
cancer case data are sent electronically to WI-PHIN neural networks.
and populate the integrated data repository.
Environmental data are linked and the exposure- Harding B, Risdon RA, Krous HF. Shaken baby syndrome.
disease relationships are explored using statistical tools BMJ 2004; 328(7442):720-1.
for ecologic exposure risk assessment. For hypothesis
testing, case-control interviews collect exposure Hargreaves KM, Stewart RJ, Oliver SR. Informed choice
histories, including parental employment and and public health screening for children: the case of
residential histories. This information technology blood spot screening. Health Expect 2005; 8(2):161-71.
approach can thus serve as the basis for building a Abstract: OBJECTIVE: To examine parents' and health
comprehensive system to assess environmental cancer professionals' views on informed choice in newborn
etiology. blood spot screening, and assess information and
communication needs. DESIGN AND
Hansen L, Bollhorn M. [The reality is--unfortunately--"on PARTICIPANTS: A qualitative study involving semi-
the other side"]. Ugeskr Laeger 2002; 164(10):1370-1. structured telephone interviews and focus groups with
47 parents of children who were either found to be
Hanson S. Engelhardt and children: the failure of libertarian affected or unaffected by the screened conditions, and
bioethics in pediatric interactions. Kennedy Inst Ethics 35 health professionals with differing roles in newborn
J 2005; 15(2):179-98. blood spot screening programmes across the UK.
Notes: GENERAL NOTE: KIE: 6 refs. RESULTS AND CONCLUSIONS: Parents and health
GENERAL NOTE: KIE: KIE Bib: personhood; professionals recognize a tension between informed
treatment refusal/minors choice in newborn blood spot screening and public
Abstract: In Engelhardt's secular bioethics, moral health screening for children. Some propose resolving
obligations derive from contracts and agreements this tension with more information and better
between rational persons, and no infants or children communication, and some with rigorous dissent
and few adolescents meet Engelhardt's requirements procedures. This paper argues that neither extensive
for being a rational person. This is a problem, as one parent information, nor a signed dissent model
cannot have any direct secular moral obligations adequately address this tension. Instead, clear, brief
toward nonpersons such as infants and adolescents. and accurate parent information and effective
The Engelhardtian concepts of ownership, indenture, communication between health professionals and
and social personhood, which are meant to allow the parents, which take into account parents' information
theory to accommodate children and adolescents needs, are required, if informed choice and public
adequately, fail to give an Engelhardtian any actual health screening for children are to coexist
means of determining the right action to take in successfully.
difficult cases, even on his or her own terms. Thus, the
theory is incapable of determining the morally correct Harkavy I. University-assisted community school program
action to take in cases involving children and therefore of West Philadelphia: democratic partnerships that
is unhelpful in dealing with moral questions involving make a difference. New Dir Youth Dev 2005;
children. (107):35-43, table of contents.
Abstract: The university-assisted community school
Hanten G, Chapman SB, Gamino JF et al. Verbal selective model is showing results for children and youth in
learning after traumatic brain injury in children. Ann West Philadelphia. The University of Pennsylvania's
Neurol 2004; 56(6):847-53. (Penn's) Center for Community Partnerships has
Abstract: Selective learning (SL), the ability to select coordinated universitywide efforts, in partnership with
items to learn from among other items, engages the community, in order to create and develop
cognitive control, which is purportedly mediated by the community school programs. The Sayre program aims
frontal cortex and its circuitry. Using incentive-based to become a university-assisted community school,
auditory word recall and expository discourse tasks, we with a comprehensive community problem-solving
studied the efficiency of SL in children ages 6 to 16 curriculum and communitywide program that is fully
years who had sustained severe traumatic brain injury integrated across both the Sayre curriculum and the
(TBI) at least 1 year earlier. We hypothesized that SL curriculum of a number of Penn's schools. The Penn-
would be compromised by severe TBI. Results Sayre project demonstrates that higher education can
indicated that children with severe TBI performed be a permanent anchor for revitalizing schools and
significantly worse than age-matched typically communities if the vast resources it possesses,
developing children on word- and discourse-level particularly its faculty, students, and staff, are brought
measures of SL efficiency with no significant group to bear in a coordinated fashion.
differences in number of items recalled from auditory
word lists or declarative facts. We conclude that severe Harkema JR, Keeler G, Wagner J et al. Effects of
TBI disrupts incentive-based cognitive control concentrated ambient particles on normal and
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![analysis in the lungs of CAPs-exposed BN rats exposed the Department of Transportation-National Highway
in September suggested that air particles derived from Traffic Safety Administration ([DOT-NHTSA], the
identified local combustion sources were preferentially funding agency) and the development and launch of a
retained in allergic airways. These results demonstrate pilot program: "Buckle-Up and Smile for Life".
that short-term exposures to CAPs from this Sections of the paper include: background information
southwestern Detroit community caused variable on the problems of disparity and access; the impact of
responses in laboratory rats and suggest that adverse community education and the benefits of collaboration;
biological responses to ambient PM2.5 may be evolution of the unique partnership, including
associated more closely with local sources of particles background information on disparities in seat belt
and weather patterns than with particle mass. usage among African Americans; a description on how
the pilot program was structured and implemented; and
Harner HM. Childhood sexual abuse, teenage pregnancy, future plans. The objective of this article is to
and partnering with adult men: exploring the encourage other oral health organizations to form
relationship. J Psychosoc Nurs Ment Health Serv 2005; alliances with the NDA (and other organizations
43(8):20-8. committed to public health) to go into underserved
Abstract: Although the mechanism by which early communities to deliver the oral health message.
victimization, specifically sexual abuse, increases the Involvement and participation on all levels, with
risk of adolescent pregnancy is unclear, a relationship diverse and non-traditional partners will make a
between previous victimization and adolescent difference. The National Dental Association applauds
pregnancy has been demonstrated. While partnering the commitment of the American Dental Assistants
with an older man may initially offer the means Association to form alliances that address the issues of
necessary to escape a neglectful or violent family of access and disparities. Groups working together for a
origin, this protection be accompanied by an imbalance common good are linked together by one common
of power and control. Both adolescent mothers notion: Caring Counts.
partnered with adult men and adolescent mothers
partnered with male peers reported sexual abuse Harper K, Steadman J. Therapeutic boundary issues in
perpetrated by family members, family friends, working with childhood sexual-abuse survivors. Am J
strangers, and peers. Policies developed to protect Psychother 2003; 57(1):64-79.
young people from victimization, including mandatory Abstract: The article describes a study of therapists
reporting and statutory rape laws, should be evaluated involved in treating survivors of childhood sexual
for their consistent application to all children, abuse. The authors focus on what induces participants
regardless of age, race, gender, or pregnancy status. to change their usual therapeutic boundaries. Through
qualitative research utilizing extensive interviews,
Harper HJ. Buckle-up and smile for life: uncommon partners written questionnaires, and a focus-group discussion,
find common ground to collaborate and eliminate the authors gathered information from therapists
disparities. Part 1. Dent Assist 2003; 72(3):8-12. related to situations that influence them to change their
Abstract: Disparities in health and lack of access to oral own boundaries. Emergent themes are discussed and
health are well-documented common concerns. Health the information is integrated with the authors'
education and health promotion increase awareness experience of supervision and psychotherapy. Concern
about the importance of prevention and the relationship for client safety is the commonly recurrent issue that
of oral health to overall health. The benefits of pushes therapists to change their boundaries. Other
collaboration and coalition building to enhance intense feelings, such as resentment of the client, worry
community outreach are well established. In order to about the client's feelings, a wish to connect and imbue
combat and correct the problems of disparities and hope are also strong influences. Self-disclosure
access, many more collaborative efforts must be put in boundaries of the therapist are challenged by the wish
place. Meaningful impact on the health of a community to balance power within the relationship. Supervision
can be made by collaborations of both traditional and provides an opportunity to examine what influences
non-traditional partners. Grassroots efforts that therapists to make subtle boundary shifts before they
mobilize coalitions around a specific cause and target become harmful boundary crossings.
specific populations can achieve far greater results than
any one entity acting alone. Well-coordinated Harris J. Human beings, persons and conjoined twins: an
community projects that represent a collaboration of ethical analysis of the judgement in Re A. Med Law
efforts can galvanize the resources, mobilize volunteers Rev 2001; 9(3):221-36.
and engender public support that will achieve a Notes: GENERAL NOTE: KIE: Harris, John
positive outcome for a common good. The integration GENERAL NOTE: KIE: 43 fn.
of oral health messages with other public health GENERAL NOTE: KIE: KIE Bib: patient care/minors;
messages and partnership with a very non-traditional personhood
entity was an approach that was adopted by the
National Dental Association (NDA). This paper Harris M, Fallot RD. Envisioning a trauma-informed service
describes the unique partnership between the NDA and
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![based on a "thermometer" categorical representation of for the reduction of stress in mothers. Some data also
the data. indicate the potential value of parent-led support
networks. CONCLUSIONS: More research and
Hashimoto T, Noguchi T, Nagai K, Uchida Y, Shimada T. clinical development are needed to establish a firmer
The organization of the communication routes between evidence base for stress interventions with parents of
the epithelium and lamina propria mucosae in the children with intellectual disabilities. There are also a
human esophagus. Arch Histol Cytol 2002; 65(4):323- number of potential practical implications of reducing
35. parental stress for maximising the efficacy of general
Abstract: Morphological studies examined parent training interventions and also behavioural
communication routes between the epithelium and programmes for children's challenging behaviours.
lamina propria mucosae in the human esophagus, using
a series of techniques including silver staining, Hatherall P. Law. On duty. Health Serv J 2003;
immunohistochemistry, transmission electron 113(5874):37.
microscopy, and scanning electron microscopy (SEM).
For SEM, tissue blocks were treated with either Haugen K, Slungard A, Schei B. [Sexual assault against
osmium/ultrasonication or NaOH. Observations women-- injury pattern and victim-perpetrator
showed the esophageal papillae to be arranged relationship]. Tidsskr Nor Laegeforen 2005;
regularly in a mostly longitudinal row. The reticular 125(24):3424-7.
fibers, consisting of fibrils approximately 40 nm in Abstract: BACKGROUND: Women who have been
diameter, were situated just beneath the epithelial basal exposed to sexual assault have the opportunity to
lamina. They showed a positive reaction with a type III consult specialised health service. The Centre for
collagen antibody, and formed a continuous sheet 2-3 victims of sexual assault at St. Olav University
microm thick with dense networks. This sheet as well Hospital, Trondheim, Norway, offers emergency
as the epithelial basal lamina had numerous foramina medical treatment, psychosocial follow-up and collects
of diameters of 3-5 microm. Immune cells such as evidence in case the victim wants to file a complaint.
lymphocytes and Langerhans cells were situated The aim of this study was to examine whether injury
around these foramina. The foramina were situated pattern and assault characteristics differed according to
both around papillae and the duct orifice of the the victim's relationship to the perpetrator.
esophageal gland. In addition, lymphoid follicles MATERIAL AND METHODS: Information about the
surrounded the duct of the esophageal gland. The assaults was collected retrospectively from medical
structural characteristics around the duct appear to be journals of 162 female clients who presented at the
those of duct-associated lymphoid tissue (DALT). centre over the period 1 June 2000 through 31 May
Thus, these foramina in the epithelial basal lamina and 2003. Depending on their relationship with the
reticular fiber sheet may represent important perpetrator, the victims were categorised into four
communication routes between the epithelium and groups: stranger, accidental acquaintance,
lamina propria mucosae. In addition, they may play an acquaintance, or partner. Assault characteristics and
important role in the mucosal immune response in the injury patterns were compared among these groups.
human esophagus. RESULTS: 69 % (111/162) of the victims knew their
offender. Accidental acquaintances were reported as
Hassall I. Response to Chaffin (2004). Child Abuse Negl perpetrator in 32 (20 %) of the assaults, acquaintances
2005; 29(3):235; author reply 241-9. in 68 (42 %), partners in 11 (7 %) and unknown
offenders in 29 (18 %). Type and severity of the sexual
Hastings RP, Beck A. Practitioner review: stress intervention assaults did not differ significantly according to victim-
for parents of children with intellectual disabilities. J perpetrator relationship. The most life-threatening
Child Psychol Psychiatry 2004; 45(8):1338-49. violence and use of a weapon were reported used by
Abstract: BACKGROUND: Parents of children with known offenders only. INTERPRETATION: In
intellectual disabilities are at increased risk for stress emergency medical response to victims of sexual
and other mental health problems. The purpose of the assaults, it should be made sure that victims,
present review is to consider the evidence base for independently of their relationship with perpetrator, are
psychological intervention to remediate stress in these met and treated equally.
parents. METHODS: A selective review of
interventions designed to reduce stress in parents of Haugland BS. Paternal alcohol abuse: relationship between
children with intellectual disabilities, with a focus on child adjustment, parental characteristics, and family
group interventions that incorporate various cognitive functioning. Child Psychiatry Hum Dev 2003;
behavioural techniques. RESULTS: Research evidence 34(2):127-46.
suggests that standard service models (e.g., respite Abstract: This study examines possible risk factors
care, case management) probably help to reduce associated with child adjustment in a sample of
parental stress. The strongest evidence base is for children with alcohol abusing fathers in Norway (N =
cognitive behavioural group interventions, especially 37). Factors included are socio-economic status,
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![severity of the fathers' alcohol abuse, parental skills. Parent assets, measured as social support and
psychological problems, and family functioning. problem-focused coping, predicted change in maternal
Children of alcohol abusing fathers were found to have and paternal parent-related stress respectively. The
more adjustment problems assessed by CBCL implications of these findings for both the science of
compared to a general population sample. The findings child development and the policies and practices of
further suggest that child adjustment in families with developmental intervention are discussed.
paternal alcohol abuse is the result of an accumulation
of risk factors rather than the effects of the paternal Hauser R, Gos T, Lipowski P, Kuczkowski J. [Retinal
alcohol abuse alone. Both general environmental risk hemorrhages as a case for shaking trauma. Case
factors (psychological problems in the fathers, family report]. Arch Med Sadowej Kryminol 2003; 53(4):363-
climate, family health and conflicts) and environmental 8.
factors related to the parental alcohol abuse (severity of Abstract: An interesting shaking trauma case was
the alcohol abuse, the child's level of exposure to the reported. A detailed analysis of the pattern of injuries
alcohol abuse, changes in routines and rituals due to and their progress allowed to reconstruct the
drinking) were related to child adjustment. The results mechanism and time point of cerebral lesions in a 6
indicate the need to obtain both parents' assessments of week old infant who survived the impact. The necessity
child adjustment, as the fathers' assessment was of postmortem investigation of the fundus and cranial
associated with different risk factors compared to the nerves in fatal cases of shaking trauma is stressed.
mothers'.
Hawkins JD, Kosterman R, Catalano RF, Hill KG, Abbott
Hauser-Cram P, Warfield ME, Shonkoff JP, Krauss MW, RD. Promoting positive adult functioning through
Sayer A, Upshur CC. Children with disabilities: a social development intervention in childhood: long-
longitudinal study of child development and parent term effects from the Seattle Social Development
well-being. Monogr Soc Res Child Dev 2001; 66(3):i- Project. Arch Pediatr Adolesc Med 2005; 159(1):25-
viii, 1-114; discussion 115-26. 31.
Abstract: This Monograph presents the results of the Abstract: OBJECTIVE: To examine the long-term
Early Intervention Collaborative Study, a longitudinal effects of the Seattle Social Development Project
investigation of the cognitive and adaptive behavior intervention in promoting positive adult functioning
development of children with developmental and preventing mental health problems, crime, and
disabilities and the adaptation of their parents, substance use (including tobacco, alcohol, and other
extending from infancy through middle childhood. The drugs) at 21 years of age. DESIGN: This
study was designed to generate and test conceptual nonrandomized controlled trial followed up
models of child and family development and contribute participants to 21 years of age, 9 years after the
to the knowledge base that informs social policy and intervention ended. We compared the following 3
practice. The sample for the investigation reported here intervention conditions: a full 6-year intervention
consists of 183 children with Down syndrome, motor (grades 1 through 6); a late 2-year intervention (grades
impairment, developmental delay and their families 5 and 6 only); and a no-treatment control condition.
who were recruited at the time of their enrollment in an SETTING: Eighteen public elementary schools serving
early intervention program in Massachusetts or New diverse neighborhoods, including high-crime
Hampshire. Data were collected at five time points neighborhoods, of Seattle, Wash. PARTICIPANTS: A
between entry to early intervention and the child's 10th sex-balanced, multiethnic sample of 605 participants
birthday. Home visits were conducted at each time across the 3 conditions who completed interviews at 21
point and included child assessments, maternal years of age (94% of the original sample in these
interview, and questionnaires completed independently conditions). INTERVENTIONS: Teacher training in
by both parents. Trajectories in children's development classroom instruction and management, child social
and parental well-being were analyzed using and emotional skill development, and parent training.
hierarchical linear modeling. Predictor variables were MAIN OUTCOME MEASURES: Self-reports of
measured at age 3 years when children were exiting functioning in school and work, emotional and mental
early intervention programs. Children's type of health, and crime and substance use at 21 years of age
disability predicted trajectories of development in and official court records. RESULTS: Broad
cognition, social skills, and daily living skills. significant effects on functioning in school and work
Children's type of disability also predicted changes in and on emotional and mental health were found. Fewer
maternal (but not paternal) child-related and parent- significant effects on crime and substance use were
related stress. Beyond type of disability, child self- found at 21 years of age. Most outcomes had a
regulatory processes (notably behavior problems and consistent dose effect, with the strongest effects in
mastery motivation) and one aspect of the family subjects in the full-intervention group and effects in the
climate (notably mother-child interaction) were key late-intervention group between those in the full-
predictors of change in both child outcomes and parent intervention and control groups. CONCLUSIONS: A
well-being. A different aspect of the family climate-- theory-guided preventive intervention that strengthened
family relations--also predicted change in child social teaching and parenting practices and taught children
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![interpersonal skills during the elementary grades had mortality widened, irrespective of socio-economic
wide-ranging beneficial effects on functioning in early status indicator used, whereas for females it widened
adulthood. only when certain socio-economic indicators were
used: occupation (unemployment measure) and
Hawkins SS, Law C. Patterns of research activity related to income, but was not significant for the other single
government policy: a UK web based survey. Arch Dis indicators or for the composite indicator.
Child 2005; 90(11):1107-11. CONCLUSIONS: Sydney trends of widening
Abstract: AIMS: To describe the patterns of child and inequalities are generally similar to those reported for
family health and wellbeing research activity in the Britain and for other industrialised countries,
fiscal year (FY) 2002/2003 in relation to UK suggesting that this is a common phenomenon and that
government policies. METHODS: Projects policies to reduce health inequalities over the past
investigating the health and wellbeing of children and quarter of a century have not been effective.
families were located through a web based survey of
major research funders, including UK government Hayez JY. [Confrontation of children and adolescents with
departments and non-departmental public bodies, pornography]. Arch Pediatr 2002; 9(11):1183-8.
research councils, and medical charities. A budget was Abstract: The author describes the influence of
estimated for each project for the FY 2002/2003, and pornography on children, focusing on pornographical
each project coded according to a framework which material on the web. Most children escape almost
reflected government priorities and research uninjured from visualization of pornography. However
methodologies. RESULTS: There was a substantial some are either traumatized, or precipitated in a strict
amount of project information posted on the websites perversion. The consequences on adolescents are
of the funding organisations, but the level of detail similar, though more complex. The hypersexualization
varied. For the FY 2002/2003, 31 organisations were of teenagers may become complicated by addiction (so
identified that commissioned 567 projects investigating called internet addiction disorder: IAD), isolation, and
the health and wellbeing of children and families. perversion. Recommendations for the parents are
Based on information from organisations' websites, this presented.
represented approximately 3% of their research
budgets. Within this funding area, low proportions of Hayman RM, Taylor BJ, Peart NS, Galland BC, Sayers RM.
research activity related to health inequalities (9% of Participation in research: informed consent, motivation
total expenditure on child and family health research), and influence. J Paediatr Child Health 2001; 37(1):51-
health economic analysis (8%), primary and secondary 4.
prevention (12%), and children and adolescents at high Abstract: OBJECTIVE: To investigate the process and
risk of ill health (14%). CONCLUSIONS: A limited quality of informed consent, motivation and influence
amount of research activity on children and families in parents who were invited to enroll their baby in a
health funded in the FY 2002/2003 is addressing UK research project. METHODOLOGY: A mixed
government policy priorities. This suggests the need to quantitative/qualitative questionnaire was sent to a
commission further research to fill gaps in the cohort invited to participate in a physiological research
evidence. project on sudden infant death syndrome (SIDS) at the
Dunedin Public Hospital, Dunedin, New Zealand.
Hayes LJ, Quine S, Taylor R, Berry G. Socio-economic Separate questionnaires were used for parents who
mortality differentials in Sydney over a quarter of a participated (94) and those who declined to participate
century, 1970-94. Aust N Z J Public Health 2002; (103). Response rates were 69% and 47%, respectively.
26(4):311-7. RESULTS: All consenting parents felt they understood
Abstract: OBJECTIVE: To examine trends in socio- the purpose and procedure of the study. The majority
economic differentials in all-cause mortality in Sydney (90%) thought the information about the study was
over a 25-year period (1970-94). METHODS: Five very good; 6.5% felt more detail was required. Eighty-
measures of single indicators (two for occupation, two five per cent found the verbal explanation the most
for education and one for income) and a composite useful source of information. All participated for
measure of socio-economic disadvantage based on altruistic reasons such as to aid SIDS research.
Census data (the Australian Bureau of Statistics' Index Although 27% had concerns about safety of the tests,
of Relative Socio-Economic Disadvantage) were used after the tests all responders felt happy with the safety
as indicators of socio-economic status by local of the tests. Inconvenience was the main reason (53%)
govemment area. The relationship between mortality for declining to participate. Twenty-eight per cent of
and socio-economic status was examined using declining parents were concerned about the safety of
quintiles based on these six measures of socio- the tests. CONCLUSION: Of those who responded to
economic status. RESULTS: Socio-economic the questionnaire, the process for obtaining informed
differentials in mortality were evident for males and consent in the SIDS studies was satisfactory. Parents'
females for all periods, and over the 25-year period the motives for participating were mostly altruistic. The
relative socio-economic differentials did not decline. role of recall bias and selection bias may make the
For males, the socio-economic status differential in implications of this study unclear.
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![Hermer L. Paradigms revised: intersex children, bioethics & relationship to 5 indicators of adolescent deviant
the law. Ann Health Law 2002; 11:195-236, table of behavior. While maltreatment in childhood poses a risk
contents. for later deviance in adolescence, the risk can be even
Notes: GENERAL NOTE: KIE: 210 fn. greater for those who have experienced more
GENERAL NOTE: KIE: KIE Bib: informed consent; transitions while growing up.
patient care/minors
Abstract: Ms. Hermer explores the controversy Herrera VM, McCloskey LA. Gender differences in the risk
surrounding the management of intersex infants and for delinquency among youth exposed to family
children in America. Her focus on the areas of medical violence. Child Abuse Negl 2001; 25(8):1037-51.
malpractice and informed consent leads her to the Abstract: OBJECTIVE: The purpose of this research
conclusion that contrary to some recommendations, a was to illuminate gender differences in adolescent
moratorium on cosmetic genital and sex assignment delinquency against a backdrop of childhood exposure
surgeries for infants and children is not warranted. to both marital violence and physical child abuse.
Rather, providers should focus on offering parents with Specifically, analyses were performed to trace the
complete information, referrals to support groups and unique effects of exposure to either form of family
forthright discussions on the dearth of information violence (marital or child) on the violent and
available. nonviolent delinquency of boys and girls. METHOD:
This is a prospective study of 299 children who were
Hernandez Robles M, Ramirez Enriquez C, Gonzalez Diaz interviewed with their mothers in 1991 about forms of
SN, Canseco Gonzalez C, Arias Cruz A, del Castillo O. abuse in the family. Approximately 5 years later a
[Psychological profile of the pediatric asthma patient]. search of juvenile court records was performed for
Rev Alerg Mex 2002; 49(1):11-5. these same children. Details on the nature of the crimes
Abstract: BACKGROUND: When a child develops were collected. Outcome variables included: (1)
asthma symptoms, several changes in his/her behavior, whether there was ever an arrest; and (2) whether there
in his/her family and in his/her social environment was ever an arrest for a violent crime. RESULTS:
begin. OBJECTIVE: To identify the most frequent Preliminary analyses indicated no gender differences in
personality traits and psychological disturbances in overall referral rates to juvenile court, although boys
asthmatic children and adolescents. MATERIAL AND were more likely than girls to be referred for property,
METHODS: A transversal, observational and felony, and violent offenses. Exposure to marital
descriptive study was performed on 85 asthmatic violence in childhood predicted referral to juvenile
children and adolescents ages from 5 to 18 years old court. Girls with a history of physical child abuse were
that attended a questionnaire, and a graphic test on 77 arrested for violent offenses more than boys with
of those children, which consisted on drawing two similar histories, but the context of violent offenses
pictures. Such pictures were analyzed by a differed dramatically by gender: Nearly all referrals for
psychotherapist to determine the personality traits and a violent offense for girls were for domestic violence.
the psychological disturbance present in these CONCLUSIONS: Although boys and girls share
individuals. RESULTS: All the children answered similar family risk factors for delinquency, girls are
positively at least one of the questions which detect more likely than boys to be arrested for violent
data related to depression in the questionnaire, being offenses in the aftermath of child physical abuse. These
the more frequent: easy anger (40%), insomnia (29%), findings suggest that it takes more severe abuse to
sadness (15%), auto-aggression or suicide ideas (11%) prompt violence in girls than is necessary to explain
and loss of appetite (6%). According to graphic test boys' violent offending.
interpretation, 39% of children showed a depression
disturbance, 29% adaptation disturbance with Herskovits EH, Gerring JP. Application of a data-mining
depression symptoms, and 12% an adaptation method based on Bayesian networks to lesion-deficit
disturbance. In addition, we found that 2 children were analysis. Neuroimage 2003; 19(4):1664-73.
victim of abuse and negligence into their families. Abstract: Although lesion-deficit analysis (LDA) has
CONCLUSION: The 100% of the evaluated asthmatic provided extensive information about structure-
children and adolescents, showed data related to function associations in the human brain, LDA has
depression presence. suffered from the difficulties inherent to the analysis of
spatial data, i.e., there are many more variables than
Herrenkohl EC, Herrenkohl RC, Egolf BP. The psychosocial subjects, and data may be difficult to model using
consequences of living environment instability on standard distributions, such as the normal distribution.
maltreated children. Am J Orthopsychiatry 2003; We herein describe a Bayesian method for LDA; this
73(4):367-80. method is based on data-mining techniques that employ
Abstract: The relationship between stability of living Bayesian networks to represent structure-function
arrangements and adolescent deviance was examined associations. These methods are computationally
for 212 adolescents in a longitudinal study of tractable, and can represent complex, nonlinear
maltreated and non maltreated children. Transitions in structure-function associations. When applied to the
caretakers and residences have a statistically significant evaluation of data obtained from a study of the
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![actualizing latent ties to already existing network definition of treatment effectiveness. In randomised
members. placebo-controlled antidepressant clinical trials (RCT),
the assessment of treatment effectiveness is commonly
Hiscock H, Wake M. Randomised controlled trial of made with the CDRS-R (improvement of 20% or 30%
behavioural infant sleep intervention to improve infant or 40%) and CGI. SSRI demonstrated significantly, but
sleep and maternal mood. BMJ 2002; 324(7345):1062- modest, improvement compared with placebo in CGI
5. score of 1 or 2: 10% more for sertraline, 16.8% more
Abstract: OBJECTIVE: To compare the effect of a for paroxetine and between 16 to 24% more for
behavioural sleep intervention with written information fluoxetine. In adults, RCT studies have shown placebo
about normal sleep on infant sleep problems and response rates of 30% to 50%, drug response rates of
maternal depression. DESIGN: Randomised controlled 45% to 50% and drug-placebo differences of 18% to
trial. SETTING: Well child clinics, Melbourne, 25%. The highest placebo response rates, in young
Australia. PARTICIPANTS: 156 mothers of infants people, may be related to the highly selected group not
aged 6-12 months with severe sleep problems representative of the general population of depressed
according to the parents. MAIN OUTCOME patients and/or to the high youths' sensibility of
MEASURES: Maternal report of infant sleep problem; psychotherapy. Patients participating in antidepressant
scores on Edinburgh postnatal depression scale at two clinical trials have a low BDI and CDI in Emslie's
and four months. INTERVENTION: Discussion on study for example (2002). In adults, previous reports
behavioural infant sleep intervention (controlled suggest that SSRI use is associated with increased
crying) delivered over three consultations. RESULTS: suicidal risk. But the analyse of 48 277 depressed
At two months more sleep problems had resolved in patients participating in RCT for nine FDA approved
the intervention group than in the control group (53/76 antidepressants fail to support an overall difference in
v 36/76, P=0.005). Overall depression scores fell suicide risk between antidepressants (SSRI) and
further in the intervention group than in the control placebo treated subjects. An inverse relationship
group (mean change -3.7, 95% confidence interval -4.7 between regional change in use of antidepressants
to -2.7, v -2.5, -1.7 to -3.4, P=0.06). For the subgroup (increased) and suicide (decreased) is found in young -
of mothers with depression scores of 10 and over more people in United States from 1990 and 2000. We can
sleep problems had resolved in the intervention group not draw a conclusion from few studies with few -
than in the control group (26/33 v 13/33, P=0.001). In participants. None suicide have been reported in
this subgroup depression scores also fell further for pharmacological studies. And the link between
intervention mothers than control mothers at two "suicidality" and MDD can not be excluded. The
months (-6.0, -7.5 to -4.0, v -3.7, -4.9 to -2.6, P=0.01) instruments of assessment in depressed young patients
and at four months (-6.5, -7.9 to 5.1 v -4.2, -5.9 to -2.5, are based on extensions of adult procedures. Whereas
P=0.04). By four months, changes in sleep problems clinical picture of MDD in children, adolescents and
and depression scores were similar. CONCLUSIONS: adults have some differences. Depressed youngsters
Behavioural intervention significantly reduces infant have more pronounced mood lability. Depressed
sleep problems at two but not four months. Maternal adolescents have more anhedonia than depressed
report of symptoms of depression decreased children. Future investigations into the efficacy and
significantly at two months, and this was sustained at safety of treatments for children and adolescents
four months for mothers with high depression scores. depression should use specific instruments directly
built on phenomenological and clinical picture of
Hjalmarsson L, Corcos M, Jeammet P. [Selective serotonin depressed children and adolescents. Comparison
reuptake inhibitors in major depressive disorder in studies of pharmacotherapy, specific psychotherapies
children and adolescents (ratio of benefits/risks)]. (not only CBT) and combined therapies are necessary
Encephale 2005; 31(3):309-16. to identify the adolescents who will benefit the most
Abstract: Major depressive disorder in children and from specific or combined therapies. Further studies
adolescents is associated with high risk of suicide and into the factors that influence treatment outcome
persistent functional impairment. While psychological including clinical picture (clinical dimensions, severity,
treatments are used as a first line treatment in mild and duration, co morbidity), genetic factor, age, and i-llness
moderately severe depression in this age group, the course may help identify appropriate treatments for
number of prescriptions for antidepressant medication children and adolescents with MDD. Studies should
(SSRI) has grown in recent years. Recently, FDA and include patients more severely ill, with associated
MHRA advised that most of SSRI should not be used psychiatric troubles, treatment resistance, history of
to treat MDD under the age of 18 years. They may relapses... In clinical studies, the link between
increase the risk of suicidal thoughts and self harm. We "suicidality" and some clinical dimensions (which take
reviewed the recent literature on efficacy and suicide part in clinical picture or not) must be analysed by
risks of SSRI in depressed young people. Conflicting assessing anhedonia, hopelessness feel, impulsive trait,
findings of SSRI efficacy have been reported in clinical borderline personality, familial inter-action, biological
studies. The discrepancies could be related to the indices. New treatment should be expand and their
heterogeneous samples and the absence of a standard efficacy and safety must be study: St John's worth,
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![CONCLUSIONS: The study showed that a coaching between sex and visual problems in the prediction of
strategy had a positive effect on maternal-infant bullying. CONCLUSIONS: For those children who
interaction in this sample. Future research is needed to require glasses, opticians should be aware of the risks
test coaching interventions in conjunction with other of bullying, and strategies should be developed and
strategies targeted to promote maternal-infant discussed that help reduce their vulnerability.
responsiveness and to reduce PPDS.
Hossain SM, Duffield A, Taylor A. An evaluation of the
Horton R. In defence of Roy Meadow. Lancet 2005; impact of a US$60 million nutrition programme in
366(9479):3-5. Bangladesh. Health Policy Plan 2005; 20(1):35-40.
Notes: GENERAL NOTE: KIE: 7 refs. Abstract: OBJECTIVE: To compare levels of
GENERAL NOTE: KIE: KIE Bib: fraud and childhood malnutrition in areas where the Bangladesh
misconduct; medical ethics Integrated Nutrition Project had been operational for
over 5 years with matched non-project areas, with the
Horwitz SM, Kerker BD. Preschool and school age children purpose of evaluating whether the project had achieved
under welfare reform. Child Psychiatry Hum Dev its objective of reducing the prevalence of underweight
2001; 32(2):107-24. among children <24 months. METHODS: The study
Abstract: This study compared the behavioral and involved an ex-post cross-sectional survey in six thanas
school problems of young children whose mothers (a locality with a population of approximately 200,000-
participated in two different income support programs, 450,000 people) in Bangladesh. Participants were
Jobs First and AFDC. The analyses also included 6,820 households (4,554 in the project areas and 2,266
measures of maternal education, maternal health, in the non-project areas) including 7183 children aged
maternal psychological factors, and family 6-59 months selected using a two-stage stratified
environment. There were no differences in child school cluster sampling frame. Main outcome measures were
or behavioral problems across the income support moderate and severe underweight, wasting and stunting
programs. Children, however, were more likely to have reported using z scores, and indicators of mothers'
school problems if they were older or if their mothers reported nutritional knowledge and practice.
received less than a high school education, reported RESULTS: 2,388 children aged 6-23 months and 6815
child behavioral problems or made criteria for children aged 6-59 months had clean anthropometric
depression on the CIDI. Behavioral problems were data. No significant difference was found between the
more likely to occur if mothers reported violence in the socio-economic variables of households in the project
home, many depressive symptoms on the CES-D, few and non-project areas. No significant difference was
child positive qualities, or if the child had repeated a found in the prevalence of either severe or moderate
grade. Several familial factors, then, must be addressed underweight (weight-for-age) in children aged 6-23
in order to ensure that children excel both academically months in the project and non-project areas: 183
and behaviorally. (11.4%, 95% confidence interval 9.9-13.2%) children
in project areas and 96 (12.2%, 95% confidence
Horwood J, Waylen A, Herrick D, Williams C, Wolke D. interval 9.9-14.8%) children in non-project areas.
Common visual defects and peer victimization in Mothers in project areas reported significantly better
children. Invest Ophthalmol Vis Sci 2005; 46(4):1177- caring practices than in non-project areas.
81. CONCLUSION: There is no evidence that the
Abstract: PURPOSE: To investigate whether wearing Bangladesh Integrated Nutrition Project has achieved
glasses, having manifest strabismus, or having a history its objectives to reduce severe underweight by 40% if
of wearing an eye patch predisposes preadolescent project areas are compared ex-post with non-project
children to being victimized more frequently at school areas. There is urgent need to review the evidence
and whether the impact may be different on boys than behind investments based on growth monitoring and
on girls. METHODS: Data were examined on 6536 promotion.
children from the Avon Longitudinal Study of Parents
and Children (ALSPAC) based in the United Kingdom. Host G. [Child abuse--from the perspective of the child].
At 7.5 years, the children undertook a detailed eye Lakartidningen 2001; 98(4):346.
examination by orthoptists, including a cover test and
visual acuity assessment. At 8.5 years, trained Howard DE, Feigelman S, Li X, Cross S, Rachuba L. The
psychologists assessed the children's bullying relationship among violence victimization, witnessing
involvement as either victim or perpetrator for overt violence, and youth distress. J Adolesc Health 2002;
and relational bullying, in a standard interview. 31(6):455-62.
RESULTS: Children currently wearing glasses or with Abstract: PURPOSE: To explore whether violence
a history of wearing eye patches were 35% to 37% victimization and witness experiences of
more likely to be victims of physical or verbal predominantly African-American, low-income, urban
bullying, even after adjustment for social class and adolescents were associated with distress and whether
maternal education. No interactions were found psychosocial factors contributed to symptomatology.
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![information about the known benefits and risks of higher levels of general parental control and
testing and recognize the parental right of refusal. authoritarian feeding practices. Alternatively,
Finally, since the absence of explicit parental consent authoritative feeding styles were associated with higher
to newborn screening is not legally defensible, levels of general parental responsiveness. Among the
children's advocates should lobby for legislation two permissive feeding styles, Hispanic parents were
permitting it in the absence of explicit consent in more likely to be indulgent, whereas African-American
specific circumstances. parents were more likely to be uninvolved. Further,
differences were found among the feeding styles on an
Hudziak JJ, Copeland W, Stanger C, Wadsworth M. independent measure of child's body mass index.
Screening for DSM-IV externalizing disorders with the
Child Behavior Checklist: a receiver-operating Huijbregts SC, de Sonneville LM, van Spronsen FJ, Licht R,
characteristic analysis. J Child Psychol Psychiatry Sergeant JA. The neuropsychological profile of early
2004; 45(7):1299-307. and continuously treated phenylketonuria: orienting,
Abstract: BACKGROUND: This study examines the vigilance, and maintenance versus manipulation-
diagnostic accuracy of the CBCL syndrome AS scales functions of working memory. Neurosci Biobehav Rev
for predicting DSM-IV Attention Deficit-Hyperactivity 2002; 26(6):697-712.
Disorder (ADHD) and Oppositional Defiant Disorder Abstract: In this paper, we review neuropsychological
with or without Conduct Disorder (ODD/CD). test results of early and continuously treated
METHODS: The sample included 370 children (187 Phenylketonuria (PKU) patients. To increase insight
probands and 183 siblings) participating in a family into the neuropsychological profile of this population,
genetic study of attention and aggressive behavior we have attempted to place the results within an
problems. Univariate and stepwise logistic regression attentional network model [Images of the mind, 1994],
analyses were used to derive models for predicting two which proposes interacting but dissociable attentional
diagnostic conditions: ADHD and ODD/CD. networks for orienting, vigilance, and executive control
RESULTS: The Attention Problems syndrome of attention. Executive control of attention is discussed
significantly predicted ADHD, and ODD/CD was against the background of the process-specific theory
significantly predicted by the Aggressive Behavior of working memory (WM) [Handbook of
syndrome. Both scales demonstrated good diagnostic neuropsychology, 1994], which postulates a distinction
accuracy, as assessed through receiver operating between the 'maintenance'-function of WM and the
characteristics analyses. Cut-point analyses confirmed 'manipulation and monitoring'-
the utility of low T-scores, 55 on the respective function.Neuropsychological results are presented for
syndromes, for efficiently discriminating cases from 67 early and continuously treated PKU patients and 73
noncases. CONCLUSIONS: CBCL syndromes display controls aged 7-14 years. Four neuropsychological
good diagnostic efficiency for assessing common tasks were employed to measure orienting, mnemonic
externalizing disorders in children. processing, interference suppression, and top-down
control in visual search. No differences were found in
Huff B. Men, meth and sex. GMHC Treat Issues 2005; 19(1- orienting and the maintenance-function of WM. In
2):7-9. addition to previously reported impairments in
sustained attention/vigilance and inhibition of
Hughes SO, Power TG, Orlet Fisher J, Mueller S, Nicklas prepotent responding, PKU patients exhibited deficits
TA. Revisiting a neglected construct: parenting styles when top-down control was required in a visual search
in a child-feeding context. Appetite 2005; 44(1):83-92. task, but showed no impairment when interference
Abstract: The extent to which general parenting suppression was required. It is discussed how the
represents feeding styles in ethnically diverse specific neuropsychological impairments in PKU may
populations is not well documented. Existing measures be a consequence of mid-dorsolateral prefrontal cortex
of child feeding have focused almost exclusively on (DLPFC) dysfunctioning due to deficiencies in
specific behaviors of European-American parents. A catecholamine modulation.
valid and reliable instrument was developed to identify
feeding styles in parents of low-income minority Hulac P. Creation and use of You Are Not Alone, a video
preschoolers. Two hundred thirty-one parents (130 for parents facing difficult decisions. J Clin Ethics
Hispanic; 101 African-American) completed 2001; 12(3):251-3.
questionnaires on feeding practices and parenting Notes: GENERAL NOTE: KIE: Hulac, Peter
styles. Based on self-reported feeding behavior, parents GENERAL NOTE: KIE: 1 ref.
were assigned to four feeding styles (authoritarian, GENERAL NOTE: KIE: KIE Bib: patient care/minors
n=84; authoritative, n=34; indulgent, n=80; and
uninvolved, n=33). Convergent validity was evaluated Hull B, McIntyre P. Mapping immunisation coverage and
by relating feeding styles to independent measures of conscientious objectors to immunisation in NSW. N S
general parenting and authoritarian feeding practices. W Public Health Bull 2003; 14(1-2):8-12.
Authoritarian feeding styles were associated with Notes: GENERAL NOTE: KIE: 12 refs.
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![able to reach or rule out a diagnosis. CONCLUSION: intraindividual change in coping over time. Evidence
The Retcam 120 digital fundus camera has utility as an for both change and continuity in the development of
in-office diagnostic tool for fundus examination of coping from adolescence to adulthood was found,
poorly cooperative children and may be a good although adolescent coping had limited impact on
alternative to examination under anesthesia or sedation stress and substance use in adulthood. Support was also
in selected cases. found for complex stress-buffering and stress-
exacerbating effects of coping on the relations between
Hussong AM, Chassin L. Parent alcoholism and the leaving major life events and adult drug use and between stress
home transition. Dev Psychopathol 2002; 14(1):139- associated with the new roles of adulthood and heavy
57. alcohol use. Implications of these findings for
Abstract: Although they have received little empirical development and adjustment in the transition to
attention, departures from the parental home play a adulthood are discussed.
significant role in demarcating the transition from
adolescence to young adulthood. The current study Hutchings J, Lane E. Parenting and the development and
examined the extent to which various features of young prevention of child mental health problems. Curr Opin
adults' experiences of leaving home differed for Psychiatry 2005; 18(4):386-91.
children of alcoholic (COAs) versus nonalcoholic Abstract: PURPOSE OF REVIEW: The government is
parents, what adolescent precursors might account for recognizing the need to deal with the growing numbers
noted differences and what indicators of young adult of antisocial young people through investing in early
adjustment are related to the leaving home experience. preventive parenting support. It is important that the
A total of 227 young adults drawn from a high-risk, services provided are evidence-based and delivered
community sample of COAs and matched controls effectively. This review briefly discusses the
were interviewed at ages 18-23 years regarding their contribution of parenting to the development of child
prior leaving home experiences. COAs showed greater mental health difficulties, particularly externalizing
difficulties in negotiating this transition, fewer positive problems, and reviews some effective early
feelings about the transition, and different reasons for intervention preventive programmes. RECENT
leaving home as compared to participants without an FINDINGS: Over 30 years of research have established
alcoholic parent. Moreover, adolescent risk behaviors, both that parenting behaviours influence the
family conflict, and family disorganization (assessed development of childhood conduct disorders and that
prior to this transition) each partly accounted for behavioural family interventions targeting specific
COAs' risk for difficulty in the leaving home transition. parenting skills are the most effective way of
Although certain aspects of the leaving home transition preventing or reducing child behaviour problems. Until
were uniquely related to young adult adjustment, future recently, however, those children at highest risk have
research is still needed to more comprehensively often had the poorest outcomes from intervention.
understand the implications for young adult Recent research has identified the factors that make
development associated with such individual parenting interventions effective and how to engage the
differences in the leaving home transition. multi-stressed, hard-to-reach families whose children
are most at risk. SUMMARY: Research has identified
Hussong AM, Chassin L. Stress and coping among children risk factors that are associated with the development of
of alcoholic parents through the young adult transition. conduct disorder and affect the quality of parenting.
Dev Psychopathol 2004; 16(4):985-1006. This has made it possible to provide preventive
Abstract: The transition to young adulthood is both a interventions, targeting families that are most at risk.
time when risky health behaviors such as substance Evaluations have shown, however, that getting
misuse peak and a time of opportunity for growth and effective preventive services to those most at risk is not
development through the acquisition of adult roles. In straightforward and programmes need to address the
this transition, coping styles include responses to the problem of recruiting parents who, by virtue of their
stressors and opportunities associated with the multiple problems, have traditionally been hard to
emergence of adulthood. The extent to which such engage. Emphasis is placed on the importance of using
coping styles are skillfully employed in part determines evidenced-based programmes in service settings in
adjustment into adulthood. The current study used a ways that are effective.
high-risk, longitudinal design to examine the
development of coping styles over adolescence, Huth-Bocks AC, Levendosky AA, Bogat GA. The effects of
continuity in these coping styles from adolescence to domestic violence during pregnancy on maternal and
adulthood, the impact of coping on adult stress and infant health. Violence Vict 2002; 17(2):169-85.
substance misuse, the ability of coping to buffer effects Abstract: The present study examined the impact of
of stress on substance use, and differences in coping domestic violence on maternal and infant health by
between at-risk youth (i.e., children of alcoholics assessing maternal health during pregnancy and infant
[COAs]) and their peers. A sample of 340 adolescents health at two months postpartum. Two hundred and
completed four assessments over ages 11-23. We used two women (68 battered and 134 non-battered) were
latent trajectory models to examine interindividual and recruited from the community and completed both
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![Abstract: PROBLEM: Although the need for mental Because the corticosteroid could not be discontinued,
health services for children and youth is on the rise in promethazine, a phenothiazine derivative, was used to
Korea, there are no data available regarding the current treat the psychotic symptoms. Symptoms resolved with
status of psychiatric nurses working with children and use of promethazine. DISCUSSION: A number of
adolescents. METHODS: Descriptive statistics were published reports describe the appearance of
used to analyze questionnaires from 324 respondents. psychological symptoms with corticosteroid use. While
FINDINGS: Only 5% of psychiatric nurses in Korea the mechanism is unclear, the reaction is usually
are working at child and adolescent-specific programs. reversible with dose reduction or discontinuation of the
The level of nurses' roles and functions vary from corticosteroid. In cases where this cannot be done,
simple to specialized. CONCLUSIONS: More effort typical treatment involves an antipsychotic medication.
should be put into networking among nurses to Most antipsychotic medications, such as the
exchange updated information and to share nursing phenothiazine class, have not been evaluated in very
strategies and strengthen college education for further young children. Promethazine is a phenothiazine
specialization and expansion of nursing roles in the derivative that has been used in children for a number
various settings. of nonpsychiatric indications. CONCLUSIONS:
Promethazine may be effective in treating steroid-
Inbar Z, Meibar R, Shehada S, Irena V, Rubin L, Rishpon S. induced psychosis in pediatric patients.
"Back to sleep": parents compliance with the
recommendation on the most appropriate sleeping Intromasso C. Reproductive self-determination in the Third
position of infants, Haifa District, Israel, 2001. Prev Circuit: the statutory proscription of wrongful birth and
Med 2005; 40(6):765-8. wrongful life claims as an unconstitutional violation of
Abstract: BACKGROUND: In 1993, the Israel Planned Parenthood v. Casey's undue burden standard.
Ministry of Health issued a formal recommendation to Women's Rights Law Report 2003; 24(2):101-20.
avoid placing healthy infants to sleep in the prone Notes: GENERAL NOTE: KIE: 249 fn.
position in order to prevent sudden infant death. The GENERAL NOTE: KIE: KIE Bib: abortion/legal
objective of the study was to study parents' compliance aspects; wrongful life
with this recommendation and to identify
characteristics of noncompliant parents of infants aged Iribarren JA, Ramos JT, Guerra L et al. [Prevention of
less than 6 months old. METHODS: The study vertical transmission and treatment of infection caused
population consisted of 1912 parents of infants aged 0- by the human immunodeficiency virus in the pregnant
12 months who visited the Haifa District primary woman. Recommendations of the Study Group for
preventive health centers during the study week and AIDS, Infectious Diseases, and Clinical Microbiology,
answered the self-administered questionnaire. the Spanish Pediatric Association, the National AIDS
RESULTS: 15.6% of infants younger than 1 year were Plan and the Spanish Gynecology and Obstetrics
placed to sleep in the prone position: 12.4% among Society]. Enferm Infecc Microbiol Clin 2001;
infants younger than 3 months, and 17.6% among 19(7):314-35.
infants 3-6 months old. Surprisingly, multiple logistic
regression analysis demonstrated that Israeli-born Irwin HJ. The relationship between dissociative tendencies
Jewish mothers were more likely to place their babies and schizotypy: an artifact of childhood trauma? J Clin
prone than Israeli-born Arab mothers or mothers born Psychol 2001; 57(3):331-42.
in the former Soviet Union who had immigrated to Abstract: Previous research has suggested a
Israel after 1990. CONCLUSIONS: At-risk behaviors relationship between dissociative tendencies and
are usually associated with minority and immigrant schizotypy. This study sought to extend the previous
populations. Culture specific and other possible reasons work in two fundamental respects. First, explicit
for our unusual findings are discussed. cognizance was taken of the multidimensionality of
both dissociative tendencies and schizotypy. Second,
Ingram DG, Hagemann TM. Promethazine treatment of the study examined the possibility that the observed
steroid-induced psychosis in a child. Ann correlation between dissociative tendencies and
Pharmacother 2003; 37(7-8):1036-9. schizotypy is an artifact of the association between
Abstract: OBJECTIVE: To report a case of steroid- each of these personality domains and a history of
induced psychosis in a child that resolved with the childhood trauma. Australian adults (N = 116) were
treatment of promethazine, a phenothiazine derivative. administered the Dissociative Experiences Scale, the
CASE SUMMARY: A 2-year-old white boy with a Schizotypal Personality Questionnaire-Brief, and the
history of relapsed acute lymphoblastic leukemia Childhood Trauma Questionnaire. Hierarchical
underwent a bone marrow transplant and developed regression analysis revealed that both pathological and
graft-versus-host disease, which was treated with nonpathological dissociative tendencies were predicted
methylprednisolone. Within 24 hours of initiation of by the dimensions of schizotypy, even after the
the methylprednisolone, the patient developed contribution of childhood trauma had been removed. It
symptoms associated with steroid-induced psychosis is concluded that the relationship between dissociative
including mania, head-banging, and excessive crying.
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![tendencies and schizotypy is not an artifact of of the Handbook would greatly contribute to improving
childhood abuse, but the clinical significance of this the management of children with psychosomatic and
relationship remains to be established. psychosocial disorders, together with the construction
of the basic network model for management of these
Isaacs D. To kill or to let die? J Paediatr Child Health 2003; children.
39(2):135-6.
Notes: GENERAL NOTE: KIE: 5 refs. Islam MN, Islam MN. Retrospective study of alleged rape
GENERAL NOTE: KIE: KIE Bib: allowing to die; victims attended at Forensic Medicine Department of
euthanasia Dhaka Medical College, Bangladesh. Leg Med
(Tokyo) 2003; 5 Suppl 1:S351-3.
Isaksen CR, Lund EB. [Shaken baby syndrome--shaking Abstract: Sexual assault is one of the fast growing
violence against infants]. Ugeskr Laeger 2002; violent crimes in Bangladesh. We carried out a
164(48):5662-3. retrospective study of 675 alleged rape victims out of
Abstract: We describe two cases of shaken baby total examined 1665 cases during 1994-2000. In the
syndrome. Both children were about three months of last seven years, 441 victims refused examination and a
age. It is important to recognise the characteristic final report is pending in 2.4% cases due to non-
features of this form of child abuse in order to prevent availability of ancillary investigation reports. We found
further damage and to ensure removal of the children that 48.9% cases were sexually abused based on
from the abusive environment. history, physical evidence and opinion of the
examining doctor although high vaginal swab for
Ishizaki Y, Kobayashi Y, Yamagata Z et al. Research on spermatozoa was found to be negative in all cases. Out
promotion of management of children with of 675 cases studied in this paper, 33.5% was in the 12-
psychosomatic and psychosocial disorders in Japan. 15 year age group, in 511 cases the assailant was
Pediatr Int 2005; 47(3):352-7. known to the victims, 23.7% was reported and was
Abstract: BACKGROUND: The number of children examined within 72 h of occurrence, unmarried
with psychosomatic and psychosocial disorders has persons constituted 56.6% cases and 69.9% was
been increasing in Japan. There are, however, few literate. In 45.8% of the cases the victims were abused
trained pediatricians who have adequate knowledge of during the daytime. Non-genital violence was observed
the treatment needed. The Research Group on the in 91 cases, 2.9% was admitted to the hospital, 2%
Promotion of Management of Children with reported with pregnancy, 0.4% reported with abortion
Psychosomatic and Psychosocial Disorders carried out and four cases had a history of previous abuse. Genital
the present study to (i) disseminate knowledge about findings included hymenal rupture in 38.9% and 9.6%
psychosomatic and psychosocial disorders of children; cases of forchette were found with recent tears. In 248
and (ii) establish a community-based network model to cases, opinion was negative due to delayed attendance,
ensure effective communication among relevant false charge and time-consuming procedures.
institutions. METHODS: To disseminate knowledge of
the psychosocial and psychosomatic disorders, the Ismail AI. Determinants of health in children and the
Research Group compiled the Handbook for problem of early childhood caries. Pediatr Dent 2003;
Psychosomatic Disorders of Children and distributed it 25(4):328-33.
to pediatricians throughout Japan. A follow-up Abstract: Early childhood caries (ECC) is a significant
questionnaire survey was then carried out. Also, in dental problem for many low-income and minority
order to examine the current status of the children in the United States. The diagnosis,
communication network between pediatricians and the prevention, and management of ECC have been based
related institutions, the Research Group conducted a upon both experiential knowledge and scientific
questionnaire survey on general pediatricians. evidence. In the prevention and management of ECC,
RESULTS: Sixty-five percent of the respondents the focus has been on modifying the dental, infectious,
indicated that they were actually using the Handbook. and behavioral determinants of the disease. The
The topics in the Handbook that were most frequently purpose of this concept paper is to expand the
referred to by the respondents were attention deficit paradigm used to understand the etiology of ECC and
hyperactivity disorders, school refusal, eating design programs to prevent and manage this condition.
disorders, and orthostatic dysregulation. Thirty-seven
percent of the participants indicated changes in their Israel BA, Parker EA, Rowe Z et al. Community-based
behavior towards psychosomatic and psychosocial participatory research: lessons learned from the Centers
problems. The results of the survey on communication for Children's Environmental Health and Disease
networks found that the pediatricians generally Prevention Research. Environ Health Perspect 2005;
collaborated with different institutions depending on 113(10):1463-71.
the nature of the problems, such as school refusal and Abstract: Over the past several decades there has been
bullying, developmental disorders, child abuse and growing evidence of the increase in incidence rates,
maltreatment, and others. CONCLUSION: Promotion morbidity, and mortality for a number of health
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![ability to develop a connected relationship. nursing practice. The purpose of this article is to
CONCLUSION: Public health nurses working with describe bioethical principles and common ethical
families at risk need to identify client fears and dilemmas faced by nurses in pediatric end-of-life care
perceptions related to home visiting, and to explain the and suggest nursing interventions to promote a
role of public health nurses and family visitors to all peaceful end-of-life experience for the child and
family members. Given the importance that mothers family.
place on the development of an interpersonal
relationship, it is important for home visitors Jacobs J, Jonas WB, Jimenez-Perez M, Crothers D.
continually to assess the quality of their relationships Homeopathy for childhood diarrhea: combined results
with clients. and metaanalysis from three randomized, controlled
clinical trials. Pediatr Infect Dis J 2003; 22(3):229-34.
Jackson JK, Vellucci J, Johnson P, Kilbride HW. Evidence- Abstract: BACKGROUND: Previous studies have
based approach to change in clinical practice: shown a positive treatment effect of individualized
introduction of expanded nasal continuous positive homeopathic treatment for acute childhood diarrhea,
airway pressure use in an intensive care nursery. but sample sizes were small and results were just at or
Pediatrics 2003; 111(4 Pt 2):e542-7. near the level of statistical significance. Because all
Abstract: OBJECTIVE: Recent studies provide three studies followed the same basic study design, the
evidence that nasal intermittent positive pressure combined data from these three studies were analyzed
ventilation (NIPPV) may stabilize the airway of to obtain greater statistical power. METHODS: Three
extremely low birth weight infants after endotracheal double blind clinical trials of diarrhea in 242 children
extubation. The objective of this project was to ages 6 months to 5 years were analyzed as 1 group.
introduce the use of NIPPV into a busy level 3 Children were randomized to receive either an
intensive care nursery. METHODS: This report individualized homeopathic medicine or placebo to be
describes the process of NIPPV introduction using a taken as a single dose after each unformed stool for 5
series of rapid-cycle improvement projects, as days. Parents recorded daily stools on diary cards, and
proposed by the Vermont Oxford Network. RESULTS: health workers made home visits daily to monitor
In the first cycle, 7 (88%) of 8 infants were children. The duration of diarrhea was defined as the
successfully extubated with NIPPV after meeting time until there were less than 3 unformed stools per
criteria for reintubation on nasal continuous positive day for 2 consecutive days. A metaanalysis of the
airway pressure alone. Proper positioning of the prongs effect-size difference of the three studies was also
in the nasopharynx was found to be an important conducted. RESULTS: Combined analysis shows a
determinant of success. In a second cycle, shorter 2.5- duration of diarrhea of 3.3 days in the homeopathy
cm nasopharyngeal prongs were more effective than group compared with 4.1 in the placebo group (P =
standard 4-cm prongs in 12 recently extubated infants 0.008). The metaanalysis shows a consistent effect-size
as assessed by objective measurements and subjective difference of approximately 0.66 day (P = 0.008).
nursing reports. A third cycle confirmed the acceptance CONCLUSIONS: The results from these studies
of this technique in our unit and demonstrated an confirm that individualized homeopathic treatment
associated decrease in markers of chronic lung disease decreases the duration of acute childhood diarrhea and
in extremely low birth weight infants during the 22 suggest that larger sample sizes be used in future
months after its introduction. CONCLUSION: This homeopathic research to ensure adequate statistical
experience supports the role for the rapid-cycle change power. Homeopathy should be considered for use as an
model in achieving effective evidence-based medical adjunct to oral rehydration for this illness.
practices in a neonatal intensive care setting.
Jacobson JL, Jacobson SW. Effects of prenatal alcohol
Jacobs AJ. Liberty, equality, and genetic selection. Pharos exposure on child development. Alcohol Res Health
Alpha Omega Alpha Honor Med Soc 2001; 64(1):15- 2002; 26(4):282-6.
20; discussion 20-3.
Notes: GENERAL NOTE: KIE: 25 refs. Jacquemin Le Vern H. [Adolescence and pornography].
GENERAL NOTE: KIE: KIE Bib: genetic Gynecol Obstet Fertil 2004; 32(5):416-9.
intervention; genetic screening; prenatal diagnosis Abstract: It is difficult to define pornography; it always
proceeds from censure. Any representation of sexual
Jacobs HH. Ethics in pediatric end-of-life care: a nursing relations forbidden by the law is considered as
perspective. J Pediatr Nurs 2005; 20(5):360-9. pornography. How can we evaluate its impact on
Abstract: Care of children at the end of life frequently teenagers? What are the possible consequences? Which
involves ethical dilemmas and difficult decisions. image of woman is carried through pornography?
These ethical dilemmas often complicate the already
challenging circumstances surrounding the death of a Jaffe ME, Sharma KK. Cybersex with minors: forensic
child; therefore, the knowledge and application of implications. J Forensic Sci 2001; 46(6):1397-402.
ethical principles becomes an essential component of Abstract: This paper is designed to assist forensic
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![psychiatrists/psychologists who evaluate adults who Abstract: BACKGROUND: Childhood asthma
commit sexual crimes against children on the Internet. continues to be a growing medical concern in the
The typical offender is an adult male who logs onto the United States, affecting > 17 million children in 1998.
Internet and enters a chat room in which children The mortality rate from asthma in children aged 5 to 14
congregate. Unbeknownst to the offender, undercover years has nearly doubled, from 1.7 deaths per million
police officers are posing as minors in the chat rooms. to 3.2 deaths per million between 1980 and 1993.
The undercover officer (pretend kid) and offender OBJECTIVE: To evaluate the use of artificial neural
engage in increasingly explicit, sexual conversation; networks (ANNs) to rate problem-based strategies for
the offender may transmit erotic photographs to the asthma management in a defined population of
undercover officer and/or arrange to meet at a motel in children. METHODS: The participants in our study
order to have sexual intercourse. The authors will were recruited from a local inner-city medical facility
discuss the relevant legal, clinical, and ethical aspects in Los Angeles. The majority of participants had
of examining these offenders, and describe specific received the diagnosis of mild-to-moderate-persistent
cases that the author (2) evaluated. asthma. Each participant was given 10 asthma-based
problems and asked to manage them. Each
Jaffe PG, Crooks CV, Wolfe DA. Legal and policy management decision and its order were entered into a
responses to children exposed to domestic violence: the database. This database was used to train an artificial
need to evaluate intended and unintended neural network (ANN). The trained ANN was then
consequences. Clin Child Fam Psychol Rev 2003; used to cluster the various performances, and outputs
6(3):205-13. were evaluated graphically. RESULTS: Three hundred
Abstract: Greater training and specialization in five performances were analyzed through our trained
working with children exposed to domestic violence neural network. Our ANN classified five major clusters
has resulted in new policies, interagency protocols, and representing different approaches to solving an acute
legislation in many states. This paper examines court- asthma case. CONCLUSIONS: ANNs can build rich
related responses in criminal, child protection, and models of complex phenomena through a training and
family court custody proceedings, which highlight pattern-recognition process. Such networks can solve
legislative changes and resulting systemic change. classification problems with ill-defined categories in
Although this legislation originated with the best of which the patterns are deeply hidden within the data,
intentions to assist and protect children, some of the and models of behavior are not well defined. In our
most striking outcomes have been negative and pilot study, we have shown that ANNs can be useful in
unintended. Laws that mandate reporting of children automating evaluation and improving our
exposed to domestic violence can clash with understanding of how children manage their asthma.
inadequate training and resources, or inadvertently
revictimize abused women. Similarly, child custody Jakobsen MS, Sodemann M, Molbak K, Alvarenga IJ,
legislation that raises a rebuttable presumption that a Nielsen J, Aaby P. Termination of breastfeeding after
violent spouse will not receive custody or joint custody 12 months of age due to a new pregnancy and other
of children after parental separation has resulted in causes is associated with increased mortality in
greater skepticism about abuse allegations We propose Guinea-Bissau. Int J Epidemiol 2003; 32(1):92-6.
that efforts at law reform can be enhanced by a more Abstract: BACKGROUND: As part of an assessment
thoughtful analysis of potential intended and of breastfeeding and child health in Guinea-Bissau, we
unintended consequences, and should be accompanied investigated the impact of mother's reason for weaning
by a comprehensive evaluation plan to monitor on subsequent child mortality. METHODS: Children
implementation effects. were identified and followed by the demographic
health surveillance system of the Bandim Health
Jain V, Ray M, Singhi S. Strangulation injury, a fatal form Project in Guinea-Bissau. Breastfeeding status and
of child abuse. Indian J Pediatr 2001; 68(6):571-2. survival were ascertained by 3-monthly follow-up
Abstract: Strangulation is a common method of home visits. At termination of breastfeeding mothers
committing murder, though underreported in Indian were interviewed about her reasons for weaning. In all,
literature. We managed a girl child, victim of child 1423 children who terminated breastfeeding after 12
abuse who later succumbed to its neurological months of age were followed to 3 years of age.
complications. This case report describes the clinical RESULTS: Median length of breastfeeding was 22
features associated with such injuries and months. Following termination of breastfeeding, 66
complications which should be anticipated in such children died before 36 months of age. In all, 62%
cases. (879/1423) were weaned because they were 'healthy'.
Compared with the 'healthy' children, all other causes
Jaing JT, Sepulveda JA, Casillas AM. Novel computer- of weaning were associated with a higher mortality
based assessment of asthma strategies in inner-city (mortality ratio [MR] = 2.97, 95% CI: 1.54-5.73). For
children. Ann Allergy Asthma Immunol 2001; 237 children weaned due to a new pregnancy the MR
87(3):230-7. was 3.25 (95% CI: 1.45-7.30). Seventy-five children
weaned because of illness had a 2.98 (95% CI: 0.95-
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![Continued surveillance of the possible negative impact Jhanjee I, Saxeena D, Arora J, Gjerdingen DK. Parents'
of HIV prevention programs is under way. Protective health and demographic characteristics predict
policies are needed to facilitate improved HIV noncompliance with well-child visits. J Am Board Fam
prevention and safety of sex workers, a key to Pract 2004; 17(5):324-31.
controlling the HIV epidemic. Abstract: BACKGROUND: The purpose of this study
was to investigate factors related to well-child visit
Jenkins T, Moellendorf D, Schuklenk U. The distribution of noncompliance in an ethnically diverse family practice
medical resources, withholding medical treatment, drug clinic population. METHODS: Participants included
trials, advance directives, euthanasia and other ethical 146 parents (131 mothers and 15 fathers) of children
issues: the Thandi case (II). Developing World Bioeth aged 0 to 24 months who received care at a St. Paul
2001; 1(2):163-74. residency clinic. Participants completed telephone
Notes: GENERAL NOTE: KIE: Jenkins, Trefor; surveys that asked about their demographic
Moellendorf, Darrel; Schuklenk, Udo characteristics, attitudes toward well-child visits,
GENERAL NOTE: KIE: 13 refs. whether the most recent planned well-child visit had
GENERAL NOTE: KIE: KIE Bib: bioethics; patient been kept, and their own and their child's health
care/minors characteristics. RESULTS: All participants thought
that well-child visits were important, with
Jensen PS, Eaton Hoagwood K, Roper M et al. The services immunizations being the highest rated reason for
for children and adolescents-parent interview: importance. Fourteen percent of parents said they had
development and performance characteristics. J Am missed a recent well-child visit, mostly because they
Acad Child Adolesc Psychiatry 2004; 43(11):1334-44. forgot. More than three fourths of parents believed visit
Abstract: OBJECTIVE: To date, no instrument has reminders were helpful, and the preferred type of
been developed that captures children's services use reminder was a telephone call. Noncompliance with
across primary care, specialty mental health, and other well-child visits was associated with the parent's
settings, including setting, treatment type, provider depressive symptoms, transportation difficulties,
discipline, and length and intensity of specific working at a job, having private (vs public) health
interventions over varying follow-up periods. The insurance, and being older (vs younger).
authors developed a highly structured services CONCLUSIONS: These results suggest that well-child
assessment measure [Services for Children and visit compliance might be enhanced by visit reminders
Adolescents-Parent Interview (SCAPI)] for use in the and improved access to transportation. The relationship
National Institute of Mental Health Multimodal of well-child visit noncompliance to parental
Treatment Study of Children With Attention Deficit depressive symptoms, if verified in other populations,
Hyperactivity Disorder (MTA). METHOD: After points to a need for greater surveillance of
successfully piloting and refining the SCAPI during children/families who do not schedule or keep well-
initial phases of the MTA, the authors used this child visits.
measure at 24 months post-randomization to ascertain
the previous 6 months of services use for all Jing H, Takigawa M, Benasich AA. Relationship of
participating (516 of 579) MTA children and families nonlinear analysis, MRI and SPECT in the
and 285 age- and gender-matched classroom control lateralization of temporal lobe epilepsy. Eur Neurol
children. RESULTS: Findings revealed meaningful, 2002; 48(1):11-9.
face-valid differences between MTA and control Abstract: OBJECTIVES: The purpose of this study was
children in levels and types of services used during the to investigate the correlation of lateralization by
previous 6-month period. Services use data reported by nonlinear analysis, magnetic resonance imaging (MRI)
parents was substantially in accord with data and interictal single-photon emission computed
independently gathered by the research data center. tomography (SPECT) in patients with temporal lobe
Site variations were found in the level and use of epilepsy. METHODS: Twenty-three patients (7 males,
several specific services, such as individual child 16 females) were examined by MRI, interictal SPECT
psychotherapy (sites ranged from 0% to 6.8% among and EEG. Nonlinear dynamic properties of neuronal
classroom controls compared with 9.7% to 46.1% networks were estimated by calculating correlation
among MTA participants) and special education dimensions on interictal EEG signals and
services (0% to 14.6% among classroom controls, corresponding surrogate data. Lateralization was
27.5% to 34.8% among MTA participants), consistent detected based on the criteria introduced in this study.
with differences reported in other studies. Concordance rates of the results among the three
CONCLUSIONS: These data support the descriptive methods were compared. RESULTS: Epileptogenic
validity of SCAPI-ascertained services use data and foci were shown in the temporal areas in 21 patients
indicate that the SCAPI can provide investigators and using the nonlinear method (8 left, 2 right, 11 both),
policymakers a valid means of assessing services type, while 20 patients showed abnormalities in temporal
intensity, onset and offset, provider type, and content. lobes on MR images (13 left, 5 right, 2 both). Low
cerebral blood flows of the temporal lobes were
detected in all patients (11 left, 8 right, 4 both).
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![the three domains of temperament, childhood behavior problems and are less often referred to mental
experiences and childhood and adolescent health services than domestic adoptees.
psychopathology make major contributions to the
development of avoidant and borderline personality Jung H, Parent AS, Ojeda SR. Hypothalamic hamartoma: a
disorders. paradigm/model for studying the onset of puberty.
Endocr Dev 2005; 8:81-93.
Juffer F, van Ijzendoorn MH. Behavior problems and mental Abstract: This article discusses the potential
health referrals of international adoptees: a meta- mechanisms by which hypothalamic hamartomas
analysis. JAMA 2005; 293(20):2501-15. (HHs) are formed and cause precocious puberty. The
Abstract: CONTEXT: International adoption involves hypothesis is presented suggesting that HHs accelerate
more than 40,000 children a year moving among more sexual development by producing bioactive substances
than 100 countries. Before adoption, international that mimic - in an accelerated time-course - the cascade
adoptees often experience insufficient medical care, of events underlying the normal initiation of puberty. It
malnutrition, maternal separation, and neglect and is also proposed that because HHs contain key
abuse in orphanages. OBJECTIVE: To estimate the transcriptional and signaling networks required to
effects of international adoption on behavioral initiate and sustain a pubertal mode of gonadotropin-
problems and mental health referrals. DATA releasing hormone (GnRH) release, they are able to
SOURCES: We searched MEDLINE, PsychLit, and trigger the pubertal process at an earlier age. The
ERIC from 1950 to January 2005 using the terms cellular components of this activating complex may
adopt* combined with (behavior) problem, disorder, include: (a) neurons able to produce GnRH within the
(mal)adjustment, (behavioral) development, clinical or HH: (b) controlling neurons synaptically connected to
psychiatric (referral), or mental health; conducted a GnRH neurons in the HH itself and/or to neuronal
manual search of the references of articles, books, book networks (including GnRH neurons) in the patient's
chapters, and reports; and consulted experts for hypothalamus, and (c) signaling-competent astrocytic
relevant studies. The search was not limited to English- and ependymoglial cells. It is also possible that the
language publications. STUDY SELECTION: Studies developmental abnormalities leading to the formation
that provided sufficient data to compute differences of HHs result from sporadic defects affecting the same
between adoptees (in all age ranges) and nonadopted genes and hence the same morphogenic pathways
controls were selected, resulting in 34 articles on involved in the embryonic development of the ventral
mental health referrals and 64 articles on behavior hypothalamus and the floor of the third ventricle.
problems. DATA EXTRACTION: Data on
international adoption, preadoption adversity, and other Junqueira V, Pessoto UC, Kayano J et al. [Equity in the
moderators were extracted from each study and health sector: evaluation of public policy in Belo
inserted in the program Comprehensive Meta-analysis Horizonte, Minas Gerais State, Brazil, 1993-1997].
(CMA). Effect sizes (d) for the overall differences Cad Saude Publica 2002; 18(4):1087-101.
between adoptees and controls regarding internalizing, Abstract: This article evaluates government measures
externalizing, total behavior problems, and use of to reduce inequity in the health sector in Belo
mental health services were computed. Homogeneity Horizonte from 1993 to 1997. Our hypothesis is that a
across studies was tested with the Q statistic. DATA municipal administration committed to equity can
SYNTHESIS: Among 25,281 cases and 80,260 reduce disparities in health with the support of the
controls, adoptees (both within and between countries) Unified National Health System (SUS). The
presented more behavior problems, but effect sizes methodology used an urban quality of life index in
were small (d, 0.16-0.24). Adoptees (5092 cases) were Belo Horizonte to detect social inequalities in living
overrepresented in mental health services and this conditions, as well as differences between the
effect size was large (d, 0.72). Among 15,790 cases component indices in the infant mortality rate. Other
and 30,450 controls, international adoptees showed municipal measures were assessed according to the
more behavior problems than nonadopted controls, but investment resulting from the implementation of a
effect sizes were small (d, 0.07-0.11). International participatory local budget and open planning process.
adoptees showed fewer total, externalizing and The urban quality of life index appeared to be an
internalizing behavior problems than domestic appropriate measure for orienting municipal
adoptees. Also, international adoptees were less often administration. The infant mortality rate proved to be a
referred to mental health services (d, 0.37) than good indicator for measuring inequality in health.
domestic adoptees (d, 0.81). International adoptees There was a reduction in IMR and mortality reducing
with preadoption adversity showed more total gaps in the districts studied. We observed greater
problems and externalizing problems than international investment of physical and financial resources in the
adoptees without evidence of extreme deprivation. districts with the lowest urban quality of life index, and
CONCLUSIONS: Most international adoptees are it can thus be stated that the municipal administration
well-adjusted although they are referred to mental reduced the prevailing inequalities.
health services more often than nonadopted controls.
However, international adoptees present fewer
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![Juretschke LJ. Ethical dilemmas and the nurse practitioner in interest. Secondary outcomes included the severity of
the NICU. Neonatal Netw 2001; 20(1):33-8. CLD, total ventilator and nasal continuous positive
Abstract: With the emergence of advanced practice airway pressure days, grades 3 and 4 intracranial
roles for nurses, including the role of the neonatal hemorrhage, periventricular leukomalacia, stages 3 and
nurse practitioner (NNP), nurses are increasingly being 4 retinopathy of prematurity, necrotizing enterocolitis,
placed in the position of making difficult decisions, pneumothorax, length of stay, late-onset sepsis, and
especially in acute or emergency situations. NNPs, pneumonia. RESULTS: The percentage of infants who
therefore, must have a working knowledge of the received dexamethasone during their NICU admission
ethical decision-making process in order to make decreased from 49% in era 1 to 22% in era 3. Of those
appropriate decisions at the bedside. who received dexamethasone, the median number of
days of exposure dropped from 23.0 in era 1 to 6.5 in
Kaan B, Toth Z, Fabian TK. [The role of sexual trauma as a era 3. The median total NICU exposure to
cause of orofacial symptoms. Case report]. Fogorv Sz dexamethasone in infants who received at least 1 dose
2004; 97(1):37-40. declined from 3.5 mg/kg in era 1 to 0.9 mg/kg in era 3.
Abstract: Authors describe a 58-sitting psychotherapy The overall amount of dexamethasone administered per
of a 46-year-old female patient with psychogenic total patient population decreased 85% from era 1 to
atypical facial pain. Sexual trauma in the childhood era 3. CLD was seen in 22% of infants in era 1 and
was found as a cause of the psychogenic pain 28% in era 3, a nonsignificant increase. The severity of
symptoms, leading to series of unnecessary extraction CLD did not significantly change across the 3 eras,
of teeth in this case. Psychotherapeutic treatment led to neither did the mortality rate. We observed a
the recovery of the somatic symptoms, and a moderate significant reduction in the use of mechanical
improvement of the behaviour related to men of this ventilation as well as a decline in the incidence of late-
patient. onset sepsis and pneumonia, with no other significant
change in morbidities or length of stay.
Kaempf JW, Campbell B, Sklar RS et al. Implementing CONCLUSIONS: Postnatal dexamethasone use in
potentially better practices to improve neonatal premature infants born between 501 and 1250 g can be
outcomes after reducing postnatal dexamethasone use sharply curtailed without a significant worsening in a
in infants born between 501 and 1250 grams. Pediatrics broad range of clinical outcomes. Although a modest,
2003; 111(4 Pt 2):e534-41. nonsignificant trend was observed toward a greater
Abstract: OBJECTIVE: The purpose of this article is to number of infants needing supplemental oxygen at 36
describe how a neonatal intensive care unit (NICU) weeks' postmenstrual age, the severity of CLD did not
was able to reduce substantially the use of postnatal increase, the mortality rate did not rise, length of stay
dexamethasone in infants born between 501 and 1250 g did not increase, and other benefits such as decreased
while at the same time implementing a group of use of mechanical ventilation and fewer episodes of
potentially better practices (PBPs) in an attempt to nosocomial infection were documented.
decrease the incidence and severity of chronic lung
disease (CLD). METHODS: This study was both a Kagan J. Biological constraint, cultural variety, and
retrospective chart review and an ongoing multicenter psychological structures. Ann N Y Acad Sci 2001;
evidence-based investigation associated with the 935:177-90.
Vermont Oxford Network Neonatal Intensive Care Abstract: Although biological processes bias humans to
Quality Improvement Collaborative (NIC/Q 2000). The develop particular cognitive, affective, and behavioral
NICU specifically made the reduction of CLD and forms, the cultural context of growth shapes these
dexamethasone use a priority and thus formulated a list forms in particular ways. Psychologists have been
of PBPs that could improve clinical outcomes across 3 indifferent to the nature of the mental structures that
time periods: era 1, standard NICU care that antedated mediate the varied psychological functions that are the
the quality improvement project; era 2, gradual usual target of inquiry. This paper argues that schemata
implementation of the PBPs; and era 3, full for perceptual events, motor programs, and semantic
implementation of the PBPs. All infants who had a networks are distinct, although interdependent, forms
birth weight between 501 and 1250 g and were that rest on different neurophysiologies. The biological
admitted to the NICU during the 3 study eras were constraints are weakest on the semantic networks that
included (era 1, n = 134; era 2, n = 73; era 3, n = 83). are influenced by the history, economy, religion,
As part of the NIC/Q 2000 process, the NICU geography, and social structure of the society. These
implemented 3 primary PBPs to improve clinical factors influence how cultures classify names for
outcomes related to pulmonary disease: 1) gentle, low emotions, categories of self-membership, and popular
tidal volume resuscitation and ventilation, permissive metaphors for human nature. One class of schemata is
hypercarbia, increased use of nasal continuous positive derived from changes in body tone. Temperamental
airway pressure; 2) decreased use of postnatal variation in the susceptibility to changes in body tone
dexamethasone; and 3) vitamin A administration. The has relevance for understanding personality and a
total dexamethasone use, the incidence of CLD, and vulnerability to anxiety disorders.
the mortality rate were the primary outcomes of
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![pediatricians and others working with children and considered.
their parents. This article reviews empirical studies
concerning childhood noncompliance. Definitions of Kamibeppu K. Reconsideration of "motherhood" in
noncompliance (also called disobedience) are contemporary Japan. Am J Psychoanal 2005; 65(1):13-
presented, and observational studies that have 29.
measured noncompliance in the laboratory and at home Abstract: In this paper, the author reconsiders
are reviewed. Studies show considerable variability in "motherhood" in Japan. This reconsideration is based
the prevalence of noncompliance, but demonstrate that on Japanese psychoanalytic knowledge and a case
it is a frequent problem for parents. Longitudinal data study of a woman. As a child she was physically
from the Pittsburgh Youth Study are presented to more abused by her father, and struggled throughout her life
closely examine the onset and stability of with conflicts with her mother. The Japanese have
noncompliance in childhood and adolescence. historically idealized the concept of "motherhood" and
Evidence suggests that extreme childhood maintained that it was possible for women to become
noncompliance is relatively stable over time, peaking the ideal mother for their children. The author
slightly during early adolescence and decreasing during maintains that "motherhood" is not dependent only on
late adolescence. Studies indicate that for some mothers, but is created and shared by fathers, children
children noncompliance predicts aggression and and all of society. In psychotherapy, the therapist
externalizing problems. Antecedents of noncompliance provides a "motherly" energy to the client and shares
including parental discipline techniques and child the "motherhood" fantasy with the client to a certain
characteristics are reviewed. Parent training programs extent. The therapist assists the client in the gradual
designed to reduce noncompliance are described, and process of abandoning the desire to be loved by the
the effectiveness of such programs is examined. ideal mother and accept "motherhood" from other
sources.
Kallstrom-Fuqua AC, Weston R, Marshall LL. Childhood
and adolescent sexual abuse of community women: Kaminer Y. Cognitive group therapy for aggressive boys. J
mediated effects on psychological distress and social Am Acad Child Adolesc Psychiatry 2005; 44(9):843;
relationships. J Consult Clin Psychol 2004; 72(6):980- author reply 843-5.
92.
Abstract: Possible mediators of sexual abuse severity Kaminski RA, Stormshak EA, Good RH 3rd, Goodman MR.
were tested on the basis of D. Finkelhor and A. Prevention of substance abuse with rural head start
Browne's (1985) traumagenic dynamics model with children and families: results of project STAR. Psychol
178 low-income African American, European Addict Behav 2002; 16(4 Suppl):S11-26.
American, and Mexican American community women Abstract: The effectiveness of a comprehensive
interviewed for Project HOW: Health Outcomes of intervention with preschool children aimed at reducing
Women. This subsample reported contact sexual abuse the risk of later substance abuse was examined. The
before the age of 18 years. Severity was level of force, intervention targeted risk factors during the preschool
number of perpetrators, relationship to perpetrator, and years linked to later substance use in adolescence and
age at first assault. As expected, structural equation adulthood. Head Start classrooms were randomly
modeling showed powerlessness, and stigmatization assigned to either the intervention or the control group.
largely mediated the effects of sexual abuse severity on A classroom-based curriculum was delivered by Head
women's psychological distress in adulthood. Start teachers who received a number of training
Powerlessness also mediated the effects of severity on workshops and continued consultation. Parent training
maladaptive social relationships. The expected path and home visits were also provided to intervention
from betrayal to relationships was nonsignificant. families. Positive parenting as well as parent-school
Overall, the results support extension of D. Finkelhor involvement increased over the 1st year of
and A. Browne's model. Possible interventions are intervention. Intervention families maintained the
addressed. positive effects on parenting into the kindergarten year
over a matched control group; however, effects on
Kamer B, Bieganski T, Filipiak-Miastkowska I, Raczynska school bonding were not maintained. Improvements in
J, Baranska D, Czyzewska S. [Difficulties in diagnosis social competence, reported by teachers and parents,
of battered child syndrome in infant]. Pol Merkuriusz were found at the end of kindergarten. No changes
Lek 2004; 16(94):368-72. were found for self-regulation.
Abstract: The diagnosis of battered child syndrome in
infants was reached on the basis of the risk factors Kamo T, Ujiie Y, Tamura A. [Actual situation and social
appraisal in social and family history, combined with prognosis of women seeking psychiatric care at the
clinical and roentgenographic examinations; the emergency hostel of Tokyo Metropolitan Women's
difficulties in establishing the diagnosis are presented. Counseling Center]. Seishin Shinkeigaku Zasshi 2002;
Long hospitalisation also revealed that the observed 104(4):292-309.
injuries are due to child abuse. The interdisciplinary Abstract: The emergency hostel of Tokyo Metropolitan
approach is needed when non-accidental injuries are
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![whether variation in findings could be accounted for by Kao YF, Liu SH. [A nursing experience with a child with
study characteristics. Results indicated that paternal rape trauma by using therapeutic play in an emergency
depression was significantly related to offspring room]. Hu Li Za Zhi 2005; 52(1):88-93.
internalizing and externalizing psychopathology and Abstract: This article conceptualized a therapeutic
father-child conflict. Larger effects for internalizing game theory to discuss the pickings process of a
symptoms were associated with the use of community preschool sexually violated victim with respect to
samples and symptom rating scales of internalizing nursing care delivery in our department of emergency
problems. medicine. In cooperation with the victim, we offered
support to prevent her from fearing loss of her capacity
Kankkunen P, Vehvilainen-Julkunen K, Pietila AM. Ethical for self-defense when facing a similar scenario. The
issues in paediatric nontherapeutic pain research. Nurs overall exercise included observation time, a return
Ethics 2002; 9(1):80-91. outpatient visit and a follow-up phone interview. By
Notes: GENERAL NOTE: KIE: KIE Bib: human using observation, role-play, leading drawing and
experimentation/informed consent; human interviews, we used Piaget's Cognitive Child
experimentation/minors; informed consent/minors Development model and game therapy theory to reduce
Abstract: The purpose of this article is to describe the the victim's sense of fear and shame, inducing the
main ethical issues in paediatric nontherapeutic victim to eliminate her confusion by talking and to
qualitative pain research. It is based on an analysis of complete the whole pickings process.
the research literature related to ethical issues in
research and on experiences from a family interview Kaplan RM. There are worse things to celebrate. S Afr Med
study focusing on pain assessment and management in J 2004; 94(4):267-8.
children aged 1-6 years. In addition, different views
concerning obtaining informed consent from children, Karapetyan AF, Sokolovsky YV, Araviyskaya ER, Zvartau
as published in the research literature, are compared. EE, Ostrovsky DV, Hagan H. Syphilis among
Ethical challenges occur during all stages of qualitative intravenous drug-using population: epidemiological
research. The risks of emotional distress and possible situation in St Petersburg, Russia. Int J STD AIDS
benefits of the results must be assessed prior to 2002; 13(9):618-23.
conducting a study. However, risks and harm are Abstract: INTRODUCTION: An epidemic of syphilis
difficult to avoid in a study in which the research area, and other sexually transmitted infections (STI) in the
pain, raises emotional distress in both parents and Russian Federation is believed to be related to the rise
children. The children's assent and parental permission in injection drug use. A study was carried out in
are both required. It is essential to obtain informed collaboration with a non-governmental organization,
consent from all family members when family research Foundation 'Vozvrastcheniye'. METHODS: Nine
is conducted. Participants' privacy and confidentiality hundred and ten injection drug users participating in
should be protected during data collection, analysis and the programme were tested for syphilis, HIV, hepatitis
publication. Protecting children from harm may be C virus (HCV) and hepatitis B virus (HBV); 65
impossible during pain research in which they are participants who had laboratory markers for syphilis
required to recall a painful postoperative period. and 45 syphilis-negative serosurvey subjects agreed to
However, after data collection they can be assisted to participate in a questionnaire study. RESULTS:
focus on pleasant activities, for example, by engaging Syphilis, HIV, HBV and HCV were diagnosed in 12%,
in playful activities with them. Finally, the role of the 0%, 48% and 79% of drug users, respectively.
nurse and the researcher should be carefully assessed, Prevalence of syphilis seromarkers was nine times
especially in qualitative research, in order to be able to higher in females than in males, and strongly
analyse the data and report the findings in an unbiased associated with sex work. CONCLUSIONS: The
manner. results of the study indicate that resources to treat and
prevent further infections including HIV should be
Kanuga M, Rosenfeld WD. Adolescent sexuality and the prioritized toward risk reduction in drug injectors and
internet: the good, the bad, and the URL. J Pediatr sex workers in St Petersburg.
Adolesc Gynecol 2004; 17(2):117-24.
Abstract: The Internet has become a widely used Karayiannis NB, Tao G, Xiong Y et al. Computerized
resource for sexual health information, especially motion analysis of videotaped neonatal seizures of
among adolescents. The appeal lies in the ease and epileptic origin. Epilepsia 2005; 46(6):901-17.
anonymity with which online seekers can obtain advice Abstract: PURPOSE: The main objective of this
and reassurance, particularly regarding sensitive topics. research is the development of automated video
This article reviews the positive and negative processing and analysis procedures aimed at the
influences of the Internet on this age group. Specific recognition and characterization of the types of
aspects of how this medium affects adolescents as well neonatal seizures. The long-term goal of this research
as how it can be used to assist them are discussed. is the integration of these computational procedures
into the development of a stand-alone automated
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![negatively associated with Parental Warmth and mother's intimate partner violence status [IPV], family
Positive Involvement, Intrusiveness and Negative cohesion and adaptability, neighborhood disorder)
Discipline, and Social Distress; parental depression uniquely predicted a child's internalizing distress and
was only negatively associated with Social Distress. externalizing distress, and the amount of variance
Child ODD symptoms had independent associations explained by the model. Results from the regression
with all outcomes; no relations were found with model predicting internalizing distress indicates that
ADHD. Sex moderated the effects of parental anxiety the five predictor variables accounted for 38% of the
on Parental Warmth and Positive Involvement such variance. Two of the five predictors were significantly
that only for mothers did greater anxiety lead to less related to child's internalizing distress scores: mother's
Parental Warmth and Positive Involvement. intimate partner violence status and maternal
psychological distress. Results from the regression
Kashner TM, Carmody TJ, Suppes T et al. Catching up on model predicting externalizing distress indicates that
health outcomes: the Texas Medication Algorithm the five predictor variables accounted for 8% of the
Project. Health Serv Res 2003; 38(1 Pt 1):311-31. variance. The two predictors significantly related to
Abstract: OBJECTIVE: To develop a statistic child's externalizing distress scores were levels of
measuring the impact of algorithm-driven disease family cohesion and maternal psychological distress.
management programs on outcomes for patients with Directions for future research and clinical implications
chronic mental illness that allowed for treatment-as- are provided.
usual controls to "catch up" to early gains of treated
patients. DATA SOURCES/STUDY SETTING: Katon W, Sullivan M, Walker E. Medical symptoms without
Statistical power was estimated from simulated identified pathology: relationship to psychiatric
samples representing effect sizes that grew, remained disorders, childhood and adult trauma, and personality
constant, or declined following an initial improvement. traits. Ann Intern Med 2001; 134(9 Pt 2):917-25.
Estimates were based on the Texas Medication Abstract: Community studies have shown that stressful
Algorithm Project on adult patients (age > or = 18) life events, psychological distress, and depressive and
with bipolar disorder (n = 267) who received care anxiety disorders are associated with 1) a range of
between 1998 and 2000 at 1 of 11 clinics across Texas. medical symptoms without identified pathology, 2)
STUDY DESIGN: Study patients were assessed at increased health care utilization, and 3) increased costs.
baseline and three-month follow-up for a minimum of In both primary care and medical specialty samples,
one year. Program tracks were assigned by clinic. patients who have syndromes with ill-defined
DATA COLLECTION/EXTRACTION METHODS: pathologic mechanisms (such as the irritable bowel
Hierarchical linear modeling was modified to account syndrome and fibromyalgia) have been shown to have
for declining-effects. Outcomes were based on 30-item significantly higher rates of anxiety and depressive
Inventory for Depression Symptomatology-Clinician disorders than do patients with comparable, well-
Version. PRINCIPAL FINDINGS: Declining-effect defined medical diseases and similar symptoms. Other
analyses had significantly greater power detecting studies show that after adjustment for severity of
program differences than traditional growth models in medical illness, patients with depression or anxiety and
constant and declining-effects cases. Bipolar patients comorbid medical disease have significantly more
with severe depressive symptoms in an algorithm- medical symptoms without identified pathology than
driven, disease management program reported fewer do patients with a similar medical disease alone. Both
symptoms after three months, with treatment-as-usual childhood maltreatment and psychological trauma in
controls "catching up" within one year. adulthood have been associated with increased
CONCLUSIONS: In addition to psychometric vulnerability to psychiatric illness and more medical
properties, data collection design, and power, symptoms. The substantial functional impairment,
investigators should consider how outcomes unfold distress, and costs associated with medical symptoms
over time when selecting an appropriate statistic to without identified pathology suggest that research
evaluate service interventions. Declining-effect studies promoting a better understanding of the
analyses may be applicable to a wide range of biopsychosocial cause of these symptoms may yield
treatment and intervention trials. pragmatic, cost-effective approaches to treatment in
medical settings.
Kaslow NJ, Heron S, Roberts DK, Thompson M, Guessous
O, Jones C. Family and community factors that predict Katumba-Lunyenya J, Joss V, Latham P, Abbatuan C.
internalizing and externalizing symptoms in low- Pulmonary tuberculosis and extreme prematurity. Arch
income, African-American children: a preliminary Dis Child Fetal Neonatal Ed 2005; 90(2):F178-9;
report. Ann N Y Acad Sci 2003; 1008:55-68. discussion F179-83.
Abstract: To learn more about the roots of internalizing Notes: GENERAL NOTE: KIE: 29 refs.
and externalizing problems in low-income, African- GENERAL NOTE: KIE: KIE Bib: AIDS; patient
American children, aged 8-12 years, particularly for care/minors
family and community factors, we aimed to determine Abstract: A mother, newly found to be positive for
which variables (mother's psychological functioning, HIV, delivered her first baby at 25 weeks gestation.
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![information about screening, and 32 of these have 70(6):1303-6.
information available in multiple languages. Most Abstract: This article makes observations about policy
programs (n=36) believe that parents should be implications and offers a combination of commentary
informed about newborn screening as a part of prenatal and recommendation regarding the special issue on the
care; however, none has rules or regulations requiring impact of childhood psychopathology interventions on
this. Five require documented informed consent; only subsequent substance abuse. The authors mention
one provides the consent form in a language other than forward-looking directives to expand the mandate for
English. Hospitals and birthing centers are required by early intervention, to expand the research agenda for
many programs to educate families, including randomized clinical trials, and to develop a policy-
providing information (n=12), obtaining informed oriented evidence base. They also note topics that
consent (n=5), informing parents of the right to refuse require consideration and offer recommendations with
screening (n=13), and documenting refusal on regard to how to proceed. The special issue, as well as
institutionally developed forms (n=9). We found this discussion, will spark thought and action directed
considerable variation in policy language across the toward the evaluation of interventions for youths to
newborn screening programs. CONCLUSIONS: The assess the degree to which treating mental disorders
complexity of current newborn screening programs and has beneficial effects on the sequelae of the initial
the likelihood of expansion in the number of conditions intervention target.
on newborn screening panels present a unique
opportunity and challenge for public health nurses to Kendall-Tackett K. The health effects of childhood abuse:
ensure that these programs are effective and that care is four pathways by which abuse can influence health.
integrated. Child Abuse Negl 2002; 26(6-7):715-29.
Abstract: OBJECTIVES: This article describes four
Kempes M, Matthys W, de Vries H, van Engeland H. possible pathways by which childhood abuse relates to
Reactive and proactive aggression in children--a health problems in adults. METHOD: Literature on the
review of theory, findings and the relevance for child long-term effects of childhood abuse is organized in a
and adolescent psychiatry. Eur Child Adolesc health psychology framework describing behavioral,
Psychiatry 2005; 14(1):11-9. social, cognitive, and emotional pathways. Key studies
Abstract: The clinical population of aggressive children from the health psychology and behavioral medicine
diagnosed as having an oppositional defiant disorder literature are included to demonstrate how these
(ODD) or a conduct disorder (CD) is heterogeneous, pathways relate to health. RESULTS: Childhood abuse
both with respect to behaviour and aetiology. Recently, puts people at risk of depression and post-traumatic
the following distinction has been proposed that might stress disorder, participating in harmful activities,
further clarify this heterogeneity: reactive aggression is having difficulties in relationships, and having negative
an aggressive response to a perceived threat or beliefs and attitudes towards others. Each of these
provocation, whereas proactive aggression is defined as increases the likelihood of health problems, and they
behaviour that anticipates a reward. In this article we are highly related to each other. CONCLUSIONS:
examine various aspects of this distinction. We will [1] Childhood abuse is related to health via a complex
examine the evidence that reactive and proactive matrix of behavioral, emotional, social, and cognitive
aggression are distinct phenomena by discussing the factors. Health outcomes for adult survivors are
theories underlying the distinction between the unlikely to improve until each of these factors is
subtypes in humans and we briefly review evidence for addressed.
a similar distinction in animals; [2] we critically review
the literature on the measurement in children via Kendrick D, Hapgood R, Marsh P. Do safety practices differ
questionnaires and behavioural observations; we then between responders and non-responders to a safety
point out that the correlation observed between the questionnaire? Inj Prev 2001; 7(2):100-3.
subtypes is due to the fact that many children show Abstract: OBJECTIVE: To compare reported safety
both types of aggression; [3] we review the literature practices between responders and non-responders to a
on specific characteristics of the subtypes giving safety survey. DESIGN: Cross sectional survey at
attention to social information processing, peer status, baseline compared with safety practices reported at
biological correlates and developmental history, and subsequent child health surveillance checks.
demonstrate that there is some evidence to suggest that SUBJECTS: Parents of children aged 3-12 months
reactive and proactive aggression are distinct registered with practices participating in a controlled
dimensions; [4] we discuss the relevance of the trial of injury prevention in primary care that did, and
distinction between reactive and proactive aggression did not, respond to the baseline survey and who
for child and adolescent psychiatry. subsequently attended child health surveillance checks.
RESULTS: No difference in safety practices was found
Kendall PC, Kessler RC. The impact of childhood between responders and non-responders to the survey
psychopathology interventions on subsequent at the 6-9 month check. Responders were more likely
substance abuse: policy implications, comments, and to report owning a stair gate (odds ratio (OR) 2.75,
recommendations. J Consult Clin Psychol 2002; 95% confidence interval (CI) 1.82 to 4.16) and socket
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![attachment was related to closer monitoring and greater improving child health, it also challenges our current
cooperation by the child in monitoring situations, perception of such programmes. Standard newborn
especially at sixth grade. The findings illustrate the screening programmes are clearly justified by the fact
importance of embedding attachment within a larger that early detection and treatment of affected
child rearing context. individuals avoids significant morbidity and mortality.
However, proposals to expand the scope and
Kerr E, Cottee C, Chowdhury R, Jawad R, Welch J. The complexity of such testing are not all supported by a
Haven: a pilot referral centre in London for cases of similar level of evidence for unequivocal benefit. We
serious sexual assault. BJOG 2003; 110(3):267-71. argue that screening for genetic susceptibility to
Abstract: OBJECTIVE: Several schemes have been complex disorders is inherently different from standard
reported to improve treatment of rape and to encourage screening and, while of potential value, must be
reporting. The development of a comprehensive considered separately from conventional testing.
forensic and follow up service for complainants of
sexual assault is described, and activities of the first Kershner M, Anderson JE. Barriers to disclosure of abuse
year are reviewed. DESIGN: Retrospective review of among rural women. Minn Med 2002; 85(3):32-7.
case records of complainants examined in The Haven. Abstract: The purposes of this study were to examine
SETTING: Department of Sexual Health in a London the prevalence of abuse (physical, emotional, and
teaching hospital. SAMPLE: All case records, 676 sexual) in women seeking care in rural medical clinics
complainants, from the first year of cases seen in The and WIC voucher pick-up sites, and to discover ways
Haven. METHODS: Description of setting up a service of improving the response of health care providers to
in partnership between the National Health Service and violence. Data were collected in 8 medical clinics and
the Metropolitan Police, called The Haven. Analysis of 17 WIC supplemental food program sites in 9 counties
a standardised proforma used for case records. of west central Minnesota during January and February
RESULTS: Mean age of complainants is 26 years 1997. Fifteen percent of respondents reported having
(range 11-66); 6% were male. Assailant was had a discussion about abuse with a health care
categorised as a stranger in 52% of cases; attack provider. Six of the 8 symptoms and injuries most
involved physical violence in 50% of cases; 24% of associated with abuse indicate diminished emotional
victims had genital injuries; 39% had other physical health. A series of barriers are identified as substantial
injuries. Immediate care given at time of forensic obstacles to obtaining help and revealing abuse to
examination included 30% of women receiving health care providers. The most frequently reported
emergency contraception and 5% of clients receiving barriers were self-reliance, reliance on God, and
post-exposure prophylaxis against HIV. Fifty-five reliance on friends and family. These findings show
percent of clients returned for a sexual health screen that a large percentage of rural women experience
and/or counselling. Thirty-one percent received abuse and that their health is adversely affected. The
screening for sexually transmitted infections and 12% barriers to disclosure of abuse reported in this study
were diagnosed with one or more infections. illustrate the complexity of disclosing abusive
CONCLUSIONS: Requirements following sexual relationships in rural and other settings. Low screening
assault include forensic examination, first aid, levels suggest that rural health care providers can
postcoital contraception, prevention and management develop additional opportunities to discuss abuse with
of sexually transmitted infections and psychosocial their patients.
support. Provision of these services within a sexual
health setting is feasible. Keupp H. [Resource support as the basis of projects for the
prevention of violence and addiction]. Prax
Kerruish N. In that case: a Lead Maternity Carer (LMC) is Kinderpsychol Kinderpsychiatr 2004; 53(8):531-46.
discussing newborn health checks with a pregnant Abstract: Lastingly effective projects for the prevention
woman and her partner. Response. N Z Bioeth J 2003; of violence and addiction must ask which resources
4(1):38-40. adolescents require for coping with their lives. A
Notes: GENERAL NOTE: KIE: 7 refs. central criteria for a successful life is the creation of
GENERAL NOTE: KIE: KIE Bib: informed coherence in one's inner life and thus the basis for
consent/minors; mass screening becoming capable of functioning in society. In earlier
social eras, the readiness to take on ready-made
Kerruish NJ, Robertson SP. Newborn screening: new identity packages was the central criteria for coping
developments, new dilemmas. J Med Ethics 2005; with life. Today, this depends on individual adaptation
31(7):393-8. and identity work, and thus the capability for self-
Notes: GENERAL NOTE: KIE: KIE Bib: genetic organisation, for "intentionality" or "embedding".
screening; patient care/minors Children and young people need "free spaces" in their
Abstract: Scientific and technological advances are worlds, in order to be able to outline themselves and to
lending pressure to expand the scope of newborn act formatively upon their everyday environment. The
screening. Whereas this has great potential for future prospects of adolescents depend upon their
options for learning the "craft of freedom". Sustainable
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![key qualifications for coping with life in globalised, about 70% of the women who were at risk of
digital capitalism must grasp education as a hard- unintended pregnancy were not using any method of
headed process in which the subject's capacity for self- contraception following OC discontinuation. Husband's
organisation is to be given optimal encouragement, so education was positively associated with the
that the patchwork of their own identity can succeed as substitution of OCs with another contraceptive method.
a self-determined creative project. Effective OC use should be advocated through
adequate counselling about how to take it correctly, the
Kezic S, Mihanovic M, Zilic-Dzeba J, Sain I. Influence of possibility of side-effects and their proper management
alcohol abuse of the father on the intensity of clinical and, more importantly, the possible alternative
picture of posttraumatic stress disorder. Coll Antropol contraceptive method should OCs prove unsatisfactory
2005; 29(2):533-5. or unsuitable. Better provider-client interactions along
Abstract: The subject of the study is the influence of with improved access to the newly established
alcohol abusing father on the clinical picture of PTSD community clinics could be instrumental in the
patient. The father plays an important identification continued and effective use of OCs.
role in the psychological development of his son.
Therefore it is to be expected that an alcohol abusing Khang YH, Cho SI, Yang S, Lee MS. [Socioeconomic
father will become a (negative) role model for his son differentials in health and health related behaviors:
and that he will also later on in stressful situations try findings from the Korea Youth Panel Survey]. J Prev
to reduce the anxiety and depression by consuming Med Pub Health 2005; 38(4):391-400.
larger quantities of alcoholic drinks. The aim of the Abstract: OBJECTIVE: This study examined the
study is to find out whether there are differences in socioeconomic differentials for the health and health
PTSD clinical picture in patients whose fathers abused related behaviors among South Korean middle school
alcohol and in those whose fathers did not have such students. METHODS: A nationwide cross-sectional
problem. The participating patients were from the interview survey of 3,449 middle school second-grade
Psychiatric hospital "Sveti Ivan". Mississippi and students and their parents was conducted using a
Watson scales were applied, as well as a questionnaire stratified multi-stage cluster sampling method. The
named "Early traumas" from which the variable response rate was 93.3%. The socioeconomic position
"alcohol abuse of the father" was selected. The analysis indicators were based on self-reported information
shows that the participants who in their family histories from the students and their parents: parental education,
had fathers who abused alcohol developed a milder father's occupational class, monthly family income,
clinical picture of PTSD, i.e. they reactions to the stress out-of-pocket expenditure for education, housing
later on were less sensitive compared to the control ownership, educational expectations, educational
group of participants whose fathers did not abuse performance and the perceived economic hardships.
alcohol and whose clinical pictures of the disorder The outcome variables that were measured were also
were more severe. based on the self-reported information from the
students. The health measures included self-rated
Khan MA. Factors associated with oral contraceptive health conditions, psychological or mental problems,
discontinuation in rural Bangladesh. Health Policy Plan the feelings of loneliness at school, the overall
2003; 18(1):101-8. satisfaction of life and the perceived level of stress.
Abstract: Oral contraceptives (OCs) account for half of The health related behaviors included were smoking,
all modern contraceptive methods used in Bangladesh, alcohol drinking, sexual intercourse, violence, bullying
however, discontinuation remains fairly high in OC and verbal and physical abuse by parents. RESULTS:
use. This paper identifies factors associated with Socioeconomic differences for the health and health
discontinuation of OC use, where discontinuation related behaviors were found among the eighth grade
refers to cessation of OC use in the 6 months prior to boys and girls of South Korea. However, the pattern
the survey. The data for this study were drawn from a varied with gender, the socioeconomic position
survey on OC compliance in rural Bangladesh. A total indicators and the outcome measures. The prevalence
of 1600 OC users, current or past, aged 15 to 49 years rates of the overall dissatisfaction with life for both
were interviewed; of these, 36% discontinued OC use. genders differed according to most of the eight
Of the women who discontinued, 47% reported the socioeconomic position indicators. All the health
experience of side-effects as the main reason for OC measures were significantly different according to the
discontinuation. Multivariate analysis identified lack of perceived economic hardship. However, the
fieldworker's visit as the strongest predictor of OC socioeconomic differences in the self-rated health
discontinuation; women who were not visited by conditions and the psychosocial or mental problems
fieldworkers had a four-fold risk of discontinuing OC were not clear. The students having higher
use. Discontinuation of OC use decreased with socioeconomic position tended to be a perpetrator of
increased duration of use and number of living bullying while those students with lower
children. OC discontinuation was associated with side- socioeconomic position were more likely to be a
effect experiences, lack of husband's support in OC use victim. CONCLUSIONS: The perceived economic
and failure to purchase OCs. Of great concern is that hardships predicted the health status among the eighth
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![for height were 1-1.5 cm higher than the mean values period. Most of these charges were paid by private
in the German Synthetic Growth Curve, which serves insurers. CONCLUSIONS: This study provides
as an internal standard. However, and most evidence supporting recent substantial increases in
importantly, in comparison with the internal standard childhood ATV-related injuries. The hospitalization
and historical normative data from Germany and impact of ATV-related injuries among children is
Switzerland, there is a continuous increase in the 97th considerable. Our data support the need for ongoing
percentile for weight and BMI, while the third creative attempts to identify effective strategies to
percentile remains unchanged. In addition, many decrease ATV injuries among children.
children with short stature and tall stature due to a
variety of endocrine disorders and genetic diseases Kilpatrick DG, Ruggiero KJ, Acierno R, Saunders BE,
which had not been diagnosed previously are now Resnick HS, Best CL. Violence and risk of PTSD,
being identified. In conclusion, the databank allows for major depression, substance abuse/dependence, and
a continuous adaptation of normative curves based on a comorbidity: results from the National Survey of
large number of children in a given population, i.e. Adolescents. J Consult Clin Psychol 2003; 71(4):692-
eastern Germany. Secondly, the system allows for 700.
detection of pathological growth curves and is already Abstract: With a national household probability sample
serving to diagnose growth disorders in a defined of 4,023 telephone-interviewed adolescents ages 12-17,
population in a systematic way. this study provides prevalence, comorbidity, and risk-
factor data for posttraumatic stress disorder (PTSD),
Kihlstrom JF, McNally RJ, Loftus EF, Pope HG Jr. The major depressive episode (MDE), and substance
problem of child sexual abuse. Science 2005; abuse/dependence (SA/D). Roughly 16% of boys and
309(5738):1182-5; author reply 1182-5. 19% of girls met criteria for at least 1 diagnosis. Six-
month PTSD prevalence was 3.7% for boys and 6.3%
Killingsworth JB, Tilford JM, Parker JG, Graham JJ, Dick for girls, 6-month MDE prevalence was 7.4% for boys
RM, Aitken ME. National hospitalization impact of and 13.9% for girls, and 12-month SA/D prevalence
pediatric all-terrain vehicle injuries. Pediatrics 2005; was 8.2% for boys and 6.2% for girls. PTSD was more
115(3):e316-21. likely to be comorbid than were MDE and SA/D.
Abstract: OBJECTIVE: All-terrain vehicle (ATV) Results generally support the hypothesis that exposure
injuries among children represent a significant and to interpersonal violence (i.e., physical assault, sexual
growing problem. Although state-level analyses have assault, or witnessed violence) increases the risk of
characterized some aspects of pediatric ATV-related these disorders and of diagnostic comorbidity.
injuries, little information on the national impact on
hospitalization is available. This study was designed to Kim HS. [Development of a sublimation program for
characterize more fully the patterns of injury, hospital Korean adolescents' aggression.]. Taehan Kanho
length of stay, and hospital charges associated with Hakhoe Chi 2004; 34(1):81-92.
ATV-related injuries, with a nationally representative Abstract: PURPOSE: The purpose of this study was to
sample. METHODS: Analyses were based on the 1997 identify a path diagram for the influence of family,
and 2000 Healthcare Cost and Utilization Project Kids' personality, sexual abuse, drug abuse, coping
Inpatient Database (KID). The KID is the only strategies, and aggressive impulsiveness on aggression,
national, all-payer database of hospital discharges for and to develop a sublimation program for Korean
children. KID data were weighted to represent all adolescent's aggression. METHOD: Data was collected
discharges from general hospitals in the United States. by self-report questionnaires. Subjects consisted of
Discharges with external cause-of-injury codes 2,111 adolescents. A proportional stratified random
consistent with off-road ATV-related injuries were sampling method was used. The major instrument was
selected, and the affected population was described. the Mental Health Questionnaire for Korean
Nationally representative rates of ATV-related injuries Adolescents, and the Cronbach's Alpha ranged from.54
were calculated, and changes between 1997 and 2000 to.95 for each subscale. Statistical methods were Chi-
were documented. RESULTS: An estimated 5292 square, correlation analysis, and path analysis.
children were hospitalized because of ATV-related RESULT: The strongest contributing variables on
injuries during the 2-year period, and hospitalizations aggression were person-related aggressive
increased 79.1% between 1997 and 2000. Rates of impulsiveness, antisocial personality, self-injured
ATV-related hospitalization were highest among aggressive impulsiveness, gender, sexual abuse,
adolescent white male subjects, consistent with psychosomatic symptoms II, drug abuse, age, parent-
previous studies. Most patients had hospital lengths of child relationship, alcohol abuse and cognitive
stay of <4 days (68%), but 10% had stays of >8 days. avoidance coping strategies in the order named. Also
Injury severity varied considerably, with more than one the author developed a multi-systemic sublimation
third of patients sustaining moderate to severe injuries. program for Korean adolescents's aggression. The
Approximately 1% of hospitalizations resulted in in- multi-systemic sublimation program involves four
hospital deaths. Total hospital charges for this injury domains including adolescents, parents, peers and
mechanism were 74367677 dollars for the 2-year study community, and has several therapeutic sub-programs
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![examined the effects of the program on 1) parental home injury (fall, scald, burn, poisoning or ingestion,
injury awareness and knowledge; 2) the extent that choking, or head injury while riding a bicycle), a non-
families used home safety measures; 3) the rate of targeted injury, or a medical illness. RESULTS: We
injury; and 4) the cost effectiveness of the intervention. contacted 774 (66%) of the 1172 original participants.
DESIGN: A randomized, controlled trial. SETTING: A A higher proportion of participants in the intervention
multicenter trial conducted at 5 hospitals in 4 Canadian group (63%) reported that home visits changed their
urban centers. PARTICIPANTS: Children <8 years knowledge, beliefs, or practices around the prevention
old, initially enrolled in an injury case-control study, of home injuries compared with those in the non-
were eligible to participate. Intervention. Subsequent to intervention group (43%; p<0.001). Over the 36 month
a home inspection conducted to determine baseline follow up period the rate of injury visits to the doctor
hazard rates for both groups, participants in the was significantly less for the intervention group (rate
intervention group received a single home visit that ratio = 0.74; 95% CI 0.63 to 0.87), consistent with the
included the provision of an information package, original (12 month) study results (rate ratio = 0.69;
discount coupons, and specific instruction regarding 95% CI 0.54 to 0.88). However, the effectiveness of
home safety measures. Main RESULTS: The median the intervention appears to be diminishing with time
age was 2 years, with males comprising ~60% of (rate ratio for the 12-36 month study interval = 0.80;
participants. The experimental groups were comparable 95% CI 0.64 to 1.00). CONCLUSIONS: A home safety
at outset in terms of case-control status, age, gender, visit was able to demonstrate sustained, but modest,
and socioeconomic status. Parental injury awareness effectiveness of an intervention aimed at improving
and knowledge was high; 73% correctly identified home safety and reducing injury. This study reinforces
injury as the leading cause of death in children, and an the need of home safety programs to focus on passive
intervention effect was not demonstrated. The adjusted intervention and a simple well defined message.
odds ratios (ORs) for the home inspection items
indicated that significant safety modifications only Kinnair D. Put the child first. Interview by Pat Healy. Nurs
occurred in the number of homes having hot water not Stand 2003; 18(4):16-7.
exceeding 54 degrees C (OR: 1.31, 95% confidence
interval [CI]: 1.14, 1.50) or the presence of a smoke Kinsley M. The thin line between love and lust. Time 2002;
detector (OR: 1.45, 95% CI: 0.94, 2.22). However, the 159(17):49.
intervention group reported home safety modifications
of 62% at 4 months and significantly less injury visits Kipp J, Killick L, Kipp W. Predicting in-home time of
to the doctor compared with the nonintervention group community care professionals. Int J Health Care Qual
(rate ratio: 0.75; 95% CI: 0.58, 0.96). The total costs of Assur Inc Leadersh Health Serv 2002; 15(1):11-6.
care for injuries were significantly lower in the Abstract: The aim of this study was to test whether the
intervention group compared with the nonintervention client homebound score (CHS), the case management
group with a cost of $372 per injury prevented. intensity score (CMIS) and the client priority visit
CONCLUSIONS: An intervention using a single home score (CPVS) could be used to predict in-home time of
visit to improve the extent to which families use safety professional caregivers in the Aspen community care
measures was found to be insufficient to influence the program. A random sample of 34 community care
long-term adoption of home safety measures, but was clients from the different geographical areas of the
effective to decrease the overall occurrence of injuries. Aspen Regional Health Authority was selected and the
Future programs should target a few, well-focused, home visits for each client were tracked for three
evidence-based areas including the evaluation of high- months. Information such as client demographics, the
risk groups and the effect of repeated visits on client diagnostic category, number and in-home time of
outcome. visits was collected. In addition, the CHS, the CMIS
and the CPVS were measured for each client. Data
King WJ, LeBlanc JC, Barrowman NJ et al. Long term were analyzed, using a robust variance estimator
effects of a home visit to prevent childhood injury: regression model. CMIS was found to be the best
three year follow up of a randomized trial. Inj Prev predictor of in-home time (coefficient 9.521, p >
2005; 11(2):106-9. 0.001), followed by the CHS and the CPVS.
Abstract: OBJECTIVE: To assess the long term effect
of a home safety visit on the rate of home injury. Kirby S. Bias, innateness and domain specificity. J Child
DESIGN: Telephone survey conducted 36 months after Lang 2004; 31(4):927-30; discussion 963-8.
participation in a randomized controlled trial of a home
safety intervention. A structured interview assessed Kirisci L, Tarter RE, Vanyukov M, Reynolds M, Habeych
participant knowledge, beliefs, or practices around M. Relation between cognitive distortions and
injury prevention and the number of injuries requiring neurobehavior disinhibition on the development of
medical attention. SETTING: Five pediatric teaching substance use during adolescence and substance use
hospitals in four Canadian urban centres. disorder by young adulthood: a prospective study.
PARTICIPANTS: Children less than 8 years of age Drug Alcohol Depend 2004; 76(2):125-33.
presenting to an emergency department with a targeted
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![useful tool in screening for unsafe caregiving of Klein M. [Child of drug addicted parents--facts, risks,
preschool children. solutions]. Kinderkrankenschwester 2005; 24(6):230-4.
Kiss C. Third joint meeting of Rumanian and Hungarian Kleinbard P. The New York City Beacons: rebuilding
pediatric hematologists/oncologists. Med Pediatr Oncol communities of support in urban neighborhoods. New
2002; 38(5):368. Dir Youth Dev 2005; (107):27-34, table of contents.
Abstract: Established in 1991 in New York City and
Kitamura T. [Early-rearing experience and environment as now operating in at least seven other cities, Beacons
etiological factors for adult-onset depressive disorder]. are designed to rebuild communities of support for
Seishin Shinkeigaku Zasshi 2004; 106(1):84-7. children and youth in urban neighborhoods. The
Beacon framework is based on research findings and
Kivitie-Kallio S, Tupola S. [Shaken baby syndrome]. practitioner experience indicating that programs taking
Duodecim 2004; 120(19):2306-12. a youth development approach are more effective than
those focused on "fixing" specific youth problems.
Klahr D. Commentary: new kids on the connectionist Successful Beacon programs provide positive ways to
modeling block. Dev Sci 2004; 7(2):165-6. meet young people's need for safety, a sense of
belonging, and mastery; they also provide opportunities
Klassen AF, Lee SK, Barer M, Raina P. Linking survey data for decision making and contributing to others. There
with administrative health information: characteristics are currently eighty Beacons in New York City,
associated with consent from a neonatal intensive care serving about 140,000 youth and adults annually.
unit follow-up study. Can J Public Health 2005; Beacons have been replicated in several parts of the
96(2):151-4. country, including Denver, Minneapolis, Oakland,
Abstract: BACKGROUND: Health services and Palm Beach County, Philadelphia, San Francisco, and
population health research often depends on the ready Savannah. The Youth Development Institute of the
availability of administrative health data. However, the Fund for the City of New York provides technical
linkage of survey-based data to administrative data for assistance and training to Beacons in New York City
health research purposes has raised concerns about and in all seven replication sites.
privacy. Our aim was to compare consent rates to data
linkage in two samples of caregivers and describe Kleinman PK. Hangman's fracture caused by suspected child
characteristics associated with consenters. METHODS: abuse. J Pediatr Orthop B 2004; 13(5):348; author
Subjects included caregivers of children admitted at reply 348.
birth to neonatal intensive care units (NICU) in British
Columbia and caregivers of a sample of healthy Kljakovic M, Parkin C. The presence of medical students in
children. Caregivers were asked to sign a consent form practice consultations. Rates of patient consent. Aust
enabling researchers to link the survey information Fam Physician 2002; 31(5):487-9.
with theirs and their child's provincially collected Abstract: OBJECTIVE: To measure the frequency of
health records. Bivariate analysis identified sample nonconsent encountered by medical students and
characteristics associated with consent. These were describe the influence of gender. METHOD: An
entered into logistic regression models. RESULTS: observational study of general practice teaching
The sample included 1,140 of 2,221 NICU children consultations. RESULTS: Subjects: 63 students (40%
and 393 of 718 healthy children. The overall response female), 67 general practitioners (30% female), and
rate was 55% and the response rate for located families 2572 patients (56% female). Outcome: 3.4% of all
was 67.1%. Consent to data linkage with the child data patients (79% female) did not give consent (4.6% for
was given by 71.6% of respondents and with caregiver male students; 1.6% for female; OR = 3.0, 95% CI 1.7-
data by 67% of respondents. Families of healthy 5.3). The rates of nonconsent did not vary between age
children were as likely to provide consent as families groups for men but occurred mainly in the 15-44 years
of NICU children. Higher rates of consent were age group for women. Male students encountered more
associated with being a biological parent, not requiring nonconsenting female patients than female students,
survey reminders, involvement in a parent support particularly in consultations with female GPs.
group, not working full-time, having less healthy CONCLUSION: Consent to allow medical students to
children, multiple births and higher income. be present in general practice consultations is usually
CONCLUSION: The level of consent achieved provided. It is typically declined for male students by
suggests that when given a choice, most people are young women attending women doctors.
willing to permit researcher access to their personal
health information for research purposes. There is Klosinski G. [Child sexual abuse. How to deal with
scope for educating the public about the nature and suspected abuse?]. MMW Fortschr Med 2001;
importance of research that combines survey and 143(5):29-31.
administrative data to address important health Abstract: Sexual abuse in children is defined as the
questions. exploitation of children by adults for the sexual
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![studied in the behavioral domain--discipline triggered randomization (P<.001 for each). Discussion of
by the child's immediate misbehavior--but rarely in the specific clinical trial details and the presence of a nurse
cognitive domain--parent-child discussions of the during the conference were associated with
child's past misbehavior. Maternal power assertion was understanding. Eighty-four percent of children were
observed in "do" and 'don't" discipline contexts from enrolled in a leukemia trial. CONCLUSIONS: Despite
14 to 45 months and in the context of mother-child oral and written explanation, half of the parents in this
discourse about a recent misbehavior at 56 months. study did not understand randomization for childhood
Mothers' use of power cohered across the "do," 'don't," leukemia trials. To make informed consent more
and discourse contexts, but its implications were effective, future research must seek to improve
domain specific. Power assertion in the 'don't" communication during this critical interchange.
discipline context predicted behavioral outcomes (more
moral conduct at 56 and 73 months, less antisocial Koelsch S, Fritz T, Schulze K, Alsop D, Schlaug G. Adults
conduct at 73 months) but not cognitive outcomes and children processing music: an fMRI study.
(moral cognition at 56 and 73 months). Power assertion Neuroimage 2005; 25(4):1068-76.
in the discourse context predicted less mature moral Abstract: The present study investigates the functional
cognition but not moral or antisocial conduct. Mothers' neuroanatomy of music perception with functional
high Neuroticism predicted more power assertion in all magnetic resonance imaging (fMRI). Three different
three contexts. Child effects were examined. subject groups were investigated to examine
developmental aspects and effects of musical training:
Kochansky GE, Herrmann F. Shame and scandal: Clinical 10-year-old children with varying degrees of musical
and Canon Law perspectives on the crisis in the training, adults without formal musical training
priesthood. Int J Law Psychiatry 2004; 27(4):299-319. (nonmusicians), and adult musicians. Subjects made
judgements on sequences that ended on chords that
Kodish E, Eder M, Noll RB et al. Communication of were music-syntactically either regular or irregular. In
randomization in childhood leukemia trials. JAMA adults, irregular chords activated the inferior frontal
2004; 291(4):470-5. gyrus, orbital frontolateral cortex, the anterior insula,
Notes: GENERAL NOTE: KIE: 39 refs. ventrolateral premotor cortex, anterior and posterior
GENERAL NOTE: KIE: KIE Bib: human areas of the superior temporal gyrus, the superior
experimentation/informed consent; human temporal sulcus, and the supramarginal gyrus. These
experimentation/minors structures presumably form different networks
Abstract: CONTEXT: Most children diagnosed as mediating cognitive aspects of music processing (such
having leukemia become research subjects in as processing of musical syntax and musical meaning,
randomized clinical trials (RCTs), but little is known as well as auditory working memory), and possibly
about how randomization is explained to or understood emotional aspects of music processing. In the right
by parents. OBJECTIVE: To investigate physicians' hemisphere, the activation pattern of children was
explanation and parental understanding of similar to that of adults. In the left hemisphere, adults
randomization in childhood leukemia RCTs. DESIGN showed larger activations than children in prefrontal
AND SETTING: A multisite study of the informed areas, in the supramarginal gyrus, and in temporal
consent communication process for RCTs of childhood areas. In both adults and children, musical training was
leukemia. Consecutive cases were recruited from correlated with stronger activations in the frontal
pediatric oncology inpatient wards at 6 US children's operculum and the anterior portion of the superior
hospitals associated with major academic medical temporal gyrus.
centers from July 1, 1999, until December 31, 2001.
The informed consent conferences were observed and Koh TH, Collie L, Budge D, Butow P. Informed consent in
audiotaped, and the information obtained was coded neonatal randomised trials. Lancet 2001;
and analyzed. Parents were interviewed shortly after 357(9266):1445-6.
the conference to ascertain their understanding. Notes: GENERAL NOTE: KIE: 4 refs.
PARTICIPANTS: Parents and members of the health GENERAL NOTE: KIE: KIE Bib: human
care team who participated in 137 informed consent experimentation/informed consent; human
conferences for children with newly diagnosed acute experimentation/minors
leukemia. MAIN OUTCOME MEASURES: Observed
explanations of randomization and parental Kohlhaas M, Wiegmann L, Gaszczyk M, Walter A,
understanding of randomization after the consent Schaudig U, Richard G. [Lacrimal duct treatment with
conference. RESULTS: Randomization was explained ring intubation in injuries of the upper and lower
by physicians in 83% of cases and a consent document eyelids]. Ophthalmologe 2001; 98(8):743-6.
was presented during the conference in 95% of cases. Abstract: BACKGROUND: Treating injuries of the
Interviews after the conference demonstrated that 68 lacrimal system with a silicon intubation is an
(50%) of 137 parents did not understand approved method to prevent post-traumatic epiphora.
randomization. Parents of racial minority and lower MATERIALS AND METHODS: Between 1990 and
socioeconomic status were less likely to understand
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![1999, operations were carried out on 44 patients with scores. The childrearing practices, maternal
injuries of the canaliculi with silicon ring intubations. socioeconomic status (SES) and age, and infants'
Interesting for us were the age distribution, causes of gestational age at birth (GA) explained 45% of the
injuries, localisation and mid- to long-term variance in infants' cognitive scores. The infants' GA,
postoperative complications. RESULTS: The age of maternal SES and age, and NCATS scores accounted
the patients was between 1.75 and 74 years, 48% of the for 32% of the motor scores on the BSID II.
injuries were caused by household accidents, 23% by DISCUSSION AND CONCLUSION: The findings
violence, 20% by traffic accidents and 9% by job- partially support a link between aspects of the mothers'
related accidents. The canaliculus inferior was injured childrearing behaviors and their infants' cognitive
in 68% of all patients. We found 10 postoperative developmental status. For motor developmental status,
complications, e.g. ectropia, a too long silicon ring or the association appeared stronger with the infants'
granuloma. We found a positive anatomical readapted characteristics than with maternal childrearing
lacrimal system in 88% and 12% of our patients practices and behaviors tested in this study.
complained of distinct to severe epiphora.
CONCLUSIONS: The treatment of lacrimal laceration Kolowski J, Nowak KM. [Infanticide in the light of post-
with a silicon intubation is an excellent method but mortem findings and court files from the period 1990-
special care should be taken with correct positioning of 2000 (selected problems)]. Arch Med Sadowej
the lid margin. Kryminol 2005; 55(2):125-9.
Abstract: Drawing upon 28 court files of the District
Kolobe TH. Childrearing practices and developmental Court in Poznan and 30 post-mortem protocols--from
expectations for Mexican-American mothers and the the Department of Forensic Medicine at Poznan
developmental status of their infants. Phys Ther 2004; Medical Academy. This article tackles the issue of
84(5):439-53. infanticide in the period from 1990 to 2000. The aim of
Abstract: BACKGROUND AND PURPOSE: The this paper was to find answers to the following
impact of parent education programs on early questions: what was the social background and mental
intervention programs is not thought to be uniform state of female offenders? How was infanticide
among children from majority and minority committed? In order to solve certain research
populations. This study examined the relationship problems, a document examination technique was
between maternal childrearing practices and behaviors employed to analyse the contents of the documents
and the developmental status of Mexican-American available. Female offenders were aged between 17 to
infants. SUBJECTS: Participants were 62 Mexican- 42 years. In the majority of cases (56.7%), perpetrators
American mother-infant pairs. The infants' mean were occupationally active, single young women with a
adjusted age was 12 months (SD=1.7, range=9-14). A low level of education and having a working-class
third of the children were diagnosed with background. In the majority of cases (80%), active
developmental delays and referred for early infanticide was committed. Most frequently, infanticide
intervention by physicians or therapists when the was committed by shutting a child into a tight space,
children received their medical follow-up. The group and tamponade of throat and larynx. Passive infanticide
was stratified according to socioeconomic status and was committed in 20% of cases, with infants left
acculturation using the Bidimensional Acculturation without care at the place of birth. No case of psychosis
Scale for Hispanics. This scale uses cutoff points to was determined in the examined material.
classify individuals into 3 levels of acculturation.
METHODS: Information on childrearing practices and Komen M. Physical child abuse and social change. Judicial
behaviors was gathered using the Parent Behavior intervention in families in The Netherlands, 1960-
Checklist (PBC), the Home Observation for 1995. Child Abuse Negl 2003; 27(8):951-65.
Measurement of the Environment (HOME) Inventory, Abstract: OBJECTIVE: To show changes in the way
and the Nursing Child Assessment Teaching Scale juvenile judges and judicial child protection workers
(NCATS). Infants' developmental status was assessed deal with physical child abuse in the period 1960-1995
by use of the Bayley Scales of Infant Development II in the Netherlands. METHOD: The study is based on
(BSID II). The Pearson product moment correlation, an analysis of files on adolescent and younger children
partial correlations, Fisher z transformation, and placed by juvenile judges in the Dutch judicial child
multiple regression analyses were used to examine the protection system during the 1960s, 1970s, 1980s, and
relationship between childrearing practices and 1990s. RESULTS: The prevalence of very severe
parenting behaviors, demographic factors, and infants' physical violence against children was lower in the
developmental status. RESULTS: Maternal nurturing recent files than in the older files. Spanking and other
behaviors, parent-child interaction, and quality of the minor violence acts were noted more often than in the
home environment were positively correlated with the older files. In the 1960s files, the parents talked still
infants' cognitive development. Maternal years of rather openly about the physical punishments they used
education modified the observed relationship between in child rearing. In spite of the growing attention for
PBC and BSID II scores but not the observed and increasing concern about child abuse among
relationship between HOME Inventory and NCATS professionals, judicial child protection workers
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![92(2):593-4. with any certainty, many of them experience labour
Abstract: A 42-item MMPI-2 scale classified 97.5% of and delivery in referral communities as a crisis event
201 clinic outpatients into groups reporting or not fraught with anxiety. The literature suggests that,
reporting prior emotional abuse. within a regionalized perinatal system, small maternity
services can offer safe care provided that an efficient
Koren G, Nulman I, Chudley AE, Loocke C. Fetal alcohol mechanism for intrapartum transfer has been
spectrum disorder. CMAJ 2003; 169(11):1181-5. established. This commentary provides
recommendations for sustainable maternity care that
Korenbrot CC, Ehlers S, Crouch JA. Disparities in will meet the needs of women, their families, and
hospitalizations of rural American Indians. Med Care maternity caregivers in rural communities. The
2003; 41(5):626-36. recommendations stem from a rural maternity care
Abstract: BACKGROUND: Disparities in program of research, consultations with communities,
hospitalization rates, particularly rates for avoidable and review of relevant epidemiologic and policy
hospitalizations, are indicators of potentially unmet literature.
health needs and inefficient use of health resources.
Hospitalization rates that the Indian Health Service Koroukian SM. Uterine rupture among women with a prior
(IHS) can report underestimate disparities for cesarean delivery. N Engl J Med 2002; 346(2):134-7.
American Indians (AIs) and Alaska Natives (ANs)
relative to other Americans, because the IHS cannot Koschel MJ. Emergency: is it child abuse? Am J Nurs 2003;
track all hospitalizations of AIs/ANs in their user 103(4):45-6.
population. OBJECTIVES: To compare hospitalization
and avoidable hospitalization rates for a rural AI/AN Koslap-Petraco MB, Parsons T. Communicating the benefits
user population with those of non-Indians living in the of combination vaccines to parents and health care
same counties where both groups use the same hospital providers. J Pediatr Health Care 2003; 17(2):53-7.
system, regardless of the expected source of payment. Abstract: Infants may receive as many as 5 separate
RESEARCH DESIGN: Retrospective analysis of injections at an office visit in order to comply with the
California hospital discharge data for 1996 linked to 2002 childhood immunization schedule. Many parents
rural IHS user data for 1995 and 1996 (3920 and healthcare providers disagree with administering 4
hospitalizations) compared with a random sample of or 5 injections at one visit, and therefore may delay
discharge data for the rest of the non-Indian population some injections until another visit. This practice may
in the 37 counties of the IHS Contract Health Service lead to decreased compliance and can increase costs for
delivery area (7840 hospitalizations). MEASURES: the parent. New combination vaccines will help to
Hospitalization and avoidable hospitalization rates and simplify the immunization schedule, and health care
risk ratios (RRs). RESULTS: Hospitalization and providers will need to be able to address parental
avoidable hospitalization rates were both higher for the concerns regarding these vaccines. Nurses are often
AI/AN user population than for the non-Indian general responsible for administering vaccines in the office
population. The age-adjusted hospitalization ratios setting, and therefore are also influential in deciding
were 72% higher for men (RR 1.72, confidence which vaccines should be ordered. The purpose of this
interval [CI] 1.40-2.12) and 52% higher for women article is to educate nurses on communicating the
(RR 1.52, CI 1.36-1.92). The comparable ratios for benefits of combination vaccines to parents and other
avoidable hospitalizations were 136% higher for men healthcare providers.
(RR 2.36, CI 1.52-3.29) and 106% higher for women
(RR 2.06, CI 1.32-3.50). CONCLUSIONS: Disparities Kostelny K, Wessells M. Psychosocial aid to children after
in both hospitalization and avoidable hospitalization the Dec 26 tsunami. Lancet 2005; 366(9503):2066-7.
rates of rural AIs/ANs in California were previously
undetected by either federal IHS or state hospital Kotagal UR, Robbins JM, Kini NM, Schoettker PJ, Atherton
discharge data alone. At least some of the disparities HD, Kirschbaum MS. Impact of a bronchiolitis
are likely reducible with improved access to care. guideline: a multisite demonstration project. Chest
2002; 121(6):1789-97.
Kornelsen J, Grzybowski S. Is local maternity care an Abstract: STUDY OBJECTIVES: The purpose of this
optional service in rural communities? J Obstet study was to determine the impact of a multisite
Gynaecol Can 2005; 27(4):329-31. implementation of an evidence-based clinical practice
Abstract: There has been a precipitous decline in the guideline for bronchiolitis. DESIGN: Before and after
number of rural communities across Canada providing study. SETTING: Eleven Child Health Accountability
local maternity care. The evidence suggests that the Initiative (CHAI) study hospitals. PATIENTS:
outcome for newborns may be worse as a result. There Children < 12 months of age with a first-time episode
is also an emerging understanding of the significant of bronchiolitis. INTERVENTION: The guideline was
physiological and psychosocial consequences for rural implemented in December 1998. Complete
parturient women. Because they cannot plan for birth preimplementation and postimplementation
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![was determined from hierarchical linear modelling. Imagery rehearsal therapy was an effective treatment
Child visits were nested within physicians, and the option for chronic nightmares in this adjudicated
most parsimonious model was selected at p < 0.05. adolescent population.
RESULTS: During the study period, 45% of physician
visits for VRTI resulted in an antibiotic prescription, Krantz G, Garcia-Moreno C. Violence against women. J
and 20% of antibiotic prescriptions were for second- Epidemiol Community Health 2005; 59(10):818-21.
line antibiotics. Relative to general practitioners, the Abstract: Violence against women is now well
odds ratio for antibiotic prescription for a VRTI was recognised as a public health problem and human
0.51 (95% confidence interval [CI] 0.42-0.62) for rights violation of worldwide significance. It is an
pediatricians and 1.58 (95% CI 1.03-2.42) for other important risk factor for women's ill health, with far
specialists. The likelihood that an antibiotic would be reaching consequences for both their physical and
prescribed for a VRTI was 0.99 for each successive mental health. This glossary aims to describe various
10,000 Canadian dollars increase in household income. forms of interpersonal violence that are directed
Pediatricians and other specialists were more likely towards women and girls. Terms and basic concepts
than general practitioners to prescribe second-line used in research and policy on this public health
antibiotics for initial therapy. Both criteria for problem will be explained.
nonadherence to evidence-based prescribing were 40%
less likely among physicians trained in Canada or the Krause ED, Mendelson T, Lynch TR. Childhood emotional
United States than among physicians trained elsewhere. invalidation and adult psychological distress: the
INTERPRETATION: The links that we identified mediating role of emotional inhibition. Child Abuse
between nonadherence to evidence-based antibiotic Negl 2003; 27(2):199-213.
prescribing in children and physician specialty and Abstract: OBJECTIVE: To evaluate a model in which
location of training suggest opportunities for chronic emotional inhibition mediates the relationship
intervention. The independent effect of household between a history of childhood emotional invalidation
income indicates that parents also have an important or abuse and adult psychological distress. METHOD:
role. One hundred and twenty-seven participants completed
a series of self-report questionnaires, and a subset of
Krakow B, Sandoval D, Schrader R et al. Treatment of this group (n=88) completed an additional measure of
chronic nightmares in adjudicated adolescent girls in a current avoidant coping in response to a laboratory
residential facility. J Adolesc Health 2001; 29(2):94- stressor. Structural equation modeling was used to
100. evaluate and compare a full and partial mediational
Abstract: PURPOSE: To evaluate imagery rehearsal model. RESULTS: Findings strongly supported a
therapy for the treatment of chronic nightmares in a model in which a history of childhood emotional
sample of adolescent girls. METHODS: Adolescent invalidation (i.e., psychological abuse and parental
girls ranging in age from 13 to 18 years were recruited punishment, minimization, and distress in response to
from the Wyoming Girls School in Sheridan, Wyoming negative emotion) was associated with chronic
(treatment group, n = 9; control group, n = 10). These emotional inhibition in adulthood (i.e., ambivalence
girls had previously suffered a high prevalence of over emotional expression, thought suppression, and
unwanted sexual experiences in childhood and avoidant stress responses). In turn, emotional inhibition
adolescence, and thus many suffered from nightmares, significantly predicted psychological distress, including
sleep complaints, and posttraumatic stress symptoms. depression and anxiety symptoms. CONCLUSION:
Imagery rehearsal therapy was provided in a 1-day (6- This study found support for a model in which the
h) workshop. Imagery rehearsal consists of three steps, relation between recollected negative emotion
all of which are performed in the waking state: (a) socialization in childhood and adult psychological
select a nightmare, (b) "change the nightmare any way distress was fully mediated by a style of inhibiting
you wish," and (c) rehearse the images of the new emotional experience and expression. Although it is
version ("new dream") 5 to 20 min each day. Control likely that childhood emotional inhibition is functional
participants received no intervention. RESULTS: At (e.g., reduces parental distress and rejection), results
baseline, these girls had been suffering from suggest that chronic emotional inhibition may have
nightmares, on average, for 4.5 years, and they long-term negative consequences for the inhibitor.
reported experiencing 20 nightmares per month, which
occurred at a frequency of at least one bad dream every Krause G, Blackmore C, Wiersma S et al. Marijuana use and
other night. At 3 months, self-reported, retrospectively social networks in a community outbreak of
assessed nightmare frequency measured in nights per meningococcal disease. South Med J 2001; 94(5):482-
month decreased 57% (p =.01, d = 1.4) and measured 5.
in nightmares per month decreased 71% (p =.01, d = Abstract: BACKGROUND: We examined the role of
1.7) in the treatment group, compared with no social networks and marijuana smoking in a
significant changes in the control group. No significant community outbreak of infections due to Neisseria
changes were noted for sleep and posttraumatic stress meningitidis. METHODS: We interviewed all patients
disorder measures in either group. CONCLUSION:
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![and their contacts. Isolates were tested by pulsed field Krisin, Basri H, Fryauff DJ et al. Malaria in a cohort of
electrophoresis and multilocus enzyme electrophoresis. Javanese migrants to Indonesian Papua. Ann Trop Med
RESULTS: Nine cases of meningococcal disease Parasitol 2003; 97(6):543-56.
occurred in the outbreak; isolates from seven cases Abstract: The epidemiology of infection by
with positive cultures were identical. Multiple Plasmodium falciparum and P. vivax was investigated
overlapping social networks were found for case- among Javanese migrants to an endemic region of
patients and their contacts. All case-patients were Papua, Indonesia. A cohort of 243 migrants from Java
linked by the marijuana-related activities of their was followed for malaria in a new settlement village in
contacts. CONCLUSION: Investigation of social the endemic Armopa area of north-eastern Papua,
networks and marijuana exposure might help identify beginning on the day each migrant arrived in the
close contacts of patients with meningococcal disease village. The subjects were monitored during home
and help prevent secondary infections. visits (three/week) and by the twice-monthly
production of bloodsmears that were checked for
Kreidler M. Group therapy for survivors of childhood sexual malarial parasites. At the end of 33 months, 159 (65%)
abuse who have chronic mental illness. Arch Psychiatr of the subjects remained under follow-up. The
Nurs 2005; 19(4):176-83. prevalence of parasitaemia in the village declined from
Abstract: Medication and supportive services are 16% among those already living there when the study
usually the approaches used to treat women with began in August 1996, to 5% when the study finished
chronic mental illness (CMI). The goal of this study in June 1999. Over this period, 596 infections by P.
was to evaluate the outcomes of group therapy for falciparum and 723 by P. vivax occurred in the cohort,
women with CMI in comparison with those for women 22 and 27 of the subjects each experiencing at least six
without CMI, all of whom experienced childhood infections by P. falciparum and P. vivax, respectively.
sexual abuse. The sample ( N=121) consisted of The incidence of malarial infection was higher during
women, all of whom were sexually abused as children. the first and second years post-migration (3.2 and 2.7
The results indicated that abused women with CMI had infections/person-year) than during the third (1.2
improved self-esteem and decreased symptom scores at infections/person-year). Although the geometric mean
the same rate as abused women without CMI. It was parasite counts for P. falciparum increased over time
suggested that nurses can play an essential role in their (1209, 1478, and 1830 parasites/microl in the first,
practice with this population. second and third years, respectively), the
corresponding values for P. vivax (497, 535 and 490
Kringlen E. [Sexual abuse, recovered memory and multiple parasites/microl) showed no such trend. Only one of
personality disorder]. Tidsskr Nor Laegeforen 2002; the nine subjects who developed severe malaria
122(2):202-8. (requiring intravenous quinine therapy) was a child,
giving an odds ratio for a case of severe malaria being
Krischer MK, Sevecke K, Lehmkuhl G, Steinmeyer EM. in an adult of 6.1 (P=0.08).
[Less severe sexual child abuse and its sequelae: are
there different psychic and psychosomatic symptoms in Krueger DW. Body self. Development, psychopathologies,
relation to various forms of sexual interaction?]. Prax and psychoanalytic significance. Psychoanal Study
Kinderpsychol Kinderpsychiatr 2005; 54(3):210-25. Child 2001; 56:238-59.
Abstract: A typology of less severe sexual encounters Abstract: Ego development or, more broadly, the sense
was used to analyze short and long term sequelae of of self has at its core a cohesive, distinct, and accurate
sexual abuse via intimate skin contact. Well known body self. Compromise of body self development as a
theoretical approaches on the harmful effects of sexual result of early overstimulation, empathic unavailability
abuse were tested. Do we find different peri- and or nonresponse of the caretaker, and inconsistency or
posttraumatic reactions dependent upon varied forms selectivity of response can lead to specific
of sexual interactions with children? A cluster analysis developmental arrests, including body-image
was calculated with symptom variables that were distortions, nonintegration of body self and
described in 141 child statements taken out of written psychological self, and difficulties in the regulation of
expert opinions. Afterwards variance analyses of these tension states and affect. The individual may then
symptom clusters were conducted in reference to six attempt to repair those disrupted developmental needs
different abuse constellations. Different symptom by such symptomatic expressions as eating disorders,
profiles were found for these six abuse constellations. compulsive exercise, substance abuse, and the creation
Panic symptoms, shame related feelings, avoidant of physical danger, as a step toward integration of mind
behavior and physical reactions showed significant and body as well as a defensive antidote to painful
results. The sequelae to different forms of less severe affect. In the psychoanalytic treatment of these
sexual child abuse differ and depend more upon the patients, the need for the analyst's attunement to the
situational dynamic than upon the kind of relationship patient's development of body self as well as
between adult and child. psychological self development is illustrated by clinical
vignettes of the enactments and attempted restitution of
specific developmental trauma.
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![neurobiology, constitution, developmental experiences, environmental factors are stronger predictors of age of
and complex internal object world. Two types of first drink than family history.
personality structure are discussed. For the
disorganized type, the psychodynamic scenario Kupkova L, Bendukidze N, Slavcev A, Ivaskova E. The
involves attempts to contend with the danger of Czech Bone Marrow Donor Registry. Ann Transplant
massive internal breakdown. For the organized type, 2001; 6(2):46-9.
the scenario involves attempts to contend with the Abstract: OBJECTIVE: The Czech Bone Marrow
danger of persecution and annihilation. For these Donor Registry (CBMD)--established 9 years ago,
women, physical violence is used because of failures in operates within the National HLA Centre, a constituent
mentalization, and is an enactment of catastrophic part of the Department of Immunology at the Institute
internal anxieties. for Clinical and Experimental Medicine. The Czech
Cord Blood Register (CSCB) was recently established
Kuperman S, Chan G, Kramer JR et al. Relationship of age (in 1996) and started its activities. METHODS: CBMD
of first drink to child behavioral problems and family is responsible for maintaining a database of HLA typed
psychopathology. Alcohol Clin Exp Res 2005; volunteer donors, for performing national and
29(10):1869-76. international searches in the file of bone marrow
Notes: CORPORATE NAME: Collaborative Study on transplantation as well as for coordinating the
the Genetics of Alcoholism communication between participating centres.
Abstract: BACKGROUND: Studies have implicated a RESULTS: The operation of the CBMD registry
wide variety of variables as being associated with an requires the modern communication technology for the
early age of first drink (AFD). AFD in turn has been exchange of data with local organisations (donor and
associated with a variety of negative outcomes in transplant centres) and with international BM
adolescence and early adulthood. This study is organisations and networks abroad (Bone Marrow
designed to quantify the contributions of these Donors Worldwide--BMDW, National Marrow Donor
antecedent variables to prediction of AFD; in particular Program--NMDP, European Donor Secretariat E.D.S.,
it will carefully examine the involvement of variables European Marrow Donor Information System--
in four areas (child characteristics, family EMDIS). CONCLUSIONS: The CBMD is fully
demographics, family psychopathology, and child integrated into international cooperation. The HLA
behavior problems). METHODS: Using data from a typed unrelated stem cells from Prague can be selected
multicenter study on alcoholism, we first investigated for patients in the whole world.
the differences between two groups of children (ages 7
to 17 years), one from families heavily loaded for Kuritarne IS. [Childhood trauma in the etiology of
alcohol dependence and the other from population borderline personality disorder]. Psychiatr Hung 2005;
controls. Second, a multidomain, multistep regression 20(4):256-70.
model using child characteristics, family Abstract: Serious, prolonged intrafamilial childhood
demographics, family psychopathology, and child sexual abuse is considered to be the main etiological
behavior problems was performed to determine factor in about half of the patients with borderline
significant contributors to predicted AFD. RESULTS: personality disorder in the USA. Special features of
Five variables initially contributed to the prediction of childhood interpersonal trauma leading to the
AFD. These included gender, age at interview, the development of borderline personality disorder are the
number of adult sibs with alcohol dependence, being seriousness of the trauma and the fact that it is sexual
held back a year in school, and conduct scale score. in nature. Serious intrafamilial childhood abuse can
However, the number of conduct symptoms appeared lead not only to the classic post-traumatic stress
to contain the contributions of gender and being held syndrome, but can influence all aspects of personality
back a grade in school, and these two variables were development, including the distortion of the sense of
subsequent removed from the model. The remaining identity, self-regulation, and the patterns of
three variables explained 45% of the model variance; interpersonal relations. Viewed from the perspective of
age at interview accounted for 38.3%, conduct scale the trauma concept, the entire range of adult borderline
score accounted for 6.2%, and the number of alcohol- symptoms are considered as being the consequences of
dependent adult sibs accounted for 0.5%. No family severe complex traumatic experiences. Other clinicians
history measures of alcohol dependence or antisocial regard such an abuse as a marker of the severity of
personality disorder were contributory to the prediction familial dysfunction and emphasize the role of other
model for AFD. CONCLUSIONS: Both the "number pathogenic factors, such as biparental neglect and
of conduct symptoms" and the "number of adult sibs biological vulnerability of the pre-borderline child.
with alcohol dependence" are inversely associated with
predicted AFD. The latter variable appears marginally Kuznetsova T, Staessen JA, Kawecka-Jaszcz K et al.
predictive of AFD and suggests a condition in which Quality control of the blood pressure phenotype in the
the child's household, regardless of strength of family European Project on Genes in Hypertension. Blood
history of AD (or antisocial personality disorder), Press Monit 2002; 7(4):215-24.
appears conducive to early drinking. Thus, child and
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![Abstract: OBJECTIVES: In the European Project on was used to examine the relative contributions of age,
Genes in Hypertension (EPOGH) standardized accuracy, and response latency on activation. Our
epidemiological methods were used to determine analysis showed that age was the most significant
complex phenotypes consisting of blood pressure (BP) predictor of activation in these brain regions. These
in combination with other traits. In this report, we findings provide strong evidence for a process of
present the quality control of one of the BP protracted functional maturation of bilateral fronto-
phenotypes. METHODS: In seven European countries parietal neural networks involved in VSWM
eight different research groups recruited random development. At least two neural systems involved in
samples of nuclear families. Trained observers VSWM mature together: (i) a right hemisphere visuo-
measured the BP five times consecutively with the spatial attentional system, and (ii) a left hemisphere
participants in the seated position at each of two phonological storage and rehearsal system. These
separate home visits, 1 to 3 weeks apart, according to observations suggest that visually and verbally
the guidelines of the British Hypertension Society. mediated mnemonic processes, and their neural
Quality assurance and quality control of this BP representations, develop concurrently during childhood
phenotype were implemented according to detailed and adolescence and into young adulthood.
instructions defined in the protocol of the EPOGH
study. RESULTS: On 31 August 2001, BP Kyncl J, Paget WJ, Havlickova M, Kriz B. Harmonisation of
measurements of 2476 subjects were available for the acute respiratory infection reporting system in the
analysis. Fewer BP readings than the five planned per Czech Republic with the European community
visit occurred in one of the eight centres, but only in networks. Euro Surveill 2005; 10(3):30-3.
0.4% of the home visits. Across centres the relative Abstract: Respiratory virus activity is detected in
frequency of identical consecutive readings for systolic Europe each winter, yet the precise timing and size of
or diastolic blood pressure varied from 0 to 6%. The this activity is highly unpredictable. The impact of
occurrence of odd readings ranged from 0 to 0.1%. Of influenza infection and/or acute respiratory infection in
the 49,488 systolic and diastolic BP readings, 24.0% European countries is continuously monitored through
ended on a zero (expected 20%). In most EPOGH a variety of surveillance systems. All of these sources
centres there was a progressive decline in the BP from of information are used to assess the nature and extent
the first to the second home visit. Overall, these of activity of influenza and other respiratory viruses,
decreases averaged 2.36 mmHg [95% confidence and to offer guidance on the prevention and control of
interval (CI): 1.98-2.74, P < 0.001] for systolic BP and morbidity and mortality due to influenza at a local,
1.74 mmHg (95% CI: 1.46-2.02, P < 0.001) for national and international level. The early warning
diastolic BP. CONCLUSIONS: Quality assurance and system for a forthcoming influenza epidemic is mainly
control should be planned at the design stage of a based on the use of a set of thresholds. In the Czech
project involving BP measurement and implemented Republic, the acute respiratory infection (ARI)
from its very beginnings until the end. The procedures reporting system, with automated data processing, uses
of quality assurance set up in the EPOGH study for the a statistical model for the early detection of unusual
BP measurements resulted in a well-defined BP increased rates of the monitored indicators. The
phenotype, which was consistent across centres. collected data consists of the number of ARI, the
number of complications due to ARI and the
Kwon H, Reiss AL, Menon V. Neural basis of protracted population registered with the reporting general
developmental changes in visuo-spatial working practitioners and paediatricians, all collected separately
memory. Proc Natl Acad Sci U S A 2002; in five age groups. To improve the reporting system in
99(20):13336-41. the Czech Republic, clinical data on the weekly
Abstract: Developmental studies have shown that incidence of influenza-like illness (ILI) within the same
visuo-spatial working memory (VSWM) performance population and the same age groups was started in
improves throughout childhood and adolescence into January 2004. These data fit the European
young adulthood. The neural basis of this protracted Commission's recently adopted ILI case definition and
development is poorly understood. In this study, we allows a better comparison of data with other countries
used functional MRI (fMRI) to examine VSWM in Europe, in particular those participating in EISS
function in children, adolescents, and young adults, (European Influenza Surveillance Scheme).
ages 7-22. Subjects performed a 2-back VSWM
experiment that required dynamic storage and Labouvie E, Bates ME. Reasons for alcohol use in young
manipulation of spatial information. Accuracy and adulthood: validation of a three-dimensional measure. J
response latency on the VSWM task improved Stud Alcohol 2002; 63(2):145-55.
gradually, extending into young adulthood. Age-related Abstract: OBJECTIVE: To evaluate the reliability and
increases in brain activation were observed in focal validity of a measure of reasons for use, which is based
regions of the left and right dorsolateral prefrontal on a cognitive mediational view of alcohol use as a
cortex, left ventrolateral prefrontal cortex (including means for affect regulation. METHOD: Data for this
Broca's area), left premotor cortex, and left and right study were obtained from the Rutgers Health and
posterior parietal cortex. Multiple regression analysis Human Development Project. Self-reports of young
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![Lam LT. Attention deficit disorder and hospitalization early responsive parenting have a special importance
owing to intra- and interpersonal violence among for children's development or is consistency across
children and young adolescents. J Adolesc Health early childhood necessary? Dev Psychol 2001;
2005; 36(1):19-24. 37(3):387-403.
Abstract: PURPOSE: To investigate the associations Abstract: The role of early versus ongoing maternal
between intra-and interpersonal violence and related responsiveness in predicting cognitive and social
injuries and the diagnosis of attention deficit disorder development was examined in home visits for mothers,
(ADD) among children and young adolescents. full-term children (n = 103), and medically low-risk (n
METHODS: This was a population-based = 102) and high-risk (n = 77) preterm children at 5
epidemiological study that analyzed data routinely ages. There were 4 maternal clusters based on warm
collected on hospitalized patients owing to injuries. and contingent responsiveness behaviors observed
Data were obtained from the routinely collected early (at 6, 12, and 24 months) and late (at 3 and 4
inpatient statistics. Information included patients' years): high early, high late; high early, low late; low
demographics, diagnostic classifications of admitting early, moderate late; and low early, low late. Children,
problem, classification of external causes of injury, especially preterm children, showed faster cognitive
length of stay, and outcome of hospitalization. Patients growth when mothers were consistently responsive.
with comorbidity of ADD were identified by the ICD- Social growth was similar in the consistently
9CM diagnosis code. Data were analyzed univirately responsive (high-high) and the early-responsive
using Pearson Chi-square tests. Logistic regression inconsistent (high-low) clusters, but greater
analyses were also applied to calculate the adjusted deceleration at 4 years among children with mothers in
odds ratio and their corresponding 95% confidence the inconsistent cluster refuted the notion of a unique
intervals. RESULTS: Significant associations between role for early responsiveness. The importance of
suicide and self-harm, injuries owing to assault, and consistent responsiveness, defined by an affective-
diagnosis of ADD were found. Patients diagnosed with emotional construct, was evident even when a broader
ADD stayed in the hospital longer than others, constellation of parenting behaviors was considered.
disregarding the cause of their injury. CONCLUSION:
Children and adolescents with ADD are at risk of being Langeland W, Draijer N, van den Brink W. Psychiatric
victims of assaults, as well as suicide and self harm. comorbidity in treatment-seeking alcoholics: the role of
Assessment for ADD can be considered as part of childhood trauma and perceived parental dysfunction.
school-age childhood screening programs. Alcohol Clin Exp Res 2004; 28(3):441-7.
Abstract: BACKGROUND: This study among
Lamberg L. Researchers seek roots of pedophilia. JAMA treatment-seeking alcoholics examined the relationship
2005; 294(5):546-7. between childhood abuse (sexual abuse only [CSA],
physical abuse only [CPA], or dual abuse [CDA]) and
Landau R. Posthumous sperm retrieval for the purpose of the presence of comorbid affective disorders, anxiety
later insemination or IVF in Israel: an ethical and disorders, and suicide attempts, controlling for the
psychosocial critique. Hum Reprod 2004; 19(9):1952- potential confounding effects of other childhood
6. adversities (early parental loss, witnessing domestic
Abstract: In October 2003, the Attorney General of the violence, parental alcoholism, and/or dysfunction) and
Government of Israel published guidelines allowing adult assault histories. METHOD: We assessed 155 (33
posthumous sperm retrieval for the purpose of later females, 122 males) treatment-seeking alcoholics using
insemination or IVF by the surviving female partner. the European Addiction Severity Index, the Structured
This paper presents an ethical and psycho-social Trauma Interview, and the Composite International
critique of the guidelines, which challenges their basic Diagnostic Interview. RESULTS: The severity of
premise that personal autonomy over-rides any other childhood abuse was associated with posttraumatic
ethical principle and argues that the autonomy of the stress disorder (PTSD) and suicide attempts in females
adult should not over-ride the well-being of the and with PTSD, social phobia, agoraphobia, and
offspring. It also shows that, despite the centrality of dysthymia in males. Among men, multiple logistic
autonomy in the guidelines, they actually infringe on regression models showed that CPA and CDA were not
the autonomy of the deceased, and pose challenges to independently associated with any of the examined
that of the surviving partner. It questions the propriety comorbid disorders or with suicide attempts. However,
and very possibility of ascertaining the 'presumed CSA independently predicted comorbid social phobia,
wishes' of the deceased for a posthumous child. agoraphobia, and PTSD. For the presence of comorbid
Finally, it argues against the document's presentation of affective disorders (mainly major depression) and
posthumous sperm retrieval as a medical procedure and suicide attempts, maternal dysfunctioning was
contends that, on the contrary, medicine and science particularly important. CSA also independently
are suborned to the exploitation of the dead. contributed to the number of comorbid diagnoses. For
females, small sample size precluded the use of
Landry SH, Smith KE, Swank PR, Assel MA, Vellet S. Does multivariate analyses. CONCLUSION: Childhood
abuse is an important factor in understanding clinical
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![Larrea C, Freire W. Social inequality and child malnutrition weekly via telephone, was visited monthly, and
in four Andean countries. Rev Panam Salud Publica underwent an extensive home interview quarterly.
2002; 11(5-6):356-64. RESULTS: The incidence of new symptoms in the
Abstract: OBJECTIVE: To analyze the effects of month before quarterly home visits ranged from 8.9%
socioeconomic, regional, and ethnic conditions on to 12.4% for individuals and from 32% to 39.7% for
chronic malnutrition in four Andean countries of South households. Four factors were significantly associated
America: Bolivia, Colombia, Ecuador, and Peru. with infection. Drinking only bottled water increased
METHODS: The study was based on Demographic and risk (relative risk [RR], 2.1; 95% confidence interval
Health Surveys (DHS) for Colombia (1995), Peru [CI], 1.2-3.7). Using hot water (RR, 0.7; 95% CI,.5-.9)
(1996), and Bolivia (1997), and on a Living Standard and bleach (RR, 0.29; 95% CI,.23-.66) for laundry and
Measurement Survey for Ecuador (1998). We reporting that germs were most likely to be picked up
developed an index of household socioeconomic status in the kitchen (RR, 0.5; 95% CI,.3-.8) were protective.
using categorical principal components analysis. We No other hygiene practices, including hand washing,
broke down the prevalence of stunting by were associated with infection risk. CONCLUSIONS:
socioeconomic status (SES), ethnicity, place of Further studies of a potential role for bottled water in
residence (large cities, small cities, towns, and infections are warranted, as is a renewed appreciation
countryside), and region (highland region versus other for the potential protective role of laundry practices
areas of the country). We applied smoothed regression such as using bleach and hot water.
curves and linear functions to analyze SES effects on
stunting, with specific models for Bolivia, Ecuador, Larson EL, Lin SX, Gomez-Pichardo C, Della-Latta P.
and Peru. RESULTS: Bolivia, Ecuador, and Peru have Effect of antibacterial home cleaning and handwashing
similar characteristics, with high stunting prevalences products on infectious disease symptoms: a
overall; higher stunting prevalences in their highland randomized, double-blind trial. Ann Intern Med 2004;
areas, particularly among indigenous populations; and 140(5):321-9.
strong socioeconomic disparities. Colombia, in Abstract: BACKGROUND: Despite the widespread
contrast, has a lower stunting prevalence and smaller household use of cleaning and personal hygiene
regional disparities. The socioeconomic gradient of products containing antibacterial ingredients, their
stunting is strong in all four countries, with prevalence effects on the incidence of infectious disease symptoms
rates in the poorest deciles at least three times as high have not been studied. OBJECTIVE: To evaluate the
as those in the top decile. DISCUSSION: The sharp effect of antibacterial cleaning and handwashing
contrast between the conditions found in Bolivia, products for consumers on the occurrence of infectious
Ecuador, and Peru and those in Colombia may be the disease symptoms in households. DESIGN:
result of specific ethnic factors affecting indigenous Randomized, double-blind clinical trial. SETTING:
groups; a particular diet profile in the highland areas, Northern Manhattan inner-city neighborhood, New
with low protein and micronutrient intake; and York. PARTICIPANTS: 238 primarily Hispanic
differences in the long-term economic and social households (1178 persons) that included at least one
development paths that the countries have taken. Along preschool-age child. Interventions: Households were
with the strong socioeconomic gradient in all the randomly assigned to use either antibacterial or
countries, the weight of ethnic and regional factors nonantibacterial products for general cleaning, laundry,
suggests the need to reduce inequality as well as to and handwashing. All products were commercially
comprehensively improve education and housing, available, but the packaging was blinded and the
better target health and nutrition programs, and products were provided free to participants.
implement participatory programs integrated into MEASUREMENTS: Hygiene practices and infectious
indigenous cultures. disease symptoms were monitored by weekly
telephone calls, monthly home visits, and quarterly
Larson EL, Lin SX, Gomez-Pichardo C. Predictors of interviews for 48 weeks. RESULTS: Symptoms were
infectious disease symptoms in inner city households. primarily respiratory: During 26.2% (717 of 2736) of
Nurs Res 2004; 53(3):190-7. household-months, 23.3% (640 of 2737) of household-
Abstract: BACKGROUND: Despite the fact that months, and 10.2% (278 of 2737) of household-
hygienic practices have been associated with reduced months, one or more members of the household had a
risk of infection for decades, the potential role of runny nose, cough, or sore throat, respectively. Fever
specific home hygiene and cleaning practices in was present during 11% (301 of 2737) of household-
reducing risk have not been explicated. OBJECTIVE: months, vomiting was present in 2.2% (61 of 2737),
This study aimed to determine the incidence and diarrhea was present in 2.5% (69 of 2737), and boils or
predictors of infectious disease symptoms over a 48- conjunctivitis were present in 0.77% (21 of 2737).
week period in inner city households. METHODS: Differences between intervention and control groups
Cleaning and hygiene practices and the incidence of were not significant for any symptoms (all unadjusted
infectious disease symptoms were closely monitored and adjusted relative risks included 1.0) or for numbers
prospectively for 48 months in 238 households. Each of symptoms (overall incidence density ratio, 0.96
household was contacted by trained interviewers [95% CI, 0.82 to 1.12]). CONCLUSIONS: The tested
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![antibacterial products did not reduce the risk for assigned by 3rd and 4th graders (n = 117) to
symptoms of viral infectious diseases in households expectations of potential perpetrators from their
that included essentially healthy persons. This does not potential victims. Each participant was requested to
preclude the potential contribution of these products to imagine potential incidents of school violence where
reducing symptoms of bacterial diseases in the home. four familiar classmates were presented as protagonists
(i.e., perpetrator and victim). An orderly manipulation
Larsson I, Svedin CG. Sexual behaviour in Swedish of the combination of the level (high or low) of
preschool children, as observed by their parents. Acta aggressiveness and susceptibility to victimization in
Paediatr 2001; 90(4):436-44. each protagonist was made. The participants were
Abstract: Issues of what constitutes normal and healthy informed whether or not the victim was about to
childhood sexual behaviour have acquired new deliver tangible rewards, display signs of suffering, or
implications in the light of child sexual abuse. retaliate (2*2*2 = 8 conditions). For each potential
Increased knowledge in this area is therefore of vital incident, the participant estimated the likelihood that an
importance and studies in different countries are attack will take place. The following order of
needed. In the present study parents of 231 children importance was found: Reward > Retaliation >
aged 3-6 y were asked to answer questionnaires about Suffering. Victim's aggressiveness was slightly
their child's behaviour at home. The questionnaire effective. From an applied perspective, most notable is
consisted of four sections: demographic data, a general the tendency to lower the likelihood of violence when
behaviour checklist, a sexual behaviour inventory, and the educator knows about the incidents.
attitudinal questions to the parents. The results showed
that children in Sweden exhibit a wide range of sexual Lassaletta A, Martino R, Gonzalez-Santiago P, Torrijos C,
behaviour, most of them developmentally related. Cebrero M, Garcia-Frias E. Reversal of an
Some behaviour appeared to be very rare in a antihistamine-induced coma with flumazenil. Pediatr
normative sample of preschool children and included Emerg Care 2004; 20(5):319-20.
behaviours usually referred to as sexualized and Abstract: Flumazenil is a competitive antagonist with
problematic. Reports on sexual behaviour in the specific action at the central benzodiazepine receptor.
children were also related to general behaviour reports, It is used when benzodiazepine intoxication is
the parent's socioeconomic level, parental attitudes suspected. Its use has also been reported in cannabis
towards child sexuality and the openness of family intoxication, chloral hydrate overdose, hepatic
habits. Conclusion: There is a need for further national encephalopathy, and alcohol intoxication. We report
studies in different settings, to help create a better the case of a 7-month-old male infant with a depressed
understanding of what constitutes both normative and level of consciousness after intentional intoxication of
deviant sexual behaviour in children. antihistamines, whose mental status fully recovered
after administration of flumazenil. To our knowledge,
Lasher LJ, Feldman MD. Celiac disease as a manifestation this is the first case in children where flumazenil has
of Munchausen by proxy. South Med J 2004; 97(1):67- been reported to reverse antihistamine-induced coma.
9.
Abstract: In typical cases of Munchausen by proxy Latalski M, Skorzynska H, Pacian A, Sokol M.
maltreatment, a mother feigns or produces illness in her Intensification of the phenomenon of violence in the
child. Her primary goal is to accrue emotional family environment of teenagers. Ann Univ Mariae
gratification, and no mental disorder better accounts for Curie Sklodowska [Med] 2004; 59(1):467-73.
the behavior. We present the first published case in Abstract: Childhood and adolescence are the periods of
which the principal manufactured ailment was celiac life when the experience of violence accumulates. As
sprue. In addition, a panoply of other ailments ranging socially weaker individuals, children and teenagers are
from seizures to behavioral abnormalities was reported. exposed to violence. The factors that increase the risk
The case is also very unusual in the involvement of the of child maltreatment include, above all, social and
paternal grandmother and, to a lesser extent, the cultural factors and the stress that family suffer from.
paternal grandfather as the perpetrators. Although The literature on this subject distinguishes four
definitive intervention to protect the child occurred categories of child maltreatment, namely: emotional,
only after 7 years had passed, multidisciplinary physical, negligence and sexual abuse. The survey
teamwork ultimately resulted in a successful outcome involved 250 representatives of high school teenagers
for the child, who is now doing well. aged 15-20, including 145 girls and 105 boys. The
research method was the survey estimating the Scale of
Laskov-Peled R, Wolf Y. School violence in the eyes of the Battered Child Syndrome (for teenagers and adults).
beholders: an integrative aggression-victimization The results show that a big group of teenagers admitted
perspective. Int J Offender Ther Comp Criminol 2002; to having experienced at least one of four kinds of
46(5):603-18. domestic violence. The group is not uniform, however,
Abstract: Five experiments explored, within the and the socio-cultural factors that affect the kind and
framework of functional measurement, the importance intensification of the phenomenon of violence have
been revealed. The most frequent reasons for using
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![violence are: low level of education, unemployment of event detection times. The accuracy rate and robustness
parents and material status connected with this fact, of the ANFIS with SCS with two EMG signals
low frequency of attendance to religious services, suggests its applicability to ES control.
alcohol abuse, and place of living. On account of the
intensification of the phenomenon of violence in the Lauritsen AK, Charles AV. [Forensic examination of
domestic environment and both direct and distant sexually abused children]. Ugeskr Laeger 2001;
consequences of the phenomenon in the form of mental 163(18):2485-8.
and physical disorders of individuals as well as the Abstract: INTRODUCTION: The Department of
dangers for the proper development of the society that Forensic Medicine, Aarhus, performs examinations of
result from it, there is a need to continue doing research children suspected to have been sexually abused when
on this phenomenon. reported to and requested by the police. A preliminary
study was taken to evaluate all cases in one year
Lau BW. Does the stress in childhood and adolescence including the legal outcome. MATERIAL AND
matter? A psychological perspective. J R Soc Health METHODS: The material included all cases in one
2002; 122(4):238-44. year, all examined on request by the police. All written
Abstract: Although stress in adults is well researched material including court decisions were reviewed.
and acknowledged, little has been discussed on the RESULTS: The material included 34 cases with three
existence and reactions of children and adolescents to boys, median-age 11 years, and 31 girls, median age
stress, despite the mounting evidence that they are six years, at the time of examination. The sexual abuse
frequently among the most affected victims of a variety events were fondling, vaginal (14), anal (7) and oral (5)
of threatening events. In reality stress is a normal part intercourse as well as showing pornography. The
of a child's or adolescent's life and encompasses medical examination was most often performed more
common, developmental stressors of daily life and than one week after the abuse. The examination
those arising from unusual or traumatic experiences. revealed normal findings in 20 cases, non specific
Apart from more well known stress from family findings including erythema of the vestibulum in 13
instability, poverty and life transitions, it is easy to cases and in only one child was a traumatic lesion with
forget or ignore the many school pressures and rupture of the hymen seen. The perpetrators were
increasingly common social phenomenon of the above 25 years of age and were family members or
'hurried child' in modern life. We can make plans of someone known to the child. Eight perpetrators were
intervention and prevention only when the condition is convicted in court, of whom three admitted having
recognised by the health care professionals. abused the child. DISCUSSION: The time interval
between the sexual abuse and the time of examination
Lauer RT, Smith BT, Betz RR. Application of a neuro-fuzzy is important to the ano-genital findings at the
network for gait event detection using examination. A medical examination in cases of sexual
electromyography in the child with cerebral palsy. child abuse seldom provides legal proof of sexual
IEEE Trans Biomed Eng 2005; 52(9):1532-40. abuse. The most important evidence is the story told by
Abstract: An adaptive neuro-fuzzy inference system the child. Therefore, the examination is a supplement
(ANFIS) with a supervisory control system (SCS) was which may support or remain neutral to the story told
used to predict the occurrence of gait events using the by the child.
electromyographic (EMG) activity of lower extremity
muscles in the child with cerebral palsy (CP). This is Lautze S, Leaning J, Raven-Roberts A, Kent R, Mazurana
anticipated to form the basis of a control algorithm for D. Assistance, protection, and governance networks in
the application of electrical stimulation (ES) to leg or complex emergencies. Lancet 2004; 364(9451):2134-
ankle muscles in an attempt to improve walking ability. 41.
Either surface or percutaneous intramuscular electrodes Abstract: This article presents an introduction to the
were used to record the muscle activity from the causes and characteristics of armed conflicts. It reviews
quadriceps muscles, with concurrent recording of the some of the key humanitarian crises that broke new
gait cycle performed using a VICON motion analysis ground in terms of the technologies and practices that
system for validation of the ANFIS with SCS. Using developed at the field level in response to each new
one EMG signal and its derivative from each leg as its complex emergency, with particular focus on the health
inputs, the ANFIS with SCS was able to predict all gait sector. It introduces the concept of humanitarian
events in seven out of the eight children, with an governance as a framework for addressing the
average absolute time differential between the VICON consequences and implications of the failure of
recording and the ANFIS prediction of less than 30 ms. worldwide governance for the protection of civilians in
Overall accuracy in predicting gait events ranged from armed conflict. Here, we term humanitarian
98.6% to 95.3% (root mean-squared error between 0.7 governance to include the use of international
and 1.5). Application of the ANFIS with the SCS to the humanitarian law and human rights instruments to
prediction of gait events using EMG data collected two govern the behaviour of state and non-state
months after the initial data demonstrated comparable organisations in conflict zones in a way that protects
results, with no significant differences between gait the lives and livelihoods of affected populations. We
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![distortions and omissions. METHOD: The Psychol 2005; 41(1):124-34.
completeness and the accuracy of the children's Abstract: Observational methods were used to examine
statements were examined by matching 64 children's aggressive children's peer relations in 2 contexts: when
statements given during police interviews with a being teased by a peer and when interacting with a best
detailed documentation of each phone call, made by the friend. Because aggressive children may have more
perpetrator during the actual phone calls. RESULTS: difficulty than nonaggressive children in both peer
All children remembered the phone call per se, but they contexts, the authors also examined whether relations
were found to omit almost all of the sexual and between behaviors across contexts varied as a function
sensitive information (perpetrator's questions and of aggression. Results indicated that aggression was
statements) and about 70% of the neutral information related to children's behavior when provoked.
given by the perpetrator. However, the children were Children's behavior when provoked was associated
accurate in the information they did report. with fewer positive and more negative interactions with
CONCLUSIONS: The fact that the children did their best friend, particularly for aggressive children.
remember more of the neutral information suggests that Results are discussed with respect to social norms in
they actually remembered the sexual information as middle childhood and informing interventions for
well, but that they chose not to report it. Results aggressive children.
indicate that children who have been sexually abused
may remember more than they report in an initial LeBlanc JC, Binder CE, Armenteros JL et al. Risperidone
interview. One possible underlying reason is that reduces aggression in boys with a disruptive behaviour
children experience shame or embarrassment. disorder and below average intelligence quotient:
analysis of two placebo-controlled randomized trials.
Lear JG. Schools and adolescent health: strengthening Int Clin Psychopharmacol 2005; 20(5):275-83.
services and improving outcomes. J Adolesc Health Abstract: The present study aimed to analyse the effect
2002; 31(6 Suppl):310-20. of risperidone on a priori defined core aggression
Abstract: School-based health services have made items. Data were pooled from 163 boys (aged 5-12
limited contributions to the well-being of school-age years, with or without comorbid attention-
children. However, they have the potential for deficit/hyperactivity disorder) with a DSM-IV
promoting health and improving service delivery for 50 diagnosis of either conduct disorder or oppositional
million children and adolescents enrolled in the nation's defiant disorder who had participated in either of two
schools. Recent changes in health care, particularly the identical, 6-week, randomized, double-blind, placebo-
spread of managed care and development of integrated controlled trials. All received treatment with either
health service networks, have reawakened mainstream placebo or oral risperidone solution (0.01-0.06
interest in school health and created the possibility for mg/kg/day). Subjects had below average intelligence
strengthening its efficiency and effectiveness.Two [intelligence quotient (IQ) 36-84] and a score of > or
promising strategies for enabling school health =24 on the Conduct Problem subscale of the Nisonger
programs to fulfill their potential are being Child Behaviour Rating Form (N-CBRF). An expert
implemented by the Massachusetts state government advisory panel selected six core aggression items from
and by an Austin, Texas, hospital system. These the N-CBRF, from which a total Aggression Score
strategies suggest measures to create either closely (AS, range 0-18) was constructed. Compared to those
linked school and community health systems or fully treated with placebo, risperidone-treated subjects
integrated school/community child health systems that experienced significantly greater mean decreases from
may have widespread benefit for children and their baseline in the AS at each of weeks 1-6 (P<0.001). By
families.Barriers to fully implementing these strategies study endpoint, aggression among risperidone-treated
and replicating them in other communities will include subjects had declined by 56.4% (mean baseline AS
the challenge of securing adequate funding, 10.1; mean endpoint AS 4.4), which was more than
disagreements regarding the appropriate content of a twice that of placebo-treated subjects (mean baseline
school health program, and opposition to new staffing AS 10.6; mean endpoint AS 8.3; 21.7% reduction).
and employment arrangements from professional and Risperidone was efficacious in reducing symptoms of
union organizations. Whether this moment of aggression in boys of below average IQ with disruptive
opportunity yields gains for child health and school behaviour disorders.
health will, for the most part, depend on forces outside
school health. Success will be particularly dependent Lee AC, Hau KL, Fong D. CT findings in hyperacute non-
on the degree to which the managed care plans or large accidental brain injury. Pediatr Radiol 2001; 31(9):673-
health care organizations see value in building more 4.
comprehensive child health systems or identify
financial benefits from linking more closely with Lee AC, Lam SY. Nonaccidental methadone poisoning. Clin
school-based services. Pediatr (Phila) 2002; 41(5):365-6.
Leary A, Katz LF. Observations of aggressive children Lee CM, Beauregard C, Bax KA. Child-related
during peer provocation and with a best friend. Dev
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![Clinicians must assist patients to make individual AQP-4 was localized to the plasma membranes of
decisions regarding disclosure. astrocytes including the perivascular end-feet. Gene
expression associated with increased AQP-4 was
Lee TC, Barshes NR, Washburn WK et al. Split-liver evaluated by high throughput gene expression analysis
transplantation using the left lateral segment: a using Affymetrix GeneChip U133A and related gene
collaborative sharing experience between two distant networks were investigated with Ingenuity Pathways
centers. Am J Transplant 2005; 5(7):1646-51. Analysis. AQP-4 expression was associated with a
Abstract: Split-liver transplantation (SLT) increases the decrease in expression of the dystrophin gene, a protein
pool of organs for pediatric orthotopic liver implicated in the anchoring of AQP-4 in perivascular
transplantation (pOLT). With increased collaboration endfeet. The decreased expression of dystrophin may
and organ sharing, transplant centers can fully indicate a loss of polarity in the distribution of AQP-4
maximize the use of all split donor allografts. Herein, in astrocytes. We conclude that the perturbed
we report the collaborative results between two distant expression of AQP-4 and dystrophin may be one factor
centers involved in a sharing alliance. The current underlying the loss of ion and water homeostasis in the
study consists of a retrospective review of 56 pediatric sclerotic hippocampus and hypothesize that the
LLS transplants performed at two collaborating centers reported changes may contribute to the epileptogenic
between 9/1997 and 10/2003. Fifty-three patients (41% properties of the sclerotic tissue.
Status 1) were transplanted using 56 left lateral
segment (LLS) grafts. Sixteen percent of LLS grafts Leeder JS. Developmental and pediatric pharmacogenomics.
were shared between the two institutions. Overall Pharmacogenomics 2003; 4(3):331-41.
patient survival at both 1 and 3 years was 90% and Abstract: Children, as well as adults, should benefit
90%, respectively. Overall graft survival at both 1 and from the discoveries of the genomic era. Many diseases
3 years was 82% and 82%, respectively. Shared patient with complex etiologies originate during childhood
and graft survival was 89% and 89%, respectively. (e.g., asthma, autism, attention deficit/hyperactivity
There was an 11% biliary complication and 18% disorder, epilepsy and juvenile rheumatoid arthritis)
vascular complication rate. Five patients required and persist into adulthood. Attempts to better
retransplantation. In conclusion, SLT increases the understand the genetic basis of age-specific disease
number of available allografts for pOLT. While SLT is processes requires an appreciation that the period of
technically demanding, with a significant learning human development encompasses the prenatal period
curve, patient and graft survival rates compare through adolescence, and is a rapidly changing,
favorably with United Network Organ Sharing dynamic process. As a result, pharmacologic
(UNOS) averages. Sharing of grafts between centers is modulation of developing gene networks may have
a safe and effective way to maximize organ usage and unintended and unanticipated consequences that do not
should be actively pursued through collaborative become apparent or relevant until later in life. Thus,
networks. there is considerable potential for large-scale
pharmacogenomic technologies to impact the
Lee TS, Eid T, Mane S et al. Aquaporin-4 is increased in the development and utilization of new therapeutic
sclerotic hippocampus in human temporal lobe strategies in children.
epilepsy. Acta Neuropathol (Berl) 2004; 108(6):493-
502. Leeder JS. Translating pharmacogenetics and
Abstract: The hippocampus of patients with mesial pharmacogenomics into drug development for clinical
temporal lobe epilepsy is often hardened and shrunken, pediatrics and beyond. Drug Discov Today 2004;
a condition known as sclerosis. Magnetic resonance 9(13):567-73.
imaging reveals an increase in the T2-weighted signal, Abstract: Pharmacogenetic and pharmacogenomic
while diffusion weighted imaging shows a higher investigations conducted in children must consider that
apparent diffusion coefficient in sclerotic hippocampi, human development from conception through to
indicating increased water content. As water transport adolescence is a rapidly changing, dynamic process.
appears to be coupled to K+ clearance and neuronal An improved understanding of the gene networks that
excitability [4], the molecular basis of the perturbed are involved in growth and development and of the
water homeostasis in the sclerotic hippocampus was unintended consequences of modulating those systems
explored. The expression of aquaporin-4 (AQP-4), the could provide insights into the susceptibility of an
predominant water channel in the brain, was studied individual to drug-induced birth defects and to
with quantitative real time PCR analysis, light pediatric adverse drug reactions. Furthermore, these
microscopic immunohistochemistry and high- technologies potentially present the opportunity to
resolution immunogold labeling. A significant increase develop novel, effective treatments for childhood
in AQP-4 was observed in sclerotic, but not in non- diseases and for adult diseases that manifest primarily
sclerotic, hippocampi obtained from patients with during childhood. The lack of pharmacogenetic and
medically intractable temporal lobe epilepsy. This pharmacogenomic investigations in children and the
increase was positively correlated with an increase in potential to impact on all age groups provides a
the astrocyte marker glial fibrillary acidic protein. considerable incentive to invest in this area of research.
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![Lindbloom EJ, Ewigman BG, Hickner JM. Practice-based pathways from income to young children's
research networks: the laboratories of primary care development. Dev Psychol 2002; 38(5):719-34.
research. Med Care 2004; 42(4 Suppl):III45-9. Abstract: A variety of family processes have been
Abstract: Medical research has traditionally been based hypothesized to mediate associations between income
in academic centers, and the findings are frequently not and young children's development. Maternal emotional
applicable in community primary care settings. The distress, parental authoritative and authoritarian
result is a large gap between the possible and the behavior (videotaped mother-child interactions), and
practical in delivering high-quality primary medical provision of cognitively stimulating activities (Home
care in the United States. Practice-based research Observation for Measurement of the Environment
networks (PBRNs), laboratories for primary care [HOME] scales) were examined as possible mediators
clinical research, are the appropriate vehicles for in a sample of 493 White and African American low-
uniting the worlds of community primary care practice birth-weight premature infants who were followed
and clinical research. Although they have received from birth through age 5. Cognitive ability was
little attention in the mainstream of clinical and health assessed by standardized test, and child behavior
services research, PBRNs have already reported a problems by maternal report, when the children were 3
variety of findings useful for primary care providers, and 5 years of age. As expected, family income was
and these networks have helped to identify key issues associated with child outcomes. The provision of
in healthcare delivery that affect important outcomes. stimulating experiences in the home mediated the
In this report, we outline the rationale for and history of relation between family income and both children's
PBRNs. We describe the organization and work of outcomes; maternal emotional distress and parenting
several productive PBRNs, giving examples of their practices mediated the relation between income and
studies that have changed the standards of modern children's behavior problems.
primary care practice. Finally, we describe a
developing electronic process for identifying research Lipley N. Rough justice? Emerg Nurse 2003; 11(2):5.
questions obtained directly from primary care
providers that can be used to focus the national primary Lipman EL. Don't let anyone bully you into thinking
care research agenda on questions of clinical relevance bullying is not important! Can J Psychiatry 2003;
and importance. As electronic technologies are fully 48(9):575.
developed and tested, they will facilitate
communication between clinicians and researchers, Listernick R. A 9-year-old boy with bizarre behavior and
thereby improving the effectiveness and efficiency of growth delay. Pediatr Ann 2003; 32(5):292-5.
practice-based research.
Litt IF. Separation of church and "state". J Adolesc Health
Linden DW, Doron MW. Eyes of Texas fasten on life, death 2002; 31(1):1.
and the premature infant. NY Times (Print) 2002; F5,
F8. Little L, Hamby SL. Memory of childhood sexual abuse
Notes: GENERAL NOTE: KIE: KIE Bib: allowing to among clinicians: characteristics, outcomes, and
die/infants current therapy attitudes. Sex Abuse 2001; 13(4):233-
48.
Linkins RW. Immunization registries: progress and Abstract: This paper reports preliminary data on a
challenges in reaching the 2010 national objective. J sample of therapists with memory of childhood sexual
Public Health Manag Pract 2001; 7(6):67-74. abuse. Therapists who reported experiencing childhood
Abstract: Immunization registries are confidential, sexual abuse (CSA, n = 131) were compared with
population-based, computerized information systems therapists who suspected sexual abuse but had no
that contain data about children's immunizations and memories (n = 24) on variables related to abuse
have been described as the cornerstone of characteristics, outcomes, and perceived difficulties
immunization delivery in the 21st century. Work to working with clients with a CSA history. Therapists
ensure the privacy of registry participants and the who suspected abuse, in contrast to those who made
confidentiality of their information, recruit provider definite reports, were more likely to report that the
participation, overcome technical and operational perpetrator was a family member, that their CSA did
challenges, and identify sustainable funding streams not involve physical contact, that there was alcoholism
has resulted in 24 percent of children less than 6 years in their families of origin, and that the CSA had
of age currently in an immunization registry in the negative effects on their relationships with their own
United States. New solutions will be needed before children, ability to trust others, sexual satisfaction, and
reaching the national health objective of increasing the work life. Therapists who suspected abuse also
proportion of children to 95 percent in a fully reported more difficulty treating CSA clients because
operational immunization registry by 2010. of interpersonal pulls during sessions, arousal without
memories of abuse, and some countertransferential
Linver MR, Brooks-Gunn J, Kohen DE. Family processes as behaviors. These findings indicate that issues related to
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![independent risk factor for major cardiovascular Abstract: BACKGROUND: Acute subdural hematoma
malformations with increased mortality of affected in infants is distinct from that occurring in older
infants. Teratology 2001; 64(2):98-106. children or adults because of differences in mechanism,
Abstract: BACKGROUND: Intensive medical care of injury thresholds, and the frequency with which the
women with diabetes has reduced their risks of bearing question of nonaccidental injury is encountered. The
infants with congenital anomalies. To assess the purpose of this study is to analyze the clinical
preventive potential of preconceptional care, the data characteristics of acute subdural hematoma in infancy,
of a population-based study of cardiovascular to discover the common patterns of this trauma, and to
malformations (CVM) were analyzed to determine the outline the management principles within this group.
morphogenetic specificity of maternal diabetes risks, METHODS: Medical records and films of 21 cases of
the morbidity and mortality of the infants, and maternal infantile acute subdural hematoma were reviewed
characteristics that might affect these risks. retrospectively. Diagnosis was made by computed
METHODS: The Baltimore-Washington Infant Study tomography or magnetic resonance imaging. Medical
was a case-control study (1981-1989) that included all records were reviewed for comparison of age, gender,
live born infants with confirmed CVM; control infants cause of injury, clinical presentation, surgical
were a representative sample of the birth cohort. A management, and outcome. RESULTS: Twenty-one
questionnaire administered in home visits recorded infants (9 girls and 12 boys) were identified with acute
parental information on social, medical, occupational, subdural hematoma, with ages ranging from 6 days to
and environmental factors. For these analyses of 12 months. The most common cause of injury was
preconceptional diabetes risks, the case group excluded shaken baby syndrome. The most common clinical
chromosomal and mendelian disorders and was divided presentations were seizure, retinal hemorrhage, and
into 3 developmental categories and 12 diagnostic consciousness disturbance. Eight patients with large
groups. RESULTS: Preconceptional maternal diabetes subdural hematomas underwent craniotomy and
was strongly associated with CVM of early embryonic evacuation of the blood clot. None of these patients
origin (odds ratio [OR] = 4.7, 95% confidence interval developed chronic subdural hematoma. Thirteen
[CI] 2.8-7.9) and with cardiomyopathy (OR = 15.1, patients with smaller subdural hematomas were treated
95% CI 5.5-41.3), but not with obstructive and conservatively. Among these patients, 11 developed
shunting defects (OR = 1.4, 95% CI 0.7-3.0). There chronic subdural hematomas 15 to 80 days (mean = 28
was heterogeneity within these developmental days) after the acute subdural hematomas. All patients
categories: among laterality defects, diabetes was with chronic subdural hematomas underwent burr hole
associated only with cardiovisceral and atrioventricular and external drainage of the subdural hematoma. At
discordance (OR = 10.0, 95% CI 3.7-27.0); among follow-up, 13 (62%) had good recovery, 4 (19%) had
outflow tract anomalies, the risk was strongly moderate disability, 3 (14%) had severe disability, and
associated with normally related great arteries (OR = 1 (5%) died. Based on GCS on admission, one (5%)
6.6, 95% CI 3.2-13.3) but not with simple had mild (GCS 13-15), 12 (57%) had moderate (GCS
transpositions; and among atrioventricular septal 9-12), and 8 (38%) had severe (GCS 8 or under) head
defects, diabetes was associated with the complete but injury. Good recovery was found in 100% (1/1), 75%
not with the partial forms (OR = 22.8, 95% CI 7.4- (8/12), and 50% (4/8) of the patients with mild,
70.5). The association in early CVM was strongest moderate, and severe head injury, respectively. Sixty-
among infants with multisystem, predominantly three percent (5/8) of those patients undergoing
VACTERL, anomalies. All-cause mortality of infants operation for acute subdural hematomas and 62%
with CVM was 39% among those with diabetic (8/13) of those patients treated conservatively had good
mothers and 17.8% in those with nondiabetic mothers. outcomes. CONCLUSIONS: Infantile acute subdural
Deceased infants of diabetic mothers were also more hematoma if treated conservatively or neglected, is an
likely to have extracardiac anomalies (P = 0.041), to be important cause of infantile chronic subdural
born prematurely (P = 0.007), and to have low birth hematoma. Early recognition and suitable treatment
weight (P = 0.011). Multivariate analyses of maternal may improve the outcome of this injury. If treatment is
factors revealed no significant confounders of the delayed or the condition is undiagnosed, acute subdural
diabetes associations. CONCLUSIONS: The evidence hematoma may cause severe morbidity or even fatality.
of diabetes-induced major cardiac defects is of urgent
clinical significance. The effectiveness of early Loimer L, Bichler A, Brezinka C et al. [Guideline of the
preconceptional care in the prevention of congenital Austrian Society of Gynecology and Obstetrics on
anomalies has been demonstrated repeatedly. suspected sexual offenses. November 2001 status].
Wien Klin Wochenschr 2002; 114(5-6):233-5.
Loftus E. Dispatch from the (un)civil memory wars. Lancet
2004; 364 Suppl 1:s20-1. Lonczak HS, Abbott RD, Hawkins JD, Kosterman R,
Catalano RF. Effects of the Seattle social development
Loh JK, Lin CL, Kwan AL, Howng SL. Acute subdural project on sexual behavior, pregnancy, birth, and
hematoma in infancy. Surg Neurol 2002; 58(3-4):218- sexually transmitted disease outcomes by age 21 years.
24. Arch Pediatr Adolesc Med 2002; 156(5):438-47.
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![Abstract: OBJECTIVE: To examine the long-term achieved a good fit with the data (Comparative Fit
effects of the full Seattle Social Development Project Index [CFI] = 0.93). A second-order structural model
intervention on sexual behavior and associated fit the data well (CFI = 0.91) and also explained 45%
outcomes assessed at age 21 years. DESIGN: of the variance in alcohol misuse at age 16. The SDM
Nonrandomized controlled trial with long-term follow- partially and significantly mediated the direct effect of
up. SETTING: Public elementary schools serving age-14 alcohol use on age-16 alcohol misuse.
children from high-crime areas in Seattle, Wash. CONCLUSIONS: The risk and protective processes
PARTICIPANTS: Ninety-three percent of the fifth- specified by the SDM serve as potential targets for the
grade students enrolled in either the full-intervention or prevention or reduction of adolescent alcohol misuse.
control group were successfully interviewed at age 21
years (n = 144 [full intervention] and n = 205 Longjohn MM, Christoffel KK. Are medical societies
[control]). INTERVENTIONS: In-service teacher developing a standard for gun injury prevention? Inj
training, parenting classes, and social competence Prev 2004; 10(3):169-73.
training for children. MAIN OUTCOME MEASURES: Abstract: CONTEXT: Following heightened gun
Self-report measures of all outcomes. RESULTS: The violence in the 1990s, many medical societies in the
full-intervention group reported significantly fewer United States adopted policies on the topic.
sexual partners and experienced a marginally reduced OBJECTIVE: Identify points of firearm violence
risk for initiating intercourse by age 21 years as policy agreement among large medical organizations.
compared with the control group. Among females, DESIGN: Fourteen national medical societies-clinical
treatment group status was associated with a focus, demonstrated interest in gun injury prevention,
significantly reduced likelihood of both becoming >2000 members-were selected for policy review in
pregnant and experiencing a birth by age 21 years. 2002. Policies were categorized on areas covered and
Among single individuals, a significantly increased items within these. Consensus areas were addressed by
probability of condom use during last intercourse was >/=7/14 societies.Consensus items were included by
predicted by full-intervention group membership; a >/=7/14 societies, shared items by 5-6. RESULTS:
significant ethnic group x intervention group There were five consensus areas: access prevention,
interaction indicated that after controlling for gun commerce, research, public education, and clinical
socioeconomic status, single African Americans were counseling. There were four consensus items:
especially responsive to the intervention in terms of restricting gun access by enforcing existing laws,
this outcome. Finally, a significant treatment x ethnic restricting access to all guns at the point of sale,
group interaction indicated that among African restricting access to handguns at the point of sale, and
Americans, being in the full-intervention group creating a national database on gun injury and death.
predicted a reduced probability of contracting a Shared items promote violence prevention, clinical
sexually transmitted disease by age 21 years. education on risks of guns in the home, treating guns as
CONCLUSION: A theory-based social development consumer products, restricting gun access to children,
program that promotes academic success, social bans on automatic weapons, and promoting trigger
competence, and bonding to school during the locks. CONCLUSIONS: Large medical societies in the
elementary grades can prevent risky sexual practices United States agree on key approaches for reducing
and adverse health consequences in early adulthood. gun injury mortality and morbidity. Future research
will be needed to track the evolution of this emerging
Lonczak HS, Huang B, Catalano RF et al. The social standard for physician action, which now includes the
predictors of adolescent alcohol misuse: a test of the consensus areas and items. It promises to be, in effect,
social development model. J Stud Alcohol 2001; a medical standard of care for gun injury prevention.
62(2):179-89. The United States experience may be useful to others
Abstract: OBJECTIVE: This study was conducted to working on gun injury prevention.
investigate the ability of the social development model
(SDM) to predict alcohol misuse at age 16 and to Longo RE. Emerging issues, policy changes, and the future
investigate the ability of the SDM to mediate the of treating children with sexual behavior problems.
effects of alcohol use at age 14 on alcohol misuse at Ann N Y Acad Sci 2003; 989:502-14.
age 16. METHOD: The sample of 807 (411 males) is Abstract: Children and adolescents with sexual
from the longitudinal panel of the Seattle Social behavior problems are a growing national concern.
Development Project which, in 1985, surveyed all While the field continues to make advances, we have
consenting fifth-grade students from 18 elementary much more work to do. We are working in a difficult
schools serving high-crime neighborhoods in Seattle, and trying period for juvenile justice. It is a time when
Washington. Alcohol use was measured at age 14, many are willing to give up on adolescents or punish
predictors of alcohol misuse were measured at age 15 them as we do adults. We have reached a point where
and alcohol misuse was measured at age 16. Structural many in our society do not know about, or care to
equation modeling was used to examine the fit of the understand, the complex issues that are the roots of
model to the data. RESULTS: All factor loadings were violence and sexual violence in youth. Certainly their
highly significant and the measurement model faith in the resiliency of youth has been tarnished. Nine
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![critical areas that need to be taken into account when years, SE 2.21, without differences between sexes (p =
working with youth with sexual behavior problems are 0.25); 6) Potential causes were divides into tree
addressed. These areas include the unfortunate but categories: I "the patient doesn't remember associated
continued trickle-down and use of adult-based facts" (30.1%, II: psychological or physical stress
treatment models to treat youth with sexual behavior (39.8%), III: facts related to sexual trauma (30.1%).
problems, changes in juvenile law that have an impact The differences (p = 0.0001); 7) Analyzed in general
on our ability to treat these youths effectively, the need by sec, the most common cause was psychological-
for continued research in developing typologies for physical stress rather than sexual trauma in men, while
youths with sexual behavior problems and valid and among women sexual trauma was most common than
reliable risk assessment scales, continued work with psychological-physical stress (p = 0.03); 8) Analyzed
understanding and developing dynamic risk factors for by age groups: in the under 5 years-old group: main
sexually abusive youth, the need to develop better cause was "I don't remember". In 5.1-25-years-old
treatments for special populations of youth with sexual group: sexual trauma; and psychological-physical
behavior problems, the need for a continuum of care, stress was the main cause in > 25 years-old group (p
what constitutes best practice in treating youths with 0.0001). CONCLUSIONS: 1) Women suffer from or
sexual behavior problems, the need for developing and consult much more frequently than man; 2) Once the
refining standards of care, and the need for continued disease is present, there would not be differences in
public education that supports prevention efforts to age, age of onset, or time or evolution into proportions
reduce sexual abuse by youth. by sex; 3) The continue forms were the predominant
ones; 4) The probable associated causes vary for each
Lopez Gaston AR, Andrusch A, Catuogno P, Lopez De age group; 5) The sub-group "I don't remember" could
Luise G, Vazquez P. [History of patients with pelvic represent in many cases a mismatch learning, but not
floor dysfunction]. Acta Gastroenterol Latinoam 2003; constantly (there are cases of stress in familiar
33(2):79-92. context); 6) In the subgroup "late childhood-
Abstract: OBJECTIVES: 1) To determine differences adolescence" the predominant causes were traumatic
between sexes; 2) To determine differences by sex and experiences in erotic zones (rapping intent, sexual
age groups in symptom onset, time of evolution, abuse, fantasies, elimination of parasites by the anus);
clinical forms and probable associated causes. 7) in the subgroup "older than 25 years-old" the
POPULATION AND SAMPLE: 83 consecutive predominant causes were physical stress, (violence,
patients with diagnosed PCP (X age = 50.9 SE 2.21). accidents, surgery) or emotional stress (familiar
25 males (30.1% x 51.2 years-old, SE 4.1) and 58 environment, social environment, affective losses).
females (69.9%, X 50.8 years-old, SE 2.2). Patients Some paradigmatic cases are presented. Anismus
with organic colon-rectum pathology (with the would be a complex situation involving an striated,
exception of hemorrhoidal pathology, proctologic voluntary, automatizated muscle (puborectalis)
surgery and active anus fissure) had been excluded. controlling independently genital-sexual, urinary and
METHODS: Colonic Double-contrasted Rx, rectum- ano-rectal functions.
sigma endoscopy, and eventually a Colonofibroscopy
Historic facts and syndromic protocol. Diagnosis Lopez-Herrera G, Garibay-Escobar A, Alvarez-Zavala BJ et
criteria: 1) Perineal inspection: perineal contraction al. Severe combined immunodeficiency syndrome
with pujo; 2) Rectal tact; 3) Ano-Rectum manometry associated with colonic stenosis. Arch Med Res 2004;
with perfused system; 4) 150 ml Rectal balloon 35(4):348-58.
expulsion dynamic; 5) Utoreported signs and Abstract: BACKGROUND: This is the first report in
symptoms from a cuestionnaire ad hoc. Division into Mexico of a case of severe combined
evolutive groups (continuous and intermittent). immunodeficiency syndrome (SCID) associated with
Division by age (< = 5, 5.1-25, > 25 years old). colonic stenosis. The patient was an 8-month-old
Experiment design: descriptive, comparative, Mexican female who died at this age. She suffered
correlation, prospective, simple blind. STATISTICS: infections due to microorganisms such as
Levene, descriptive, chi square, ANOVA, Kruskall- Mycobacterium tuberculosis, bacille Calmette-Guerin
Wallis, Kendal tau b. RESULTS: 1) Difference in sex (BCG), Candida sp., and Pneumocystis carinii; and had
proportion was significative (p = 0.0001); 2) There frequent diarrhea. She was HIV-negative without
were not differences between sexes in age media at the familial history of immunodeficiency. The aim of the
moment of the study (p = 0.92; 3) The continue work was to analyze the immunologic status of this
evolutive form represented 77.1%, (p = 0.0001) but patient. METHODS: Peripheral blood from the patient
there weren't differences between sexes (p = 0.19) and from a healthy matched control were analyzed by
There weren't evolutive differences between age flow cytometry to determine peripheral leukocytes and
groups. (p = 0-78) 4) Age of onsec: x = 24.04 years- production of cytokines and their receptors in T-
old, SE 2.02 (4-80 years-old), without differences lymphocytes and monocytes. Immunohistochemical
between sexes (p = 0.16). 14.5% started before age of analysis was performed in spleen and lymph node
5, 85% after that age, without differences between sections from the patient and control samples to assess
sexes (p = 0.07); 5) The time of evolution x = 26.7 alterations in architectural and cellular distribution
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![children's behavior. Negative appraisal bias with explaining how GISs are applied, we stressed their
respect to mothers' own (but not unfamiliar) children ability to integrate data, which makes it possible to
was related to mothers' overreactivity, independent of perform epidemiologic evaluations in a simpler, faster,
child misbehavior. Overreactivity was not related to automated way that simultaneously analyzes multiple
mothers' preferential negative encoding either of their variables with different levels of aggregation. In this
own or of unfamiliar children's behavior. However, in study, GISs were applied in analyzing infant mortality
the case of mothers' own children, preferential negative data with three levels of aggregation in countries of the
encoding moderated the relation between negative Americas from 1995 to 2000. RESULTS: Infant
appraisal bias and overreactive discipline, such that the mortality in the Region of the Americas was estimated
negative appraisal bias-overreactivity relation was at an overall average of 24.4 deaths per 1,000 live
significant only in the context of high preferential births. However, the inequalities that were found
negative encoding. indicate that the probability of an infant death is almost
20 times greater in the less developed countries of the
Lorenz JM. Prenatal counseling and resuscitation decisions Region than in more developed ones. Mapping infant
at extremely premature gestation. J Pediatr 2005; mortality throughout the Region of the Americas
147(5):567-8. allowed us to identify the countries that need to focus
more attention on health policy and health programs,
Lorenz JM. The roles of the community and physician in but not to determine what specific actions are of the
treatment decisions for extremely premature infants. highest priority. An analysis of smaller geopolitical
Paediatr Perinat Epidemiol 2002; 16(1):5-7. units (states and municipalities) revealed important
differences within countries. This shows that, as is true
Loughrey J. Medical information, confidentiality and a of data for the entire Region of the Americas, using
child's right to privacy. Leg Stud (Soc Leg Scholars) national-level average figures for indicators can
2003; 23(3):510-35. obscure the differences that exist within countries.
Notes: GENERAL NOTE: KIE: 154 fn. When we examined the relationship between female
GENERAL NOTE: KIE: KIE Bib: confidentiality/legal illiteracy and malnutrition as determinants of infant
aspects; patient care/minors mortality in Brazil and Ecuador, we identified social
Abstract: Following the Gillick case in 1986, it was and epidemiologic strata where risk factors had
recognised that mature minors were owed a duty of different distribution patterns and that thus require
confidentiality in respect of their medical information. health interventions that match their individual social
Subsequent cases confirmed that the duty was also and epidemiologic profiles. CONCLUSIONS: With
owed to non-competent children, including infants, but this type of epidemiologic study using GISs at the local
without explaining the basis for finding the existence level of health services, it is easy to see how a health
of such a duty and its scope. It is particularly unclear event and its risk factors behave at a specific period in
when and upon what legal basis a doctor could disclose time. It is also possible to identify patterns in the
information to parents when their child wished to keep spatial distribution of risk factors and in these factors'
it confidential. This paper will examine the law of potential impact on health. Using GISs in an
confidentiality as it applies to children, identifying appropriate way will make it easier to deliver more
issues which are problematic. Developments in the law effective, equitable public health services.
of personal confidences which have taken place as a
result of the Human Rights Act 1998, and the Lu D, Medeiros LJ, Eskenazi AE, Abruzzo LV. Primary
recognition of Article 8 rights as part of the law, will follicular large cell lymphoma of the testis in a child.
be reviewed and analysed from the perspective of the Arch Pathol Lab Med 2001; 125(4):551-4.
duty of confidence owed to children in respect of their Abstract: Primary follicular lymphoma of the testis in
medical information. Finally, the paper will offer an childhood is extremely rare. To our knowledge, only 5
explanation of a basis for disclosure to parents which cases have been reported to date. We report a case in a
minimises violations of a minor's autonomy. 6-year-old boy who presented with painless right
scrotal enlargement. Right radical orchiectomy
Loyola E, Castillo-Salgado C, Najera-Aguilar P, Vidaurre revealed a follicular large cell lymphoma with diffuse
M, Mujica OJ, Martinez-Piedra R. [Geographic areas confined to the testis and epididymis, clinical
information systems as a tool for monitoring health stage IE. Immunohistochemical stains demonstrated
inequalities]. Rev Panam Salud Publica 2002; that the neoplastic cells were of B-cell lineage, positive
12(6):415-28. for CD10, CD20, CD79a, and BCL-6. Staining for
Abstract: OBJECTIVE: To show how geographic CD21 accentuated networks of dendritic reticulum
information systems (GISs) can be used as cells within the nodules. The cells were negative for
technological tools to support health policy and public BCL-2, p53, and T-cell antigens. There was no
health actions. METHODS: We assessed the evidence of the t(14;18) detected by polymerase chain
relationship between infant mortality and a number of reaction. The data suggest that follicular lymphoma of
socio-economic and geographic determinants. In the testis in children has a different pathogenesis than
follicular lymphoma in adults.
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![Lubsen-Brandsma MA. [Adhesions of the labia minora in with lesion or neuroimaging data allowing descriptions
three young girls]. Ned Tijdschr Geneeskd 2003; of brain-behavior relations to be made with increasing
147(2):53-6. confidence. One such battery is the Cambridge
Abstract: Three girls, 2, 5 and 6 years of age, had labial Neuropsychological Testing Automated Battery
adhesions: one without complaints but whose mother (CANTAB), and current studies in which the
was anxious about abnormal anatomy of the external CANTAB has been used to measure executive
genitalia, one with urinary problems because of functions in children are reviewed. CONCLUSIONS:
pooling of the urine in the almost completely covered Computerized batteries of this type can record aspects
vagina, relapsing after surgical intervention, and one of performance that are difficult for psychometrists to
with irregular adhesions because of sexual abuse. In all achieve, and these may reflect activity in developing
three, after (repeated) application of oestrogen cream neural networks with more sensitivity than can be
the adhesions reduced or disappeared. Adhesions of the achieved with traditional tests. However, before
labia minora can often be noticed under the age of 8 computerized test administration becomes a routine
years and dissolve after that age during the period of part of pediatric neuropsychological assessment,
progressive natural oestrogen production. Therapy several obstacles must be overcome. Despite these
consists of application of oestrogen cream on the limitations, it is concluded that computerized
contact surface of the labia minora. Surgical treatment assessment can improve the field by facilitating the
is disputable and causes a high recurrence, probably collection of normative and clinical data.
higher than conservative treatment.
Luecken LJ, Lemery KS. Early caregiving and physiological
Lucassen A, Parker M. Revealing false paternity: some stress responses. Clin Psychol Rev 2004; 24(2):171-91.
ethical considerations. Lancet 2001; 357(9261):1033-5. Abstract: Inadequate early caregiving has been
Notes: GENERAL NOTE: KIE: Lucassen, Anneke; associated with risks of stress-related psychological
Parker, Michael and physical illness over the life span. Dysregulated
GENERAL NOTE: KIE: 20 refs. physiological stress responses may represent a
GENERAL NOTE: KIE: KIE Bib: confidentiality; mechanism linking early caregiving to health
genetic counseling; truth disclosure outcomes. This paper reviews evidence linking early
caregiving to physiological responses that can increase
Luce R. The Children Act: key points and implications for vulnerability to stress-related illness. A number of
nursing. Nurs Times 2005; 101(17):26-7. high-risk family characteristics, including high conflict,
Abstract: This article sets out the key points of the divorce, abuse, and parental psychopathology, are
Children Act 2004 and considers the implications for considered in the development of stress vulnerability.
practice, with particular regard to the patient Three theoretical pathways linking caregiving to
assessment process and the links between adult physiological stress responses are outlined: genetic,
behaviour and child protection. psychosocial, and cognitive-affective. Exciting
preliminary evidence suggests that early caregiving can
Lucey J. Abuse of people trying to protect children from impact long-term physiological stress responses.
abuse. Lancet 2001; 358(9292):1556. Directions for future research in this area are
suggested.
Luciana M. Practitioner review: computerized assessment of
neuropsychological function in children: clinical and Lueder GT. Retinal hemorrhages in accidental and
research applications of the Cambridge nonaccidental injury. Pediatrics 2005; 115(1):192;
Neuropsychological Testing Automated Battery author reply 192.
(CANTAB). J Child Psychol Psychiatry 2003;
44(5):649-63. Lugina HI, Johansson E, Lindmark G, Christensson K.
Abstract: BACKGROUND: Computers have been used Developing a theoretical framework on postpartum
for a number of years in neuropsychological care from Tanzanian midwives' views on their role.
assessment to facilitate the scoring, interpretation, and Midwifery 2002; 18(1):12-20.
administration of a variety of commonly used tests. Abstract: OBJECTIVES: to describe a theoretical
There has been recent interest in applying framework developed from the views of midwives in
computerized technology to pediatric relation to provision of systematic postpartum care.
neuropsychological assessment, which poses unique DESIGN: qualitative focus group study using grounded
demands based on the need to interpret performance theory approach. SETTING: Dar es Salaam, Tanzania.
relative to the child's developmental level. FINDINGS: PARTICIPANTS: 49 nurse-midwives in five focus
However, pediatric neuropsychologists have tended to group discussions each having 9-11 participants.
implement computers in the scoring, but not FINDINGS: the components of the Basic Social
administration, of tests. This trend is changing based Process of 'Becoming a good resource and support
on the work of experimental neuropsychologists who person for the postpartum woman' consisted of
frequently combine data obtained from test batteries 'reflection' as an entry point into the process.
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![regression). FINDINGS: Having parents willing to transport and transport issues pertaining to networking
supply alcohol increased frequency (P < 0.05) of beer, of neonatal medical care are highlighted and illustrated
wine and spirits consumption, intensity (P < 0.05) of with reference to local experience in British Columbia.
wine, spirits and illicit alcohol consumption, and
increased probabilities (P < 0.10) of binge drinking and Lupton D, Fenwick J. 'They've forgotten that I'm the mum':
participation in drinking (P < 0.05). No effects were constructing and practising motherhood in special care
seen from living in a single-parent household. Having nurseries. Soc Sci Med 2001; 53(8):1011-21.
received education about alcohol, narcotics and Abstract: Little sociological research has sought to
tobacco had a negative association only with intensity investigate the ways in which women with hospitalized
(P < 0.10) of beer consumption. Having a father who newborn infants construct and practice motherhood.
was currently unemployed was associated with an This article seeks to address this lacuna, using data
increased (P < 0.05) probability of binge drinking but a from a qualitative research project based in two
reduced (P < 0.05) frequency of wine consumption. Australian neonatal nurseries. Thirty-one mothers of
CONCLUSIONS: The positive effect of having parents hospitalized newborns and 20 neonatal nurses were
willing to supply alcohol could reflect that these interviewed, and other data were obtained via
individuals face lower acquisition costs or lower observations of the nurseries, tape-recorded verbal
psychological costs in consumption. It could also interactions between parents and nursery staff and
reflect a price effect, if the individual receives the casual conversations with mothers and nurses. The data
alcohol free from his or her parents. revealed that while the mothers' and nurses' discourses
on what makes a 'good mother' in the context of the
Lung FW, Lin TJ, Lu YC, Shu BC. Personal characteristics neonatal nursery converged to some extent, there were
of adolescent prostitutes and rearing attitudes of their important differences. The mothers particularly
parents: a structural equation model. Psychiatry Res emphasized the importance of physical contact with
2004; 125(3):285-91. their infants and breastfeeding, while the nurses
Abstract: The aim of this study was to investigate the privileged presence in the nursery and willingness to
risk factors of family structure, personality traits, and learn about the infant's condition and treatment. There
other variables among adolescent prostitutes. The was evidence of power struggles between the mothers
subjects comprised 158 adolescent prostitutes in a and nurses over the handling and treatment of the
halfway house as the case group and 65 high school infants, which had implications for how the mothers
girls as the control group. Data were collected by using constructed and practised motherhood. The mothers
questionnaires about demographic information, the attempted to construct themselves as 'real mothers',
Junior Eysenck Personality Questionnaire and the which involved establishing connection with their
Parental Bonding Instrument. A high rate of tobacco, infants and normalizing them. In time, many of the
alcohol and drug use was found in the case group. mothers sought to position themselves as the 'experts'
Numerous factors distinguished the cause-effect on their infants. For their part, the nurses attempted to
relationship among adolescent prostitutes. Of all risk position themselves as 'teachers and monitors of the
factors studied, maternal protection, paternal care, parents', 'protectors of the infants' and 'experts' by
neurotic characteristics, tobacco use, discontinuous virtue of their medical training and experience.
schooling and a dysfunctional family had the most Differences in defining the situation resulted in
direct effect. These results provide useful information frustration, resentment and anger on the part of the
for the evaluation of and interventions with adolescent mothers and disciplinary and surveillance actions on
prostitution. the part of many of the nurses, both covert and overt.
The nurses' attitude to and treatment of the mothers
Luoma R, Raboei E, Fadallah S, al-Sherif N. [On was integral in the development of the mothers'
investigating sexual abuse of a child]. Duodecim 2001; relationship with their infants in the nurseries, and this
117(9):1004; author reply 1005. influence extended beyond discharge of the infants.
Lupton BA, Pendray MR. Regionalized neonatal emergency Lush L, Walt G, Ogden J. Transferring policies for treating
transport. Semin Neonatol 2004; 9(2):125-33. sexually transmitted infections: what's wrong with
Abstract: This article reviews the components that global guidelines? Health Policy Plan 2003; 18(1):18-
facilitate an effective neonatal emergency transport 30.
network, and discusses the human resources required Abstract: The paper uses a case study of the
for safe transport, including a section focused on the development of syndromic management for treating
option of an expanded role for the paramedic. In sexually transmitted infections (STIs) and subsequent
addition, the topics of transport equipment, policies recommending worldwide use of syndromic
communications, quality assurance, data management, management guidelines. These treatment policies
family support and education are addressed in the emerged in the late 1970s from researchers and public
context of a neonatal transport programme. Finally, health physicians working in sub-Saharan Africa where
elements involved in the organization of neonatal they had to treat large numbers of STIs in difficult
circumstances. Syndromic management was initially
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![newborns. After the mandate, newborns were less vaginal birth or 2-3 days after cesarean birth) decreased
likely to be examined as recommended on day 3 or 4. from 52% to 16% for vaginally born infants and from
Because of changes in hospital prices, the two policies 87% to 63% for cesarean-born infants (P =.001).
had minimal effects on HMO expenditures for hospital Although the legislation mandated coverage for home
and home-based services. visits after short stays, only 12.4% of short-stay
newborns had early home visits. Overall, 50% of
Madhavan S. Fosterage patterns in the age of AIDS: infants had early home or clinic follow-up; compared
continuity and change. Soc Sci Med 2004; 58(7):1443- with those who did not receive early follow-up, these
54. infants were more likely to have complete
Abstract: An estimated 4 million children, or about immunizations (adjusted odds ratio [OR], 1.09; 95%
10% of the entire South African population, will be confidence interval [CI], 1.03-1.14), urgent care or
orphaned by the year 2015. There is growing consensus emergency department visits (adjusted OR, 1.22; 95%
that the extended family system is no longer capable of CI, 1.07-1.39), and readmissions (adjusted OR, 2.49;
providing for orphans given severe economic 95% CI, 2.02-3.08). CONCLUSIONS: Although
constraints. There is, therefore, an urgency to develop implementation of Minnesota's early discharge
appropriate interventions to support families and take legislation corresponded with significantly increased
care of these children. This article examines some of lengths of stay, very few short-stay infants received the
the existing literature on child fosterage and uses it to postdischarge care for which coverage was mandated.
highlight understudied aspects of the current situation Our findings indicate, however, that infants at higher
of children orphaned through AIDS in South Africa. Of risk for adverse outcomes were appropriately identified
particular concern are the points of continuity and to receive early follow-up.
change in fosterage patterns before and after the onset
of the epidemic in South Africa. I suggest that an Maffei FA, Powers KS, van der Jagt EW. Apparent life-
understanding of the short- and long-term threatening events as an indicator of occult abuse. Arch
consequences for children orphaned by AIDS in South Pediatr Adolesc Med 2004; 158(4):402; author reply
Africa calls for historical contextualisation given that 402-3.
child fostering, both voluntarily and involuntarily, has
been a feature of black family life since well before the Magee BD. Uterine rupture among women with a prior
onset of HIV/AIDS. In addition, I demonstrate the cesarean delivery. N Engl J Med 2002; 346(2):134-7.
value of examining kinship, family, and networks in
order to fully understand the circumstances of fostering Mahalingam S, Meanger J, Foster PS, Lidbury BA. The viral
these children. The paper concludes with a call for manipulation of the host cellular and immune
more research on children orphaned by AIDS in South environments to enhance propagation and survival: a
Africa that will provide not only more data, but also focus on RNA viruses. J Leukoc Biol 2002; 72(3):429-
enrich theoretical approaches to studying patterns of 39.
child fosterage in Africa and elsewhere. Abstract: Virus infection presents a significant
challenge to host survival. The capacity of the virus to
Madhiwalla N. Women's illnesses: life cycle approach. Natl replicate and persist in the host is dependent on the
Med J India 2003; 16 Suppl 2:35-8. status of the host antiviral defense mechanisms. The
study of antiviral immunity has revealed effective
Madlon-Kay DJ, DeFor TA, Egerter S. Newborn length of antiviral host immune responses and enhanced our
stay, health care utilization, and the effect of Minnesota knowledge of the diversity of viral immunomodulatory
legislation. Arch Pediatr Adolesc Med 2003; strategies that undermine these defences. This review
157(6):579-83. describes the diverse approaches that are used by RNA
Abstract: OBJECTIVE: To describe newborn length of viruses to trick or evade immune detection and
stay, postdischarge follow-up, and health care response systems. Some of these approaches include
utilization in the context of Minnesota's early discharge the specific targeting of the major histocompatibility
legislation. DESIGN AND SETTING: Retrospective complex-restricted antigen presentation pathways,
study using claims data from a large managed care apoptosis, disruption of cytokine function and
organization. PARTICIPANTS: Term newborns born signaling, exploitation of the chemokine system, and
from January 1995 through February 1999 (N = 22 interference with humoral immune responses. A
944). OUTCOME MEASURES: Newborn length of detailed insight into interactions of viruses with the
stay, home or clinic visits within 1 week of discharge immune system may provide direction in the
(early follow-up), immunizations completed by age 3 development of new vaccine strategies and novel
months, readmissions within 1 month of discharge, and antiviral compounds.
urgent care or emergency department visits within 2
months of discharge. RESULTS: After enactment of Maher J, Macfarlane A. Inequalities in infant mortality:
Minnesota's early discharge legislation in 1996, the trends by social class, registration status, mother's age
percentage of newborns with short stays (0-1 days after and birthweight, England and Wales, 1976-2000.
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![Health Stat Q 2004; (24):14-22. decrease the risk of divorce and facilitate marital
Abstract: This article examines trends in inequalities in functioning, but the effects were small. Greater
infant mortality in England and Wales between 1976 Christian conservatism was modestly associated with
and 2000. It describes variations in neonatal, greater endorsement and use of corporal punishment
postneonatal and infant mortality by mother's age, with preadolescents. Isolated findings suggested that
registration status, father's social class, multiplicity and greater parental religiousness relates to more positive
birthweight. Throughout the period, social class parenting and better child adjustment. The scope,
differences in mortality were wider in the postneonatal meaningfulness, and potential strength of findings were
period than the neonatal period and there was restricted because of reliance on global or single-item
considerable variation in infant mortality by age of measures of religious and family domains. To facilitate
mother, birthweight and multiplicity within both more conceptually and methodologically sophisticated
manual and non-manual groups. research, the authors delineated mechanisms by which
the substantive and psychosocial elements of religion
Maher VF, Ford J. The heartbreak of parents patriae. could benefit or harm family adjustment.
JONAS Healthc Law Ethics Regul 2002; 4(1):18-22.
Notes: GENERAL NOTE: KIE: 10 refs. Mahoney G, Wheeden CA, Perales F. Relationship of
GENERAL NOTE: KIE: KIE Bib: patient care/minors; preschool special education outcomes to instructional
treatment refusal/minors practices and parent-child interaction. Res Dev Disabil
2004; 25(6):539-58.
Mahon-Daly P, Andrews GJ. Liminality and breastfeeding: Abstract: Developmental outcomes attained by children
women negotiating space and two bodies. Health Place receiving preschool special education services in
2002; 8(2):61-76. relationship to both the general instructional approach
Abstract: It is almost universally accepted that used by their teachers and their parents' style of
breastfeeding infants is nutritionally superior to bottle- interaction were examined. The sample included 70
feeding. However, despite this medical advice, in many children from 41 Early Childhood Special Education
countries breastfeeding rates remain low and in the (ECSE) classrooms. The type of instructional model
UK, rates are relatively static. The literature on children received was determined by dividing the
breastfeeding has discussed international rates and the sample into three clusters based upon six global ratings
broad socio-economic factors influencing these rates. of children's classroom environment: Choice;
Through an observational study of a group of Cognitive Problem-Solving; Child-Initiated Learning;
breastfeeding and non-breastfeeding women in the Developmental Match; Child-Centered Routines; and
United Kingdom, this research utilises contemporary Rewards and Discipline Strategies. Based on this
theoretical perspectives on the body, space and rites of analysis, 27 children were classified as receiving
passage, and investigates the reasons why some developmental instruction; 15 didactic instruction; and
breastfeeding mothers may be in a liminal period, and 28 naturalistic instruction. Observations of parent-child
the breastfeeding event itself, at times, a liminal and interaction collected at the beginning and end of the
marginalised act. The paper argues that, for the group year were classified along four dimensions using the
studied, breastfeeding is sometimes discouraged by its Maternal Behavior Rating Scale: Responsiveness,
medicalisation, and that breastmilk and breastfeeding Affect, Achievement Orientation and Directiveness.
are often considered by mothers to be embarrassing. Results indicated that the kinds of experiences that
Many of the women studied regarded certain public children received varied significantly across the three
and private places to be unacceptable places to instructional models. However, there were no
breastfeed and claimed to modify their behaviour significant differences in the impact of these
accordingly. The paper demonstrates the value of instructional models on children's rate of development.
conducting locally based qualitative research into Regression analyses indicated that children's rate of
breastfeeding experiences, and of using theoretical development at the end of intervention was
perspectives from post-medical geography to interpret significantly related to their parents' style of interaction
women's experiences. but was unrelated to the type of instructional model
they received.
Mahoney A, Pargament KI, Tarakeshwar N, Swank AB.
Religion in the home in the 1980s and 1990s: a meta- Mahua C. Children's bill smacks of compromise. Nurs
analytic review and conceptual analysis of links Times 2004; 100(28):12-3.
between religion, marriage, and parenting. J Fam
Psychol 2001; 15(4):559-96. Maida AM, Molina ME, Erazo R. [Munchausen syndrome
Abstract: The authors reviewed 94 studies published in by proxy, an unusual presentation]. Rev Med Chil
journals since 1980 on religion and marital or parental 2001; 129(8):917-20.
functioning. Meta-analytic techniques were used to Abstract: We report a 12 year old girl that first
quantify religion-family associations examined in at consulted for fever with bilateral knee arthralgias. A
least 3 studies. Greater religiousness appeared to neurological workout was started due to a progressive
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![gait disturbance, but all results were incongruent with determining whether pornography consumption may or
nerve or nerve root lesions, leading to the diagnosis of may not lead to sexually aggressive outcomes. In future
a functional paralysis. The patient worsened to the work, it is important not to use an overly simplistic lens
point of prostration. Due to the suspicion that the of focus in which pornography exposure is seen as
mother was inducing the symptoms, the patient was generally harmful or not. Depending on particular
admitted to the hospital, where she improved notably. constellations of personality characteristics, the effects
She was discharged walking. The improvement during of pornography may differ considerably among
hospital stay confirmed the diagnosis of a Munchausen different teenagers as well as within different cultures.
by proxy syndrome, mimicking a disabling The research suggests that particular concerns may be
neurological condition. needed for those who are highly frequent consumers of
pornography, those who seek out sexually violent
Majeed A. Referral of Dr Peter Mansfield to the GMC. BMJ content, and those who also have other risk factors.
2001; 323(7309):356.
Malcoe LH, Duran BM, Montgomery JM. Socioeconomic
Major EF. [Treatment of psychologically traumatised disparities in intimate partner violence against Native
patients in Norway]. Tidsskr Nor Laegeforen 2003; American women: a cross-sectional study. BMC Med
123(19):2709-12. 2004; 2:20.
Abstract: BACKGROUND: The Norwegian Abstract: BACKGROUND: Intimate partner violence
Directorate of Health and Social Affairs is carrying out (IPV) against women is a global public health problem,
a project on various aspects of traumatic stress. The yet data on IPV against Native American women are
present survey was carried out in 2001 in order to extremely limited. We conducted a cross-sectional
gather more knowledge about these patients within the study of Native American women to determine
mental health care system. MATERIAL AND prevalence of lifetime and past-year IPV and partner
METHODS: 325 hospitals, outpatient clinics and injury; examine IPV in relation to pregnancy; and
district psychiatric centres were asked by questionnaire assess demographic and socioeconomic correlates of
to comment on the types of traumatised patients they past-year IPV. METHODS: Participants were recruited
treated, their own perceived professional skills, the from a tribally-operated clinic serving low-income
diagnoses they used and the therapy they offered, and pregnant and childbearing women in southwest
their contact with national and regional specialist units. Oklahoma. A self-administered survey was completed
RESULTS: Refugees and victims of sexual abuse were by 312 Native American women (96% response rate)
the groups treated by most units; only a few treated attending the clinic from June through August 1997.
veterans of UN/NATO peacekeeping forces. Half of Lifetime and past-year IPV were measured using
the units reported lack of professional skills in treating modified 18-item Conflict Tactics Scales. A
refugees. Only a few units reported changes in socioeconomic index was created based on partner's
diagnosis and treatment as a result of advice from the education, public assistance receipt, and poverty level.
specialist units. INTERPRETATION: The high RESULTS: More than half (58.7%) of participants
frequency of units reporting a need for better skills in reported lifetime physical and/or sexual IPV; 39.1%
treating refugees is a challenge to the mental health experienced severe physical IPV; 12.2% reported
care system and the specialist units. The results suggest partner-forced sexual activity; and 40.1% reported
a need for discussion of the role of the national and lifetime partner-perpetrated injuries. A total of 273
regional specialist units as well as a need for closer women had a spouse or boyfriend during the previous
cooperation between psychiatric and primary health 12 months (although all participants were Native
care. American, 59.0% of partners were non-Native).
Among these women, past-year prevalence was 30.1%
Makkar RP. Concerns about research and prevention for physical and/or sexual IPV; 15.8% for severe
strategies in Munchausen Syndrome by Proxy (MSBP) physical IPV; 3.3% for forced partner-perpetrated
abuse. Child Abuse Negl 2003; 27(9):987-8. sexual activity; and 16.4% for intimate partner injury.
Reported IPV prevalence during pregnancy was 9.3%.
Malakoff D. Human research. Nigerian families sue Pfizer, Pregnancy was not associated with past-year IPV (odds
testing the reach of U.S. law. Science 2001; ratio = 0.9). Past-year IPV prevalence was 42.8%
293(5536):1742. among women scoring low on the socioeconomic
index, compared with 10.1% among the reference
Malamuth N, Huppin M. Pornography and teenagers: the group. After adjusting for age, relationship status, and
importance of individual differences. Adolesc Med household size, low socioeconomic index remained
Clin 2005; 16(2):315-26, viii. strongly associated with past-year IPV (odds ratio =
Abstract: This article focuses on the effects of exposure 5.0; 95% confidence interval: 2.4, 10.7).
to pornography on teenagers, particularly males, and CONCLUSIONS: Native American women in our
concentrates on sexually aggressive outcomes and on sample experienced exceptionally high rates of lifetime
the characteristics of the individual as crucial in and past-year IPV. Additionally, within this low-
income sample, there was strong evidence of
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![tamoxifen (TAM) 20 mg oral daily. RESULTS: There with substance use disorders.
were no dose-limiting toxicities. Nineteen percent of
patients had grade III drug-related toxicities including: Marais S, Kritzinger A. Farm worker injuries on Western
62% of patients showed progressive disease after two Cape fruit farms: the role of the lay health worker.
courses (8 wk). Nineteen percent received four courses. Curationis 2005; 28(4):86-92.
No clinical responses were observed. At weeks two and Abstract: AIM AND METHOD: An exploratory and
eight of therapy, IGF-1 serum levels dropped 46% ( < descriptive study to obtain basic data on the extent,
0.0001, n = 21) and 53% ( = 0.003, n = 10). The nature, sources and severity of injuries sustained on
difference of the area under the curve (AUC) minus fruit farms was conducted. The possibility of utilizing
baseline AUC (DeltaAUC) for arginine-stimulated GH lay health workers (LHWs) on farms to document
serum levels at week two was lower than baseline ( < routine information on injuries was also investigated.
0.01). At weeks two and eight, GH peak values were Descriptive information of all injuries occurring on
lower than baseline ( < 0.0001 and = 0.002, selected farms, both occupational and other, needing
respectively). CONCLUSIONS: A long-acting some form of treatment, were documented over a one-
somatostatin analog was able to lower IGF-1 levels of year period from June 1999 to May 2000. A purposive
OS patients. IGF-BP-3 and GH were only transiently non-probability sampling method was used. Forty-eight
reduced. Although ONC was well tolerated, no fruit farms with a history of trained LHWs were
sustained clinical responses were observed. The purposefully selected. Injuries were documented using
pathophysiology of serum versus tissue concentrations a one-page questionnaire. RESULTS: A total of 500
of IGF-1 as well as the interplay of IGFs, IGF-binding injuries were recorded, giving an average of 10.4
proteins, and other growth factors and cytokines in injuries per farm per year. Half of these injuries were
osteosarcoma warrants further investigation. A better work-related. Workers aged 20-39 were most at risk.
understanding of these processes should lead to a more Injuries sustained were related to routine activities of
effective exploitation of these pathways for the targeted fruit farming, occurred mostly in the orchards and
therapy of OS. involved cuts, bruises and abrasions to the hands,
including the fingers, and the eyes. Most of the non-
Manwell LB, Czabala JC, Ignaczak M, Mundt MP. work related injuries occurred in and around the home.
Correlates of depression among heavy drinkers in A third of these injuries were sustained by persons <
Polish primary care clinics. Int J Psychiatry Med 2004; 20. A large percentage of the non-work related injuries
34(2):165-78. were violence- and alcohol related. Most of the injuries
Abstract: OBJECTIVE: Depression and co-morbid required basic primary health care that could be
substance abuse disorders are a major public health managed by the LHW. Injury severity caused people to
problem. Information is limited for patients attending take time off for one third of the cases.
Polish primary care clinics. This article addresses 30- CONCLUSION: A relatively high occupational injury
day and lifetime prevalence of major depression in a rate in comparison to high-income countries.
heavy drinking population from 12 Polish primary care Occupational Health and Safety legislation needs to be
clinics. METHOD: 277 heavy drinkers were institutionalized and adhered to. Alcohol and violence
interviewed by a researcher in each clinic. Heavy on farms is a serious public health problem. LHWs
drinking was defined as more than 20 drinks per week could potentially play an important role in
for males, or more than 13 drinks per week for females, documenting injury data.
or consumption of more than four drinks five or more
times in the previous 30 days, or two or more positive Maranan P. Training community members for action:
replies to the CAGE questions. Criteria from the Washington's Action Training Network. J Health Hum
Diagnostic and Statistical Manual were used to assess Serv Adm 2002; 24(4):413-30.
lifetime and past 30-day depression. RESULTS: 35% Abstract: The Children's Alliance in Washington State
of women and men met criteria for depression in the 30 has established an ambitious goal of building the
days prior to the interview. Lifetime rates were 45% "Children's Action Network" (Network), a statewide
for women and 52% for men. Men and women with a network of children's advocates who regularly take
CAGE score of 4 were at higher risk for both 30-day action to inform public policy related to children and
(67%, OR = 3.85 [1.47, 10.08]) and lifetime (78%, OR families. There are currently about 3,000 members in
= 3.28 [1.12, 9.66]) depression. Recreational drug users the Network. Policy advocacy training is an integral
and patients reporting symptoms of anti-social component of the Network providing advocates with
personality disorders were at increased risk for lifetime necessary tips and tools for communicating with
depression. Subjects reporting symptoms of a policy-makers. In order to meet key objectives and
childhood conduct disorder were at higher risk for 30- overcome significant challenges and barriers, the
day depression. CONCLUSIONS: Depression among training program evolved greatly over the last five
patients with substance abuse problems is a common years. This article describes some of the challenges
problem. The rates are higher than for other countries faced, particularly in reaching specific target
and highlight the need for Polish primary care populations, key strategies undertaken, and how the
clinicians to routinely screen for depression in patients curriculum developed over time.
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![Marcovitch H. Learning from tragedies: clinical lessons Abstract: The authors examined the
from the Climbie report. Qual Saf Health Care 2003; neuropsychological status of 22 preschoolers at risk for
12(2):82-3. attention-deficit/hyperactivity disorder (ADHD) and 50
matched control children, using measures of nonverbal
Margolina IA, Kozlovskaia GV, Proselkova ME. [Mental working memory, perceptual and motor inhibition, and
development of children in condition of chronic memory for relative time. All tasks included paired
physical abuse: methodical aspect]. Zh Nevrol control conditions, which allowed for the isolation of
Psikhiatr Im S S Korsakova 2005; 105(9):4-9. discrete executive function constructs. Group
Abstract: Mental dysfunction of 130 children aged 0-14 differences were evident on several measures of
years with a history of family physical abuse was neuropsychological functioning; however, after
studied using a number of known methods adapted for accounting for nonexecutive abilities, no deficits could
early aged children including an original scale of be attributed to specific functions targeted by the tasks.
mental dysfunction assessment, which has been Performance on executive measures was not related to
elaborated in Mental Health Research Center objective indices of activity level or ratings of ADHD
(Moscow). A battery of clinico-psychopathological and symptoms. Yet, the fact that at-risk preschoolers were
clinico-psychological methods allowed comprehensive highly symptomatic casts doubt on whether executive
assessment of mental state, with 95% cases of mental function deficits and/or frontostriatal networks
dysfunction being found in the group studied. The most contribute etiologically to early behavioral
pronounced were depression spectrum disorders. manifestations of ADHD.
Marino R, Villa A, Guerrero S. A community trial of Marks L. Sacred practices in highly religious families:
fluoridated powdered milk in Chile. Community Dent Christian, Jewish, Mormon, and Muslim perspectives.
Oral Epidemiol 2001; 29(6):435-42. Fam Process 2004; 43(2):217-31.
Abstract: OBJECTIVE: To demonstrate the Abstract: Quantitative research examining linkages
effectiveness of a dental caries prevention program on between family relationships and religious experience
the primary dentition of Chilean rural children, using has increased substantially in recent years. However,
fluoridated powdered milk and milk derivatives. related qualitative research, including research that
METHODS: Fluoridated milk and milk-cereal was examines the processes and meanings behind recurring
given to about 1000 preschool children in Codegua, a religion-family correlations, remains scant. To address
rural community located in the 6th Region of Chile, this paucity, a racially diverse sample (N = 24) of
using the standard National Complementary Feeding married, highly religious Christian, Jewish, Mormon,
Program (PNAC). The daily fluoride dose from and Muslim parents of school-aged children were
fluoridated powdered milk was estimated at 0.25 mg interviewed regarding the importance of religious
for infants (0-2 years old), 0.5 mg for children aged 2-3 family interactions, rituals, and practices in their
years and 0.75 for children aged 3-6 years. Cross- families. Mothers and fathers discussed several
sectional samples of children aged 3-6 years were religious practices that were meaningful to them and
taken from Codegua (study community) from 1994 to explained why these practices were meaningful.
1999 and from La Punta (control community) from Parents also identified costs and challenges associated
1997 and 1999. RESULTS: Significant reductions with these practices. Interview data are presented in
(72%) were observed in the dmfs indices in the 3-6- connection with three themes: (1) "practicing [and
year-old groups in Codegua, when comparing 1999 parenting] what you preach," (2) religious practices,
with 1994 data. In 1999, children in the study family connection, and family communion, and (3)
community showed significantly lower dmfs than costs of family religious practices. The importance of
children in the control community (41%). The family clinicians and researchers attending to the
proportion of caries-free children in the study influence of religious practice in the lives of highly
community increased after 4 years of program religious individuals and families is discussed.
implementation (from 22.0% to 48.4%).
CONCLUSION: Under Chilean rural conditions, Marks MB, Lawson HA. Co-production dynamics and time
fluoridation of powdered milk distributed through the dollar programs in community-based child welfare
PNAC is an effective caries prevention alternative for initiatives for hard-to-serve youth and families. Child
areas where water fluoridation might not be feasible. Welfare 2005; 84(2):209-32.
Abstract: Hard-to-serve youth and families residing in
Marjorie V. The mutilated orchid. RCM Midwives 2005; high-poverty communities often have multiple,
8(3):119. interlocking needs. These needs necessitate complex
service models. The complex model described in this
Marks DJ, Berwid OG, Santra A, Kera EC, Cyrulnik SE, article combines a unique approach to wraparound
Halperin JM. Neuropsychological correlates of ADHD services with a coproduction framework and related
symptoms in preschoolers. Neuropsychology 2005; theories. The model aims to improve outcomes for
19(4):446-55. vulnerable youth and their families, simultaneously
strengthening communities by employing residents and
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![engaging participants in community service. Examples Abstract: The anterior cingulate is a key component of
derived from current pilot projects illustrate co- neural networks subserving attention and emotion
production's importance for other child welfare regulation, functions often impaired in patients with
initiatives. psychosis. The study aimed to examine anterior
cingulate volumes and sulcal morphology in a group of
Marleau JD. Birth order and fratricide: an evaluation of patients with childhood-onset schizophrenia (COS)
Sulloway's hypothesis. Med Sci Law 2005; 45(1):52-6. compared with controls. Brain magnetic resonance
Abstract: Sulloway (1996) suggested that older siblings imaging (MRI) scans were obtained in 13 COS and 18
were more likely to be fratricidal than younger ones. matched control children, ages 6-17 years. Volume
Our data, based on 113 case studies found in the measures for the anterior cingulate gyrus (ACG) were
psychiatric, psychological and criminological literature obtained through manual labeling. A determination of
since 1959, confirms his hypothesis. In 72 out of the 92 cingulate sulcal pattern (single or double) was made for
cases (78%) where age could be determined, the each hemisphere. The COS group had a reduced
aggressor was older than the victim. The same held leftward skew of the double cingulate sulcal pattern,
true even when the age of aggressor, sex of aggressor and absence of the normal left>right ACG volume
and victim, presence or not of a blood tie, and presence asymmetry. The right ACG was larger in the COS than
of one or more victims are taken into account. in controls. The schizophrenic children showed
Surprisingly, most of the aggressors in our sample were decreases in all ACG volumes with age, while the
under the age of 18 years. Also, first-borns were more controls showed increases or no change. The data
often the aggressor than the victim. This result seems suggest that significant cingulate abnormalities may
to confirm the Adlerian theory of dethronement. Some result from deviations in progressive
suggestions and hypotheses are advanced for future neurodevelopmental processes, beginning before birth
research to improve our understanding of this and continuing through childhood and adolescence, in
phenomenon. persons who develop schizophrenia. These structural
differences may relate to the well-described cognitive
Marley JA, Buila S. Crimes against people with mental deficits these children display, and to the cardinal
illness: types, perpetrators, and influencing factors. Soc symptoms of schizophrenia.
Work 2001; 46(2):115-24.
Abstract: The current emphasis on studying why Marques NM, Lira PI, Lima MC et al. Breastfeeding and
people with severe mental illness are potentially violent early weaning practices in northeast Brazil: a
has overlooked the effect of violence committed longitudinal study. Pediatrics 2001; 108(4):E66.
against these individuals. To balance the understanding Abstract: OBJECTIVES: To describe breastfeeding
of the person-in-environment conceptualization of practices from 0 to 12 months of age in 4 small towns
severe mental illness, the nature, scope, and effect of that are representative of urban northeast Brazil and to
crime and victimization should be examined as part of identify factors associated with introduction of other
the context in which these individuals live and milk in the first month of life. METHODS: From
function. The study reported in this article examined January to August 1998, 364 mothers were interviewed
the nature and scope of victimization as experienced by at delivery to ascertain antenatal care; delivery room
234 individuals with a diagnosed major mental illness; practices; and their intentions regarding breastfeeding,
what types of victimization experiences occurred pacifiers, and introduction of water, teas, and other
during their lifetime; what specific victimization milk. Their perceptions of home support and the
experiences these individuals identified as the most advantages of breastfeeding also were assessed.
troubling; who the perpetrators for these specific Thereafter, daily information about feeding practices
victimization experiences were; and what influence was collected at twice-weekly home visits. When other
demographic and clinical characteristics played in milk was started, a second interview was conducted to
influencing the risk of victimization among this group. ascertain initial and current breastfeeding problems and
The study indicates that social workers should better use of a pacifier. Reasons for starting other milk were
assess for experiences of victimization among people investigated using 5-point Likert scales. RESULTS:
with mental illness and better understand the effect of Mothers were positive toward breastfeeding, and 99%
such experiences on the individual's symptoms and breastfed their new infant. Few intended to breastfeed
day-to-day functioning. exclusively, and in the first week 80% gave water/tea
and 56% used a pacifier. The median duration of
Maroteaux P, Le Merrer M. [Battered or brittle child?]. Arch exclusive breastfeeding was 0 days, and the median age
Pediatr 2003; 10(8):679-80. for starting other milk was 24 days. The median
duration of breastfeeding was 65 days for mothers who
Marquardt RK, Levitt JG, Blanton RE et al. Abnormal started other milk within 1 month and 165 days for
development of the anterior cingulate in childhood- other mothers. After adjustment for confounding
onset schizophrenia: a preliminary quantitative MRI variables, the main factors associated with introduction
study. Psychiatry Res 2005; 138(3):221-33. of other milk within 1 month were pacifier use in the
first week (odds ratio [OR], 4.01; 95% confidence
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![interval [CI]: 2.07-7.78), intention to start other milk in emerges from our study. Most of the mutations of
the first month (OR, 3.79; 95% CI: 1.74-8.24), giving uncharged and solvent inaccessible residues and the
water/tea in the first week (OR, 3.07; 95% CI: 1.56- truncations must disrupt the basic structure of the
6.03), and leaving the maternity ward before protein. The mutations of charged residues would be
breastfeeding was started (OR, 2.59; 95% CI: 1.34- expected to interfere with internal hydrogen bonding
5.04). CONCLUSION: Although breastfeeding is networks, introducing severe incompatible partnering
common in this community, it rarely is exclusive and that is caused by poor packing or electrostatic
takes place for a relatively short duration. Identification repulsions.
of risk factors for early introduction of other milk
offers potential avenues for future intervention, Martin PL. Moving toward an international standard in
including improvement of breastfeeding support in informed consent: the impact of intersexuality and the
antenatal and maternity services. Internet on the standard of care. Duke J Gend Law
Policy 2002; 9:135-69.
Marsella LT, Savastano L, Saracino V, Del Vecchio R. Notes: GENERAL NOTE: KIE: 310 fn.
[Child labour]. Clin Ter 2005; 156(6):273-80. GENERAL NOTE: KIE: KIE Bib: informed
Abstract: The authors emphasize the violation of consent/minors; patient care/minors
children's and adolescents' rights as a result of the
exploitation of child labour. Besides the legal aspect, Martin SG. Children exposed to domestic violence:
they pointed out the medical features related to the psychological considerations for health care
delicate growing process of the child in the phases of practitioners. Holist Nurs Pract 2002; 16(3):7-15.
development and adaptation of the main organs to hard Abstract: This article reviews the psychological impact
work. Currently the problem is being supervised by of exposure to domestic violence on child
those states that recognize the right for minors to be development. The purpose is to give insight to the
protected against any kind of physical, mental, spiritual following questions: How does the experience of
and moral risk. family violence affect a child's perception of the world
and relationships with others? What type of coping
Marsh A. Testing pregnant women and newborns for HIV: style might this same child be likely to develop? What
legal and ethical responses to public health efforts to factors help protect a child who has been exposed to
prevent pediatric AIDS. Yale J Law Fem 2001; violence in the home? In addition, the article discusses
13(2):195-263. assessment considerations for health care practitioners
Notes: GENERAL NOTE: KIE: Marsh, Andrea and recommends areas for future research and public
GENERAL NOTE: KIE: 444 fn. policy development.
GENERAL NOTE: KIE: KIE Bib: AIDS/testing and
screening; public health Martin SL, Mackie L, Kupper LL, Buescher PA, Moracco
KE. Physical abuse of women before, during, and after
Marsh M. The missing piece. Nurs Stand 2003; 17(25):22-3. pregnancy. JAMA 2001; 285(12):1581-4.
Abstract: CONTEXT: Clinicians who care for new
Martin MA, Rubio JC, Buchbinder J et al. Molecular mothers and infants need information concerning
heterogeneity of myophosphorylase deficiency postpartum physical abuse of women as a foundation
(McArdle's disease): a genotype-phenotype correlation on which to develop appropriate clinical screening and
study. Ann Neurol 2001; 50(5):574-81. intervention procedures. However, no previous
Abstract: We report on 54 Spanish patients with population-based studies have been conducted of
McArdle's disease from 40 unrelated families. postpartum physical abuse. OBJECTIVES: To examine
Molecular analysis revealed that the most common patterns of physical abuse before, during, and after
R49X mutation was present in 70% of patients and pregnancy in a representative statewide sample of
55% of alleles. The G204S mutation was less frequent North Carolina women. DESIGN, SETTING, AND
and found in 14.8% of patients and 9% of mutant PARTICIPANTS: Survey of participants in the North
alleles. The W797R mutation was observed in 16.5% Carolina Pregnancy Risk Assessment Monitoring
of patients, accounting for 13.7% of mutant alleles. System (NC PRAMS). Of the 3542 women invited to
Moreover, 78% of mutant alleles among Spanish participate in NC PRAMS between July 1, 1997, and
patients can be identified by using polymerase chain December 31, 1998, 75% (n = 2648) responded. MAIN
reaction-restriction fragment length polymorphism OUTCOME MEASURES: Prevalence of physical
analysis for the R49X, G204S, and W797R mutations, abuse during the 12 months before pregnancy, during
which makes noninvasive diagnosis possible through pregnancy, and after infant delivery; injuries and
molecular genetic analysis of blood DNA. Six novel medical interventions resulting from postpartum abuse;
mutations were found. Three were missense mutations, and patterns of abuse over time in relation to
E348K, R601W, and A703V; two nonsense mutations, sociodemographic characteristics and use of well-baby
E124X and Q754X; and one single base pair deletion, care. RESULTS: The prevalence of abuse before
533 delA. No clear genotype-phenotype correlation pregnancy was 6.9% (95% confidence interval [CI],
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![5.6%-8.2%) compared with 6.1% (95% CI, 4.8%- Martinez CR Jr, Forgatch MS. Adjusting to change: linking
7.4%) during pregnancy and 3.2% (95% CI, 2.3%- family structure transitions with parenting and boys'
4.1%) during a mean postpartum period of 3.6 months. adjustment. J Fam Psychol 2002; 16(2):107-17.
Abuse during a previous period was strongly predictive Abstract: This study examined links between family
of later abuse. Most women who were abused after structure transitions and children's academic,
pregnancy (77%) were injured, but only 23% received behavioral, and emotional outcomes in a sample of 238
medical treatment for their injuries. Virtually all divorcing mothers and their sons in Grades 1-3.
abused and nonabused women used well-baby care; Multiple methods and agents were used in assessing
private physicians were the most common source of family process variables and child outcomes. Findings
care. The mean number of well-baby care visits did not suggest that greater accumulations of family transitions
differ significantly by maternal patterns of abuse. were associated with poorer academic functioning,
CONCLUSION: Since well-baby care use is similar for greater acting-out behavior, and worse emotional
abused and nonabused mothers, pediatric practices may adjustment for boys. However, in all three cases, these
be important settings for screening women for relationships were mediated by parenting practices:
violence. Parental academic skill encouragement mediated the
relationship between transitions and academic
Martines J, Paul VK, Bhutta ZA et al. Neonatal survival: a functioning, and a factor of more general effective
call for action. Lancet 2005; 365(9465):1189-97. parenting practices mediated the relationships between
Notes: CORPORATE NAME: Lancet Neonatal transitions and acting out and emotional adjustment.
Survival Steering Team
Abstract: To achieve the Millennium Development Martinez-Campillo Garcia F, Maura da Fonseca A, Santiago
Goal for child survival (MDG-4), neonatal deaths need Oliva J et al. [Vaccine coverage study and intervention
to be prevented. Previous papers in this series have with health community agents in a marginal gypsy
presented the size of the problem, discussed cost- community of Alicante]. Aten Primaria 2003;
effective interventions, and outlined a systematic 31(4):234-8.
approach to overcoming health-system constraints to Abstract: OBJEDTIVESn To measure the vaccination
scaling up. We address issues related to improving coverage in a pediatric population living in Parque
neonatal survival. Countries should not wait to initiate Ansaldo, Montoto, Casa Larga, Cabrera Vicario, San
action. Success is possible in low-income countries and Anton and Travesia del Canal and evolution after an
without highly developed technology. Effective, low- intervention health program performed by Gypsy
cost interventions exist, but are not present in educators specially trained for such intervention.
programmes. Specific efforts are needed by safe DESIGN: Descriptive study, pretest-postest without
motherhood and child survival programmes. Improved control group. SETTING: Community. Primary health
availability of skilled care during childbirth and care. Participants. Four hundred and sixty three
family/community-based care through postnatal home marginals Gypsies children younger than 15 years old.
visits will benefit mothers and their newborn babies. MEASUREMENTS AND MAIN RESULTS: The
Incorporation of management of neonatal illness into project includes an educational program and health
the integrated management of childhood illness care actions by means of home visits. Duration of the
initiative (IMCI) will improve child survival. project was from 1-10-96 until 1-10-97 and from 1-10-
Engagement of the community and promotion of 98 until 1-10-99. Before intervention the vaccine
demand for care are crucial. To halve neonatal coverage was for polio, diphtheria and tetanus 41%,
mortality between 2000 and 2015 should be one of the pertussis 24% and measles, mumps and rubella 36%.
targets of MDG-4. Development, implementation, and After intervention the overall coverage increased 17%.
monitoring of national action plans for neonatal The vaccine coverage was for polio, diphtheria and
survival is a priority. We estimate the running costs of tetanus 53%, pertussis 45% y measles, mumps and
the selected packages at 90% coverage in the 75 rubella 54%. CONCLUSIONS: This study shows up
countries with the highest mortality rates to be US4.1 the low vaccine coverage founded and the increase of
billion dollars a year, in addition to current overall coverage after the intervention in 17%. We also
expenditures of 2.0 billion dollars. About 30% of this conclude of the intervention the necesity of
money would be for interventions that have specific collaboration between Gypsies associations, health
benefit for the newborn child; the remaining 70% will primary care centers and public health centers to carry
also benefit mothers and older children, and out efficacy interventions in marginal population.
substantially reduce rates of stillbirths. The cost per
neonatal death averted is estimated at 2100 dollars Martinez E. Children's Dental Safety Net--a collaborative
(range 1700-3100 dollars). Maternal, neonatal, and initiative of San Diego County's Council of
child health receive little funding relative to the large Community Clinics. Compend Contin Educ Dent 2002;
numbers of deaths. International donors and leaders of 23(12 Suppl):36-8.
developing countries should be held accountable for
meeting their commitments and increasing resources. Martino SC, Collins RL, Kanouse DE, Elliott M, Berry SH.
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![Social cognitive processes mediating the relationship families to rethink the kind of education parents are
between exposure to television's sexual content and providing their childrenwith/their own education. For
adolescents' sexual behavior. J Pers Soc Psychol 2005; the other ones, it was perceived as a support for
89(6):914-24. behavioral problems. As noticed, some parents stressed
Abstract: This study used multiple-group structural a negative influence falling upon their children, which
equation modeling to test a model explaining the made them more disobedient on their return home, and
association between exposure to televised sexual causing disciplinary procedures harder to be
content and initiation of intercourse among an established. The conclusion is that reintegration of the
ethnically diverse national sample of 1,292 target children/adolescents is harnessed by violence
adolescents. The authors hypothesized, on the basis of happening inside families.
social-cognitive theory, that exposure to televised
sexual content would influence adolescents' safe-sex Martyn C. Politics as a determinant of health. BMJ 2004;
self-efficacy, sex-related outcome expectancies, and 329(7480):1423-4.
perceived peer norms regarding sex, and that each of
these would, in turn, influence intercourse initiation. Masi G, Millepiedi S, Mucci M, Bertini N, Milantoni L,
Findings support a model in which the relationship Arcangeli F. A naturalistic study of referred children
between exposure to TV's sexual content and and adolescents with obsessive-compulsive disorder. J
intercourse initiation is mediated by safe-sex self- Am Acad Child Adolesc Psychiatry 2005; 44(7):673-
efficacy among African Americans and Whites but not 81.
among Hispanics. Outcome expectancies and perceived Abstract: OBJECTIVE: To report on clinical features,
peer norms may also mediate the link between comorbidity, and response to pharmacotherapy in
exposure and intercourse initiation among all 3 children and adolescents with obsessive-compulsive
racial/ethnic groups, although evidence of this could disorder (OCD) naturalistically followed and treated
not be confirmed. with serotonin reuptake inhibitors (SRIs). METHOD:
A consecutive series of 94 patients (65 males, 29
Martins CB, Andrade SM. [Epidemiology of accidents and females, age 13.6 +/- 2.8 years), referred in the period
violence against children in a city of Southern Brazil]. January 2001-April 2004, diagnosed with a clinical
Rev Lat Am Enfermagem 2005; 13(4):530-7. interview (Diagnostic Interview for Children and
Abstract: This study aimed to analyze the Adolescents-Revised), and followed for 10 +/- 6
epidemiological characteristics of accidents and months, were included in the study. RESULTS:
violence against children under 15 years old who lived Contamination obsessions and washing rituals were
in Londrina, a city in the South of Brazil, in 2001. associated with less impairment than other subtypes of
Morbidity data were collected from general hospitals OCD. Aggressive sexual obsessions and checking
records and mortality data were obtained from the rituals as well as symmetry obsessions and ordering-
Municipal Mortality Information Center. A total of repeating rituals were more frequently comorbid with
8,854 children were studied, which corresponded to an tic disorders. According to the Clinical Global
incidence rate of 74.8/1,000 children. Admission and Impressions-Improvement scale (score 1 or 2), 63
fatality rates were 4.2% and 0.2%, respectively. The subjects (67%) were responders to treatment.
incidence rate was higher among two-year olds Nonresponders were more severely impaired and had a
(109/1,000) and male victims prevailed (60.7%). Other higher number of comorbid disorders, namely, bipolar
causes of injuries were the main subtype of external disorder and conduct disorder (p < .05). Forty-seven
cause (61.0%), followed by events of undetermined patients (50%) received an SRI monotherapy, whereas
intention (30.6%) and by transport-related injuries the other 47 (50%) needed other medications. Patients
(7.5%). The head was the most affected body part receiving SRI monotherapy were less severely
(34.9%) and superficial injuries were the most frequent impaired; had a later onset of OCD; were at a younger
kind of trauma (32.4%). The results contribute to the age at the visit, had higher rates of depression and
planning of injury control and prevention actions. anxiety and lower rates of bipolar disorder, attention-
deficit/hyperactivity disorder, and conduct disorder (p
Martins CS, Ferriani MG. [Reintegration of victimized < .05). CONCLUSIONS: Long-term naturalistic
children and adolescents in their parents' view]. Rev prospective studies in pediatric patients with OCD
Bras Enferm 2003; 56(6):651-4. might represent an important source of information for
Abstract: This study aims at learning, from some everyday care regarding the effectiveness of a
aggressor families' point of view, the way reintegration treatment over extended periods of time under routine
of child and adolescent victims into their own families clinical conditions.
happen, in the city of Ribeirao Preto-SP in 2002. The
methodology used is descriptive and qualitative; data Mason PR, Gregson S, Gwanzura L, Cappuccinelli P,
were collected through interviews and observation of Rapelli P, Fiori PL. Enzyme immunoassay for
participants. Nine families whose children were urogenital trichomoniasis as a marker of unsafe sexual
institutionalized were surveyed. Results showed that behaviour. Epidemiol Infect 2001; 126(1):103-9.
the institutionalization of children is a way for some
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![for any rise in rates of anorexia nervosa. Although compared with controls. Performance on the Starry
some contributors to these trends have been identified, Night, a test demanding alerting and sensory-orienting
much remains to be learned about the key risks but not executive attention function, was significantly
involved. SUMMARY: Monitoring time trends in child associated with lesion size in the alerting and sensory-
and adolescent mental health is essential for service orienting networks but not the executive attention
planning; knowledge of changing trends can also network. Furthermore, earlier age at lesion acquisition
provide important pointers to potential risk factors. was significantly associated with poorer attention
Current data sources allow relatively reliable tracking function even when lesion size was controlled. These
of trends in some areas, but remain severely limited in findings support the theory of dissociable networks of
others. Further research is needed to understand the attention and add to evidence from studies of children
mechanisms underlying recently identified trends in with diffuse and focal brain damage that early insults
child and adolescent mental health. are associated with worse long-term outcomes in many
domains of neuropsychological function. In addition,
Maughan B, Rowe R, Messer J, Goodman R, Meltzer H. these results may provide clues towards the
Conduct disorder and oppositional defiant disorder in a understanding of mechanisms underlying attention in
national sample: developmental epidemiology. J Child children.
Psychol Psychiatry 2004; 45(3):609-21.
Abstract: BACKGROUND: Despite an expanding Maxeiner H. Demonstration and interpretation of bridging
epidemiological evidence base, uncertainties remain vein ruptures in cases of infantile subdural bleedings. J
over key aspects of the epidemiology of the 'antisocial' Forensic Sci 2001; 46(1):85-93.
disorders in childhood and adolescence. METHODS: Abstract: Report of two cases of lethal infantile
We used cross-sectional data on a nationally subdural bleedings (SDB). Bridging vein (BV) ruptures
representative sample of 10,438 5-15-year-olds drawn were directly proven as the source of the (minimal)
from the 1999 British Child Mental Health Survey to SDB by a postmortem X-ray. In the controversial
examine age trends, gender ratios and patterns of discussion concerning the causes of infantile SDB,
comorbidity in DSM-IV Conduct Disorder (CD) and proof of the occurrence of several BV ruptures is seen
Oppositional Defiant Disorder (ODD). RESULTS: CD as an important sign of a trauma of significant degree.
was significantly more common in boys than girls, and Although infantile SDB undoubtedly can result from
increased in prevalence with age. Among children who accidental as well as intentional injuries, and therefore,
met diagnostic criteria for CD, status violations and the SDB itself does not allow far-reaching conclusions
other non-aggressive conduct problems increased with as to the cause of injury, the presence of several BV
age, while aggressive symptoms became less common. ruptures combined with an SDB of insignificant
Gender differences in ODD varied by reporter. volume, in an infant dead or in a deep coma on clinical
Estimates of age trends in ODD depended heavily on presentation, is not compatible with the supposition of
treatment of overlaps with CD. Following DSM-IV a minor fall as the cause. We have not observed such
guidelines (where ODD is not diagnosed in the findings as the result of a minor accidental event for
presence of CD), rates of ODD fell with age; if that more than 15 years.
constraint was released, clinically significant rates of
oppositionality persisted at similar levels from early Maxeiner H. [Evaluation of subdural hemorrhage in infants
childhood to middle adolescence. CD and ODD after alleged minor trauma]. Unfallchirurg 2001;
showed high levels of overlap, and both diagnoses 104(7):569-76.
showed substantial comorbidity with other non- Abstract: QUESTIONING: Recently the discussion
antisocial disorders. CONCLUSIONS: Results from concerning the causes of infantile subdural bleedings
this large-scale study confirm and extend previous (SDB) has become quite controversial. The wide-
findings in the epidemiology of the disruptive spread interpretation that most of these cases are the
behaviour disorders. result of abuse, especially by the shaken-baby-
syndrome, was doubted, and the role of (even minor)
Max JE, Robin DA, Taylor HG et al. Attention function accidental events was emphasized. METHODS: This
after childhood stroke. J Int Neuropsychol Soc 2004; situation should be analyzed basing on the official
10(7):976-86. statistics of the causes of death in the city of Berlin
Abstract: We investigated attentional outcome after (1978-1998) and the autopsy material of our institute
childhood stroke and orthopedic diagnosis in medical (1978-1999). RESULTS: In this period, approximately
controls. Twenty-nine children with focal stroke 440.000 children lived their first year of life in our city.
lesions and individually matched children with Only 80 violent deaths of infants (up to 1 year old)
clubfoot or scoliosis were studied with standardized were recorded in the official statistics, including 27
attention and neuroimaging assessments. Stroke lesions deaths due to blunt forces, with 24 lethal head injuries
were quite varied in location and commonly involved as the main group. Only two cases were attributed to
regions implicated in Posner's model of attention "falls under unclear conditions"; all other accidental
networks. Children with stroke lesions performed cases were the results of traffic accidents or falls from
significantly more poorly regarding attention function a height. No death due to an undoubted minor fall was
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![recorded, nor was any in our autopsy material. We subdural hemorrhages should be kept from another: a)
investigated 10 cases of infantile SDB, all without skull patients suffering a moderate head injury from a minor
fractures and gross brain injuries. Only 1 victim had a accident which results in a subdural bleeding (from a
SDB of a significant volume; in all other cases only small intracranial lesion) often do not deteriorate soon
small amounts of blood were present in the subdural after the impact, develop a hemorrhage of significant
space. Bridging vein ruptures were directly volume, respond well to therapy and have a good
demonstrated in 8 cases and were bilaterally in most prognosis. b) cases with a history of no or only of an
instances; recently their detection has been simplified insignificant trauma, infants dead or nearly dead on
by postmortem x-ray using contrast material. All 10 clinical presentation, often a poor outcome in cases of
cases were interpreted as typical acceleration- survival. There is typically no significant subdural
deceleration injuries (as in shaking), although only in 2 bleeding despite multiple bridging vein ruptures in the
cases a confession of this procedure could be obtained. majority of these cases: the subdural hemorrhage is
CONCLUSION: Comparing cases of accidental and here only a visible sign of a much more serious and
non-accidental SDB in the literature, infantile SDB general cerebral alteration, resulting in a rapid increase
obviously cannot be looked at as a homogeneous of intracranial pressure (often complicated by
entity: two quite different types should be kept respiratory arrest) which prevents a signifant bleeding
separate: the patients suffering from an accidental SDB into the subdural space. This combination of findings is
due to a minor fall mostly do not deteriorate typically found in victims of massive events (car
immediately after the trauma, develop SDB of some occupants in high-velocity crashes) and not compatible
volume, up to a space-occupying mass lesion, and have with a supposition of a minor fall causing this.
often a good prognosis. A lethal outcome is extremely
uncommon; we have not observed a single case of an May PA, Gossage JP. Estimating the prevalence of fetal
infantile lethal SDB resulting from such a minor injury alcohol syndrome. A summary. Alcohol Res Health
for more than 20 years. The source of the SDB in those 2001; 25(3):159-67.
cases currently is unknown in most instances. The Abstract: Since the late 1970s, many studies have
second group of infantile SDB includes the well-known reported on the prevalence of fetal alcohol syndrome
group of shaken-baby-syndrome: no adequate history, (FAS), alcohol-related birth defects (ARBD), and
infants dead or nearly dead on clinical presentation, alcohol-related neurodevelopmental disorders
often a poor outcome if the event is survived, typically (ARND). The three main types of research methods
no significant volume of SDB, and--according to our used in these studies are passive surveillance, clinic-
experiences--in all cases BV ruptures. This based studies, and active case ascertainment. This
combination of several BV ruptures with no significant article describes each of these methods, including their
subdural bleeding is not compatible with a supposition strengths and weaknesses, and summarizes the
of a minor fall causing this. estimated prevalence of FAS produced by each of these
approaches. The maternal risk factors associated with
Maxeiner H. [A postmortem view on "pure" subdural FAS and other alcohol-related anomalies include
hemorrhages in infants and toddlers]. Klin Padiatr advanced maternal age, low socioeconomic status,
2002; 214(1):30-6. frequent binge drinking, family and friends with
Abstract: In the last years, the discussion concerning drinking problems, and poor social and psychological
the causes of infantile subdural hemorrhages became indicators. Overall, the available literature points to a
controversial. Many authors still suppose that child prevalence rate of FAS of 0.5 to 2 cases per 1,000
abuse is the predominant cause of such cases. On the births in the United States during the 1980s and 1990s.
other hand, reports presenting series of accidental cases
were published, and the fear of an overdiagnosis of the May WE. "Jodie" and "Mary": separating the Maltese twins.
shaken baby syndrome has been expressed. Our Natl Cathol Bioeth Q 2001; 1(3):407-16.
autopsy material concerning all lethal head injuries of Notes: GENERAL NOTE: KIE: May, William E
infants and toddlers from 2 decades was reviewed. 17 GENERAL NOTE: KIE: 32 fn.
of these 64 cases were characterized by the following: GENERAL NOTE: KIE: KIE Bib: patient care/minors
history of no trauma or only an insignificant event;
children found dead or apnoic or in coma; no skull Maybloom B, Champion Z. Development and
fractures; no focal brain injury; ruptures of several implementation of a multi-centre information system
bridging veins but only minimal subdural bleeding. 11 for paediatric and infant critical care. Intensive Crit
victims were infants (1st year of life) and either 3 were Care Nurs 2003; 19(6):326-41.
2 years resp. 3 - 6 years old; 50 % off all lethal head Abstract: BACKGROUND: With no UK collective
injuries of infants were of this type, while only 25 % information system, a need existed to establish an
resp. 10 % of the following age groups. None of these integrated information system for public and private
17 cases was a result of a minor accident witnessed by sector hospitals providing paediatric and infant critical
unrelated persons. Abuse could be ascertained with a care services. A lack of information in the past made it
high degree of probability in most cases and remained difficult for those procuring, providing and monitoring
quite likely in the others. Two different types of
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![services to make informed, evidence-based decisions men (70%, or 7 of 10) recommended a leave of 1 to 3
using reliable integrated data. OBJECTIVES: To months, and all women preferred a 3-month maternity
develop and implement a collective multi-purpose or child care leave of absence. During surgical practice,
information system for paediatric and infant critical only 12% (2/17) of men but 64% (7/11) of women
care that was easily adaptable to any UK infant or have taken time off for either childbearing or child
paediatric critical care setting. Information outputs had care. Half of the respondents (21/42) have a formal
to fulfil policy requirements and meet the needs of leave of absence policy at work, 52% (11/21) of which
stakeholders. METHOD: Two minimum datasets, are paid leave programs. Although the workweek of
corresponding data definitions, survey forms and a user our practicing graduates is 69 +/- 16 hours for men and
database were developed through a process of 64 +/- 12 hours for women, 62% (26/42) spend more
consultation by utilising an information partnership. than 20 hours per week parenting. More than 80%
Design, content, development and implementation (27/32) would consider a part-time surgical practice for
issues were identified, discussed and resolved through more parenting involvement; one third of the
a co-ordinated collaborative process. RESULTS: Data responders suggested that 30 hours a week constitutes a
collection was implemented in all London and reasonable part-time practice, one third preferred fewer
Brighton National Health Service (NHS) general and than 30 hours, and one third favored more than 30
cardio-thoracic paediatric intensive care (PIC) units, hours per week. Data are presented as mean +/- SD.
several private PIC units and one NHS tertiary referral CONCLUSIONS: Childbearing and child care may
neonatal unit (NNU) 24 months from project start. have an enormous impact on one's decision to pursue a
CONCLUSIONS: The development of universal career in surgery. To attract and retain the best
integrated information systems for defined settings of candidates for future surgeons, formal policies on the
care is achievable within reasonable timeframes; availability of child care services in the residency
however, successful development and implementation program and the workplace should be studied and
requires working within an information partnership to implemented. Furthermore, national studies are needed
maximise co-ordination, co-operation and to define appropriate, acceptable workweeks for part-
collaboration. Those collecting and using data must be time or flexible practices and the duration of leaves of
identified and involved in all aspects of development absence for childbearing or child care.
from project start. Financial and manpower resources
must be well planned. Datasets should be as small as Mayor S. Report calls for clinical networks to improve
possible in order to make the collection of complete babies' survival. BMJ 2003; 326(7391):680.
and valid data realistically achievable. When
considering service-based information needs, Mayor S. WHO report shows public health impact of
considerable thought should be given to a multi- violence. BMJ 2002; 325(7367):731.
purpose; multi-use approach based on the most refined
minimum dataset possible. Maziak W. Smoking in Syria: profile of a developing Arab
country. Int J Tuberc Lung Dis 2002; 6(3):183-91.
Mayer KL, Ho HS, Goodnight JE Jr. Childbearing and child Abstract: One of the main obstacles to tobacco control
care in surgery. Arch Surg 2001; 136(6):649-55. in the Middle East lies in the shortage of reliable,
Abstract: HYPOTHESIS: The responsibility for standardised data on the spread and patterns of tobacco
childbearing and child care has a major effect on use in society. In Syria, a project aiming at drawing an
general surgical residency and subsequent surgical epidemiological map of the tobacco epidemic in this
practice. METHODS: A survey of all graduates from a country was started 4 years ago. Overall, nine studies
university general surgical training program between have resulted, with a total of 6780 participants. The
1989 and 2000. RESULTS: Twenty-seven women and crude prevalence of current smoking among adults in
44 men completed general surgical training at our Syria, based on combined information from all studies,
university during the period, and 42 (59%) responded is 48% and 9% for males and females, respectively.
to our survey. The age at completion of the residency The prevalence of current smoking among high school
was 34.0 +/- 2.2 years for men and 33.9 +/- 2.8 years adolescents is 16% and 7% for boys and girls,
for women. During residency, 64% (14/22) of the men respectively, and was strongly associated with parental
and 15% (3/20) of the women had children. At the time and sibling smoking. High school students from
of the survey, 21 (95%) of the men and 8 (40%) of the families with parents and/or siblings who smoked were
women had children. Most residents (24 [57%] of 42) 4.4 times more likely to be current smokers than those
relied on their spouse for child care. During surgical from non-smoking families. The biggest influx of new
practice, 18 (43%) indicated that they rely on their smokers among males in Syria is occurring in the early
spouse; 19 (45%) use day care, home care, or both; and twenties, but an earlier pattern can occur among youths
(8%) of 26 are unsatisfied with their current child care with low academic performance or socioeconomic
arrangement. During training, 38% (5/13) of men and status. Smoking in women, evaluated by data from
67% (2/3) of women took time off for maternity leave, physicians, tends to start later than in men and
paternity leave, or child care. Two of 3 surgeons would continues to increase with age. Women's smoking in
like to have had more time off during residency; most
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![Syria is related to their level of social liberalisation. 'region of interest' approaches usually adopted, and
Data show that active smoking is associated with an variable inclusion criteria for subjects across the autism
increased risk of respiratory diseases among smokers, spectrum. Moreover, despite a consensus that autism
and that exposure to environmental tobacco smoke probably affects widely distributed brain regions, the
(ETS) is associated with an increased risk of issue of anatomical connectivity has received little
respiratory symptoms in children. Knowledge about the attention. Therefore, we planned a fully automated
harmful effects of smoking and the desire to quit are voxel-based whole brain volumetric analysis in
disproportionate to the rate of successful cessation. The children with autism and normal IQ. We predicted that
evidence collected indicates possible avenues for brain structural changes would be similar to those
tobacco control in Syria, including price increases, previously shown in adults with autism spectrum
smoking cessation programmes, restriction of disorder and that a correlation analysis would suggest
adolescents' access to cigarettes, and intensive structural dysconnectivity. We included 17 stringently
prevention work among women. diagnosed children with autism and 17 age-matched
controls. All children had IQ >80. Using Brain
Mazzoni CM. The rights of the embryo and the foetus in Activation and Morphological Mapping (BAMM)
private law: the Italian experience. Law Hum Genome software, we measured global brain and tissue class
Rev 2002; (17):83-97. volumes and mapped regional grey and white matter
Notes: GENERAL NOTE: KIE: KIE Bib: embryo; differences across the whole brain. With the
embryo and fetal research; personhood expectation that volumes of interconnected regions
correlate positively, we carried out a preliminary
Mbassa Menick D, Ngoh F. [Psychological mistreatment of exploration of 'connectivity' in autism by comparing
children with sickle cell disease in Cameroon: the nature of inter-regional grey matter volume
description and analysis of 1 case]. Med Trop (Mars) correlations with control. Children with autism had a
2001; 61(2):163-8. significant reduction in total grey matter volume and
Abstract: Psychological maltreatment of a children significant increase in CSF volume. They had
with sickle-cell disease is a form of parental significant localized grey matter reductions within
dysfunction provoked by a crisis situation. In most fronto-striatal and parietal networks similar to findings
cases, this type of child abuse involves a relatively in our previous study, and additional decreases in
harmonious family going through a period of ventral and superior temporal grey matter. White
adaptation that jeopardizes its internal equilibrium. The matter was reduced in the cerebellum, left internal
weakest components of the family, i.e., the children, capsule and fornices. Correlation analysis revealed
become the scapegoats for the crisis. After a brief significantly more numerous and more positive grey
description of this disorder, the authors analyze the matter volumetric correlations in controls compared
different causes that lead to eruption of intra-familial with children with autism. Thus, using similar
violence. Several cultural, social, and economic factors diagnostic criteria and image analysis methods in
combine to trigger the maltreatment to which hapless otherwise healthy populations with an autistic spectrum
children with sickle-cell disease fall victim. Special disorder from different countries, cultures and age
legislation to provide appropriate child care is the only groups, we report a number of consistent findings.
alternative to prevent these situations from becoming Taken together, our data suggest abnormalities in the
chronic subject only to the socio-economic conditions anatomy and connectivity of limbic-striatal 'social'
of the parents and prevailing ethos. brain systems which may contribute to the brain
metabolic differences and behavioural phenotype in
McAliley LG, Daly BJ. Baby Grace. Hastings Cent Rep autism.
2002; 32(1):12; discussion 13-5.
Notes: GENERAL NOTE: KIE: KIE Bib: allowing to McBeth J, Morris S, Benjamin S, Silman AJ, Macfarlane GJ.
die/infants; treatment refusal/minors Associations between adverse events in childhood and
chronic widespread pain in adulthood: are they
McAlonan GM, Cheung V, Cheung C et al. Mapping the explained by differential recall? J Rheumatol 2001;
brain in autism. A voxel-based MRI study of 28(10):2305-9.
volumetric differences and intercorrelations in autism. Abstract: OBJECTIVE: Clinic based studies suggest
Brain 2005; 128(Pt 2):268-76. that adverse events in childhood may predispose to
Abstract: Autism is a disorder of neurodevelopment chronic pain in adult life. These have been conducted
resulting in pervasive abnormalities in social on highly selected groups, and it is unknown whether
interaction and communication, repetitive behaviours these relationships hold in the general population and
and restricted interests. There is evidence for functional to what extent the increased rate of adverse childhood
abnormalities and metabolic dysconnectivity in 'social events in persons with pain is an artefact of differential
brain' circuitry in this condition, but its structural basis reporting. We examined the hypothesis that chronic
has proved difficult to establish reliably. Explanations widespread pain was associated with reports of adverse
for this include replication difficulties inherent in experiences in childhood and whether any observed
relationships could be explained by differential recall.
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![0.001) and "know how to use" it (24% versus 4%, p < low TB incidence, frequently among groups whose
0.002). This study provides further support for the use drug use or other illegal activities complicate control
of tailored communication to address the prevention of efforts. TB programs should consider the use of
injuries to young children but calls for continued network analysis as a supplement to routine contact
investigation in the area. investigations to identify unrecognized patterns of M.
tuberculosis transmission.
McDougle CJ, Stigler KA, Posey DJ. Treatment of
aggression in children and adolescents with autism and McEvoy M, Lee C, O'Neill A et al. Are there universal
conduct disorder. J Clin Psychiatry 2003; 64 Suppl parenting concepts among culturally diverse families in
4:16-25. an inner-city pediatric clinic? J Pediatr Health Care
Abstract: The optimal clinical management of 2005; 19(3):142-50.
aggression in children and adolescents involves both Abstract: INTRODUCTION: Cultural competence is
behavioral and pharmacologic intervention strategies. necessary in providing care to culturally diverse
This article reviews medication treatments for families. Numerous studies have emphasized
youngsters with autistic disorder and conduct disorder, similarities and differences between predetermined
conditions for which the pharmacologic management cultural groups, yet few have studied groups across
of aggression is often necessary. Efficacy results and cultures. This project aimed to investigate parenting
associated adverse effects from selected clinical trials concepts, which in this context pertains to philosophy
of most classes of psychotropic medications are of parenting and child care practices across cultures.
discussed. While preliminary progress has been made METHOD: Using a grounded theory approach,
in the development of medication treatments for these ethnographic interviews of 46 families representing 27
serious disorders of youth, additional controlled countries were taped, transcribed, and analyzed.
research and longitudinal studies are needed to better RESULTS: Similarities in parenting concepts were
understand the efficacy and tolerability of currently found among families. Teaching values and respect and
available compounds within each diagnostic group. the need for strict discipline were important. A sense of
community, family, and spirituality/religion was
McDowell BM. Volunteering--a community partnership. J strong. Television was viewed as educational and
Spec Pediatr Nurs 2002; 7(3):121-2. parents anticipated opportunities for jobs and higher
education for their children. Parents were more
McElroy PD, Rothenberg RB, Varghese R et al. A network- inclined to use medical treatments than home remedies
informed approach to investigating a tuberculosis for acute illnesses, which may have been linked to the
outbreak: implications for enhancing contact finding that their providers had a strong influence.
investigations. Int J Tuberc Lung Dis 2003; 7(12 Suppl Parents feared children playing alone outdoors;
3):S486-93. distrusted nonfamily babysitters; and felt conflicted
Abstract: BACKGROUND: To elucidate networks of between a desire for cultural preservation versus
Mycobacterium tuberculosis transmission, it may be assimilation. DISCUSSION: Universal concepts in
appropriate to characterize the types of relationships parenting philosophies and practices exist among
among tuberculosis (TB) cases and their contacts (with culturally diverse families. Providers may approach
and without latent TB infection) in addition to relying anticipatory guidance by addressing global parental
on traditional efforts to distinguish 'close' from 'casual' concerns that transcend culture in order to relieve time
contacts. SETTING: A TB outbreak in a US low constraints and the overwhelming task of being
incidence state. OBJECTIVE: To evaluate whether knowledgeable about all cultures.
social network analysis can provide insights into
transmission settings that might otherwise go McFarlane A, Clark CR, Bryant RA et al. The impact of
unrecognized by routine practices. DESIGN: All adult early life stress on psychophysiological, personality
outbreak-associated cases (n = 19) and a convenience and behavioral measures in 740 non-clinical subjects. J
sample of their contacts with and without latent TB Integr Neurosci 2005; 4(1):27-40.
infection (LTBI) (n = 26) were re-interviewed in 2001 Abstract: Early Life Stress (ELS) has been associated
using a structured questionnaire. Network analysis with a range of adverse outcomes in adults, including
software was used to create diagrams illustrating abnormalities in electrical brain activity [1], personality
important persons within the outbreak network, as well dimensions [40], increased vulnerability to substance
as types of activities TB cases engaged in with their abuse and depression [14]. The present study seeks to
contacts. RESULTS: Drug use and drug sharing were quantify these proposed effects in a large sample of
more commonly reported among cases and their non-clinical subjects. Data for the study was obtained
infected contacts than among contacts without LTBI. from The Brain Resource International Database (six
TB cases central to the outbreak network used crack laboratories: two in USA, two in Europe, two in
cocaine, uncovering the need to focus control efforts on Australia). This study analyzed scalp
specific sites and persons involved in illicit drug use. electrophysiological data (EEG eyes open, closed and
CONCLUSION: Outbreaks occur even in areas with target auditory oddball data) and personality (NEO-
FFI), history of addictive substance use and ELS) data
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![that was acquired from 740 healthy volunteers. The McGeary J. The costs of penance. Time 2002; 159(12):53-4.
ELS measures were collected via a self-report measure
and covered a broad range of events from childhood McGee R, Williams S, Nada-Raja S. Is cigarette smoking
sexual and physical abuse, to first-hand experience of associated with suicidal ideation among young people?
traumatizing accidents and sustained domestic conflict Am J Psychiatry 2005; 162(3):619-20.
[41]. Analysis of covariance, controlling for age and Abstract: OBJECTIVE: The authors examined the
gender, compared EEG data from subjects exposed to association between suicidal ideation in early
ELS with those who were unexposed. ELS was adulthood and daily tobacco smoking in a community
associated with significantly decreased power across sample of adolescents. METHOD: Participants were
the EEG spectrum. The between group differences enrolled in a longitudinal study of health and
were strongest in the eyes closed paradigm, where development. The factors of disadvantage,
subjects who experienced ELS showed significantly impulsiveness, stress, depressed mood, tobacco
reduced beta (F1,405=12.37, p=.000), theta smoking, other substance use, and parental attachment
(F1,405=20.48, p=.000), alpha (F1,405=9.65, p=.002) were included in multivariate modelling of suicidal
and delta power (F1,450=36.22, p=.000). ELS exposed ideation. RESULTS: Data on tobacco use were
subjects also showed a significantly higher alpha peak available for 764 participants. Early tobacco smoking
frequency (F1,405=6.39, p=.012) in the eyes closed was significantly predictive of later suicidal ideation,
paradigm. Analysis of covariance on ERP components but there was no longer a significant relationship when
revealed that subjects who experienced ELS had high levels of stress and depression and low levels of
significantly decreased N2 amplitude (F1,405=7.73, parental attachment in adolescence were included in
p=.006). Analyses of variance conducted on measures the multivariate model. CONCLUSIONS: Tobacco
of personality revealed that subjects who experienced smoking in adolescence does not appear to elevate the
ELS had significantly higher levels of neuroticism risk of later suicidal ideation.
(F1,264=13.39, p=.000) and openness (F1,264=17.11,
p=.000), but lower levels of conscientiousness, than McGillicuddy NB, Rychtarik RG, Morsheimer ET.
controls (F1,264=4.08, p=.044). The number of ELS Psychometric evaluation of the parent situation
events experienced was shown to be a significant inventory: a role-play measure of coping in parents of
predictor of scores on the DASS questionnaire [27], substance-using adolescents. Psychol Assess 2004;
which rates subjects on symptoms of depression 16(4):386-90.
(F3,688=16.44, p=.000, R2=.07), anxiety Abstract: This article reports on the generalizability,
(F3,688=14.32, p=.000, R2=.06) and stress reliability, and construct validity of the Parent Situation
(F3,688=20.02, p=.000, R2=.08). Each additional early Inventory (PSI), a role-play measure of coping skills in
life stressor was associated with an increase in these parents experiencing problems from an adolescent's
scores independent of age, gender and the type of drug and alcohol use. Generalizability was robust (.80)
stressor. Furthermore, the number of ELS experiences and alternate form and test-retest reliability were
among smokers was also found to be a positive satisfactory. PSI skillfulness was negatively related to
predictor of the nicotine dependency score (Faegstrom the parent's own substance use and to the adolescent's
Test For Nicotine Dependence, [19]) (F3,104=10.99, alcohol use. The PSI shows promise as a reliable and
p=.000, R2=.24), independent of age, gender and type potentially valid measure of coping in this population
of stressor. In conclusion, we highlight the impact of a and has direct implications for developing and
history of ELS showed significant effects on brain evaluating skill-based parent training programs.
function (EEG and ERP activity), personality
dimensions and nicotine dependence. McGinn D. Father fixit. Newsweek 2002; 139(19):42-3.
McGarvey TP, Haen C. Intervention strategies for treating McGlade MS, Saha S, Dahlstrom ME. The Latina paradox:
traumatized siblings on a pediatric inpatient unit. Am J an opportunity for restructuring prenatal care delivery.
Orthopsychiatry 2005; 75(3):395-408. Am J Public Health 2004; 94(12):2062-5.
Abstract: This article examines the course of treatment Abstract: Latina mothers in the United States enjoy
for 2 traumatized siblings in an acute inpatient child surprisingly favorable birth outcomes despite their
psychiatric unit following severe physical abuse by social disadvantages. This "Latina paradox" is
their mother. In treating these 2 boys, the authors used particularly evident among Mexican-born women. The
intervention strategies that can be applied to the social and cultural factors that contribute to this
treatment of other traumatized siblings in institutional paradox are maintained by community networks--
settings. Issues of self-worth, survivor guilt, and informal systems of prenatal care that are composed of
conflictual sibling dynamics are illustrated as they family, friends, community members, and lay health
relate to the treatment. In addition, transference- workers. This informal system confers protective
countertransference dynamics are examined. factors that provide a behavioral context for healthy
births. US-born Latinas are losing this protection,
McGeary D. Editorial board's eye view. Emerg Nurse 2003; although it could be maintained with the support of
11(2):9.
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![stays (10.1 days vs 4.6 days), and longer hospital deviation]) was significantly higher than SNAP for
length of stays (25.5 days vs 14 days). Most predictive survivors (13 +/- 6.1). However, this difference
of noncompliance was the number of medical diminished steadily and by DOL 10 was no longer
appointments ordered by physicians. Patients with 3 or statistically significant (12.7 +/- 4.9 vs 10.0 +/- 4.8).
more appointments were less likely to be compliant On each NICU day, at all ranges of SNAP scores, there
with follow-up. After hospital discharge, children were were at least as many infants who would ultimately
more likely to visit a primary care physician compared survive as would die. Consequently, the positive
with a subspecialist (95% vs 82%). When patients were predictive value of any SNAP value for subsequent
ordered to see a specialist, scheduled appointments mortality was <0.5 on all NICU days. Prediction
were much better attended than the recommended profiles were obtained for 230 ventilated infants
appointments (92% vs 67%). CONCLUSIONS: Lack reflecting over 11 000 intuitions obtained on 2867
of ordered medical follow-up did not affect emergent patient days. One hundred fifty-seven (81%) of 192
visits. In this group of critically ill children, a survivor profiles displayed consistent accurate
significant percentage (28%) did not receive timely prediction profiles-at least 90% of their NICU
medical follow-up. No socioeconomic or demographic ventilation days were characterized by 100% prediction
risk factors were identified in noncompliant children. of survival. Twenty-five (13%) of 192 surviving
However, severity of illness (higher peak pediatric risk infants survived somewhat unexpectedly; that is, after
of mortality score, longer PICU stay, and longer at least 1 day characterized by at least 1 estimate of
hospital stay) and the number of follow-up "death." Thirty-three (60%) of the 55 nonsurvivors died
appointments ordered were predictors of before DOL 10. Eighty-two percent of the prediction
noncompliance. Potential exists for implementing profiles for these early dying infants were
strategies to improve compliance in identified homogeneous, dismal, and accurate. Twenty-two
populations. (40%) of the 55 nonsurvivors died after DOL 10.
Seventeen (78%) of these 22 late-dying infants were
McQuoid-Mason D. Parental refusal of blood transfusions predicted to live by many observers on many hospital
for minor children solely on religious grounds--the days. Sixty-one (30%) of 230 profiled patients had at
doctor's dilemma resolved. S Afr Med J 2005; least 1 NICU day characterized by at least 1 prediction
95(1):29-30. of death; 26/61 (43%) of these patients were
Notes: GENERAL NOTE: KIE: KIE Bib: treatment incorrectly predicted; that is, they survived. Seventeen
refusal/minors infants who were predicted to die during but survived
nonetheless were assessed neurologically at 1 year.
Meacham J. Sex and the church. A case for change. Fourteen (82%) of these 17 were not neurologically
Newsweek 2002; 139(18):22-32. normal-8 were clearly abnormal, 1 suspicious, and 5
had died. CONCLUSIONS: If absolute certainty about
Meadow W, Frain L, Ren Y, Lee G, Soneji S, Lantos J. mortality is the only criterion that can justify a decision
Serial assessment of mortality in the neonatal intensive to withhold or withdraw life-sustaining treatment in the
care unit by algorithm and intuition: certainty, NICU, these data would make such decisions difficult
uncertainty, and informed consent. Pediatrics 2002; on the first day of life, and increasingly problematic
109(5):878-86. thereafter. However, if we acknowledge that medicine
Notes: GENERAL NOTE: KIE: 40 refs. is inevitably an inexact science and that clinical
GENERAL NOTE: KIE: KIE Bib: allowing to predictions can never be perfect, we can ask the more
die/infants; patient care/minors interesting question of whether good but less-than-
Abstract: OBJECTIVES: Does predictive power for perfect predictions of imprecise but ethically relevant
outcomes of neonatal intensive care unit (NICU) clinical outcomes can still be useful. We think that they
patients get better with time? Or does it get worse? We can-and that they must.
determined the predictive power of Score for Neonatal
Acute Physiology (SNAP) scores and clinical intuitions Meadows LM, Thurston WE, Lackner S. Whealth study:
as a function of day of life (DOL) for newborn infants women's reports of childhood abuse. Health Care
admitted to our NICU. METHODS: We identified 369 Women Int 2001; 22(5):439-54.
infants admitted to our NICU during 1996-1997 who Abstract: Most samples of adult women will contain a
required mechanical ventilation. We calculated SNAP significant proportion who have been or are currently
scores on DOL 1, 3, 4, 5, 7, 10, 14, 21, 28, and weekly in abusive relationships. While past research has linked
thereafter until either death or extubation. We also childhood abuse of girls to adult health concerns, little
asked nurses, residents, fellows, and attendings on each is known about the process through which women
day of mechanical ventilation: "Do you think this child retrospectively reconcile these experiences. This article
is going to live to go home to their family, or die before reports on data collected in an ongoing project on
hospital discharge?" RESULTS: Two thousand twenty- midlife women's health. Twenty-seven of 50 urban,
eight SNAP scores were calculated for 285 infants. On middle-class participants in this phase of the project
DOL 1, SNAP for nonsurvivors (24 +/- 8.7 [standard reported childhood abuse experiences. In the analysis,
several aspects of these experiences were identified:
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![find an association between either HIV status or Menick DM. [Sexual abuse at schools in Cameroon: results
prenatal drug exposure and poor behavioral outcomes. of a survey-action program in Yaounde]. Med Trop
The strongest correlates of increased behavioral (Mars) 2002; 62(1):58-62.
symptoms were demographic characteristics. Abstract: The purpose of this questionnaire-based
CONCLUSIONS: This study suggests that although a study was to determine the incidence of sexual abuse in
high prevalence of behavioral problems does exist schools in Yaounde, Cameroon, to assess the extent of
among HIV-infected children, neither HIV infection teacher involvement in such acts and to provide
nor prenatal drug exposure is the underlying cause. children an opportunity to come forward with their
Rather, other biological and environmental factors are experiences. The author hypothesized that the number
likely contributors toward poor behavioral outcomes. of sexual abuse victims was increasing and that the
most frequent abusers were teachers, school staff, and
Melton GB. Mandated reporting: a policy without reason. classmates. To check this hypothesis, a total of 1710
Child Abuse Negl 2005; 29(1):9-18. questionnaires were sent to 10 public and private
secondary schools between January 4 and April 30,
Menard CB, Bandeen-Roche KJ, Chilcoat HD. 1999. The response rate was 98.7%. A total of 269
Epidemiology of multiple childhood traumatic events: students reported being sexual abused before the age of
child abuse, parental psychopathology, and other 16 for an overall incidence of 15.9%. There were 74
family-level stressors. Soc Psychiatry Psychiatr boys (27.5%) and 195 girls (72.5%) with a mean age
Epidemiol 2004; 39(11):857-65. 11.6 years (range 4 to 15 years) at the time of abuse.
Abstract: BACKGROUND: Multiple family-level Sexual abuse involved rape in 38.7% of cases, fondling
childhood stressors are common and are correlated. It in 54.6% and pornographic scenes in 6.7%. Of the 274
is unknown if clusters of commonly co-occurring sexual abusers identified, 86.5% were men and 13.5%
stressors are identifiable. The study was designed to were women. Sexual abuse took place within the
explore family-level stressor clustering in the general family in 31.4% of cases and outside the family setting
population, to estimate the prevalence of exposure 68.6%. Sexual abuse occurred in a school setting in
classes, and to examine the correlation of approximately 15% of cases and involved classmates in
sociodemographic characteristics with class approximately 30%. The alleged extrafamilial abusers
prevalence. METHOD: Data were collected from an were teachers in 7.9% of cases and tutors in 7.6%.
epidemiological sample and analyzed using latent class Survey data supports the working hypothesis of this
regression. RESULTS: A six-class solution was study and warrants implementation of a program to
identified. Classes were characterized by low risk prevent sexual abuse in schools.
(prevalence=23%), universal high risk (7 %), family
conflict (11 %), household substance problems (22 %), Menikoff J. The involuntary research subject. Camb Q
non-nuclear family structure (24 %), parent's mental Healthc Ethics 2004; 13(4):338-45.
illness (13 %). CONCLUSIONS: Class prevalence Notes: GENERAL NOTE: KIE: 20 refs.
varied with race and welfare status, not gender. GENERAL NOTE: KIE: KIE Bib: genetic screening;
Interventions for childhood stressors are person- human experimentation/informed consent; human
focused; the analytic approach may uniquely inform experimentation/minors
resource allocation.
Mercer J. Coercive restraint therapies: a dangerous
Menick DM. [Problems of child sexual abuse in Africa or alternative mental health intervention. MedGenMed
the imbroglio of a double paradox: the example of 2005; 7(3):6.
Cameroon]. Child Abuse Negl 2001; 25(1):109-21. Abstract: Physicians caring for adopted or foster
Abstract: OBJECTIVE: This study has investigated the children should be aware of the use of coercive
prevalence of sexual abuse cases in Cameroon (Africa) restraint therapy (CRT) practices by parents and mental
and approached the way these cases are solved. health practitioners. CRT is defined as a mental health
METHOD: 405 medical certificates have been intervention involving physical restraint and is used in
reviewed within a three years period. RESULTS: Over adoptive or foster families with the intention of
405 medical certificates, 19 cases of sexual abuse have increasing emotional attachment to parents. Coercive
been identified. All the victims were girls. The great restraint therapy parenting (CRTP) is a set of child care
majority of them were aged 10-14 (57.9%) and 15-19 practices adjuvant to CRT. CRT and CRTP have been
(31.6%). The sexual assaults have been perpetrated out associated with child deaths and poor growth.
of the family. CONCLUSION: The results show Examination of the CRT literature shows a conflict
evidence of sexual abuse cases in Africa. Friendly with accepted practice, an unusual theoretic basis, and
adjustments by private contracts and family an absence of empirical support. Nevertheless, CRT
interventions with financial amends for the parents of appears to be increasing in popularity. This article
the victims are often preferred to the court of justice, discusses possible reasons for the increase, and offers
because of poverty, cultural pressures and judicial suggestions for professional responses to the CRT
injunctions. problem.
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![Mercer JA. The Protestant child, adolescent, and family. and hospitalizations (IRR, 0.57; CI, 0.36-0.92; P =
Child Adolesc Psychiatr Clin N Am 2004; 13(1):161- 0.02). Death of a parent with HIV was associated with
81, ix. a threefold increase in mortality among HIV-negative
Abstract: This article addresses Protestant Christianity children < 10 years old (hazard ratio, 2.9; CI, 1.1-8.1; P
as an often-overlooked but significant factor in clinical = 0.04). Of 134 bacterial isolates from family members
work with children and adolescents. Noting the wide before cotrimoxazole treatment, 89 (66%) were
range of beliefs and practices among Protestants, the resistant to cotrimoxazole; of 75 recovered during
article identifies key tenets of Protestant faith that cotrimoxazole treatment, 54 (72%) were resistant (P =
shape the worldviews of children, adolescents, and 0.41). INTERPRETATION: Cotrimoxazole
their families. Clinical implications of these beliefs are prophylaxis taken by persons with HIV was associated
explored, with particular attention to three potentially with decreased morbidity and mortality among family
psychopathologic features: the religious legitimation of members. Antimicrobial resistance among diarrheal
child maltreatment; paranormal, direct experiences of pathogens infecting family members did not increase.
the divine through unusual perceptions such as trance Concerns regarding the spread of bacterial resistance
states or visions deemed normal within their religious should not impede implementation of cotrimoxazole
context but that may also evidence serious pathology; programs.
and sexuality issues of particular significance for
adolescents. Research suggests that Protestant beliefs Mermin J, Lule J, Ekwaru JP et al. Effect of co-trimoxazole
also constitute resources for clinical work because they prophylaxis on morbidity, mortality, CD4-cell count,
appear to be protective factors in relation to depression, and viral load in HIV infection in rural Uganda. Lancet
avoidance of high-risk behaviors, and other measures 2004; 364(9443):1428-34.
of resiliency among adolescents. Clinicians who do not Abstract: BACKGROUND: Prophylaxis with co-
take the Protestant Christian family's religious/spiritual trimoxazole (trimethoprim-sulphamethoxazole) is
worldview into consideration in case formulation risk recommended for people with HIV infection or AIDS
misunderstanding or alienating them from treatment. but is rarely used in Africa. We assessed the effect of
The article concludes with suggestions for such prophylaxis on morbidity, mortality, CD4-cell
collaboration. count, and viral load among people with HIV infection
living in rural Uganda, an area with high rates of
Merk T. Beyond the burns. Managing the pain & bacterial resistance to co-trimoxazole. METHODS:
consequences of pediatric burns. JEMS 2001; 26(9):66- Between April, 2001, and March, 2003, we enrolled,
75; quiz 76-7. and followed up with weekly home visits, 509
individuals with HIV-1 infection and their 1522 HIV-
Mermin J, Lule J, Ekwaru JP et al. Cotrimoxazole negative household members. After 5 months of
prophylaxis by HIV-infected persons in Uganda follow-up, HIV-positive participants were offered daily
reduces morbidity and mortality among HIV- co-trimoxazole prophylaxis (800 mg trimethoprim, 160
uninfected family members. AIDS 2005; 19(10):1035- mg sulphamethoxazole) and followed up for a further
42. 1.5 years. We assessed rates of malaria, diarrhoea,
Abstract: BACKGROUND: The effect of hospital admission, and death. FINDINGS: Co-
cotrimoxazole prophylaxis taken by persons with HIV trimoxazole was well tolerated with rare (<2% per
on community health and antimicrobial resistance is person-year) adverse reactions. Even though rates of
unknown. OBJECTIVE: To assess the effect of resistance in diarrhoeal pathogens were high (76%),
cotrimoxazole prophylaxis taken by persons with HIV co-trimoxazole prophylaxis was associated with a 46%
on morbidity, mortality, and antimicrobial resistance of reduction in mortality (hazard ratio 0.54 [95% CI 0.35-
diarrheal pathogens infecting their HIV-negative 0.84], p=0.006) and lower rates of malaria
family members. DESIGN: Prospective cohort in rural (multivariate incidence rate ratio 0.28 [0.19-0.40],
Uganda. METHODS: A total of 879 persons with HIV p<0.0001), diarrhoea (0.65 [0.53-0.81], p<0.0001), and
and 2771 HIV-negative family members received hospital admission (0.69 [0.48-0.98], p=0.04). The
weekly home-visits. After 5 months, persons with HIV annual rate of decline in CD4-cell count was less
received daily cotrimoxazole prophylaxis and during prophylaxis than before (77 vs 203 cells per
households were followed for an average of 17 microL, p<0.0001), and the annual rate of increase in
additional months. FINDINGS: During the study, 224 viral load was lower (0.08 vs 0.90 log(10) copies per
participants with HIV (25%) and 29 household mL, p=0.01). INTERPRETATION: Daily co-
members (1%) died. Mortality among HIV-negative trimoxazole prophylaxis was associated with reduced
family members < 10 years old was 63% less during morbidity and mortality and had beneficial effects on
the cotrimoxazole period than before [hazard ratio, CD4-cell count and viral load. Co-trimoxazole
0.37; 95% confidence interval (CI), 0.14-0.95; P = prophylaxis is a readily available, effective intervention
0.04]. Malaria among family members was less for people with HIV infection in Africa.
common during cotrimoxazole treatment [incidence
rate ratio (IRR), 0.62; CI, 0.53-0.74; P < 0.0001], as Merry S, McDowell H, Hetrick S, Bir J, Muller N.
were diarrhea (IRR, 0.59; CI, 0.45-0.76; P = 0.0001), Psychological and/or educational interventions for the
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![occurs in adolescence with a disproportionate increase a higher prevalence in the mothers of children born
in prevalence rates for girls, it is likely that girls and with isolated OFCs (cases). CONCLUSIONS: Some
boys will respond differently to interventions. maternal diseases are risk factors for the pathogenesis
Although differences have been reported in studies in of isolated OFCs. It is worth considering the prevention
this review the findings are contradictory and a more of possible harmful effects of influenza by vaccination
definitive delineation of gender specific responses to during the expected epidemic period.
interventions would be helpful.
Mettner J. Champion of children. Minn Med 2003; 86(3):8-
Merskey H. Abuse and ACTH response to corticotropin- 12.
releasing factor. Am J Psychiatry 2002; 159(1):157;
author reply 157-8. Metzger X. [Data aggregation in measuring inequalities and
inequities in the health of populations]. Rev Panam
Mertin P, Mohr PB. Incidence and correlates of posttrauma Salud Publica 2002; 12(6):445-53.
symptoms in children from backgrounds of domestic Abstract: OBJECTIVES: To compare how different
violence. Violence Vict 2002; 17(5):555-67. degrees of data aggregation influence the measurement
Abstract: In recent years, evidence has emerged of the of health inequalities and health inequities within a
presence of posttrauma symptoms in children from population, and to assess the appropriateness of those
backgrounds of domestic violence. The present study different degrees of data aggregation in performing
examined the incidence and correlates of posttrauma studies on inequalities and inequities. METHODS: As
symptoms in 56 children of mothers who had been an example, we used data on the infant mortality rate in
residents in women's shelters in Adelaide, South Costa Rica in 1973 and in 1984 and calculated
Australia. The most frequently endorsed symptoms measurements that are frequently used to quantify
among this sample of children were being troubled by inequalities and inequities. RESULTS: According to
distressing thoughts, conscious avoidance, our results, the inequality measures presented (except
hypervigilance, and sleep difficulties. Twenty percent for those that were derived using regression models)
of children met the criteria for a diagnosis of are not sensitive to data aggregation by socioeconomic
posttraumatic stress disorder (PTSD). Children meeting groups. However, when geographic areas are
full PTSD criteria scored significantly higher on compared, more disaggregation of the data results in
measures of anxiety, depression, and dissociation. the measures indicating greater inequality.
Results support the use of a posttrauma framework for CONCLUSIONS: Our results show that some
understanding the effects on children of living with measures can vary widely depending on the level of
domestic violence. data aggregation. It is thus crucial to know how to
select these measures and also how to aggregate the
Metneki J, Puho E, Czeizel AE. Maternal diseases and data in a way that is consistent with the objectives of
isolated orofacial clefts in Hungary. Birth Defects Res each study.
A Clin Mol Teratol 2005; 73(9):617-23.
Abstract: BACKGROUND: Isolated orofacial clefts Meyer-Bahlburg HF. Child-adult sexual contact:
(OFCs) are likely to be caused by gene-environment terminology. Arch Sex Behav 2002; 31(2):157.
interaction; therefore, the objective of the current study
was to evaluate the possible association between all Meyers LA, Pourbohloul B, Newman ME, Skowronski DM,
maternal diseases during pregnancy and isolated cleft Brunham RC. Network theory and SARS: predicting
lip with or without cleft palate (CL+/-CP) and posterior outbreak diversity. J Theor Biol 2005; 232(1):71-81.
cleft palate (PCP) in the offspring. METHODS: The Abstract: Many infectious diseases spread through
database of the large population-based Hungarian populations via the networks formed by physical
Case-Control Surveillance of Congenital contacts among individuals. The patterns of these
Abnormalities, 1980-1996, was evaluated. The contacts tend to be highly heterogeneous. Traditional
database includes 1374 cases with isolated CL+/- CP "compartmental" modeling in epidemiology, however,
and 601 with PCP, plus 38,151 matched population assumes that population groups are fully mixed, that is,
controls (without defects) and 20,868 patient controls every individual has an equal chance of spreading the
with other defects. Data collection was based on disease to every other. Applications of compartmental
prospective medical records, retrospective maternal models to Severe Acute Respiratory Syndrome (SARS)
data via a self-reported questionnaire, and home visits resulted in estimates of the fundamental quantity called
of nonresponding families. RESULTS: An increased the basic reproductive number R0--the number of new
risk for isolated CL+/- CP was found for children born cases of SARS resulting from a single initial case--
to mothers with influenza, common cold, orofacial above one, implying that, without public health
herpes, and gastroenteritis during pregnancy. Risk for intervention, most outbreaks should spark large-scale
isolated PCP was increased in children of mothers with epidemics. Here we compare these predictions to the
influenza, sinusitis, and bronchitis. Among chronic early epidemiology of SARS. We apply the methods of
maternal diseases, epilepsy and angina pectoris showed contact network epidemiology to illustrate that for a
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![single value of R0, any two outbreaks, even in the distinguishing bipolar from attention-
same setting, may have very different epidemiological deficit/hyperactivity disorder subjects.
outcomes. We offer quantitative insight into the CONCLUSIONS: While there was a significant
heterogeneity of SARS outbreaks worldwide, and heterogeneity in estimates between studies, a consistent
illustrate the utility of this approach for assessing pattern of elevations in inattention/hyperactivity,
public health strategies. depression/anxiety, and aggression was identified.
Michalowski S. Reversal of fortune--Re A (Conjoined Middeldorp S, Peters M. [Diagnostic image (177). A lifeless
Twins) and beyond: who should make treatment infant. Shaken baby syndrome]. Ned Tijdschr
decisions on behalf of young children? Health Law J Geneeskd 2004; 148(23):1168; author reply 1168.
2001; 9:149-69.
Notes: GENERAL NOTE: KIE: 74 fn. Mifflin P. Protection of children born with severe
GENERAL NOTE: KIE: KIE Bib: informed disabilities. Part 1: The legal framework. Pract
consent/minors Midwife 2001; 4(1):30-1.
Michalowski S. Sanctity of life--are some lives more sacred Mifflin P. Protection of children born with severe
than others? Leg Stud (Soc Leg Scholars) 2002; disabilities. Part 2: Some relevant cases and their
22(3):377-97. implications. Pract Midwife 2001; 4(2):30-1.
Notes: GENERAL NOTE: KIE: 105 fn.
GENERAL NOTE: KIE: KIE Bib: allowing to Mifflin PC. Jodie and Mary. Ethical and legal implications
die/infants; allowing to die/legal aspects; patient of separating conjoined twins. Pract Midwife 2001;
care/minors 4(7):48-9.
Abstract: Court decisions concerning the life and death
of patients become more and more frequent in the Mijanovich T, Weitzman BC. Which "broken windows"
context of medical practice. One of the most matter? School, neighborhood, and family
controversial decisions in this area in recent years has characteristics associated with youths' feelings of
been the decision of the Court of Appeal in Re A unsafety. J Urban Health 2003; 80(3):400-15.
(Conjoined Twins: Medical Treatment), authorising the Abstract: Young people's fears of victimization and
separation of conjoined twins. This paper will argue feelings of unsafety constitute a serious and pervasive
that the decision was flawed both on legal and moral public health problem and appear to be associated with
grounds and that its potential implications for future different factors than actual victimization. Our analysis
cases are more far-reaching than the judgment itself of a population-based telephone survey of youths aged
suggests. 10-18 years in five economically distressed cities and
their suburbs reveals that a substantial minority of
Mick E, Biederman J, Pandina G, Faraone SV. A youths feel unsafe on any given day, and that an even
preliminary meta-analysis of the child behavior greater number feel unsafe in school. While some
checklist in pediatric bipolar disorder. Biol Psychiatry traditional predictors of victimization (such as low
2003; 53(11):1021-7. socioeconomic status) were associated with feeling
Abstract: BACKGROUND: A possible explanation for unsafe, perceived school disorder was the major factor
the ongoing controversy surrounding pediatric bipolar associated with such feelings. Disorderliness may thus
disorder is that differences in assessment be the school's version of "broken windows," which
methodologies lead to conflicting results. One way to serve to signal to students a lack of consistent adult
address methodological differences in assessment concern and oversight that can leave them feeling
across studies is to use a single standardized unsafe. We suggest that fixing the broken windows of
assessment of psychopathology to calibrate the school disorderliness may have a significant, positive
findings reported in different studies. To this end, we impact on adolescents' feelings of safety.
conducted a meta-analysis of several studies that have
employed the Child Behavior Checklist in the Mikropoulos TA, Strouboulis V. Factors that influence
assessment of children with a diagnosis of bipolar presence in educational virtual environments.
disorder. METHODS: MEDLINE was searched for all Cyberpsychol Behav 2004; 7(5):582-91.
publications that utilized the Child Behavior Checklist Abstract: The present article is a part of a project for
in addition to structured diagnostic interviews to assess the measurement of presence in educational virtual
pediatric bipolar disorder. Random effects models were environments (VEs), since presence is correlated with
used to calculate combined estimates of Child Behavior higher levels of cognitive performance and emotional
Checklist clinical subscales. RESULTS: Children with development, factors that contribute to knowledge
bipolar disorder had scaled scores of >70 in the construction. The aim of our study was to investigate
Aggression, Attention Problems, and the sense of presence of 12-year-old pupils within an
Anxious/Depressed subscales of the Child Behavior educational VE representing an ancient Greek house
Checklist. The Child Behavior Checklist was useful in through a sense of embodiment and the ability to
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![Minkovitz CS, Hughart N, Strobino D et al. A practice- with someone at the practice (OR, 0.95 [95% CI, 0.56
based intervention to enhance quality of care in the first to 1.63] and OR, 2.82 [95% CI, 1.57 to 5.08]).
3 years of life: the Healthy Steps for Young Children CONCLUSION: Universal, practice-based
Program. JAMA 2003; 290(23):3081-91. interventions can enhance quality of care for families
Abstract: CONTEXT: There is growing concern of young children and can improve selected parenting
regarding the quality of health care available in the practices.
United States for young children, and specific
limitations have been noted in developmental and Minns RA, Busuttil A. Patterns of presentation of the shaken
behavioral services provided for children in the first 3 baby syndrome: four types of inflicted brain injury
years of life. OBJECTIVE: To determine the impact of predominate. BMJ 2004; 328(7442):766.
the Healthy Steps for Young Children Program on
quality of early childhood health care and parenting Mintz Y, Shapira SC, Pikarsky AJ et al. The experience of
practices. DESIGN, SETTING, AND one institution dealing with terror: the El Aqsa Intifada
PARTICIPANTS: Prospective controlled clinical trial riots. Isr Med Assoc J 2002; 4(7):554-6.
enrolling participants between September 1996 and Abstract: BACKGROUND: During a period of 13
November 1998 at 6 randomization and 9 quasi- months--1 October 2000 to 31 October 2001--586
experimental sites across the United States. Participants terror assault casualties were treated in the trauma unit
were 5565 children enrolled at birth and followed up and emergency department of Hadassah University
through age 3 years. INTERVENTION: Incorporation Hospital (Ein Kerem campus); 27% (n = 158) were
of developmental specialists and enhanced hospitalized and the rest were discharged within 24
developmental services into pediatric care in hours. OBJECTIVES: To analyze the special
participants' first 3 years of life. MAIN OUTCOME requirements of a large number of victims who
MEASURES: Quality of care was operationalized received treatment during a short period. METHODS:
across 4 domains: effectiveness (eg, families received Data were attained from the main admitting office and
> or =4 Healthy Steps-related services or discussed >6 the trauma registry records. Factors analyzed included
anticipatory guidance topics), patient-centeredness (eg, age, gender, mechanism of injury, anatomic site of
families were satisfied with care provided), timeliness injury, Injury Severity Score, and length of stay.
(eg, children received timely well-child visits and RESULTS: Males comprised 81% of the hospitalized
vaccinations), and efficiency (eg, families remained at patients. The majority of the injuries (70%) were due to
the practice for > or =20 months). Parenting outcomes gunshot wounds and 31% of the hospitalized patients
included response to child misbehavior (eg, use of were severely injured (ISS > or = 16). Twelve patients
severe discipline) and practices to promote child died, yielding a mortality rate of 7.5%.
development and safety (eg, mothers at risk for CONCLUSION: The nature of the injuries was more
depression discussed their sadness with someone at the complex and severe than trauma of other etiologies, as
practice). RESULTS: Of the 5565 enrolled families, noted by the mean length of stay (10.2 vs. 7.2 days),
3737 (67.2%) responded to an interview at 30 to 33 mean intensive care unit stay (2.8 vs. 0.9 days), and
months (usual care, 1716 families; Healthy Steps, 2021 mean operations per patient (0.7 vs. 0.5). The mean
families). Families who participated in the Healthy insurance cost for each hospitalized terror casualty was
Steps Program had greater odds of receiving 4 or more also higher than for other trauma etiologies (US$ 3,200
Healthy Steps-related services (for randomization and vs. 2,500).
quasi-experimental sites, respectively: odds ratio [OR],
16.90 [95% confidence interval [CI], 12.78 to 22.34] Mirsal H, Kalyoncu A, Pektas O, Tan D, Beyazyurek M.
and OR, 23.05 [95% CI, 17.38 to 30.58]), of discussing Childhood trauma in alcoholics. Alcohol Alcohol 2004;
more than 6 anticipatory guidance topics (OR, 8.56 39(2):126-9.
[95% CI, 6.47 to 11.32] and OR, 12.31 [95% CI, 9.35 Abstract: AIMS: Many studies have been conducted to
to 16.19]), of being highly satisfied with care provided evaluate the relationship between childhood trauma
(eg, someone in the practice went out of the way for and alcoholism. In this study 80 alcoholics were chosen
them) (OR, 2.06 [95% CI, 1.64 to 2.58] and OR, 2.11 according to their hospitalization order. The control
[95% CI, 1.72 to 2.59]), of receiving timely well-child group consisted of 60 subjects, with no history of
visits and vaccinations (eg, age-appropriate 1-month alcohol use, matched with the patient group in age and
visit) (OR, 1.98 [95% CI, 1.08 to 3.62] and OR, 2.11 sex. METHODS: A sociodemographic and clinical data
[95% CI, 1.16 to 3.85]), and of remaining at the form, a questionnaire focusing on traumatic life
practice for 20 months or longer (OR, 2.02 [95% CI, experiences in childhood and The Childhood Trauma
1.61 to 2.55] and OR, 1.75 [95% CI, 1.43 to 2.15]). Questionnaire, Hamilton Depression Rating Scale, and
They also had reduced odds of using severe discipline Hamilton Anxiety Rating Scale were applied to both
(eg, slapping in face or spanking with object) (OR, groups. RESULTS: Significant differences were found
0.82 [95% CI, 0.54 to 1.26] and OR, 0.67 [95% CI, between the two groups on traumatic life experiences
0.46 to 0.97]). Among mothers considered at risk for in childhood. Results suggested that childhood trauma
depression, those who participated in the Healthy Steps positively correlates with anxiety and affective
Program had greater odds of discussing their sadness
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![[RR], 1.6; 95% confidence interval [CI], 1.0-2.5). Both Monagle P, Robb B, Driscoll S, Bowes G. Organ retention
boys and girls reported "being disrespected" and following paediatric and perinatal autopsy: where to
"teasing" as popular reasons for a fight. Events from here? J Paediatr Child Health 2002; 38(4):405-8.
involving girls were more commonly related to a
"recurrence of a previous fight" (RR, 6.4; 95% CI, 1.9- Mondaini N, Ponchietti R, Gontero P et al. Penile length is
21.5), were more likely to end because of adult normal in most men seeking penile lengthening
intervention (RR, 1.7; 95% CI, 1.1-2.6), and have a procedures. Int J Impot Res 2002; 14(4):283-6.
family member try to physically break up the fight Abstract: Concerns over penile size and a desire for a
(RR, 3.7; 95% CI, 1.5-9.1). CONCLUSION: Violent longer penis are common in the male population. The
events involving preadolescent and early adolescent number of male patients seeking an andrological
girls are more likely to be in response to a previous consultation for the problem of 'short penis' is
event and to involve the home environment and family increasing. We looked at the numbers of patients
member intervention. Health care professionals should presenting to a University andrology clinic over a 2-y
screen violently injured girls for safety concerns and period and correlated their perceived penis size with
retaliation plans and consider engaging the family in the accepted norms. Sixty-seven patients were
efforts to prevent future events. evaluated with a median age of 27 (range 16-55)
complaining of 'short penis' and requesting surgical
Molnar BE, Roberts AL, Browne A, Gardener H, Buka SL. correction. Clinical history, including the IIEF-5
What girls need: recommendations for preventing questionnaire and an accurate physical examination
violence among urban girls in the US. Soc Sci Med were obtained. Data concerning measures of penile
2005; 60(10):2191-204. length and circumference were recorded in both the
Abstract: The last decade saw increases in arrests of flaccid and fully stretched states and compared to the
girls for violent behavior and a corresponding concern normal reference range as previously described in the
that girls' involvement in violence was increasing in the nomogram we recently published (Eur Urol 2001; 39:
USA. However, there are few empirical studies of the 183-186.). All patients were also asked to estimate the
dynamics of violence by girls, leaving providers of length of a normal sized penis.Fourty-four (65.7%)
violence prevention programs and policy-makers complained of a short penis only while flaccid, 22
without evidence on which to base gender-appropriate patients (32.8%%) while both flaccid and erect, and
prevention strategies. To address this gap, qualitative only one patient (1.5%) was worried only by the erect
interviews were conducted with a diverse sample of 61 length of the penis. Fifteen (22.4%) also complained
urban girls aged 11-17. Findings were compared with about their penile circumference. Fifty-seven (85%)
quantitative interviews from the prospective cohort of patients thought a 'normal' penile length should range
961 girls from whom these respondents were drawn, from 10 to 17 cm (median value of 12 cm). Ten
from the Project on Human Development in Chicago patients (15%) were not able to estimate 'normal' penile
Neighborhoods. Mixed-method techniques were size. No patient was found to have a penile length
employed. Qualitative data were analyzed for girls' under the 2.5 percentile according to our nomogram.
recommendations for preventing involvement in Forty-two (62.7%) subjects recalled the problem
violence. Data from the larger cohort were used to test starting in childhood, when they felt that their penis
these recommendations quantitatively. Due to study was smaller than their friends'. In 25 patients (37.3%)
design, in the qualitative sample, 36 girls (64%) were the problem started in the teenage years after seeing
involved in recent violence, most often with or against erotic images. Our data show that most men who seek
other girls. Pro-social behavior was common among penile lengthening surgery overestimate 'normal' penile
both violent and nonviolent girls. In the overall cohort length. In our series, none of the patients could be
sample, 24.9% of girls reported violent perpetration classified as having a severely short penis according to
and 97% reported pro-social activities. Eight themes our nomogram and none had any anatomical penile
regarding staying safe and preventing violence abnormality. Most found the use of a nomgram to show
emerged from the qualitative interviews: girls stayed them how they compared with other men helpful. We
safe by staying home, avoiding dangerous people, suggest that documentation of such a demonstration
staying busy with after-school activities, remaining should be made for any man seeking an opinion on
calm when confronted, using escorts, and fighting back penile lengthening surgery.
if attacked. Girls' protective influences included:
empathic parental involvement, positive relationships Monsen RB. Adopting children. J Pediatr Nurs 2004;
with peers and older youth, and involvement in safe 19(3):214-5.
and constructive activities. These findings emphasize
that safety in community, school, and family settings is Monsen RB. Advocating for children. J Pediatr Nurs 2004;
critical for girls in avoiding violence and other risky 19(5):364-5.
behaviors. Violence prevention programs should focus
on enhancing girls' relationships with mothers, older Monsen RB. Children hearing. J Pediatr Nurs 2003;
girls, and friends their age. 18(6):421-2.
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![111(4 Pt 2):e450-60. After controlling for language, demographics, health
Abstract: OBJECTIVE: Multidisciplinary teams from status, socio-economic characteristics, and mothers'
11 medical center neonatal intensive care units prenatal care use, infants of US-born MA mothers had
collaborated in a quality improvement project with a rates of use similar to WNH. However, even after
focus on family-centered care. METHODS: Through a controlling for the study variables, infants of Mexico-
process of self-analysis, literature review, born mothers were less likely (OR = .83) to use the
benchmarking site visits, and expert consultation, 10 developmental clinic. Hispanics continued to lag
potentially better practice (PBP) areas were defined. behind in the use of services compared with WNHs.
Improvement activities in 4 of the 10 areas are given as The disparity is not a function of ethnicity, but appears
examples of successes and challenges that individual attributable to demographic and socio-economic
centers encountered. The 4 areas are vision and characteristics. Infants who had a CHN visit were
philosophy, unit culture, family participation in care, significantly more likely (OR = 2.51) to use the
and families as advisors. RESULTS: Centers were at developmental clinic than those without a nurse visit.
different places for all of the PBPs at the beginning and Infants whose mothers had inadequate prenatal care
throughout the collaboration. Seven centers developed were less likely to use these follow-up services even
or revised their vision or philosophy of care statements after controlling for study variables. CONCLUSIONS:
about family-centered care. Incorporating the vision Infants whose mothers had inadequate prenatal care
and philosophy of care into performance appraisals, should be targeted for more intense CHN visits. Infants
hiring of new personnel, and changing unit culture to a of mothers born in Mexico may need additional
more family-centered practice were more challenging support/assistance in using the developmental clinic.
than developing the statements. Full parent
participation in care requires unrestricted access to the Moores A, Pace NA. Children's rights in Europe. Eur J
neonatal intensive care unit. The shift from considering Anaesthesiol 2005; 22(4):245-8.
parents to be "visitors" to being partners in caring for
their child was more difficult for centers with restricted Moosajee M. Violence--a noxious cocktail of genes and the
visitation policies. All centers developed, expanded, or environment. J R Soc Med 2003; 96(5):211-4.
started plans for establishing family advisory councils.
The experience of 2 centers is described. Moraczewski AS. Against the separation of Jodie and Mary.
CONCLUSIONS: Family-centered care is more of a Ethics Medics 2001; 26(6):1-2.
journey than a destination. Collaborating centers in this Notes: GENERAL NOTE: KIE: Moraczewski, Albert
project found themselves at different places in that S
journey. Through perseverance in implementing the GENERAL NOTE: KIE: KIE Bib: patient care/minors
PBPs, all have moved further along the path.
Morad Y, Avni I, Capra L et al. Shaken baby syndrome
Moore PD, Bay RC, Balcazar H, Coonrod DV, Brady J, without intracranial hemorrhage on initial computed
Russ R. Use of home visit and developmental clinic tomography. J AAPOS 2004; 8(6):521-7.
services by high risk Mexican-American and white Abstract: OBJECTIVE: We sought to describe the
non-Hispanic infants. Matern Child Health J 2005; unique characteristics of children diagnosed with
9(1):35-47. shaken baby syndrome (SBS) despite the absence of
Abstract: OBJECTIVE: To investigate whether US- intracranial hemorrhage on cranial computerized
born infants of mothers of Mexican descent who were tomography (CT) on hospital admission. METHODS:
enrolled in Arizona's Newborn Intensive Care Program Using an international e-mail-based listserv for
(NICP) received follow-up services (developmental professionals with an interest in child abuse, we
clinic and community health nurse [(CHN)] home identified and reviewed the charts of children
visits) at the rates similar to White non-Hispanic hospitalized in different medical centers who were
(WNH) infants. Socio-economic and health status diagnosed with SBS although CT disclosed no signs of
characteristics were controlled using stepped intracranial bleeding. Children with normal imaging
regressions in order to assess the impact of each on were not included. RESULTS: Eight cases were
service use. METHODS: This population-based study identified. All children had cerebral edema in CT,
used retrospective data from the NICP administrative which was severe on 7/8 cases (88%). All of these
database that were linked to birth certificates for years children had extensive retinal hemorrhage. The
1994-1998. The study population was limited to prognosis was poor; 5/8 infants died (63% mortality),
Arizona-born infants; it included 7442 infants of WNH and the rest had permanent neurologic damage.
mothers, 2612 infants of US-born Mexican American CONCLUSION: The diagnosis of SBS can be
(MA) mothers and 2872 infants of Mexico-born established even when CT at presentation does not
mothers. Four service use indicators were used in the demonstrate intracranial hemorrhage. We hypothesize
analysis. RESULTS: Both Hispanic infant subgroups that rapidly developing cerebral edema may cause
were less likely to have a CHN visit by 6 months and increased intracranial pressure and tamponade that
by 1 year, and to average fewer CHN visits. A smaller prevents the accumulation of intracranial blood. The
percent attended the developmental clinic by age one.
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![out and enhance mutual collaboration and spontaneous education is more important than statutory mandate.
networking. In this instance, WIFY functioned as a
communication tool. When answering sheets were Morrongiello BA, Kiriakou S. Mothers' home-safety
collected and obtained responses were analyzed as practices for preventing six types of childhood injuries:
cases, a rather materialistic view was suggested among what do they do, and why? J Pediatr Psychol 2004;
Japanese children and a more disciplined view, which 29(4):285-97.
put much value on school and home, was suggested Abstract: OBJECTIVE: To identify determinants of
among Chinese children. Further studies are needed to mothers' home-safety practices for preventing six types
confirm the changing environmental views of children of common injuries to children (burns, poisoning,
from the collaborative research framework. drowning, cuts, strangulation/suffocation/choking, and
falls). METHODS: Home interviews were conducted
Mork M. [Medical problems and needs of follow-up in a with mothers of children 19-24 and 25-30 months old
group of children with mild cerebral palsy]. Tidsskr about home-safety practices. For each of 30 safety
Nor Laegeforen 2001; 121(13):1566-9. precautions to prevent these six types of injuries,
Abstract: BACKGROUND: There is no specialized mothers indicated whether or not they engaged in the
health service for routine follow-up for ambulatory practice, and explained why. RESULTS: Regression
children with cerebral palsy in Rogaland county. Our analyses revealed both common and unique
aim was to investigate the kind of medical problems determinants of mothers' home-safety practices to
these children had and whether these problems were prevent these six types of home injuries. For burns,
discovered by the health services. MATERIAL AND cuts, and falls, beliefs that child characteristics and
METHODS: 37 children with cerebral palsy born parent characteristics elevated the child's risk of injury
1987-1992 were investigated. They were all were the key determinants of the mother's engaging in
independent walkers without mental retardation at the precautionary measures. For drowning, poisoning, and
time of selection. The majority had spastic hemiplegia suffocation/strangulation/choking, health beliefs also
or spastic diplegia. Their parents were interviewed and contributed to predict mothers' practices, including
the children underwent a neurological examination. beliefs about potential injury severity and extent of
RESULTS: Orthopedic problems such as scoliosis, hip effort required to implement precautionary measures.
abnormalities, tight tendons and muscles, and leg CONCLUSIONS: The factors that motivated mothers
length discrepancy were not discovered by the local to engage in precautionary measures at home varied
health service. The children had a high incidence of depending on the type of injury. Intervention programs
epilepsy, visual disorders and minor speech problems. to enhance maternal home-safety practices will need to
Minor learning difficulties were frequent. target different factors depending on the type of injury
INTERPRETATION: Children with mild cerebral to be addressed.
palsy have specific problems and need the attention of
neuropediatricians in order to establish the primary and Morrow AL, Guerrero ML. From bioactive substances to
secondary problems involved. research on breast-feeding promotion. Adv Exp Med
Biol 2001; 501:447-55.
Morrill AC, Dai J, Dunn S, Sung I, Smith K. Child custody Abstract: Despite known health benefits, exclusive
and visitation decisions when the father has perpetrated breast-feeding for at least 4 months is uncommon in
violence against the mother. Violence Against Women many countries. In Mexico, most mothers initiate
2005; 11(8):1076-107. breast-feeding but few breast-feed exclusively.
Abstract: This research evaluated the effectiveness of OBJECTIVE: The objective was to examine the
statutes mandating a presumption against custody to a effectiveness of home visits by lay peer counselors to
perpetrator of domestic violence (DV) and judicial increase exclusive breast-feeding among mothers in a
education about DV. Across six states, the authors periurban area of Mexico. METHODS: An
examined 393 custody and/or visitation orders where ethnographic assessment conducted in 1994 that
the father perpetrated DV against the mother and identified key maternal beliefs, practices, and needs
surveyed 60 judges who entered those orders. With the was used to guide educational strategies. Lay
presumption, more orders gave legal and physical counselors were recruited from the same community
custody to the mother and imposed a structured and trained by La Leche League. From March 1995
schedule and restrictive conditions on fathers' visits, through September 1996, pregnant women were
except where there was also a "friendly parent" identified by community census and invited to
provision and a presumption for joint custody. The participate. Women were enrolled into a randomized,
presumption is effective only as part of a consistent controlled study of 3 groups: no intervention (control),
statutory scheme. Although 86% of judges had 3 visits, and 6 visits during pregnancy and early
received DV education, they scored no better in postpartum. Data collection was performed by a social
knowledge or attitudes. More of their orders gave worker apart from the counselors. Exclusive breast-
mothers sole physical custody, and knowledge was feeding was defined by WHO criteria. RESULTS: The
associated with maternal custody, yet fewer structured study enrolled 130 women; 52 were in the 3-visit
or restricted fathers' visitation. Quality of DV group, 44 in the 6-visit group, and 34 in the control
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![group. Study groups did not differ in the maternal giving rise to a number of health/well-being-related
characteristics or initiation of breast-feeding (96%). At themes. The paper concludes that using a range of
3 months postpartum, exclusive breast-feeding was methods, including visual methods, has helped to
practiced by only 12% of controls vs. 52% in the 3- explore quality of life issues for children that are
visit group and 67% in the 6-visit group (P < 0.001, log usually neglected in studies of young people's health-
rank test). In the first 3 months, significantly (P = related behaviours.
0.037) fewer intervention than control infants had an
episode of diarrhea (11% vs. 26%, respectively). Morton JB, Munakata Y. Active versus latent
Intervention effectiveness was independent of maternal representations: a neural network model of
factors or birth hospital. CONCLUSIONS: This unique perseveration, dissociation, and decalage. Dev
experimental study demonstrated a dramatic increase in Psychobiol 2002; 40(3):255-65.
exclusive breast-feeding and a significant reduction in Abstract: Children of different ages often perseverate,
infant illness in an urban community through well- repeating previous behaviors when they are no longer
designed maternal support including early intervention appropriate, despite appearing to know what they
and repeated contact. should be doing. Using neural network models, we
explore an account of these phenomena based on a
Morrow OI, Sweat MD, Morrow RH. The matalisi: pathway distinction between active memory (subserved by the
to early sexual initiation among the youth of Mpigi, prefrontal cortex) and latent memory (subserved by
Uganda. AIDS Behav 2004; 8(4):365-78. posterior cortex). The models demonstrate how (a)
Abstract: This paper describes the role and personal perseveration occurs when an active memory of
characteristics of the "matalisi,'' a previously currently relevant knowledge is insufficiently strong to
unreported phenomenon uncovered during a study of overcome a latent bias established by previous
youth sexual behavior in Uganda. The "matalisi,'' a go- experience, (b) apparent dissociations between
between, played a central role in sexual relationships of children's knowledge and action may reflect
most youth in Mpigi, Uganda. The first phase of the differences in the amount of conflict between active
study was an ethnographic inquiry of youth (ages 10- and latent memories that children need to resolve in the
16) sexual behavior. During this phase it became tasks, and (c) differences in when children master
evident that matalisis were used in most courtships and formally similar tasks (decalage) may result from
initial sexual liaisons. The second phase included a differences in the strength of children's initial biases.
sociometric investigation of youth networks and a mini The models help to clarify how prefrontal development
survey of youth who had been matalisis. Among youth may lead to advances in flexible thinking.
interviewed, 47.3% of males (105/222) and 14.1% of
females (42/298) had experienced sexual intercourse. Morton JB, Munakata Y. What's the difference? Contrasting
For 88%, participating as someone's matalisi preceded modular and neural network approaches to
first coitus. By understanding the role of the matalisi, understanding developmental variability. J Dev Behav
interventions may be developed to improve sex Pediatr 2005; 26(2):128-39.
education and more effectively address sexual Abstract: Understanding why development differs
behaviors that lead to unwanted pregnancies, STIs, and across individuals is an important challenge for
HIV infection. developmental theory. This paper evaluates two
approaches to developmental variability observed in
Morrow V. Using qualitative methods to elicit young domains such as language processing and across
people's perspectives on their environments: some populations such as typically developing children,
ideas for community health initiatives. Health Educ children with developmental disorders, and typical
Res 2001; 16(3):255-68. adults. Modular accounts attribute developmental
Abstract: This paper describes qualitative methods variability to delay, damage, or dysfunction in discrete
used in a research project for the former Health underlying structures. Neural network approaches
Education Authority, exploring Putnam's concept of attribute developmental variability to emergent effects
'social capital' in relation to children and young of graded variations in an interactive, developing
people's well-being and health. Putnam's system. The authors conclude that neural network
conceptualization of social capital consists of the approaches offer more formal and parsimonious
following features: trust, reciprocal support, civic accounts of the nature and sources of developmental
engagement, community identity and social networks, variability.
and the premise is that levels of social capital in a
community have an important effect on people's well- Moskalewicz J, Zulewska-Sak J. [Alcohol drinking in the
being. Research was carried out with 102 children aged time of political transition in Poland. Report of the
between 12 and 15 in two relatively deprived parts of a National Health Programme ]. Przegl Epidemiol 2003;
town in southeast England. The paper describes the 57(4):713-23.
research setting, methods, consent process and ethical Abstract: The National Health Programme was adopted
issues that arose. It explores how the methods in Poland in the mid-1990s. It consists of 18 targets
generated different forms of interconnected data,
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![including target 4 that calls for diminishing alcohol familial risk for substance abuse and antisocial
consumption and changing its structure as well as behaviors.
limiting health harms associated with alcohol. The
programme is being monitored on bi-annual basis. The Moss HB, Lynch KG, Hardie TL, Baron DA. Family
monitoring covers a level of alcohol consumption and functioning and peer affiliation in children of fathers
associated harm including trends in mortality and with antisocial personality disorder and substance
morbidity as well as in road accidents in 1990-2001 dependence: associations with problem behaviors. Am
period. During the period in point, particularly in the J Psychiatry 2002; 159(4):607-14.
beginning of the transition alcohol consumption Abstract: OBJECTIVE: Family functioning and peer
increased at least by one third reaching 10-11 litres of influences are theoretically linked to child
pure ethanol per capita, mostly due to sudden psychopathology. This study quantified the functional
disruption of the alcohol control system and high tide status of families with fathers with substance
of unrecorded supply. Currently, the consumption is dependence with or without comorbid antisocial
estimated to be 9.5-10.0 litres with 30% share of the personality disorder and evaluated the peer
unrecorded. During last decade recorded morbidity due environments of preadolescent offspring. The authors
to mental disorders associated with alcohol increased examined associations between the child's
by 80% and 60% respectively in out- and in-patient psychopathology, paternal substance
system while mortality rates almost doubled. Male dependence/antisocial personality disorder status, and
mortality due to liver diseases increased by 50% while measures of family and peer environments. METHOD:
that of women remained relatively flat. In last few Families with the presence or absence of paternal
years, alcohol related mortality tended to decline substance dependence were subdivided into those with
slightly parallel to consumption trends. Significant and without paternal antisocial personality disorder.
improvement has been achieved in prevention of Grouped families were contrasted on measures of
drunken diving. The number of deaths in alcohol family functioning, the child's peer affiliation, and the
related road accidents decreased two fold while a rate child's problem behaviors. Regression analysis
of drunken crashes per 1000 vehicles dropped three determined the influence of these factors on the child's
times. psychopathology. RESULTS: Families with paternal
substance dependence functioned worse than normal
Moss HB, Lynch KG, Hardie TL. Affiliation with deviant comparison families. However, families with paternal
peers among children of substance dependent fathers substance dependence and antisocial personality
from pre-adolescence into adolescence: associations disorder (N=34) did not differ markedly from those
with problem behaviors. Drug Alcohol Depend 2003; with substance dependence without antisocial
71(2):117-25. personality disorder (N=84). The children of fathers
Abstract: OBJECTIVE: Affiliation with delinquent with both substance dependence and antisocial
peers has been shown to be a major risk factor for the personality disorder had greater affiliation with deviant
development of antisocial and substance abuse peers than those with substance dependence without
behaviors in adolescence. However, little data are antisocial personality disorder and comparison families
available concerning the developmental trajectories of (N=104). CONCLUSIONS: Children of fathers with
deviant peer affiliation. METHOD: In this study, we substance dependence and antisocial personality
have prospectively examined the density of deviant disorder demonstrated higher externalizing and
peers among the social networks of children of drug internalizing psychopathology than those with
dependent fathers at age 10, and at 2 and 5 year follow- substance dependence but not antisocial personality
ups, and compared them with those of controls. disorder and those without either condition. Paternal
Measures of internalizing and externalizing substance dependence/antisocial personality disorder
psychopathology were employed as time varying status and the child's affiliation with deviant peers were
covariates, while socioeconomic status (SES) was used most robustly associated with the child's
as a time invariant covariate. A pattern mixture psychopathology. Research is needed to develop
analysis of missing data was conducted. RESULTS: interventions that effectively address parental risk and
Using mixed effects models, we found significant main healthy peer relations.
effects of time, group, externalizing psychopathology,
and to lesser extent, SES on the magnitude of Moura AT, Reichenheim ME. [Are we really detecting
affiliation with deviant peers. Greater deviant peer violence in families of children visiting our health
affiliation among the high-risk children was found at services? The experience of a public health service in
each time point. Externalizing psychopathology Rio de Janeiro, Brazil]. Cad Saude Publica 2005;
augmented the magnitude of deviant peer affiliation in 21(4):1124-33.
both high-risk and comparison children. Abstract: Domestic violence, particularly in childhood,
CONCLUSION: Offspring of drug dependent fathers is a growing public health concern. Information on
have heightened affiliation with deviant peers from morbidity is mostly underreported due to constraints in
pre-adolescence through mid-adolescence. This social case detection. This paper analyzes the frequency of
developmental process may be a component of the events measured actively by outpatient services as
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![implemented. The sample included a total of 5,317 particularly women referred to drug abuse treatment by
parents and 2,581 children. The response rate was 98%. child welfare due to prenatal drug use. Seventy-one
All participants were asked to give answers according such women who used drugs during pregnancy were
to current situation. RESULTS: Approximately a third randomly assigned to either receive three MI sessions
of children in the counties without community-based or to watch two educational videos and participate in a
intervention and a fifth in the counties with home visit. Treatment retention group attendance and
community-based intervention could access small arms random urine analysis results were evaluated in these
and explosive devices at home. Boys were more women during the first 8 weeks of treatment. No
exposed than girls (p=0.001). In the communities with differences were found between the two conditions on
community-based intervention, children were less these variables. Possible reasons for these negative
exposed to the devices, such as small-arms, hand findings are discussed, as are ideas for future research
grenades, and explosives, which were the main cause with coerced populations.
of injuries. In 1994, parents in counties without
community-based intervention handled weapons in Mulvihill A, Buncic JR. Vertical sensory nystagmus
front of their children in 45% cases vs 31% of those in associated with intraocular haemorrhages in the shaken
the counties with community-based intervention baby syndrome. Eye 2004; 18(5):545-6.
(p<0.001). In 1995, the percentages were 44 and 32,
respectively (p<0.001). CONCLUSION: Although it is Munjanja SP. Ethics in reproductive health: clinical issues in
impossible to quantify the exact amount of risk Zimbabwe. Cent Afr J Med 2001; 47(6):159-63.
reduction due to health intervention alone, community- Notes: GENERAL NOTE: KIE: 14 refs.
based intervention reduced the exposure of children to GENERAL NOTE: KIE: KIE Bib: reproduction
weapons. Abstract: Reproductive health can present health
practitioners with ethical problems because of the
Mukadam S, Gilles EE. Unusual inflicted hot oil burns in a complex interaction between cultural practices, the
7-year-old. Burns 2003; 29(1):83-6. laws of the country and individual personal
Abstract: Pediatric burn injuries occur not infrequently preferences. In particular, the problems of pregnancy,
as the result of abuse. While the majority of these burns sexually transmitted infections, family planning, sexual
are inflicted scald burns, those due to contact or violence, and domestic abuse require a good
contact/scald mechanisms may present diagnostic knowledge of the laws of the country and the culture in
challenges. A child with unusual combined contact and which they operate. The practitioner should at all times
scald burns caused by a metal spatula heated in hot respect the patient's autonomy and serve their best
cooking oil is described. The odd pattern of healed interests, whilst keeping in mind the legitimate interest
injury limited the initial diagnosis to inflicted healing of their partners, spouses, parents or guardians.
burns. Despite the initial lack of disclosure, an inflicted
etiology was supported by clearly delineated margins, Munoz Cobos F, Martin Carretero ML, Vivancos Escobar D,
macular lesions with hyper-pigmented rims and Blanca Barba F, Rodriguez Carrion T, Ruiz Ramos M.
variegated central regions. Additional findings of [Improving care for victims of domestic violence.
numerous adult bites and bruises provided adjunctive Impact of a priority intervention]. Aten Primaria 2001;
support for an inflicted etiology. Aspects of this case 28(4):241-8.
are atypical for the usual demographics of a burn Abstract: OBJECTIVE: To evaluate the impact of a
victim. This case extends the known presentations of priority intervention in the care given to women who
inflicted contact/scald burns. are victims of domestic violence and their children.
DESIGN: Non-randomised intervention study.
Mulholland H. Child protection. The nurse's role. Nurs SETTING: Urban health centre. PATIENTS: Women
Times 2003; 99(18):20-4. and children living at a reception centre for families
suffering domestic violence and who had clinical
Mulholland H. Nurses can make sure it never happens again. records opened at the health centre. Pre-intervention
Nurs Times 2003; 99(5):10-1. group (December 1997-July 1999): 36 women, 70
children. Post-intervention group (August 1999-June
Mullins SM, Suarez M, Ondersma SJ, Page MC. The impact 2000): 35 women and 41 children.Interventions.
of motivational interviewing on substance abuse Allocation to a single family doctor and paediatrician.
treatment retention: a randomized control trial of Elimination of bureaucratic obstacles and prioritised
women involved with child welfare. J Subst Abuse care. Social/family assessment by the social worker.
Treat 2004; 27(1):51-8. Preferential inclusion in programmes: Women: family
Abstract: Previous studies have supported the efficacy planning, hepatitis B vaccination, pregnancy control,
of Motivational Interviewing (MI) in increasing early diagnosis of breast cancer (women > 50), same
treatment engagement and retention among people with for cervical cancer. Children: child health (< 5)
substance abuse disorders. However, few studies have (priority activities: psychomotor development and
assessed the impact of MI with coerced populations, somatometry) and vaccinations. This intervention
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![outcome data available, there were 17 miscarriages and years of use.
48 perinatal deaths observed. There was a strong trend
towards reduced risk of pregnancy loss among women Nainan OV, Armstrong GL, Han XH, Williams I, Bell BP,
receiving multiple doses of penicillin (adjusted OR for Margolis HS. Hepatitis a molecular epidemiology in
perinatal mortality for each additional dose received, the United States, 1996-1997: sources of infection and
0.63; 95% CI, 0.48-0.84). CONCLUSIONS: While this implications of vaccination policy. J Infect Dis 2005;
association requires further investigation, these results 191(6):957-63.
suggest that there may be substantial benefit to Abstract: BACKGROUND: The genetic relatedness of
providing multiple doses of benzathine penicillin to hepatitis A virus (HAV) isolates was determined to
treat maternal syphilis in this setting. identify possible infection sources for case patients in
the Sentinel Counties Study of Acute Viral Hepatitis.
Myers JE. Examination of liability considerations for METHODS: A 315-nucleotide segment of the VP1-P2
professionals in child protection. Child Abuse Negl region of the HAV genome was amplified and
2002; 26(10):1007-9. sequenced from serum of case patients and analyzed
together with risk-factor data. RESULTS: Of 508
Myers JE. Keep the lifeboat afloat. Child Abuse Negl 2002; HAV-RNA-positive case patients, 449 (88.4%) were
26(6-7):561-7. interviewed, and 255 (50.1%) reported >/=1 risk factor.
Some 123 unique nucleotide sequence patterns
Naciones Unidas. Asamblea General. Los derechos del niño: (UNSPs) were identified--77 (62.6%) from only 1 case
Resolución aprobada por la Asamblea General. New patient and the rest in 2-99 persons. Among
York: Naciones Unidas, 2003:17. international travelers, a single person was more often
infected with a single type of UNSP (17/54 [31.5%]),
Nagelkerke NJ, Jha P, de Vlas SJ et al. Modelling compared with other case patients (48/393 [12.2%];
HIV/AIDS epidemics in Botswana and India: impact of P<.001). UNSPs from travelers to Mexico (33/37
interventions to prevent transmission. Bull World [89.2%]) clustered with those from Hispanic children
Health Organ 2002; 80(2):89-96. (47/49 [95.9%]). Of 119 men who had sex with men,
Abstract: OBJECTIVE: To describe a dynamic 96 (80.7%) had the same or similar UNSPs, which
compartmental simulation model for Botswana and were also found in 37 men and 10 women with no
India, developed to identify the best strategies for identified infection source. CONCLUSION: HAV is
preventing spread of HIV/AIDS. METHODS: The often transmitted within networks of persons with
following interventions were considered: a behavioural similar risk factors, which may be the infection source
intervention focused on female sex workers; a for others in the community.
conventional programme for the treatment of sexually
transmitted infections; a programme for the prevention Nair MK. Child abuse. Indian Pediatr 2004; 41(4):319-20.
of mother-to-child transmission; an antiretroviral
treatment programme for the entire population, based Nandi S, Kumar R, Ray P, Vohra H, Ganguly NK. Group A
on a single regimen; and an antiretroviral treatment streptococcal sore throat in a periurban population of
programme for sex workers only, also based on a northern India: a one-year prospective study. Bull
single regimen. FINDINGS: The interventions directed World Health Organ 2001; 79(6):528-33.
at sex workers as well as those dealing with sexually Abstract: OBJECTIVE: To estimate the incidence and
transmitted infections showed promise for long-term risk factors of group A streptococcus (GAS) sore throat
prevention of human immunodeficiency virus (HIV) among school-aged children living in a periurban slum
infection, although their relative ranking was uncertain. area of Chandigarh, North India. METHODS: A total
In India, a sex worker intervention would drive the of 536 children aged 5-15 years from 261 families
epidemic to extinction. In Botswana none of the identified by a systematic random selection method
interventions alone would achieve this, although the were enrolled in the study. Episodes of sore throat were
prevalence of HIV would be reduced by almost 50%. recorded through fortnightly home visits over a one-
Mother-to-child transmission programmes could year period. The local vernacular (Hindi) terms gala
reduce HIV transmission to infants, but would have no kharab (bad throat) and khansi jukam (cough and cold)
impact on the epidemic itself. In the long run, were used to identify symptoms of sore throat, and
interventions targeting sexual transmission would be throat swab specimens were collected from children
even more effective in reducing the number of HIV- who had these symptoms on the day of the home visit.
infected children than mother-to-child transmission Bacterial culture was carried out and the isolation of
programmes. Antiretroviral therapy would prevent GAS was confirmed using group-A-specific antiserum.
transmission in the short term, but eventually its effects FINDINGS: The incidences of sore throat and GAS
would wane because of the development of drug sore throat were, respectively, 7.05 and 0.95 episodes
resistance. CONCLUSION: Depending on the country per child-year. The incidence was higher in the
and how the antiretroviral therapy was targeted, 25- following situations: among 11-year-olds, during the
100% of HIV cases would be drug- resistant after 30 winter (November to January) and rainy (August)
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![that patients' faith and trust in nurses produces a CASE REPORT: We present a case of Menkes disease
positive effect on patients and families, and nurses complicated by progressive macrocephaly following
themselves derived satisfaction from the experience of the development of massive subdural haematomas.
giving spiritual care. In this respect, spiritual care These lesions associated with femoral metaphyseal
interventions promote a sense of well-being in nurses spurs could be confused with nonaccidental injury such
as well as being a valuable part of total patient care. as that seen in the shaken baby syndrome.
CONCLUSION: The study concluded that there is DISCUSSION: This case emphasises that Menkes
scope for developing an ideal model of spiritual care disease, like glutaric aciduria type 1, should be
using the critical incident data from this study. included in the differential diagnosis of unexplained
subdural haematomas and neurological deficits in
Narbona J, Crespo N. [Developmental amnesias]. Rev infants.
Neurol 2002; 34 Suppl 1:S110-4.
Abstract: OBJECTIVE: The literature on clinical and Navaie-Waliser M, Misener M, Mersman C, Lincoln P.
physiophatologic characteristics of the spectrum of Evaluating the needs of children with asthma in home
memory disorders in childhood is reviewed in this care: the vital role of nurses as caregivers and
article. DEVELOPMENT: There are only a few educators. Public Health Nurs 2004; 21(4):306-15.
detailed reports of permanent specific memory Abstract: To date, few evaluations have examined
disorders in children. Early anoxo ischaemic issues specific to children's asthma management in
bihippocampal injuries can cause a selective permanent their homes. This study examined the characteristics,
impairment of episodic daily life memory with risk factors, and needs of children with asthma, and the
preservation of semantic learning and general impact of home health nurses on improving
intelligence; this dissociation has been related to partial parents'/family caregivers' knowledge about asthma
hippocampal damage whilst the entorhinal, triggers and management. The medical records of
parahippocampal and prefrontal cortices, which are children, </=19 years, residing in New York City, who
critical to systematized memorizing and work memory, were admitted to home care with asthma in 1999 (n =
keep normal. Biological psychiatry research has shown 1,007) were reviewed retrospectively to collect a wide
that early childhood amnesias after psychological range of data. The majority of children with asthma in
maltreatment or abuse could be related to damage in home care were </=5 years, male, racial/ethnic
neuronal systems which support memory, caused by minorities, and hospital referred. Approximately one in
glutamatergic cascade. Both severe bilateral four children with asthma suffered from additional
hippocampal sclerosis (also mediated by toxic comorbidities. Home environmental triggers included
neurotransmitters) in early malignant epilepsies, and dust/dust mites, animal dander, mold,
massive bilateral damage of mesial temporal lobes due perfumes/detergents, and cigarette smoke. Notable
to herpex virus encephalitis or Reye's syndrome, cause psychosocial triggers were family tensions, physical
severe amnesic deficits, frequently accompanied by activity, anxiety/stress, and friends/peer pressure. Most
absence of any language development and autism with parents/family caregivers had inadequate knowledge
features of Kluver-Bucy syndrome. There are also on about recognition of asthma attacks and its triggers and
record some examples of Korsakoff's syndrome in management. Discharge assessments suggested that
children with midfossa tumors. CONCLUSIONS: All home health nurses can help improve caregivers'
types of classical amnesias described in adults have knowledge about asthma management. Children with
been observed in children. Developmental amnesias are asthma in home care have diverse needs, receive few
probably more frequent than currently presumed. It nurse home visits, and have parents/family caregivers
must be paid special attention to selective in need of more intensive education on asthma
autobiographical memory impairments in individuals symptom recognition and management.
who underwent a partial bihippocampal damage in
perinatal or early postnatal periods; they are to be Navarro V, Borrell C, Benach J et al. The importance of the
distinguished from, although it may coexist with, other political and the social in explaining mortality
clinical situations such as attention deficit disorder or differentials among the countries of the OECD, 1950-
semantic pragmatic disorder. 1998. Int J Health Serv 2003; 33(3):419-94.
Abstract: This article analyzes (within the conceptual
Nassogne MC, Sharrard M, Hertz-Pannier L et al. Massive frame defined in the previous article) the impact of
subdural haematomas in Menkes disease mimicking political variables such as time of government by
shaken baby syndrome. Childs Nerv Syst 2002; political parties (social democratic, Christian
18(12):729-31. democratic or conservative, liberal, and ex-dictatorial
Abstract: INTRODUCTION: Menkes disease is an X- that have governed the OECD countries during the
linked inherited disorder of intestinal copper absorption 1950-1998 period) and their electoral support on (1)
resulting in copper deficiency. Cardinal features redistributional policies in the labor market and in the
include hair abnormalities, facial dysmorphism, severe welfare state; (2) the income inequalities measured by
neurological impairment, hypothermia, arterial Theil and Gini indexes; and (3) health indicators, such
anomalies, bone abnormalities and a fatal outcome. as infant mortality and life expectancy. This analysis is
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![carried out statistically by a bivariate and a multivariate unprotected sexual contact with multiple partners (risk
analysis (a pooled cross-sectional study). Both analyses of sexually transmitted diseases, of an unwanted
show that political variables play an important role in pregnancy), substance abuse, delinquency, school
defining how public and social policies determine the failure or suicide. Professionals who deal with
levels of inequalities and affect the level of infant adolescents should be aware of the devastating medical
mortality. In general, political parties more committed and psychosocial sequelae of sexual abuse and should
to redistributional policies, such as social democratic be able to recognize it, incorporating questions
parties, are the most successful in reducing inequalities regarding victimization into the psycho-social or sexual
and improving infant mortality. Less evidence exists, history. A medical examination, including an external
however, on effects on life expectancy. The article also anogenital inspection and in selected cases a pelvic
quantifies statistically the relationship between the examination, should always be performed. It is
political and the policy variables and between these important to acknowledge that normal anogenital
variables and the dependent variables--that is, the findings do not exclude sexual abuse and that a
health indicators. multidisciplinary medical-psychosocial evaluation is
mandatory.
Navratil F. [Genital infections in prepubertal girls]. Ther
Umsch 2002; 59(9):475-9. Needlman R, Toker KH, Dreyer BP, Klass P, Mendelsohn
Abstract: Vulvitis and vulvovaginitis are the most AL. Effectiveness of a primary care intervention to
common gynecologic complaint in prepubertal girls. support reading aloud: a multicenter evaluation. Ambul
The frequently observed therapeutic failures are due Pediatr 2005; 5(4):209-15.
mainly to lack of knowledge of the characteristics of Abstract: OBJECTIVE: Failure to read at grade level
this age group, of age and development in appropriate predicts life-long economic and social disability. Early
diagnostic procedures and of therapeutic measures exposure to reading aloud may prevent reading
similar to those in the adult female patient. Prepubertal problems. This study seeks to determine whether
girls are anatomically, physiologically and behaviorally institution of Reach Out and Read (ROR) programs is
at relative risk for vulvovaginitis. Symptoms include associated with increased reading aloud in a national
pruritus, genital pain, "vulvar dysuria" and discharge. sample. DESIGN: Before-after intervention study:
History taking and a general pediatric examination are separate convenience samples were studied before and
mandatory, thereafter an age appropriate careful after institution of ROR programs at multiple sites.
anogenital examination should follow. It requires time, PARTICIPANTS AND SETTING: A convenience
patience and knowledge of the different non sample of parents of children age 6-72 months seeking
traumatizing examination techniques. The findings in routine health care at 19 clinical sites in 10 states.
girls with vulvovaginitis are variable and erythema, INTERVENTIONS: The ROR model incorporates
excoriations and discharge can be found. The genital anticipatory guidance about reading aloud and
inspection and the use of microscopy and distribution of free picture books at health supervision
microbiologic studies are helpful in planning an visits from 6 months through 5 years as well as reading
appropriate therapy. The majority of vulvovaginal aloud in the waiting room. MAIN OUTCOME
infections in children are nonspecific but they can also MEASURES: Parents were interviewed about their
be caused by specific organisms and are mostly attitudes and practices related to reading aloud, using
bacterial. Yeast infections are not found in otherwise questions drawn from validated instruments.
healthy prepubertal girls. The therapeutic approach RESULTS: The sample included 1647 subjects (730
consists of improved anogenital hygiene, sitz/tub baths intervention, 917 comparison). After controlling for
and use of non irritating soaps. However if an multiple potential confounding factors, significant
abnormal population of bacteria is present associations were found between exposure to ROR and
antimicrobial therapy should be considered. reading aloud as a favorite parenting activity (Adjusted
Reassurance and a review of preventive methods are Odds Ratio [AOR] 1.6, P < .001); reading aloud at
crucial in the management of girls with vulvovaginitis. bedtime (Adjusted Odds Ratio [AOR*rsqb; 1.5, P <
.001); reading aloud 3 or more days per week (AOR
Navratil F. [Sexual abuse in adolescence: patient assessment, 1.8, P < .001); and ownership of > or = 10 picture
necessity and meaning of the physical examination]. books (AOR 1.6, P < .001). CONCLUSIONS: In a
Gynakol Geburtshilfliche Rundsch 2003; 43(3):146-51. national sample, implementation of ROR programs was
Abstract: The objective of this paper is to report on the associated with increased parental support for reading
characteristics of sexual abuse in adolescence, on the aloud. This study provides evidence of the
medical evaluation and interpretation of findings and effectiveness of a primary care intervention strategy to
on the necessity of a multidisciplinary intervention. promote reading aloud to young children.
Sexual abuse is a common problem affecting children
and adolescents, males and females of any age or Neggers Y, Goldenberg R, Cliver S, Hauth J. Effects of
socio-economic class. 10-22% of adolescents are domestic violence on preterm birth and low birth
victims of sexual abuse. They engage more frequently weight. Acta Obstet Gynecol Scand 2004; 83(5):455-
in risk-taking behaviours, such as early sexual activity, 60.
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![Abstract: BACKGROUND: Domestic violence is Nelson S. Your body tells the truth. Ment Health Today
increasingly recognized as a potentially modifiable risk 2003; 20-3.
factor for adverse pregnancy outcomes. This study was
conducted to evaluate the relationship between abuse Nemeth L, O'Briain DS, Puri P. Demonstration of neuronal
during pregnancy or within the last year and low birth networks in the human upper urinary tract using
weight and preterm birth. METHODS: From 1997 to confocal laser scanning microscopy. J Urol 2001;
2001, 3149 low income, relatively low-risk pregnant 166(1):255-8.
women (82% African-American) participated in this Abstract: PURPOSE: To our knowledge innervation of
prospective study. The Abuse Assessment Screen, a the upper urinary tract and its role in motility and
validated screening tool, which assesses emotional, sensation are not clearly understood. The whole mount
physical or sexual abuse, injuries due to physical abuse preparation technique provides 3-dimensional (D)
and physical abuse in the index pregnancy, was filled morphology of the innervation and its relationship of
out by 3103 women. RESULTS: Of the women branching and interconnecting nerve fibers to each
screened, 26.6% reported emotional abuse, 18.7% other and to the neighboring tissues. Confocal laser
reported physical abuse in the past year and 10.3% scanning microscopy provides dramatic optical
women reported being beaten, bruised, threatened with advantages for detecting 3-D structures in thick
a weapon or being permanently injured. Abuse during specimens. We investigated the distribution and
pregnancy was reported by 5.9% of the women. Low morphology of the neuronal structures in the human
birth weight and preterm birth occurred in 10.9% and upper urinary tract using the whole mount preparation
10.2% of the pregnant women, respectively. Logistic technique and confocal laser scanning microscopy.
regression analyzes indicated that injury due to MATERIALS AND METHODS: Whole mount
physical abuse within the past year was significantly preparations of the human renal pelvis and ureter were
associated with both preterm birth [adjusted odds ratio stained by standard immunohistochemical method
(AOR) = 1.6, 95% confidence interval (CI) = 1.1-2.3] using various neuronal markers (protein gene product
and low birth weight (AOR = 1.8, 95% CI = 1.3-2.5) 9.5, neuron specific enolase and neurofilament). The 3-
after adjusting for other covariates. The mean birth D architecture of the specimens was investigated with
weight of infants born to women who were injured due the help of confocal laser scanning microscopy.
to physical abuse was significantly lower (-75.2 g, p = RESULTS: We detected 2 mesh-like neuronal
0.04) than the mean birth weight of infants of women networks or plexus in the human upper urinary tract.
who were not injured. CONCLUSION: These results The first and more prominent plexus was located in the
indicate that in our population, injuries resulting from submucosa between the lamina propria and tunica
physical abuse are associated with both low birth muscularis, and the second neuronal network was
weight and preterm birth. found between the smooth muscle fibers of the ureteral
wall. There were frequent interconnections between the
Nelms BC. Emotional abuse: helping prevent the problem. J 2 networks in the ureteral wall. CONCLUSIONS: To
Pediatr Health Care 2001; 15(3):103-4. our knowledge our study shows for the first time that
there are 2 well formed mesh-like neuronal plexus in
Nelson CA. Can we develop a neurobiological model of the human upper urinary tract. Our findings suggest
human social-emotional development? Integrative that the autonomic nervous system of the human upper
thoughts on the effects of separation on parent-child urinary tract may have a significant role in the
interactions. Ann N Y Acad Sci 2003; 1008:48-54. propagation, coordination and modulation of
Abstract: After summarizing the main points raised in ureteropelvic peristalsis.
articles by Kaslow et al. and Plotsk, a number of
questions that derive from these authors' work are Nemets B, Witztum E, Kotler M. [False memory syndrome:
listed. Additional questions are then posed, the answers state of the art]. Harefuah 2002; 141(8):726-30, 760.
to which will likely facilitate one's ability to translate Abstract: The review describes the heated dispute on
animal models of child psychopathology into human the present state of recovered traumatic memories.
terms. After summarizing the various advantages and There are two main schools concerning the status of
disadvantages to models using mice, rats, and recovered memories of child abuse. One school
monkeys, several examples of recent research that have believes in their authenticity unconditionally. Those
attempted to meld animal models with human studies who oppose the authenticity claim False Memory
are described. Syndrome's existence. They describe it as "a serious
form of psychopathology characterized by strongly
Nelson EA. Category D: unknown whether ill treatment is believed pseudomemories of childhood sexual abuse"
cause. Arch Dis Child 2003; 88(7):645. and "condition in which a person's identity and
interpersonal relationships are centered around a
Nelson L. Quashed convictions reignite row over British cot memory of traumatic experience which is objectively
deaths. Nature 2004; 427(6973):384. false but in which the person strongly believes". This
review presents the allegations of both sides involved
in the dispute, with updates of scientific and judicial
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![references and relevant recommendations to care used drugs and had problems related to drug use.
takers.
Newman BS, Dannenfelser PL. Children's protective
Neto MT. Regionalization, networks and neonatal transport. services and law enforcement: fostering partnerships in
J Matern Fetal Neonatal Med 2002; 11(2):140. investigations of child abuse. J Child Sex Abus 2005;
14(2):97-111.
Neufeld S, Wright SM, Gaut J. Not raising a "bubble kid": Abstract: Although collaboration in child abuse
farm parents' attitudes and practices regarding the investigations has been emphasized since 1974,
employment, training and supervision of their children. barriers, including role conflicts and organizational
J Rural Health 2002; 18(1):57-66. differences, have often been reported. This study
Abstract: This article explores farm parents' attitudes describes the process of collaboration based on the
and practices regarding the employment, training and perceptions of investigators working with a Child
supervision of their children among a sample of 24 Advocacy Center. Telephone interviews were
farm couples from southeastern Washington state. The conducted with 290 child protective service workers
goal was to gain a greater understanding of parental and law enforcement officers from 28 child advocacy
attitudes and practices in order to devise appropriate centers in 20 different states. Respondents identified
and meaningful efforts to improve the safety of barriers to the process of collaboration such as conflicts
children and adolescents involved in farm work. over case control and facilitators including co-housing
Demographic data regarding the farm families and their and cross-training. Conditions that should contribute to
farm safety practices were collected through a short successful collaboration are discussed.
questionnaire, and parental attitudes and practices
regarding the employment, training and supervision of Newman JD, Sheehan KM, Powell EC. Screening for
their children were explored through open-ended, semi- intimate-partner violence in the pediatric emergency
structured interviews. The results suggest that farm department. Pediatr Emerg Care 2005; 21(2):79-83.
parents have developed a logical and consistent set of Abstract: OBJECTIVE: The aims of this study were to
beliefs and attitudes regarding the employment, determine the annual prevalence of intimate-partner
training, and supervision of their children that is based violence (IPV) in an urban pediatric emergency
in part on the belief that farm work is highly beneficial department (ED) among mothers seeking care for their
to their children's development. Safety interventions to children, to examine the associations between IPV and
reduce childhood farm injuries will have to family socioeconomic characteristics, triage time, and
acknowledge farm work as important and beneficial for child's diagnosis, and to describe perceptions and
children in order to maintain legitimacy and credibility. preferences for IPV screening. METHODS: A
Nevertheless, because farm parents' practices regarding confidential 15-item survey was completed by 451
their children's employment reflect cultural beliefs and women caretakers who were unaccompanied by a male
values regarding children and child-rearing, some partner in an urban pediatric ED associated with a
recommended safety guidelines will be difficult to children's hospital. Women were enrolled during 4-
implement. hour time blocks selected to represent ED use patterns
during June and July 2002. Survey questions addressed
Newcomb MD, Locke TF. Childhood adversity and poor experiences of IPV (physical or sexual violence and
mothering: consequences of polydrug abuse use as a perception of safety) in the preceding year and
moderator. Addict Behav 2005; 30(5):1061-4. preferences for IPV screening. We also collected
Abstract: Drug abuse consequences have been typically information about the women's socioeconomic
examined as a direct or main effect on various later characteristics and the child's triage time and diagnosis.
outcomes. Drug abuse may also serve as a consequence RESULTS: Fifty women reported IPV, an annual
that alters (moderates) critical developmental prevalence of 11%. Compared with white women, the
trajectories. This study examined the relationship relative risk of IPV among black women was 1.1 (95%
between childhood adversity factors (parent alcohol confidence interval [CI], 1.0-1.2) and among Hispanic
and drug-related problems, childhood maltreatment) women was 1.1 (95% CI, 1.0-1.2). Compared with
and future parenting practices through an analysis of women who completed college, the relative risk of
the moderating effects of polydrug problems. Data women who had not completed high school was 5.8
from a community sample of mothers was divided into (95% CI, 2.0-26.4). We observed no association with
two groups based on the median split level of polydrug poverty. Women who reported IPV more often sought
problems (alcohol, marijuana, cocaine) that they care for their child in the evening (4-12 pm, chi2, P <
reported (low, N=123; high, N=114). Confirmatory 0.01); there was no association with the child's
factor models (CFAs) were developed for the two diagnosis. Most (75%) stated that IPV screening in the
groups and compared with multiple group analyses pediatric ED was appropriate. CONCLUSIONS: The
(MGAs). Results revealed that mothers who had annual prevalence of IPV in a pediatric ED is 11%. As
parents with alcohol or drug-related problems were socioeconomic and visit characteristics are imprecise in
more likely to become poor parents, if they themselves identifying women at risk, screening should include all
women. Screening for IPV in the pediatric ED is
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![relationships, recommendations were developed for some of the children to be infected with Chlamydia
each of 5 common situations: when a patient may not trachomatis. Therefore, the risk for sexually abused
yet recognize the abuse, when s/he may not be ready or children to be infected with Chlamydia trachomatis or
able to disclose the abuse, when s/he chooses to remain Neisseria gonorrhoeae is very low, depending on the
in an abusive relationship, when s/he is seeking care kind of abuse and the perpetrator's possible risk
for an acute assault, and when s/he has left the behaviour, age, and gender. As a conclusion, only
relationship but not yet healed. Interview excerpts children with a clear indication should be tested for
representing each of the identified themes are used to these sexually transmitted diseases.
create a 30-minute educational documentary. A written
companion guide covers the traditional aspects of Nievas F, Justicia F. Development of memory structures for
domestic violence education. In teaching about homographs using pathfinder network representations.
domestic violence or other health problems where it is Span J Psychol 2003; 6(1):12-27.
difficult for physicians to understand their patients Abstract: Some studies with children have shown that
intuitively, an educator's most important role may be to there is no semantic priming at short stimulus onset
direct learners to listen to the experience and wisdom asynchrony (SOA) in lexical decision and naming tasks
of patients. for homographs. The predictions of spreading
activation theories might explain this missing effect.
Nicoletti A. A role for the nurse practitioner. J Pediatr There may be differences in children's and adults'
Adolesc Gynecol 2001; 14(2):101-2. memory structures. We have explored this hypothesis.
The development of memory structure representations
Nielsen LA, Mikkelsen SJ, Charles AV. [Chlamydia for homographs was measured by a Pathfinder
trachomatis and Neisseria gonorrhoeae infections in algorithm. In Experiment 1, the three dependent
sexually abused children in Jutland]. Ugeskr Laeger variables were: the number of links in the network,
2002; 164(49):5806-9. closeness measures (C), and distances between nodes.
Abstract: INTRODUCTION: At the Department of Results revealed developmental differences in network
Forensic Medicine, University of Aarhus, Denmark, structure representations in adults and children. In
examinations are performed of children who are Experiment 2, results revealed that these differences
suspected of having been sexually abused. The medical were not due to the cohort effect. In Experiment 3, the
forensic investigation aims at documenting sexual relationship between associative strength, as measured
abuse if there are any physical findings. The presence by associative norms, and distances, as measured by
of certain sexually transmitted diseases, which cannot Pathfinder algorithm, was explored. The results of
be explained otherwise, may be such documentation. these three experiments and empirical research from
This article focuses on Chlamydia trachomatis and semantic priming experiments show that these
Neisseria gonorrhoeae, and the risk for the sexually differences in memory structure representations could
abused child to contract these diseases. MATERIAL be one of the sources of the missing semantic priming
AND METHODS: Retrospectively, we went through effect in children.
the Institute's files from 1996 to 2000 concerning child
abuse. Information about age, sex, cultures for Nilsson C, Horgby K, Borres MP. [Increasing number of
Chlamydia trachomatis and for Neisseria gonorrhoeae, child abuse cases in Sweden--in accordance with
and the results of these cultures was registered. If the reality?]. Lakartidningen 2001; 98(19):2298-301.
child had been cultured, the suspected perpetrator's age Abstract: The number of police reports on child assault
and gender were registered as well. The children were shows an increasing trend during the last two decades
all between 0 and 15 years of age, and in all cases the in Sweden. The purpose of this article is to present
suspicion of sexual abuse had led to reporting to the possible explanations. Increased awareness of child
police. RESULTS: 295 girls and 41 boys were abuse, legislative reforms, changes in attitudes toward
examined in the period from 1996 to 2000. A total of corporal punishment and violence in general, and
100 cultures for Chlamydia trachomatis and 105 changed routines within schools can explain the
cultures for Neisseria gonorrhoeae were performed. increasing trend in police reporting. An actual increase
Among the 111 children who were examined for in the rate of child abuse is possible but less likely.
Chlamydia trachomatis and/or Neisseria gonorrhoeae Reports of increasingly violent behavior among young
there were no positive results. In 102 cases the people must be taken seriously.
suspected perpetrator was known to be one or more
men, and only in one case it was a women. The mean Nishida A, Sugiyama S, Aoki S, Kuroda S. Characteristics
age of the suspected perpetrators was 35.4 years. and outcomes of school refusal in Hiroshima, Japan:
DISCUSSION: The prevalence of Neisseria proposals for network therapy. Acta Med Okayama
gonorrhoeae and Chlamydia trachomatis should reflect 2004; 58(5):241-9.
the prevalence in the group of perpetrators. Neisseria Abstract: The authors conducted a study on children
gonorrhoeae is uncommon outside Copenhagen, the undergoing treatment at major school refusal treatment
capital of Denmark, whereas Chlamydia trachomatis is centers in Hiroshima Prefecture. On the whole, school
quite common. On this background, we had expected
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![refusal in the prefecture was found to peak between 13 conflicting tasks imposed on the physician.
and 14 years of age. By age group, the main reason for Complementary to pediatric exclusion of genuine
school refusal in elementary school group was parent- disease, psychopathological assessment is required to
child relationship with separation anxiety. Given exclude other sources of deviant illness behaviour.
additional problems such as neglect at home and Factious disorder shares particular features (active
complicated social situations in their schools, junior violation of the child, false report of history,
high school students were found to present diverse aggravated symptom presentation and increased
symptoms from introversion and self-analysis to doctor-hopping, difficulties in conforming maternal
extroversion, neglect of studies, and delinquency. report in biomedical data) with other
Among high school students, there were more cases psychopathological entities (child abuse, simulation,
suffering withdrawal and schizophrenia spectrum dissociative disorders, somatoform disorders including
disorders. The major task regarding treatment seems to hypochondria, variants of maternal overprotection and
lie in how to treat complex cases combining different infantilization, psychosis or delusion in the mother).
problems. We summarized herein the studies we have Criteria for differentiation are presented. Three
carried out and propose a model for a network therapy concepts on the psychopathological etiology of
system based on functional liaisons between treatment factitious disorder by proxy are relevant: In some
centers. With this system, a child psychiatric medical cases, it may be conceived as secondary manifestation
facility plays the part of a liaison center for the overall of a primary psychopathological entity or personality
network system. disorder. Learning theory emphasises operant rewards
received from vicarious sick role. Attachment theory
Nixon RD, Sweeney L, Erickson DB, Touyz SW. Parent- provides possible explanations concerning the
child interaction therapy: a comparison of standard and traumatic impact on the child, early sources of
abbreviated treatments for oppositional defiant psychopathology in the fabricating mother and risks for
preschoolers. J Consult Clin Psychol 2003; 71(2):251- intergenerational transmission of factitious disorders.
60.
Abstract: Families of 54 behaviorally disturbed Nokes DJ, Okiro EA, Ngama M et al. Respiratory syncytial
preschool-aged children (3 to 5 years) were randomly virus epidemiology in a birth cohort from Kilifi district,
assigned to 1 of 3 treatment conditions: standard Kenya: infection during the first year of life. J Infect
parent-child interaction therapy (PCIT; STD); modified Dis 2004; 190(10):1828-32.
PCIT that used didactic videotapes, telephone Abstract: We report estimates of incidence of
consultations, and face-to-face sessions to abbreviate respiratory syncytial virus (RSV) infection during the
treatment; and a no-treatment waitlist control group first year of life for a birth cohort from rural, coastal
(WL). Twenty-one nondisturbed preschoolers were Kenya. A total of 338 recruits born between 21 January
recruited as a social validation comparison condition. 2002 and 30 May 2002 were monitored for symptoms
Posttreatment assessment indicated significant of respiratory infection by home visits and hospital
differences in parent-reported externalizing behavior in referrals. Nasal washings were screened by use of
children, and parental stress and discipline practices immunofluorescence. From 311 child-years of
from both treatment groups on most measures observation (cyo), 133 RSV infections were found, of
compared with the WL group. Clinical significance which 48 were lower respiratory tract infections
testing suggested a superior effect for the STD (LRTIs) and 31 were severe LRTIs, resulting in 4
immediately after intervention, but by 6-month follow- hospital admissions. There were 121 primary RSV
up, the two groups were comparable. The findings infections (248 cyo), of which 45 were LRTIs and 30
indicate that abbreviated PCIT may be of benefit for were severe LRTIs, resulting in 4 hospital admissions;
families with young conduct problem children. there was no association with age. RSV contributed
significantly to total LRTI disease in this vaccine-target
Noeker M. [Factitious disorder and factitious disorder by group.
proxy]. Prax Kinderpsychol Kinderpsychiatr 2004;
53(7):449-67. Noland JS, Singer LT, Short EJ et al. Prenatal drug exposure
Abstract: Similar to the adult patient, a child or and selective attention in preschoolers. Neurotoxicol
adolescent may actively feign or produce artificial Teratol 2005; 27(3):429-38.
symptoms (synonymous: Munchausen syndrome). The Abstract: Deficits in sustained attention and
more frequent case is that the child suffers from being impulsivity have previously been demonstrated in
an object of symptom fabrication induced by a close preschoolers prenatally exposed to cocaine. We
person caring for the child, regularly the mother assessed an additional component of attention,
(Munchausen syndrome by proxy). This review focuses selective attention, in a large, poly-substance cocaine-
on psychopathological aspects of the clinically more exposed cohort of 4 year olds and their at-risk
relevant factitious disorder by proxy. Typical comparison group. Employing postpartum maternal
behaviour and personality characteristics are presented report and biological assay, we assigned children to
that can be taken as clinical warning signs. Doctor- overlapping exposed and complementary control
mother-interaction is affectively challenging due to groups for maternal use of cocaine, alcohol, marijuana,
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![child behavior problems, and overreactive discipline southwest border hospital's in-house asthma
was a final mediator in 3 cases. More variance was educational program. DATA SOURCES: (1)
accounted for in mothers' than fathers' ratings. For "Increasing the Knowledge Base of Asthmatics and
mothers' ratings, the most variance was accounted for Their Families through Asthma Clubs along the
in boys' externalizing and girls' internalizing behavior Southwest Border." (2) American Lung Association.
problems. (3) National Institutes of Health, National Heart, Lung
and Blood Institute. (4) Referrals from a southwest
O'Neill DJ. Electronic tagging of people with dementia. border hospital. CONCLUSIONS: Only two of 23
Tagging should be reserved for babies, convicted patients referred for asthma follow-up were readmitted
criminals, and animals. BMJ 2003; 326(7383):281. to hospital and/or emergency care during the following
Notes: GENERAL NOTE: KIE: 5 refs. year. Large group teaching pretest-posttest score means
GENERAL NOTE: KIE: KIE Bib: behavior control; for 3,429 fourth and fifth grade students revealed a
patient care/drugs 23% increase in asthma knowledge. Small follow-up
groups of students received in-depth asthma education.
O'Neill M. Ohio's patient-physician privilege: whether IMPLICATIONS FOR PRACTICE: Effectiveness of
planned parenthood is a protected party. J Law Health hospital inpatient asthma education combined with
2002-2003; 17(2):297-325. outpatient family follow-up was supported. An
additional finding was that southwest border families
O'Shaughnessy RJ. Violent adolescent sexual offenders. are more receptive to visits arranged with a school
Child Adolesc Psychiatr Clin N Am 2002; 11(4):749- nurse in their children's school than to home visits from
65. primary care clinic nurses.
Abstract: The past 20 years have brought a significant
increase in the general knowledge about adolescent Oermann MH, Lowery NF, Thornley J. Evaluation of Web
offenders and sexual offenders and the potential harm sites on management of pain in children. Pain Manag
that they cause to victims. Currently, however, we are Nurs 2003; 4(3):99-105.
left with perhaps more questions than answers in Abstract: Increasingly, consumers access the Internet
several important areas. We have concluded that there for information about their health problems and
is no single cause or etiologic agent common to all treatments and to learn more about their health care.
sexual offenders. Sexual offenders are by nature a Although Web sites can be valuable resources, the
complex and a heterogeneous group, and sexual information may not be accurate or current. The
offending is likely caused by multiple causation and purpose of this project was to evaluate the quality of
interactive factors. Awareness has spread as to the Web sites for parents on the management of children's
necessity of providing appropriate assessment and pain. The Health Information Technology Institute
treatment facilities for adolescents. The limited criteria were used to evaluate 40 Web sites identified
outcome studies indicate a lower recidivism rate for from two search engines: MSN and Google. After the
adolescent offenders than adult offenders. This may evaluation process was completed, the readability of
reflect a better prognosis for adolescent offenders who the sites was determined. Of the 40 sites, 29 (72.5%)
have not had years of reinforcement of deviant sexual provided useful information for parents searching to
arousal patterns and whose personality traits are more educate themselves about pain management. Other
malleable than those of adult offenders. Further sites advertised the pain management services of their
research is needed in the area of subclassification of facility or were not relevant for patient education. The
sexual offenders, controlled treatment studies, and reading levels of the Web sites ranged from grade 7.7
prospective longitudinal studies to determine more to 12; the mean reading grade level of the 40 sites was
accurate risk assessment. 10.8, too high for many consumers. This article
discusses the role of the nurse in evaluating health Web
Oberklaid F. Child advocacy and the Queen's representative; sites and teaching patients how best to use the Web for
an unlikely link. Arch Dis Child 2003; 88(11):980. their health information.
Oberle A. [Possibilities and limitations of children's Oh KJ, Shin YJ, Moon KJ, Hudson JL, Rapee RM. Child-
physicians in exposing of child abuse]. rearing practices and psychological disorders in
Kinderkrankenschwester 2002; 21(8):345-8. children: cross-cultural comparison of Korea and
Australia. Yonsei Med J 2002; 43(4):411-9.
Ochsner AK, Alexander JL, Davis A. Increasing awareness Abstract: The present study was designed to explore
of asthma and asthma resources in communities on the cultural differences in the relationship between
southwest border. J Am Acad Nurse Pract 2002; parenting behaviors and psychological adjustment of
14(5):225-30, 232, 234. the child. Mother-son interaction behaviors of 37
Abstract: PURPOSE: To provide outpatient asthma Korean boys (11 with Anxiety Disorder, 10 with
education for children and families along the southwest Externalizing Disorders and 16 Non-clinical boys) and
border of the U.S. and to study the effectiveness of a 54 Australian boys (20 with Anxiety Disorder, 17 with
Externalizing Disorders and 17 Non-clinical boys)
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![activity increases in frontal and parietal regions. We Abstract: This article examines the individual
hypothesized that this would be mediated by components of bipolar disorder in children and the
maturation of white matter. Twenty-three healthy behaviors that can escalate as a result of misdiagnosis
children aged 8-18 years were investigated. Brain and treatment. The brain/behavior relationship in
activity was measured using the blood oxygen level- bipolar disorders can be affected by genetics,
dependent (BOLD) contrast with functional magnetic developmental failure, or environmental influences,
resonance imaging (fMRI) during performance of a which can cause an onset of dramatic mood swings and
working memory (WM) task. White matter dysfunctional behavior. School is often the site where
microstructure was investigated using diffusion tensor mental health disorders are observed when comparing
imaging (DTI). Based on the DTI data, we calculated behaviors with other children. Assessing the emotional,
fractional anisotropy (FA), an indicator of myelination academic, and health needs of a student with a bipolar
and axon thickness. Prior to scanning, WM score was disorder is a critical step in designing effective
evaluated. WM score correlated independently with FA interventions and school accommodations. Without
values and BOLD response in several regions. FA appropriate medical, psychological, pharmaceutical,
values and BOLD response were extracted for each and academic interventions, a child is at risk for
subject from the peak voxels of these regions. The FA uncontrolled mania, depression, substance abuse, or
values were used as covariates in an additional BOLD suicide. The school nurse is part of the
analysis to find brain regions where FA values and multidisciplinary team and plays a key role in
BOLD response correlated. Conversely, the BOLD facilitating case management to potentially reverse this
response values were used as covariates in an possible negative trajectory. Successful case
additional FA analysis. In several cortical and sub- management provides children with bipolar disorder
cortical regions, there were positive correlations the opportunity to reach their academic potential.
between maturation of white matter and increased brain
activity. Specifically, and consistent with our Olson SL, Ceballo R, Park C. Early problem behavior
hypothesis, we found that FA values in fronto-parietal among children from low-income, mother-headed
white matter correlated with BOLD response in closely families: a multiple risk perspective. J Clin Child
located grey matter in the superior frontal sulcus and Adolesc Psychol 2002; 31(4):419-30.
inferior parietal lobe, areas that could form a functional Abstract: Examined proximal and contextual factors
network underlying working memory function. most strongly related to externalizing behavior among
young children growing up in low-income, mother-
Olesen T. [Chlamydia among children and adolescents]. headed families. Participants were 50 low-income
Ugeskr Laeger 2005; 167(47):4482-3; author reply single mothers and their preschool-age children who
4483. were visited twice in the home setting. Measures of
proximal (low levels of supportive parenting, high
Olivan-Gonzalvo G. [Prevalence of hepatitis B, hepatitis C, levels of punitive disciplinary practices, low levels of
HIV and latent tuberculosis infection and syphilis in a maternal emotional well-being) and contextual (low
population of immigrant children at high social risk]. maternal support, high levels of family stress) risk were
Enferm Infecc Microbiol Clin 2004; 22(4):250. assessed in relation to maternal reports of child
externalizing behavior and an index of negative child
Oliveira RG, Marcon SS. [Infantile and juvenile sexual behavior during a clean-up task. Child defiance during
exploration: causes, consequences and relevant aspects the clean-up task was highly associated with punitive
for health professionals]. Rev Gaucha Enferm 2005; maternal control in the same situation but had no other
26(3):345-57. direct correlates. However, multiple risk factors
Abstract: This article brings a literature revision about representing both proximal and contextual variables
the infantile and juvenile sexual exploration. It were associated with variations in children's behavior
approaches the subject of sexual exploration in the problem scores. Mothers of children with high
national context by adopting, as crossed theme, behavior problem scores reported lower feelings of
different forms of violence, particularly the gender self-efficacy in handling child care and emotional
kind. It presents the causes and consequences of this stressors, more frequent use of punitive child
kind of violence for the individuals' health. From disciplinary practices, and lower feelings of satisfaction
reports on some experiences, it points out and discusses with the quality of their supportive resources than
relevant aspects of the performance of health others. Maternal self-evaluations of coping efficacy
professionals when facing the problem. mediated the relation between perceived support and
child behavior problems, suggesting that constructs of
Oliver-Vazquez M. [The ethics of public health]. P R Health personal control are important to represent in future
Sci J 2003; 22(1):21-2. studies of highly stressed parents.
Olson PM, Pacheco MR. Bipolar disorder in school-age Omar HA. Child and adolescent prostitution. J Pediatr
children. J Sch Nurs 2005; 21(3):152-7. Adolesc Gynecol 2002; 15(5):329-30.
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![children with environmental deprivation alone (i.e. low hospital discharge, on completion of the domiciliary
parental socioeconomic status [SES] and evidence of care programme and after 1 y, and in the CG at the
neglect), (2) children born to fathers with heroin corresponding points in time, which were during
dependency fathers, and (3) control individuals of hospitalization, at hospital discharge and after 1 y. No
average SES. One hundred and sixty children (84 statistical differences were observed between the
males and 76 females; average age at examination 8 groups in emotional well-being, except that mothers in
years) were evaluated between 1998 and 1999. All the EDG had a lower level of situational anxiety at the
were attending mainstream schools. All participants time of hospital discharge compared with CG mothers
were examined by a paediatrician and a psychologist whose infants remained in hospital. One year after the
using standard neurological and psychological age- birth, the EDG mothers said they had felt better
appropriate tests, as well as tests and questionnaires to prepared to take responsibility for the care of their
assess learning ability and attention span. The Conners babies after completion of the domiciliary care
and Achenbach questionnaires and the Pollack Taper programme, in contrast to CG mothers. However, no
test were used to assess possible presence of attention- statistical differences were observed in the recollection
deficit-hyperactivity disorder (ADHD). Mothers were of anxiety, confidence in handling the baby and periods
assessed for ADHD using Wender's questionnaire. of mental imbalance. No statistical difference was
Children born to parents with heroin dependency raised observed in breastfeeding rates between the groups.
at home and those of low SES exhibited intellectual Fathers in the EDG group tended to perceive their
impairment both on verbal and performance skills. babies as being healthier, compared with CG fathers.
They also had impaired reading and arithmetic skills. CONCLUSION: Early discharge of preterm infants
Children born to mothers with heroin dependency but followed by domiciliary nursing care did not seem to
who were adopted at a young age had normal have any major effect on the parents' anxiety and their
intellectual and learning abilities, except for some assessment of infant health.
reduced function on the performance Wechsler
Intelligence Scale for Children-Revised. We found a Osman M, Kebede Y, Anberbir S. Magnitude and pattern of
high rate of ADHD among all children born to parents injuries in north Gondar administrative zone, northwest
with heroin dependency, including those adopted, as Ethiopia. Ethiop Med J 2003; 41(3):213-20.
well as in children with low parental SES. The highest Abstract: A prospective study was carried out between
rate of ADHD was in children born to mothers with April and July 2000 in North Gondar administrative
heroin dependency raised at home, being twice that zone, Northwest Ethiopia, to assess the magnitude,
observed in the other groups. Mothers of these groups pattern, outcome and burden of injuries. All trauma
of children also had a high rate of ADHD. victims presenting to twenty health institutions were
included. Of 37026 patients registered, 1982 (5.4%)
Orr RD. Clinical ethics case consultation. Ethics Med 2002; presented with injury as main complaint. Trauma
18(2):33-4. constituted about 46% of surgical patients, which
Notes: GENERAL NOTE: KIE: KIE Bib: treatment shows a significant burden to the institutions. Seventy
refusal/minors three percent of the injured patients were males. The
Abstract: Question: Should we seek a court order to use leading cause of injury was assault (48.5%) followed
blood products and/or extra-corporeal membrane by fall down injury (18.6%) and road traffic injuries
oxygenation (ECMO) on this critically ill child of (14.7%). Of the vehicle related injuries, 59.6% were
Jehovah's Witness parents? caused by commercial vehicles. Admission was
required in 15.2% of the injured patients. An average
Ortenstrand A, Winbladh B, Nordstrom G, Waldenstrom U. of 4.2 hours was required for initial outpatient
Early discharge of preterm infants followed by management. The average hospital stay for the
domiciliary nursing care: parents' anxiety, assessment admitted patients was twelve and half days. In this and
of infant health and breastfeeding. Acta Paediatr 2001; other parts of Ethiopia, injury prevention efforts should
90(10):1190-5. focus on assault, falls and transport safety with special
Abstract: The aim of this study was to evaluate the attention to commercial vehicles. A community-based
effect of early discharge of preterm infants, followed study is also recommended to explore the burden of
by domiciliary nursing care, on the parents' anxiety, trauma on the general community.
their assessment of infant health and breastfeeding.
Seventy-five families including 88 preterm infants who Osterhoudt KC. A toddler with recurrent episodes of
were physiologically stable but in need of further unresponsiveness. Pediatr Emerg Care 2004;
special care, such as gavage feeding, were allocated to 20(3):195-7.
an early discharge group (EDG) that was offered home
visits (n = 40), or to a control group offered standard Overstreet K, Mannino FL, Benirschke K. The role of
neonatal care (CG) (n = 35). Seventy families (37 in placental pathology in the evaluation of interpersonal
the EDG and 33 in the CG) completed the study to the violence: a case of abdominal gunshot wound in a 27-
1-y follow-up. Data were collected by means of week gravid uterus. J Perinatol 2002; 22(8):675-8.
questionnaires on three occasions: in the EDG, at
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![historical data. The composition of the 2004-2005 videoconferencing were installed, connected by ISDN
influenza vaccine has been modified compared with the lines at 128 kbit/s. Fifty-three general practitioners
2003-2004 season and includes an A/Fujian/411/2002 (GPs) were surveyed. The survey showed that the GPs
(H3N2)-like virus strain and a new B virus strain (a had difficulties in using computers, but they had
B/Shanghai/361/2002-like virus). definite intentions to use teleconsultation for neurology
cases and 83% of the respondents stated that they
Paine RW, Grossberg S, Van Gemmert AW. A quantitative would probably use the technique. During the study, 90
evaluation of the AVITEWRITE model of handwriting neurology teleconsultations took place over 55 weeks.
learning. Hum Mov Sci 2004; 23(6):837-60. The average consultation rate was 1.6 teleconsultations
Abstract: Much sensory-motor behavior develops per week (SD 1.3, range 0-6). The conferences lasted
through imitation, as during the learning of 10-45 min. Longer teleconsultations were mainly due
handwriting by children. Such complex sequential acts to technical difficulties in using computers on the part
are broken down into distinct motor control synergies, of users with a low level of computer literacy. The
or muscle groups, whose activities overlap in time to patients were 42 males and 46 females, with a mean
generate continuous, curved movements that obey an age of 38 years (SD 20, range 1-84); two patients were
inverse relation between curvature and speed. The discussed twice. The benefits consisted mainly of
adaptive vector integration to endpoint handwriting advice on patient medication, diagnosis and the
(AVITEWRITE) model of Grossberg and Paine (2000) prevention of unnecessary specialist consultations or
[A neural model of corticocerebellar interactions laboratory examinations. Doctor-doctor
during attentive imitation and predictive learning of teleconsultation allows the rapid resolution of queries
sequential handwriting movements. Neural Networks, which otherwise cause stress to patients and increase
13, 999-1046] addressed how such complex the cost and complexity of care.
movements may be learned through attentive imitation.
The model suggested how parietal and motor cortical Paivio SC. Stability of retrospective self-reports of child
mechanisms, such as difference vector encoding, abuse and neglect before and after therapy for child
interact with adaptively-timed, predictive cerebellar abuse issues. Child Abuse Negl 2001; 25(8):1053-68.
learning during movement imitation and predictive Abstract: OBJECTIVE: This study is a follow-up to a
performance. Key psychophysical and neural data previously reported outcome study evaluating the
about learning to make curved movements were efficacy of an emotionally focused therapy for adult
simulated, including a decrease in writing time as survivors of childhood abuse. The present purpose was
learning progresses; generation of unimodal, bell- to evaluate the stability of self-reports of child
shaped velocity profiles for each movement synergy; maltreatment in the context of reduced
size scaling with isochrony, and speed scaling with psychopathology after therapy. The Childhood Trauma
preservation of the letter shape and the shapes of the Questionnaire (CTQ; Bernstein et al., 1994) was used
velocity profiles; an inverse relation between curvature to measure the extent of child abuse and neglect.
and tangential velocity; and a two-thirds power law METHOD: The CTQ and measures of
relation between angular velocity and curvature. symptomatology, abuse resolution, and self-esteem
However, the model learned from letter trajectories of were administered at pretreatment to 44 clients and
only one subject, and only qualitative kinematic after 6 months of therapy to 33 therapy completers.
comparisons were made with previously published Post-treatment interviews also assessed changes in
human data. The present work describes a quantitative clients' perceptions of self and abusive and neglectful
test of AVITEWRITE through direct comparison of a others. Analyses examined change on dependent
corpus of human handwriting data with the model's measures, in interviews, and on the CTQ, as well as the
performance when it learns by tracing the human test-retest and alpha reliabilities of CTQ factor scales,
trajectories. The results show that model performance and the relationship of CTQ factor scales with
was variable across the subjects, with an average pretreatment measures of distress. RESULTS:
correlation between the model and human data of Analyses revealed significant reductions in
0.89+/-0.10. The present data from simulations using psychopathology on all dependent measures and
the AVITEWRITE model highlight some of its reduced self-blame, negatively biased memories,
strengths while focusing attention on areas, such as avoidance, and minimization of the abuse after therapy.
novel shape learning in children, where all models of Reports of abuse and physical neglect on the CTQ
handwriting and the learning of other complex sensory- remained stable from pre- to post-therapy. All CTQ
motor skills would benefit from further research. dimensions demonstrated good internal consistency
and convergent validity with trauma-specific measures
Paiva T, Coelho H, Araujo MT et al. Neurological of distress. CONCLUSIONS: The stability of the CTQ
teleconsultation for general practitioners. J Telemed in the context of significantly reduced psychopathology
Telecare 2001; 7(3):149-54. contributes to evidence supporting the accuracy of
Abstract: A neurology teleconsulting network was retrospective self-reports of childhood abuse.
implemented between a university hospital in Lisbon
and five nearby health centres. PCs equipped for Paivio SC, Laurent C. Empathy and emotion regulation:
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![lower Caesarean section (CS) rate was observed with greater co-occurrence of different forms of
misoprostol (7.5% vs. 13.3%, p > 0.05) but with the maltreatment, especially involving sexual abuse, than
disadvantage of higher abnormal fetal heart rate (FHR) men.
tracings (22.5% vs. 12%, p > 0.05). From the
misoprostol group more neonates were admitted to the Paradise JL, Dollaghan CA, Campbell TF et al. Otitis media
intensive neonatal unit, than from the dinoprostone and tympanostomy tube insertion during the first three
group (13.5% vs. 4.8%, p > 0.05). One woman had an years of life: developmental outcomes at the age of
unexplained stillbirth following the administration of four years. Pediatrics 2003; 112(2):265-77.
one dose of dinoprostone. CONCLUSIONS: Vaginal Abstract: OBJECTIVE: In a long-term, prospective
misoprostol, compared with dinoprostone in the study, we set out to determine whether otitis media in
regimens used, is more effective in elective inductions the first 3 years of life persisting for periods currently
of labor beyond 40 weeks of gestation. Nevertheless, considered developmentally threatening actually results
this is at the expense of more abnormal FHR tracings in later impairments of children's cognitive, language,
and more admissions to the neonatal unit, indicating speech, or psychosocial development; whether prompt
that the faster approach is not necessarily the better insertion of tympanostomy tubes prevents or lessens
approach to childbirth. any such impairments; and whether, irrespective of
causality, associations exist between persistent early-
Papin T, Houck T. All it takes is leadership. Child Welfare life otitis media and later developmental impairments.
2005; 84(2):299-310. This report describes findings in study participants at
Abstract: The authors, as leaders in a public child the age of 4 years. METHODS: We enrolled 6350
welfare system, have teamed together and reached out healthy infants from 2 to 61 days of age at urban
to their private sector partners in a large, rural county hospitals and 2 small-town/rural and 4 suburban private
in western Colorado. This effort was part of a pediatric practices. We regularly evaluated the children
comprehensive, communitywide effort to redesign and for the presence of middle-ear effusion (MEE)
fundamentally improve the entire child welfare service throughout their first 3 years of life by pneumatic
delivery system. Across the country in many areas otoscopy, supplemented by tympanometry; we
where collaboration and integration have been the monitored the validity of the otoscopic observations on
focus, we often hear voices in the private and public an ongoing basis; and we treated children for otitis
sector declaring the importance of integration. Why, media according to specified guidelines. In the clinical
then, does it not happen as a general course of action? trial component of the study, we randomly assigned
The authors believe the answer lies in leadership, both 429 children who met specified minimum criteria
public and private. They hold the Mesa County model regarding the persistence of MEE to undergo
up as witness to that fact. tympanostomy tube insertion either promptly or after a
defined extended period if MEE remained present. In
Papworth S, Cartlidge P. Learning from adverse events - the the associational component of the study, we selected a
role of confidential enquiries. Semin Fetal Neonatal representative sample of 241 children who ranged from
Med 2005; 10(1):39-43. having no MEE to having MEE the cumulative
Abstract: National confidential enquiries collect data duration of which fell just short of meeting
on adverse events to identify shortfalls and improve randomization criteria for the clinical trial. In 397
future clinical care; they also highlight inadequacies in (92.5%) of the children in the clinical trial and in 234
service organisation. This article focuses on the work (97.1%) of the children in the representative sample,
of the Confidential Enquiry into Maternal Deaths we assessed cognitive, language, speech, and
(CEMD) and the Confidential Enquiry into Stillbirths psychosocial development at the age of 4 years, using
and Deaths in Infancy (CESDI). formal tests, conversational samples, and parent
questionnaires. RESULTS: In children in the
Paquette D, Laporte L, Bigras M, Zoccolillo M. [Validation randomized clinical trial, there were no statistically
of the French version of the CTQ and prevalence of the significant differences in mean (+/-standard deviation)
history of maltreatment]. Sante Ment Que 2004; scores (higher denotes more favorable) favoring the
29(1):201-20. early-treatment group over the late-treatment group on
Abstract: This study demonstrates that the five the General Cognitive Index of the McCarthy Scales of
maltreatment scales in the long and short versions of Children's Abilities (97 +/- 14 and 98 +/- 14,
the CTQ are valid and usable with French-speaking respectively); the Peabody Picture Vocabulary Test-
populations. It also shows emotional neglect to be the Revised, a measure of receptive language (90 +/- 15 vs
most common form of maltreatment in its general 92 +/- 16); the Nonword Repetition Test, a measure of
population sample, and physical neglect to be the least phonological memory (66 +/- 12 vs 70 +/- 12); the
common. Physical, emotional and sexual abuse Number of Different Words, a measure of word
prevalences in the convenience sample roughly diversity (150 +/- 34 vs 150 +/- 31); the Mean Length
correspond to the rates generally obtained in non- of Utterance in Morphemes, a measure of sentence
clinical samples. Finally, women in the sample display length and grammatical complexity (3.4 +/- 0.8 vs 3.4
+/- 0.7); or the Percentage of Consonants Correct-
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![own species. These results suggest that the "perceptual they were. From the letters of referral, 37% contained a
narrowing" phenomenon may represent a more general reason for GA and 63% did not give any reason or
change in neural networks involved in early cognition. justification for GA. CONCLUSION: There is
evidence that referring practitioners do not adequately
Pascual-Castroviejo I, Pascual Pascual SI, Ruza-Tarrio F, explain the risks of the anaesthetic to parents or
Viano J, Garcia-Segura JM. [Battered baby syndrome. guardians of children undergoing GA. There is also a
Report of a case with severe sequelae]. Rev Neurol lack of clear justification in the letters of referral for
2001; 32(6):532-5. providing GA. PRACTICE IMPLICATION: It is
Abstract: OBJECTIVE. To present a case with shaken- essential that the alternatives and the risks of GA are
baby syndrome after having seizures and respiratory discussed and if GA is still required, a clear
problems. CLINICAL CASE. A previously normal justification should be contained in the letter of referral
child of 7 months of age presented an acute picture of as part of informed consent. More importantly the
status epilepticus with respiratory problems and referring practitioner should keep a contemporaneous
periods of apnea. He was studied with record of this, preferably with a signature from the
electroencephalography, computerized tomography, parent or guardian on agreement of referral.
magnetic resonance (MR) imaging and spectroscopic-
MR. The child showed the presence of small subdural Paterson J, Tukuitonga C, Butler S, Williams M. Infant bed-
and epidural hematomas in both frontal regions 24 sharing among Pacific families in New Zealand. N Z
hours after the onset of the problem. The follow-up Med J 2002; 115(1154):241-3.
with MR studies revealed voluminous subdural Abstract: AIM: To describe infant bed-sharing among
bilateral hygroma that increased the size along the Pacific families in New Zealand. METHODS: The data
following six months, despite treatment with bilateral were gathered as part of the Pacific Island Families:
subdural-peritoneal shunt, and the patient showed First Two Years of Life (PIF) Study in which 1376
infantile spasms. At 8 years of age, the patient shows mothers were interviewed when their infants were six-
severe mental retardation with autistic behavior and weeks-old. Maternal reports of infant bed-sharing
blindness, though he is able to walk without help and practices were assessed by questions about infant sleep
he has not seizures. The subdural hygroma decreased location and the number of people who usually shared
the size, but MR shows severe cortico-subcortical a mattress with the infant. RESULTS: Over half of the
atrophy of both parieto-occipital regions. Spectroscopic mothers (54.9%) reported that their infants shared a
MR study discloses severe neuronal lost and gliosis. mattress with other people, 44.2% sharing with one
CONCLUSIONS. The shaken-baby syndrome causes other person, the remainder sharing with two or more
severe encephalopathy and vision problems, blindness people. Of the bed-sharing infants, 4.7% slept on a
in many cases, after showing voluminous subdural mattress on top of the bed, and 4.7% only slept part of
and/or epidural hematomas which lead to a severe the night in the shared bed. CONCLUSIONS: Together
neuronal lost and gliosis. Shaken-baby syndrome is not with effective information delivery, the educational and
always associated with skull fracture nor is necessarily housing issues that many Pacific families in New
related with battered-child syndrome. Zealand face need to be addressed so that parents can
make informed decisions about infant care practices.
Patel AM. Appropriate consent and referral for general
anaesthesia - a survey in the Paediatric Day Care Unit, Patric D. Safeguarding children through police checks: a
Barnsley DGH NHS Trust, South Yorkshire. Br Dent J discussion. Paediatr Nurs 2004; 16(9):36-8.
2004; 196(5):275-7; discussion 271.
Notes: GENERAL NOTE: KIE: 7 refs. Patten P. Medicolegal diary: standards of conduct. N Z Med
GENERAL NOTE: KIE: KIE Bib: informed J 2001; 114(1125):50-1.
consent/minors
Abstract: BACKGROUND: In November 1998 the Patterson GR, DeGarmo D, Forgatch MS. Systematic
General Dental Council introduced guidelines for changes in families following prevention trials. J
dental practitioners when referring a patient for general Abnorm Child Psychol 2004; 32(6):621-33.
anaesthesia (GA). The practitioner is required to Abstract: A selective prevention design was applied to
explain the risks associated with GA and the 238 recently separated families. Of these, 153 mothers
alternatives, give a detailed medical history and a clear randomly assigned to the experimental (E) group
justification for providing GA in the letter of referral. participated in 14 group sessions focused on Parent
METHOD: A survey was administered on 202 parents Management Treatment (PMT). Prior analyses showed
or guardians, which aimed to investigate whether they that, over time, the group of families in the untreated
felt that their dental practitioners had advised them of group deteriorated in both parenting practices and in
any risks of GA prior to referral. A record was also child outcomes. In keeping with the classic prevention
made if any reasons were given for the provision of pattern, families in the E group showed modest
GA in the letter of referral. RESULTS: The majority of improvements in parenting and in child outcomes.
the parents or guardians (66%) felt that they were not Improvements in parenting were associated with
informed of any of the risks of GA and 25% felt that
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![parents. Further, a measure of parental monitoring was half of the plans had restrictions on the number of
used, and information was also collected on other outpatient visits, with limits ranging from 12 to 60
aspects of the family milieu, and on the adolescents' clinic visits a year. More than half of the plans had
peers. Statistical models. Logistic regression analysis limitations on the number of inpatient days, ranging
was employed. As the sample consisted of pupils from 20 to 60 days a year. Diagnoses excluded from
clustered within classes within schools, a three-level coverage included autism, mental retardation, problems
error structure for the logistic regression model was related to child abuse, and impulse control disorders,
estimated. FINDINGS. There was a strong association such as kleptomania and pyromania. Half of the
between early conduct problems and subsequent services excluded could be categorized as either social
cannabis initiation. Also conduct problems at a and human services or complementary medicine rather
potential subclinical level seemed to have great impact. than as mental health care. CONCLUSIONS: Plans
The effect was significantly stronger in girls than in commonly had service and diagnostic exclusions that
boys. Serious CP was found to have a moderate effect could disrupt children's health care. The results of the
upon cannabis initiation in boys, whereas aggressive study emphasize a need to address the types of
and covert CP had strong effects in girls. Early onset of treatment covered by mental health insurance.
puberty and early sexual involvement had no impact,
whereas early use of cigarettes proved an important Peeters F, Wessel I, Merckelbach H, Boon-Vermeeren M.
precursor to cannabis use. CONCLUSIONS. Conduct Autobiographical memory specificity and the course of
problems are important precursors of early onset major depressive disorder. Compr Psychiatry 2002;
cannabis use, but probably represent gender-specific 43(5):344-50.
aetiologies. There might be an important potential for Abstract: This study examined the stability of
prevention of early onset drug use in the prevention of autobiographical memory dysfunction (i.e., difficulties
early conduct problems, in particular for girls. in retrieving specific memories) during the course of
major depressive disorder, its relation to early adverse
Pedersen W, Samuelsen SO. [New patterns of sexual experiences, and its influence on the course of
behaviour among adolescents]. Tidsskr Nor Laegeforen depressive disorder. Using the Autobiographical
2003; 123(21):3006-9. Memory Test (AMT), specificity of autobiographical
Abstract: BACKGROUND: We wanted to investigate memory was assessed in 25 subjects with a current
erotic and sexual behaviour in adolescents, with depressive disorder at baseline, and at 3 and 7 months
emphasis on the trend over the last decade. follow-up. Also, information about self-reported
MATERIALS AND METHODS: Two large, survey- childhood traumatization, and demographic and
based representative studies of Norwegian adolescents clinical variables was obtained. Autobiographical
(each with approx. 11 000 respondents) from 1992 and memory performance was relatively stable over time
2002 (response rates 97% and 92%). FINDINGS: despite clinical improvement in the sample. It was not
Median age at first intercourse has decreased by 12 related to depression severity at baseline, while higher
months in females over this ten-year time span (to 16.7 levels of childhood traumatization were correlated with
years), while the decrease among males was more more specific memory performance to negative cue
modest. Furthermore, oral sex now has the same words at baseline, but not during follow-up. Specific
prevalence as coitus from the mid-teen years on and autobiographical responses to negative cue words
seems to be introduced at the same point in time. predicted a better prognosis, whereas specific
Finally, females are as inclined as males to break the responses to positive cue words were not related to
norm of being in love as the basis for a sexual prognosis. Autobiographical memory dysfunction in
relationship. INTERPRETATION: More adolescents depression appears to be stable over time, is related to
are now sexually active and more risky sexual short-term prognosis in depression, and may act as a
behaviour might be a consequence. However, the vulnerability factor that influences the long-term
findings also suggest increased gender equality and a course of depressive disorders.
new cohort of more sexually active and self-confident
females. Pelias MK, Markward NJ. Newborn screening, informed
consent, and future use of archived tissue samples.
Peele PB, Lave JR, Kelleher KJ. Exclusions and limitations Genet Test 2001; 5(3):179-85.
in children's behavioral health care coverage. Psychiatr Notes: GENERAL NOTE: KIE: 25 refs.
Serv 2002; 53(5):591-4. GENERAL NOTE: KIE: KIE Bib: genetic research;
Abstract: OBJECTIVE: The objective of this study was genetic screening; human experimentation/informed
to identify benefit limits, diagnostic exclusions, and consent
service exclusions of private behavioral health care Abstract: Recent advances in genetic technologies have
plans that can influence the delivery of care to children. combined with established protocols for genetic
METHODS: A total of 128 commercial, employment- screening to provide immense benefits to individuals
based behavioral health plans were examined for types and the public. In most American jurisdictions,
of benefit limits, service exclusions, and diagnostic newborn screening is mandated by law and does not
exclusions applicable to children. RESULTS: Almost require parental consent for the collection or testing of
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![the blood samples. Screening programs have been reuptake inhibitors are limited in number, evidence
successful in identifying affected infants at an early supports their use as first-line antidepressant
stage for effective treatment of some genetic diseases. medication in youth depression. Available evidence
The public health benefit of screening programs is suggests that various treatment modalities are useful in
recognized and affirmed. However, collections of the treatment of suicidal youths, e.g. cognitive
surplus, stored samples have become immensely behavioral therapy and specialized emergency room
attractive to researchers in medical genetics and the interventions. Much of the decrease in suicide ideation
biomedical sciences. As geneticists have sought access and suicide attempts seems to be attributable to
to the newborn screening samples, they have nonspecific elements in treatment. For high-risk youth,
recognized concerns related to whether they should use providing continuity of care is a challenge, since they
the samples, and, if so, under what conditions. This are often noncompliant and commonly drop out or
paper addresses the ethical issues associated with terminate their treatment prematurely. Developing
genetic screening and recommends an informed efficacious treatments for suicidal children and
consent protocol that may be used to balance individual adolescents would offer better possibilities to prevent
and parental rights with the interests of researchers suicides.
who wish to use surplus samples in studies of genetic
disease. Pellai A, Castelli B, Scyslowska G et al. [Child sexual abuse
primary prevention: outcome evaluation of a health
Pelkonen M, Marttunen M. Child and adolescent suicide: education project implemented in Milan's elementary
epidemiology, risk factors, and approaches to schools]. Ann Ig 2003; 15(5):529-39.
prevention. Paediatr Drugs 2003; 5(4):243-65. Abstract: The study we present is aimed at evaluating
Abstract: Suicide is rare in childhood and early the efficacy of a child sexual abuse prevention program
adolescence, and becomes more frequent with that involved children attending 4th and 5th grade in
increasing age. The latest mean worldwide annual rates Milan's (Italy) elementary schools. The project
of suicide per 100 000 were 0.5 for females and 0.9 for involved 53 classes (10 of 4th, 43 of 5th grade) during
males among 5-14-year-olds, and 12.0 for females and school year 2000-2001. Children filled a questionnaire
14.2 for males among 15-24-year-olds, respectively. In before the beginning of the project and two months
most countries, males outnumber females in youth after the end; the questionnaire evaluates children's
suicide statistics. Although the rates vary between perception of risk and their self-efficacy skills in
countries, suicide is one of the commonest causes of adopting protective strategies when involved in at risk
death among young people. Due to the growing risk for situations. Final analysis has involved 674 children,
suicide with increasing age, adolescents are the main 51.8% girls, 48.2% boys; 19.6% of children attended
target of suicide prevention. Reportedly, less than half 4th grade, 80.4% 5th grade. Percentage of children that
of young people who have committed suicide had recognize the potential danger in the suggested at-risk
received psychiatric care, and thus broad prevention situation is higher in post-test then in pre-test (87.9%
strategies are needed in healthcare and social services. vs 73.2%) and the number of them that does not adopt
Primary care clinicians are key professionals in any self-defence strategy decreases (from 35.3% to
recognizing youth at risk for suicide. This article 21.0%). The project increased the number of children
reviews recent population-based psychological autopsy that know body puberal changes (from 16.0% to
studies of youth suicides and selected follow-up studies 32.8%). According to these results it is evident that the
of clinical populations and suicide attempters, program increased children's capacity to recognize and
analyzing risk factors for youth suicides. As youth use self defence strategies in at risk situations. These
suicides are rare, research on risk factors for youth results call for a potential extention and replication of
suicidal ideation and attempted suicide is also briefly this health education program.
reviewed. The relationship between psychiatric
disorders and adolescent suicide is now well Pennington DJ, Lonergan GJ, Mendelson KL. How well do
established. Mood disorders, substance abuse and prior we prepare pediatric radiologists regarding child
suicide attempts are strongly related with youth abuse? Results of a survey of recently trained fellows.
suicides. Factors related to family adversity, social Pediatr Radiol 2004; 34(1):59-65.
alienation and precipitating problems also contribute to Abstract: BACKGROUND: Pediatric radiologists
the risk of suicide. The main target of effective serve an important role in the radiologic diagnosis,
prevention of youth suicide is to reduce suicide risk investigation, and in legal proceedings in cases of child
factors. Recognition and effective treatment of abuse. The Society for Pediatric Radiology should
psychiatric disorders, e.g. depression, are essential in evaluate and insure the adequacy of training of
preventing child and adolescent suicides. Research on pediatric radiologists for this important role.
the treatment of diagnosed depressive disorders and of OBJECTIVE: The Society for Pediatric Radiology
those with suicidal behavior is reviewed. In the Committee on Child Abuse, 2002, conducted a 24-
treatment of youth depression, psychosocial treatments question survey to evaluate the scope and perceived
have proved to be useful and efficacious. Although adequacy of training received by pediatric radiology
studies on the effectiveness of selective serotonin fellows regarding the radiologic diagnosis of child
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![abuse and the associated legal process. MATERIALS identified an acute opiate intoxication. The child also
AND METHODS: Eighty-four surveys were mailed to developed chest wall rigidity, a rare complication of
radiologists who had completed a year in pediatric narcotic use. We discuss the emergency department
radiology fellowship training during the years 1999 and management, as well as the toxicologic and child
2000. There were 33 surveys returned for an overall protection investigations.
response of 39%. RESULTS: Respondents' perception
of adequacy of training was best for the radiologic Perez-Albeniz A, de Paul J. Dispositional empathy in high-
diagnosis of child abuse. The majority perceived they and low-risk parents for child physical abuse. Child
were not well trained in the investigative and legal Abuse Negl 2003; 27(7):769-80.
processes regarding child abuse. The majority would Abstract: OBJECTIVE: The present study was
welcome standardized training. CONCLUSION: designed to investigate dispositional empathy in high-
Current pediatric radiology training programs do not risk parents for child physical abuse, using self-report
sufficiently prepare pediatric radiologists for their role instruments. More specifically, the objective was to
in the legal system regarding child abuse. A know if high-risk parents for child physical abuse, in
standardized program to train pediatric radiologists comparison with low-risk parents, show deficits on
about the imaging diagnosis of child abuse and their main dimensions of dispositional empathy: empathic
role in the legal system is recommended. concern, role-taking, and personal distress. METHOD:
Based on their scores on the Abuse Scale of the CAP
Penson RT, Amrein PC. Faith and freedom: leukemia in Inventory (Milner, 1986), 36 high-risk and 38 low-risk
Jehovah Witness minors. Onkologie 2004; 27(2):126-8. for child physical abuse participants were selected from
a total sample of 440 Basque Country (Spain) general
Perera H, Rodrigo GD. Met and unmet needs of children population parents. Both groups were statistically
with epilepsy in a paediatric tertiary care setting. matched on sociodemographic variables. The
Ceylon Med J 2004; 49(1):11-4. Interpersonal Reactivity Index (IRI, Davis, 1980), the
Abstract: OBJECTIVE: To investigate the extent to Hogan Empathy Scale (HES, Hogan, 1969) and the
which the health needs were met or unmet in children Questionnaire Measure of Emotional Empathy
with epilepsy attending a tertiary care outpatient (QMEE, Mehrabian & Epstein, 1972) were used to
setting. PATIENTS AND METHOD: A semi- assess dispositional empathy. RESULTS: As expected,
structured interview was used to collect relevant high-risk, relative to low-risk, parents showed lower
information from the parents. It focused on total scores on the HES and QMEE measures and
ascertaining the quality of health care received by the lower scores on the IRI "Empathic concern" dimension.
children, including the extent to which attention was Moreover, high-risk, relative to low-risk, parents
given to epilepsy related physical, behavioural, social showed higher scores on the IRI "Personal distress"
and educational impairments that were identified by the dimension. No differences between groups were
parents. RESULTS: There was satisfactory seizure observed for the IRI "Perspective-taking" dimension.
control in the majority. Most children received only CONCLUSIONS: Findings of the present study
one anticonvulsant and side-effects were reported to be supported the hypothesis that high-risk parents for
minimal. A large majority had behavioural problems, child physical abuse show a deficit in dispositional
and social and educational difficulties to a lesser empathy. High-risk parents reported less feelings of
extent. Parents were concerned about the implications warmth, compassion and concern for others and more
of these problems, but there was little communication feelings of anxiety and discomfort that result from
about them in the doctor-patient contact. Even where observing another's negative experience.
the problems were communicated, parent satisfaction
about the interventions was low. Parents identified the Perez-Albeniz A, de Paul J. Gender differences in empathy
availability of more consultation time and provision of in parents at high- and low-risk of child physical abuse.
more information on epilepsy as their expectations Child Abuse Negl 2004; 28(3):289-300.
from doctors. CONCLUSIONS: This study shows that Abstract: OBJECTIVES: The present research was
awareness and communication about the multiple designed to study empathy in high-risk parents for
health problems of children with epilepsy are necessary child physical abuse. The main objective was to study
to improve the quality of health care given to them. if high-risk mothers and fathers, compared to low-risk
mothers and fathers, presented more Personal distress,
Perez A, Scribano PV, Perry H. An intentional opiate less Perspective-taking, less Empathic concern and a
intoxication of an infant: when medical toxicology and deficit in dispositional empathy toward their partner
child maltreatment services merge. Pediatr Emerg Care and children. METHOD: Based on their scores on the
2004; 20(11):769-72. Abuse Scale of the CAP Inventory [J.S. Milner, The
Abstract: We present an instructive case of a 5-week- Child Abuse Potential Inventory: Manual, 2nd ed.,
old infant seen in the emergency department with acute Psytec Corporation, Webster, NC], 19 (9 fathers and 10
inspiratory stridor and depressed level of mothers) high- and 26 (12 fathers and 14 mothers) low-
consciousness. His emergency department course risk parents for child physical abuse were selected from
a total sample of 331 parents of the Spanish general
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![population. Both groups were statistically matched on healthcare districts, a total of 65 being overusers of
sociodemographic variables. The Interpersonal emergency care (8 or more visits). The month of
Reactivity Index (IRI) [Catalog of Selected Documents August (32.3%). Sundays (44.56%) and the 12:00
in Psychology 10 (1980) 85] and the Parent/Partner p.m.-2:00 p.m. timeframe (8.38%) are the times when
Empathy Scale (PPES) [N.D. Feshbach, N. Caskey, A the greatest demand for care occurs, the differences
new scale for measuring parent empathy and partner being statistically significant. Televised soccer games
empathy: factorial structure, correlates and clinical were associated to a 19.8% (p < 0.001) rise in demand
discrimination, 1985] were used to assess dispositional as compared to the control period. CONCLUSIONS: A
empathy. RESULTS: An interaction between risk high degree of use of the extrahospital emergency care
status and gender for "Personal distress" and units has been found to exist, a major part of the
"Perspective-taking" was found. High-risk mothers for demand being concentrated at highly specific points in
child physical abuse showed more "Personal distress" time. A major degree of care is provided to those
than low-risk mothers and low-risk fathers. High-risk visiting from outside their own healthcare districts.
fathers for child physical abuse showed less Television soccer game broadcasts is associated with
"Perspective-taking" than low-risk mothers and low- the greater utilization of the emergency care services.
risk fathers. No difference between both groups was
found for the IRI "Empathic concern" dimension. Perez-Duenas B, Valls-Sole J, Fernandez-Alvarez E et al.
Moreover, high-risk, compared to low-risk, parents Characterization of tremor in phenylketonuric patients.
showed lower scores both on the "Empathy toward the J Neurol 2005; 252(11):1328-34.
partner" and on the "Empathy toward the child" Abstract: Tremor of unknown origin is detected in 10-
dimensions of the PPES. No interaction between risk 30% of early-treated and in more than 30% late-treated
status and gender was found for the PPES dimensions. phenylketonuric patients. With the aim of
CONCLUSIONS: Findings of the present study characterizing tremor in phenylketonuria, we carried
supported the hypothesis that high-risk parents for out a systematic study in 54 patients aged 6 to 37 years.
child physical abuse show a deficit both in general Tremor examination was done by applying the
empathy and in empathy toward their family members. WHIGET Tremor Rating Scale and by accelerometer
Moreover, findings suggested the existence of a recording (BYOPAC System MP100WSW). Age at
different pattern of deficits in empathy for high-risk diet onset, IQ test results, concomitant plasma
fathers and high-risk mothers. phenylalanine levels and index of dietary control were
also studied. Tremor was not observed at rest in any
Perez Alonso EJ. [Critical considerations on the legal case, but was apparent in 22 patients (40.7%) when
regulation of sex selection (II)]. Law Hum Genome carrying out a kinetic task. In 15 patients tremor was
Rev 2002; (17):99-124. also evident during maintenance of a postural task at a
frequency ranging between 7.5 and 12.7 Hz. Frequency
Perez-Ciordia I, Catalan Fabo F, Zalacain Nicolay F, of tremor was not significantly modified by loading the
Barriendo Antonanzas M, Solaegui Diaz de Guerenu R, arms or by increasing muscle contraction. Patients with
Guillen Grima F. [Profile of the Emergency demand tremor had a later age at onset of phenylalanine
and influence of televised soccer games on an extra- restricted diet (p < 0.001). Other treatment-related
hospital center in the Tafalla health care district. variables did not differ between patients with and
Navarre, Spain]. Rev Esp Salud Publica 2003; without tremor. Our results of the neurophysiological
77(6):735-47. examination suggest that tremor in phenylketonuric
Abstract: BACKGROUND: The demand placed on patients is dependent on a dysfunction of central
both hospital as well as extrahospital emergency care nervous system networks and may be an index of
units currently continues to increase at a growing rate. cerebral damage.
This study has a twofold objective: the quantification
and study of the personal characteristics of the users Perez-Olmos I, Fernandez-Pineres PE, Rodado-Fuentes S.
who are demanding emergency care and assessing [The prevalence of war-related post-traumatic stress
whether televised soccer games have any bearing on disorder in children from Cundinamarca, Colombia].
the utilization of emergency care services. METHODS: Rev Salud Publica (Bogota) 2005; 7(3):268-80.
A longitudinal descriptive study (9,723 users Abstract: OBJECTIVE: Determining the prevalence of
demanding care) and study of cases and controls (1,284 post-traumatic stress disorder (PTSD) related to the
users demanding care) according to whether or not a type of war exposure and associated factors in school-
soccer game was being televised by means of a logistic aged children from three Colombian towns.
regression model. The associations were quantified by METHODS: Cross-sectional epidemiological study.
means of the odds ratio (OR). Those dealt with by Representative randomised sample of 493 children
telephone or in infirmaries were not included in the aged 5-14. The children were evaluated during 2002
study. RESULTS: A total 10.6% of the demand using semi-structured psychiatric interviews and the
involved home visits, 4.8% of this total having been clinician administered PTSD scale. 167 children were
sent to hospital. A total 13.3% of the demand evaluated in La Palma who had been chronically
corresponds to individuals visiting from other exposed to war, 164 in Arbelaez who had had recent
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![emotional functioning and physical health, parenting 1999, 30 patients [19 women and 11 men, mean age 35
behaviors, and neighborhood and school years (range 2.50 to 65)], followed at the Clinic for
characteristics. The findings from the Better Allergic Diseases of the University hospital
Beginnings, Better Futures Project are encouraging and "Aleksandrovska", Medical University of Sofia,
provide unique evidence for the extent to which a Bulgaria, were interviewed blindly in order to assess
universal, comprehensive, community-based their compliance with pharmacologic therapy. All
prevention strategy can promote the longer term patients were suffering from different types of asthma.
development of young children, their families, and RESULTS: The level of compliance among the studied
their neighborhoods. group of patients is 86%. In comparison with the
literary data where the level of non-compliance is 20%
Peters RJ Jr, Tortolero SR, Addy RC et al. The relationship the obtained level is lower--14%. The reasons for non-
between sexual abuse and drug use: findings from compliance according to the patients are: the
Houston's Safer Choices 2 program. J Drug Educ 2003; appearance of ADRs, the high prize of the drugs, the
33(1):49-59. hard application of the drug form.
Abstract: Self-report drug use data were collected from
282 female alternative school students surveyed Petrunik M, Weisman R. Constructing Joseph Fredericks:
through the Safer Choices 2 study in Houston, Texas. competing narratives of a child sex murderer. Int J Law
Data collection took place between October 2000 and Psychiatry 2005; 28(1):75-96.
March 2001 via audio-enabled laptop computers Abstract: Joseph Fredericks--one of Canada's most
equipped with headphones. Logistic regression notorious sex offenders--was defined through the
analyses indicated that sexual abuse history was institutions that dealt with him from his infancy to his
significantly associated with lifetime use (OR = 1.9, p death to the inquest held after his death. In this paper,
< or = 0.05). While the relationships tested in this study we locate in historical context and compare the
are exploratory, they provide evidence for an important different narratives that were constructed of his life in
connection between sexual abuse and substance use each of these institutional settings from unwanted child
among female alternative school students. to 'mental defective' to psychiatric offender to criminal
recidivist to victim to iconic sexual predator. We show
Peterson C, Ringner M. Analyzing tumor gene expression that each of these narratives claimed to capture the
profiles. Artif Intell Med 2003; 28(1):59-74. essence of Fredericks in terms of what were his core
Abstract: A brief introduction to high throughput characteristics and what remedies were necessary for
technologies for measuring and analyzing gene the problems he posed only to be superseded by new
expression is given. Various supervised and narratives based on different assumptions. Finally, we
unsupervised data mining methods for analyzing the show how one of these conceptions of Frederick's
produced high-dimensional data are discussed. The essence influenced a shift in Canadian public policy for
main emphasis is on supervised machine learning sex offenders toward the greater emphasis on
methods for classification and prediction of tumor gene community protection characteristic of public policy in
expression profiles. Furthermore, methods to rank the the United States.
genes according to their importance for the
classification are explored. The approaches are Petry NM, Steinberg KL. Childhood maltreatment in male
illustrated by exploratory studies using two examples and female treatment-seeking pathological gamblers.
of retrospective clinical data from routine tests; Psychol Addict Behav 2005; 19(2):226-9.
diagnostic prediction of small round blue cell tumors Notes: CORPORATE NAME: The Women's Problem
(SRBCT) of childhood and determining the estrogen Gambling Research Center
receptor (ER) status of sporadic breast cancer. The Abstract: Little empirical research has evaluated
classification performance is gauged using blind tests. childhood abuse in pathological gamblers. This study
These studies demonstrate the feasibility of machine describes results of an analysis of childhood
learning-based molecular cancer classification. maltreatment histories among 149 pathological
gamblers being treated at 1 of 7 gambling treatment
Petkova V, Dimitrova Z. Asthma, drug medication and programs. Measurements included instruments
noncompliance. Boll Chim Farm 2002; 141(5):355-6. assessing gambling behavior and the Childhood
Abstract: According to the new concepts, asthma is a Trauma Questionnaire (CTQ; D. P. Bernstein et al.,
chronic disease of the upper respiratory tracts, caused 1994). Women scored higher than men on the overall
by different cells, including the mastocits and CTQ scale and subscales measuring childhood physical
eozinofils. The patients that are suffering from neglect, emotional abuse, and sexual abuse. Severity of
episodic, frequent, or chronic asthma are participating childhood maltreatment was significantly and
very energetic in the treatment--they have to know and independently associated with lower age of onset of
control the symptoms of their disease and also to gambling and increased severity of gambling problems.
possess technical skills to perform the treatment. This study suggests that childhood maltreatment is
METHODOLOGY: Between March 1 and July 31, prevalent in pathological gamblers, especially female
gamblers. These results warrant further investigation of
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![the role of childhood maltreatment in the etiology of relationship between exposure and posttraumatic stress,
pathological gambling and its treatment. but one's subjective appraisal of danger and threat at
the time of exposure may be a better predictor of
Petticrew M. Systematic reviews from astronomy to posttraumatic stress than more objective measures of
zoology: myths and misconceptions. BMJ 2001; exposure. We examined the role of peritraumatic
322(7278):98-101. response in posttraumatic stress reactions in over 2,000
middle school children 7 weeks after the 1995
Peychl I. [Shaken baby syndrome]. Cas Lek Cesk 2005; Oklahoma City, Oklahoma, bombing. While many
144(3):185-7; discussion 188-9. children reported hearing and feeling the blast and
Abstract: Shaken baby syndrome represents a specific knowing direct victims, most were in school at the time
form of the Abused child syndrome. Injury usually of the explosion and therefore were not in direct
concerns the baby's head and the brain and it is caused physical proximity to the incident. Physical,
by thoughtless treatment accompanied by harsh interpersonal, and television exposure accounted for
shaking movements of the head and neck. It can cause 12% of the total variance in our measure of
a contusion of the cervical spinal hord, a rupture of the posttraumatic stress when peritraumatic response was
bridging veins, intracranial bleeding and a brain tissue ignored. Peritraumatic response and television
impairment either due to the direct axonal damage, or exposure accounted for 25% of the total variance, and
namely by hypoxic-ischaemic insult. The development physical and interpersonal exposure were not
of the lesion can be fatal, or it can result in permanent significant in this context. These findings suggest the
impairment of the motor system, in mental or sensory importance of peritraumatic response in children's
deficits. Occurrence of the syndrome in the Czech reactions to terrorism. These early responses can be
Republic is not known, foreign data give 25 cases per used to help determine which children may experience
100000 children below one year of age. Injured babies difficulty over time.
represent over 1% of those hospitalised at paediatric
units of intensive care and more than 10% of the death Phillips M. Joan of Arc meets Mary Poppins: maternal re-
rate at those departments. Proved abuse has forensic nurturing approaches with male patients in Ego-State
consequences: however, convictive evidence can be Therapy. Am J Clin Hypn 2004; 47(1):3-12.
difficult to obtain. Article gives a concrete case of a Abstract: Many patients with posttraumatic
boy with the diagnose Shaken baby syndrome. fragmentation demonstrate a positive response to the
corrective possibilities provided through Ego-State
Pezdek K, Morrow A, Blandon-Gitlin I et al. Detecting Therapy. However, full resolution of presenting
deception in children: event familiarity affects symptoms may not occur for individuals with
criterion-based content analysis ratings. J Appl Psychol significant childhood histories of parental abuse and
2004; 89(1):119-26. neglect without opposite sex, as well as same sex, re-
Abstract: Statement Validity Assessment (SVA) is a nurturing interventions. This presentation emphasizes
comprehensive credibility assessment system, with the the use of maternal re-nurturing methods with men
Criterion-Based Content Analysis (CBCA) as a core who struggle with the effects of significant attachment
component. Worldwide, the CBCA is reported to be deficits in early life. Case examples feature male
the most widely used veracity assessment instrument. patients with long-term difficulties in their adult
We tested and confirmed the hypothesis that CBCA relationships with women that had proved refractory to
scores are affected by event familiarity; descriptions of other therapy methods. Following Ego-State Therapy
familiar events are more likely to be judged true than interventions with maternal symbolic figures, however,
are descriptions of unfamiliar events. CBCA scores these problems improved dramatically. Therapeutic
were applied to transcripts of 114 children who implications for cross-gender re-nurturing with patients
recalled a routine medical procedure (control) or a who report different types of maternal attachment
traumatic medical procedure that they had experienced trauma are explored and discussed.
one time (relatively unfamiliar) or multiple times
(relatively familiar). CBCA scores were higher for Piaggio G, Carroli G, Villar J et al. Methodological
children in the relatively familiar than the relatively considerations on the design and analysis of an
unfamiliar condition, and CBCA scores were equivalence stratified cluster randomization trial. Stat
significantly correlated with age. Results raise serious Med 2001; 20(3):401-16.
questions regarding the forensic suitability of the Notes: CORPORATE NAME: WHO Antenatal Care
CBCA for assessing the veracity of children's accounts. Trial Research Group
Abstract: The World Health Organization and
Pfefferbaum B, Doughty DE, Reddy C et al. Exposure and collaborating institutions in four developing countries
peritraumatic response as predictors of posttraumatic have conducted a multi-centre randomized controlled
stress in children following the 1995 Oklahoma City trial, in which clinics were allocated at random to two
bombing. J Urban Health 2002; 79(3):354-63. antenatal care (ANC) models. These were the standard
Abstract: Studies have demonstrated a positive 'Western' ANC model and a 'new' ANC model
consisting of tests, clinical procedures and follow-up
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![violence and trauma? What methodologies exist that Compared with the nonresilient, resilient children were
show promise of affecting a better understanding of less likely to use two avoidance coping strategies
violence and trauma? (internalizing [p=.002] and externalizing [p=.017]).
The level of actual support received by resilient and
Pilowsky DJ, Zybert PA, Hsieh PW, Vlahov D, Susser E. nonresilient children did not differ significantly
Children of HIV-positive drug-using parents. J Am (p=.202). Perceived support was greater among
Acad Child Adolesc Psychiatry 2003; 42(8):950-6. resilient children (as reported by their parents; p
Abstract: OBJECTIVE: Associations between human <.001), and their parents reported lower parenting
immunodeficiency virus (HIV) status of injection drug stress (p=.042). CONCLUSIONS: A significant
users (IDUs) and their children's psychopathology and proportion of children of injection drug users are in
social functioning were examined. METHOD: Parents need of clinical care. Interventions to help children of
(N = 61) were drawn from an ongoing longitudinal substance-abusing parents modify their coping style
study of inner city, primarily African-American IDUs. merit exploration.
Children (N = 79) were 6 to 11 years of age, currently
living with the IDU parent. Parental variables included Pimlott-Kubiak S, Cortina LM. Gender, victimization, and
HIV status, apparent and inapparent HIV infection outcomes: reconceptualizing risk. J Consult Clin
(with HIV-related medical symptoms and/or disclosure Psychol 2003; 71(3):528-39.
of parental HIV status to children; with neither medical Abstract: Large-scale studies of gender differences in
symptoms nor disclosure, respectively), presence of psychopathological reactions to victimization have
HIV-related medical symptoms, HIV disclosure status focused on posttraumatic stress disorder, overlooking
to each child, and depression as ascertained by the other trauma-related disorders. The present study
Center for Epidemiologic Studies-Depression. expands this literature with a contextualized
Children's outcomes (competencies, psychiatric examination of interpersonal aggression exposure and
symptoms, and disorders) were assessed with the Child sequelae. Using k-means cluster analysis on a sample
Behavior Checklist and the Schedule for Affective of 16,000, the authors identified 8 distinct profiles of
Disorders and Schizophrenia for School-Age Children. exposure to sexual violence, physical assault, stalking,
RESULTS: Children of IDU parents exhibited high and emotional abuse. Analyses of covariance then
rates of psychopathology. Parental HIV infection per se suggested links among victimization profile, gender,
had no discernible impact on children's outcomes. The and mental and physical health. Results revealed no
apparent HIV infection of a parent was associated with meaningful interactive effects of gender and
an eightfold increase (odds ratio 7.80; 95% confidence interpersonal aggression on outcomes, once lifetime
interval 1.56-39.09) in the prevalence of disruptive exposure to aggressive events was adequately taken
behavior disorders (compared with children of HIV- into account. These findings argue against theories of
negative parents). Parental depression was associated female victims' greater vulnerability to pathological
with a threefold increase in the prevalence of children's outcomes, instead linking risk to exposure history.
disruptive behavior disorders (odds ratio 3.49, 95%
confidence interval 1.11-11.04). CONCLUSIONS: Pinosa C, Marchand C, Tubiana-Rufi N, Gagnayre R,
Parental HIV status per se does not seem to have a Albano MG, D'Ivernois JF. The use of concept
differential impact on the affected children. The mapping to enlighten the knowledge networks of
apparent HIV infection of a parent may be associated diabetic children: a pilot study. Diabetes Metab 2004;
with children's externalizing symptoms and disorders. 30(6):527-34.
Abstract: OBJECTIVE: The value of concept mapping
Pilowsky DJ, Zybert PA, Vlahov D. Resilient children of in enlightening nature and organization of knowledge
injection drug users. J Am Acad Child Adolesc was shown with adult diabetic or obese patients. Our
Psychiatry 2004; 43(11):1372-9. objectives were to ascertain the relevance and
Abstract: OBJECTIVE: To examine associations feasability of concept mapping in diabetic children
between resilience in children of injection drug users during an educational program. METHOD: This
and children's coping strategies, parenting stress, and qualitative research was performed in 5 children from 8
children's social support. METHOD: Injection drug- to 13 years. Concept maps were drawn at the beginning
using parents (n=91) and their children aged 6 to 11 (Phase 1) and at the end (Phase 2) of an educational
(n=117) were recruited in Baltimore (1997-1999). program. During the interview each child was invited
Resilience was defined as scoring in the lowest quartile to express himself starting from the central concept:
of the Child Behavior Checklist total psychopathology "diabetes", and to express his/her knowledge,
score. Coping strategies used by resilient and representations, and life experience. RESULTS: The
nonresilient children, the extent and types of social ten maps analysis shows: an increase of knowledge
support that they received, and the level of parenting between phase 1 and phase 2 (+34%), towards a
stress reported by their parents were compared and deepening of initial knowledge and an addition of new
contrasted. RESULTS: Rates of depressive, anxiety, knowledge (43% and 41% of the added knowledge); a
and disruptive behavior disorders were 15.4%, 22.2%, decrease of inaccurate knowledge in phase 2; an
and 21.4%, respectively, for the entire sample. enrichment of the knowledge networks (+16 cross
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![links); an increase of knowledge related to the ways to child's family in 3 cases, a household employee
behave knowledge (+42%). CONCLUSION: This working at the child's home in three cases, a teacher in
preliminary report demonstrated that concept maps 1, and a neighbor in 1. Syphilitic tests were negative in
were feasible, useful and relevant in therapeutic all children. However HIV infection was detected and
education of children. This method allowed us to show the contaminator was identified in one 10-year-old girl.
how every child connected his knowledge and how it The results of this study document the correlation
was modified by an educational intervention. Concept between anogenital warts and sexual abuse. In Black
maps therefore contributed to individual educational Africa, the consequences of child sexual abuse, which
diagnosis and assessment of new knowledge is not uncommon especially in major cities, are
integration. aggravated by the high prevalence of HIV infection.
Pirila-Parkkinen K, Pirttiniemi P, Alvesalo L, Silven O, Pittman T. Significance of a subdural hematoma in a child
Heikkila J, Osborne RH. The relationship of with external hydrocephalus. Pediatr Neurosurg 2003;
handedness to asymmetry in the occlusal morphology 39(2):57-9.
of first permanent molars. Eur J Morphol 2001;
39(2):81-9. Pivarcsi A, Homey B. Chemokine networks in atopic
Abstract: Handedness has been shown to be related to a dermatitis: traffic signals of disease. Curr Allergy
number of systematic asymmetries in body dimensions, Asthma Rep 2005; 5(4):284-90.
dermatoglyphic patterns and cerebral morphology. The Abstract: Atopic dermatitis is a chronic or chronically
aim here was to compare linear and angular tooth relapsing inflammatory skin disease with a prevalence
crown asymmetries of the permanent molars in healthy ranging from 10% to 20% in children and 1% to 3% in
right-handed and left-handed subjects. The material adults of developed countries. Skin-infiltrating
comprised 27 children with recorded concordant left- leukocytes play a pivotal role in the initiation and
side dominance of hand, eye and foot. The controls amplification of atopic skin inflammation. Recent
were an age- and sex-matched group with right side studies demonstrated that infiltration of inflammatory
dominance. The material is based on the Collaborative cells into tissues is regulated by chemokines. A subset
Perinatal Project where detailed medical records and of chemokines including CCL27, CCL17, CCL22,
the dentitions, including accurate dental impressions, CCL18, CCL11, and CCL13 are highly expressed in
of over two thousand American children were atopic dermatitis. The corresponding chemokine
examined in the USA in the sixties. Machine vision receptors are found on the main leukocyte subsets
technique was used to obtain accurate three- involved in allergic skin inflammation, such as T cells,
dimensional information from the occlusal surfaces of eosinophils, and dendritic cells. In this article, we
the first permanent upper and lower molars. The provide an overview of the role of chemokines in the
directional asymmetry values of angular measurements complex immunopathogenesis of atopic dermatitis,
of mandibular first molars showed evidence of highlighting potential areas for therapeutic
asymmetry of opposite direction between the two intervention.
examined groups. The results indicate that occlusal
morphology of first permanent molars may be affected Pizzi NJ. Bleeding predisposition assessments in
by handedness, and this tendency is most evident in the tonsillectomy/adenoidectomy patients using fuzzy
angular measurements of the mandibular molars. interquartile encoded neural networks. Artif Intell Med
Fluctuating asymmetry did not differ significantly 2001; 21(1-3):65-90.
between the examined groups. Abstract: A fuzzy set theoretic methodology is
described that serves as a classification preprocessing
Pitche P, Kombate K, Gbadoe AD, Tchangai-Walla K. strategy for supervised feed-forward neural networks.
[Anogenital warts in young children in hospital This methodology, fuzzy interquartile encoding,
consultation in Lome (Togo). Role of transmission by determines the respective degrees to which a feature
sexual abuse]. Med Trop (Mars) 2001; 61(2):158-62. belongs to a collection of fuzzy sets that overlap at the
Abstract: The purpose of this 20-month prospective respective quartile boundaries of the feature. These
study conducted in the dermatology department of membership values are subsequently used in place of
Lome Teaching Hospital was to determine the the original feature. This transformation has a
prevalence of sexual abuse in pre-adolescent children normalizing effect on the feature space and is more
with anogenital warts. From May 1997 to December robust to feature outliers. Its effectiveness is
1998, a total of 16 cases of anogenital warts were scrutinized using several synthetic data sets with
diagnosed in children under the age of 12 years. Sexual various underlying distributions. Fuzzy interquartile
abuse was discovered in 8 cases. All 8 cases involved encoding is shown to consistently improve the
girls (mean age, 6.1 +/- 1.9 years). The mode of discriminatory power of the underlying classifiers.The
acquisition involved self-infection from non anogenital methodology is also applied to two biomedical data
warts in three cases and contamination by the mother in sets relating to tonsillectomy and/or adenoidectomy
three cases. In two cases the mode of acquisition could patients who may or may not have had a predisposition
not be identified. The alleged abuser was a member of
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![children. Lower monitoring was also related to utilization of temporal information. Given the observed
children's pattern of after-school activities that were involvement of the frontal-subcortical networks in
connected to at-risk behavior. Parental involvement ADHD, we examined judgment of durations in
and supervision of children's day-to-day activities seem children with ADHD (N = 27) and age- and gender-
particularly important in socializing children's behavior matched control subjects (N = 15). Two judgment tasks
at the time of early adolescence. were administered: short duration (550 ms) and long
duration (4 s). The two groups did not differ
Radimer KL, Radimer KL. Measurement of household food significantly in their judgments of short interval
security in the USA and other industrialised countries. durations; however, subjects with ADHD performed
Public Health Nutr 2002; 5(6A):859-64. more poorly when making judgments involving long
Abstract: OBJECTIVE: To describe the history and intervals. The groups also did not differ on a judgment-
current status of household food security measurement. of-pitch task, ruling out a generalized deficit in
CONCLUSIONS: In the 1980s evidence of rising auditory discrimination. Selective impairment in
levels of hunger was a concern for many, but disputed making judgments involving long intervals is
by some, Americans. Acknowledgement and consistent with performance by patients with frontal
quantification of hunger was hindered by the lack of an lobe lesions and suggests that there is a deficiency in
accepted definition and measure of hunger. Qualitative the utilization of temporal information in ADHD
research at Cornell provided a conceptual framework, (possibly secondary to deficits in working memory
description, definition and survey items for hunger. and/or strategy utilization), rather than a problem
The Community Childhood Hunger Identification involving a central timing mechanism.
Project developed an instrument used in numerous
communities. Based upon these initiatives, widely Raghavan C, Swan SC, Snow DL, Mazure CM. The
accepted definitions of hunger and food insecurity, and mediational role of relationship efficacy and resource
the US Household Food Security Module for its utilization in the link between physical and
measurement, now exist. The module classifies psychological abuse and relationship termination.
households as food-secure, or food-insecure without Violence Against Women 2005; 11(1):65-88.
hunger or with moderate or severe hunger, and contains Abstract: This study examines the roles of physical and
household-, adult- and child-referent items. Its emotional abuse and resource utilization, relationship
inclusion in the Current Population Survey (CPS) since efficacy, and childhood abuse on relationship status
1995 has yielded annual estimates of food insecurity. A (together or separated) in a sample of 69 low-income,
six-item short form of the module, for surveys with nonsheltered battered women. Separate path models
severe time constraints, classifies households only as were conducted for physical and psychological abuse.
food-secure or food-insecure without or with hunger Increased physical abuse was related to separated
and contains no child-specific items. Surveys using the status, increased resource utilization, and decreased
18-item or short-form module can compare results with efficacy. The effect of physical abuse on status was
published national data from the CPS. Information mediated by resource utilization and efficacy, whereas
about the module is available at the effect of psychological abuse on status was
http://www.ers.usda.gov/briefing/foodsecurity and partially mediated only by utilization. Increased
http://www.fns.usda/fsec. Current research on food childhood abuse was associated with together status.
security measurement includes measurement of Baseline psychological but not physical abuse
individual food insecurity and hunger, module predicted a longer term separated status thereby
performance regarding hunger duration and frequency, suggesting that the effects of psychological abuse may
performance of the module in population sub-groups, be enduring.
and the effect of translations on module meaning and
performance. National surveys in Canada, New Rahi JS, Manaras I, Tuomainen H, Hundt GL. Meeting the
Zealand and Australia also have measured food needs of parents around the time of diagnosis of
security. disability among their children: evaluation of a novel
program for information, support, and liaison by key
Radonovich KJ, Mostofsky SH. Duration judgments in workers. Pediatrics 2004; 114(4):e477-82.
children with ADHD suggest deficient utilization of Abstract: OBJECTIVE: Key worker programs for
temporal information rather than general impairment in families of children with disabilities, to promote
timing. Child Neuropsychol 2004; 10(3):162-72. information provision, emotional support, and liaisons
Abstract: Clinicians, parents, and teachers alike have among different agencies, have long been advocated
noted that individuals with ADHD often have but not extensively implemented. We report the impact
difficulties with "time management," which has led on the experiences of parents and the practices of
some to suggest a primary deficit in time perception in health care professionals of a novel, hospital-based,
ADHD. Previous studies have implicated the basal key worker service (Community Link Team [CLT]),
ganglia, cerebellum, and frontal lobes in time implemented in the pediatric ophthalmology
estimation and production, with each region purported department of Great Ormond Street Hospital (London,
to make different contributions to the processing and United Kingdom). DESIGN, SETTING, AND
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![response among African American, Asian American, known to cry a lot, in order to help parents to cope with
Caucasian, and Hispanic mothers. Prev Sci 2001; this crying.
2(4):209-27.
Abstract: The effectiveness of the Incredible Years Reimherr JP, McClellan JM. Diagnostic challenges in
Parenting Program was evaluated in a low-income children and adolescents with psychotic disorders. J
sample of Caucasian, African American, Hispanic, and Clin Psychiatry 2004; 65 Suppl 6:5-11.
Asian mothers whose children were enrolled in Head Abstract: The diagnosis of psychotic disorders in
Start. Data from two prior intervention studies children and adolescents is often complex and
[Webster-Stratton (1998) Journal of Consulting and challenging. The symptomatic overlap between
Clinical Psychology, 66(5), 715-730; Webster-Stratton different psychotic conditions and other emotional,
et al. (in press) Journal of Clinical Child Psychology] behavioral, and developmental disorders has led to
were combined, yielding a sample of 634 families (370 high rates of misdiagnosis, especially at time of onset.
Caucasian, 120 African American, 73 Asian, 71 The clinical expression and progression of diagnosable
Hispanic) across 23 Head Start centers. Centers were disorders are affected by maturational processes. Thus,
matched and assigned randomly to either an psychotic illnesses in pediatric patients may vary from
experimental condition (8-12 weeks of weekly 2-hr adult presentations because of developmental factors.
parenting classes), or a control condition (the regular Establishing a specific diagnosis is difficult when the
Head Start Program without parenting groups). differential diagnosis comprises disorders that share
Families in both conditions were assessed using home common symptoms and are frequently comorbid. The
observations of parent-child interactions and parent clinical assessment depends as much on input from
reports of parenting style and discipline strategies and parents and teachers as from the patients themselves,
child behavior problems in the fall (baseline) and and there may be conflict between these different
spring (postintervention) of the children's Head Start perceptions. This article reviews recent research and
year. Families were reassessed 1 year later. Following current concepts relating to diagnostic challenges in
treatment, intervention mothers were observed to be pediatric psychiatry.
more positive, less critical, more consistent, and more
competent in their parenting than were control mothers. Reinherz HZ, Paradis AD, Giaconia RM, Stashwick CK,
Additionally, children of intervention parents were Fitzmaurice G. Childhood and adolescent predictors of
observed to exhibit fewer behavior problems than were major depression in the transition to adulthood. Am J
control children. Differences in treatment response Psychiatry 2003; 160(12):2141-7.
across ethnic groups were few, and did not exceed the Abstract: OBJECTIVE: The identification of predictors
number expected by chance. Parents from all groups of major depression in the transition to adulthood has
reported high satisfaction levels following the direct application to prevention and intervention efforts
parenting program. Results indicate that the Incredible designed to forestall depression in this high-risk period.
Years Program is accepted by and effective with The current study identified childhood and adolescent
diverse populations. familial and behavioral-emotional factors predicting
depression during this critical developmental stage.
Reijneveld SA, van der Wal MF, Brugman E, Hira Sing RA, METHOD: The 354 participants were part of a single-
Verloove-Vanhorick SP. [Prevalence of parental age cohort from a predominately Caucasian working-
behaviour to diminish the crying of infants that may class community whose psychosocial development has
lead to abuse]. Ned Tijdschr Geneeskd 2004; been traced prospectively since age 5. In these
148(45):2227-30. analyses, data collected during childhood and
Abstract: OBJECTIVE: To estimate the prevalence of adolescence were related to diagnoses of major
parental actions to stop infant crying that may threaten depression at ages 18-26. RESULTS: During the
infant health, and to determine specific risk groups transition to adulthood, 82 participants (23.2%)
regarding these actions. DESIGN: Descriptive. experienced major depression. Bivariate indicators of
METHOD: Before their visit to a well-baby clinic in later depression included a family history of depression
the Netherlands, parents of 3345 infants aged 1-6 or substance use disorders, family composition, and
months (96.5% response) filled out an anonymous childhood family environments perceived as violent
questionnaire on actions that they undertook to stop and lacking cohesiveness. Also significant were self-
their child crying. RESULTS: At 6 months, 5.6% (95% and mother-reported internalizing behaviors, as well as
confidence interval: 4.2-7.0%) of all the parents self-rated anxiety and depressive symptoms.
reported having smothered, slapped, or shaken their Multivariable analyses showed family violence, family
infant at least once because of its crying. The highest composition, internalizing problems during
risks for detrimental parental actions were run by adolescence, and low family cohesion to be the most
infants of parents from non-industrialised countries, of salient factors. CONCLUSIONS: These results
parents with no or only a part-time job, and of parents highlight familial and behavioral-emotional predictors
who had judged their infant's crying as excessive. of depression that can serve as foci for identifying
CONCLUSION: Clinicians should be aware of the youth in need of intervention.
observed risk factors for abuse of young children
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![I. Retrospective assessment of exposure to traffic air schools and that school nurses make use of various
pollution using the ExTra index in the VESTA French strategies or "tricks of the trade" to handle these
epidemiological study. J Expo Anal Environ Epidemiol problems. This research highlights the need for a
2005; 15(6):524-33. contribution from the pharmacy profession in this
Abstract: This study applies a traffic exhaust air important and neglected area of drug therapy.
dispersion model (the ExTra index) to 403 children
enrolled in a French multicentric case-control study, Rey JM, Sawyer MG, Prior MR. Similarities and differences
the VESTA study (Five [V] Epidemiological Studies between aggressive and delinquent children and
on Transport and Asthma). The ExTra index adolescents in a national sample. Aust N Z J Psychiatry
(previously validated by our team) was used to assess 2005; 39(5):366-72.
lifelong average traffic-related air pollutant (TAP) Abstract: OBJECTIVE: To examine differences in the
concentrations (nitrogen oxides) children in the study correlates, comorbidity and use of services between
were exposed to in front of their living places. ExTra aggressive and delinquent children and adolescents.
index took into account traffic density, topographical METHOD: An Australian representative sample (n =
parameters (building height, road and pavement width), 4083) of parents of children and adolescents were
weather conditions (wind direction and strength) and administered a psychiatric diagnostic interview, the
background pollution levels. Topographical and traffic Child Behaviour Checklist, and other instruments to
data were collected, using a specific questionnaire for measure service use. The characteristics of children
each home, school or nursery address, attended by with high scores (top 5%) in the aggressive and
children. The assessment of time-weighted NOx levels delinquent syndromes or both were then examined.
in front of the children's living places highlighted RESULTS: The proportion of aggressive children
significant disparities: mean ExTra index values and decreased with increasing age while that of delinquents
share attributable to proximity traffic were, increased. The aggressive group was specifically
respectively, 70+/-42 and 14+/-22 microg/m3 NOx associated with the impulsive-hyperactive subtype of
equivalent NO2 for the 403 children in our study. Not attention deficit hyperactivity disorder (ADHD) (OR =
only would this diversity not have been revealed using 12.63; 95% CI = 5.97-26.74). Comorbidity between
urban background pollution data provided by air ADHD, aggression and delinquency was less frequent
quality networks, it would have resulted in 40% of the among adolescents than in children, with the exception
children being misclassified with regard to their TAP of the inattentive subtype in which comorbidity was
exposure by underestimating it in half of the cases and higher. Both aggressive and delinquent groups had a
overestimating it in the other half. Such errors of considerable overlap with conduct disorder. Aggressive
classification, which are highly prejudicial in and delinquent youths used services more often, but
epidemiology, argue strongly for the use of an index parents perceived aggressive children as more in need
such as the ExTra, which enables TAP exposure to be of help than delinquent ones. Living in a sole parent
reconstructed within the framework of retrospective or family was specifically associated with the delinquent
prospective epidemiological studies. group (OR = 3.34; 95% CI = 2.25-4.96).
CONCLUSIONS: The results suggest that these
Reutzel TJ, Patel R. Medication management problems empirically derived syndromes while sharing many
reported by subscribers to a school nurse listserv. J Sch features also differ in important ways, highlighting the
Nurs 2001; 17(3):131-9. need for further convergence between categorical and
Abstract: Given the potentially serious consequences of dimensional classifications. Their differential
suboptimum medication management practices in association with the subtypes of ADHD requires
elementary and secondary schools and the fact that this further examination and may help to understand the
topic has been subject to little empirical inquiry, the relationship between ADHD and conduct problems.
purpose of this study was to obtain a preliminary The importance of aggressive behaviour in children
understanding of the types of medication management should not be underestimated since it is associated with
problems that school nurses face, as well as the significant psychopathology, parental distress and use
strategies they use to solve those problems. An analysis of services.
of messages related to medication management that
appeared on the SCHLRN-L listserv (a 1,400-member Reyes H, Perez-Cuevas R, Sandoval A et al. The family as a
discussion group for schools nurses) was performed. determinant of stunting in children living in conditions
All messages sent to the listserv during a 5-month of extreme poverty: a case-control study. BMC Public
period were monitored. Any discussion thread that Health 2004; 4:57.
began during this time period and addressed the Abstract: BACKGROUND: Malnutrition in children
management of medications was selected for possible can be a consequence of unfavourable socioeconomic
inclusion in the study. The result was a group of 71 conditions. However, some families maintain adequate
threads. The listserv participants described a wide array nutritional status in their children despite living in
of medication management problems and suggested poverty. The aim of this study was to ascertain whether
numerous strategies for solving them. This study shows family-related factors are determinants of stunting in
that serious medication management problems exist in young Mexican children living in extreme poverty, and
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![whether these factors differ between rural or urban stepfathers (30.3%) were the most frequent aggressors,
contexts. METHODS: A case-control study was with the former victimizing more children (19.7%) and
conducted in one rural and one urban extreme poverty the latter adolescents (17.1%).
level areas in Mexico. Cases comprised stunted
children aged between 6 and 23 months. Controls were Ribisl KM, Lee RE, Henriksen L, Haladjian HH. A content
well-nourished children. Independent variables were analysis of Web sites promoting smoking culture and
defined in five dimensions: family characteristics; lifestyle. Health Educ Behav 2003; 30(1):64-78.
family income; household allocation of resources and Abstract: The present study examined smoking culture
family organisation; social networks; and child health and lifestyle Web sites listed on Yahoo!, a popular
care. Information was collected from 108 cases and Internet search catalog, to determine whether the sites
139 controls in the rural area and from 198 cases and were easily accessible to youth, featured age or health
211 controls in the urban area. Statistical analysis was warnings, and mentioned specific tobacco brands. A
carried out separately for each area; unconditional content analysis of photographs on these sites assessed
multiple logistic regression analyses were performed to the demographics of individuals depicted and the
obtain the best explanatory model for stunting. amount of smoking and nudity in the photographs. The
RESULTS: In the rural area, a greater risk of stunting sample included 30 Web sites, all of which were
was associated with father's occupation as farmer and accessible to youth and did not require age verification
the presence of family networks for child care. The services to enter them. Cigarette brand names were
greatest protective effect was found in children cared mentioned in writing on 35% of the sites, and brand
for exclusively by their mothers. In the urban area, risk images were present on 24% of the sites. Nearly all of
factors for stunting were father with unstable job, the photographs (95%) depicted smoking, 92%
presence of small social networks, low rate of featured women, and 7% contained partial or full
attendance to the Well Child Program activities, breast- nudity. These results underscore the need for greater
feeding longer than six months, and two variables research and monitoring of smoking-related Internet
within the family characteristics dimension (longer content by health educators and tobacco control
duration of parents' union and migration from rural to advocates.
urban area). CONCLUSIONS: This study suggests the
influence of the family on the nutritional status of Ricci FL. The Italian national telemedicine programme. J
children under two years of age living in extreme Telemed Telecare 2002; 8(2):72-80.
poverty areas. Factors associated with stunting were Abstract: The Italian national telemedicine programme
different in rural and urban communities.Therefore, included a broad range of research projects, but they all
developing and implementing health programs to served the common purpose of bringing about
tackle malnutrition should take into account such improvements in health-care management and
differences that are consequence of the social, performance. The programme consisted of seven
economic, and cultural contexts in which the family projects, each of which had specific research and
lives. training objectives, and a three-year duration. The
systems developed in the course of the programme
Ribeiro MA, Ferriani MG, Reis JN. [Sexual abuse of were not experimental prototypes:they were intended
children and adolescents: characteristics of sexual to be pre-commercial systems. The functional and
victimization in family relations]. Cad Saude Publica clinical merits of the products and systems developed
2004; 20(2):456-64. were evaluated, and their costs and benefits measured
Abstract: This study analyzes the characteristics of with reference to those already in use. The seven
sexual abuse committed within the family against age projects were completed in 1999. The Italian Ministry
groups classified according to the Brazilian Statute for of Universities, Research and Technology granted
Children and Adolescents (the prevailing legislation on research funds totalling 50,000,000 Euros for the whole
matters pertaining to minors) and treated at the programme. While the results of the research were
Reference Center for Children and Adolescents and the promising, successful projects alone are not sufficient
Guardianship Councils in Ribeirao Preto, Sao Paulo to reduce costs in health-care. Indeed, far more money
State, Brazil, from 1995 to 2000. Some 234 abuses can be saved simply by encouraging the uptake on a
were identified, committed by 217 aggressors, against larger scale of many technologies and practices that
210 families and a total of 226 victims. A total of 131 already exist.
children (48.7%) and 95 adolescents (41.2%),
predominantly females, were victimized. Children Ricciardi C, Guastadisegni C. Environmental inequities and
ranging from 10 to 12 years were the most frequently low birth weight. Ann Ist Super Sanita 2003;
abused (19.5%), as well as adolescents from 12 to 14 39(2):229-34.
years old (17.3%). The majority of the victims live in Abstract: The effects of environmental exposures to
families with 3 (19.9%) or 4 children (177%), and the toxic agents, are related to different levels of exposure,
firstborn are the most frequently abused (33.6%). The genetic and biological susceptibility, risk perception
majority of aggressors who acted alone victimized only and socioeconomic status (SES). In the present study
one individual (86.7%). Fathers (34.2%) and
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![Riem S. [Sexual abuse--neglect--violence. Accordingly you Riley EP, Mattson SN, Li TK et al. Neurobehavioral
diagnose child abuse]. MMW Fortschr Med 2002; consequences of prenatal alcohol exposure: an
144(8):16. international perspective. Alcohol Clin Exp Res 2003;
27(2):362-73.
Rigby MJ, Kohler LI, Blair ME, Metchler R. Child health Abstract: This article represents the proceedings of a
indicators for Europe: a priority for a caring society. symposium at the 2002 Research Society on
Eur J Public Health 2003; 13(3 Suppl):38-46. Alcoholism/International Society for Biomedical
Abstract: BACKGROUND: Measurement of children's Research on Alcoholism meeting in San Francisco,
health is important for two reasons: first, because CA. The organizers were Edward P. Riley and Sarah
young people are citizens in their own right, yet largely N. Mattson, and the chairperson was Edward P. Riley.
unable to act as self-advocates, particularly at the The presentations were (1) Neurobehavioral deficits in
population level; and second, because their health alcohol-exposed South African infants: preliminary
determines the health of the future population. findings, by Sandra W. Jacobson, Christopher D.
Indicators based on measurements of child health are Molteno, Denis Viljoen, and Joseph L. Jacobson; (2) A
important for identifying progress, problems and pilot study of classroom intervention for learners with
priorities, changes over time, and newly emergent fetal alcohol syndrome in South Africa, by Colleen
issues. The European Community Health Monitoring Adnams, M. W. Rossouw, M. D. Perold, P. W.
Programme (HMP) is a comprehensive programme to Kodituwakku, and W. Kalberg; (3) Differential effects
develop and implement a set of national-level of prenatal alcohol exposure on fluid versus
indicators. The Child Health Indicators of Life and crystallized intelligence, by P. W. Kodituwakku, W.
Development (CHILD) project is the only population Kalberg, L. Robinson, and P. A. May; (4)
group-specific project, seeking to determine a holistic Neurobehavioral outcomes of prenatal alcohol
set of measures. METHODS: The project endeavoured exposure: early identification of alcohol effects, by
to address all aspects of child health and its Claire D. Coles; (5) Fetal alcohol syndrome in
determinants, balancing positive and negative aspects. Moscow, Russia: neuropsychology test performance,
It undertook a structured search of published evidence by Sarah N. Mattson, E. P. Riley, A. Matveeva, and G.
to seek to identify, and validate, indicators of health Marintcheva; and (6) Long-term follow-up of Finnish
and illness, health determinants and challenges to children exposed to alcohol in utero in various
health, quality of healthcare support and health- durations, by Marit I. Korkman and I. Autti-Ramo. The
promoting national policies. A systematic approach discussant was Ting-Kai Li.
was used in identifying valid indicators, and in
assembling a balanced composite list. All ages from Ripamonti C, Bianchi M. The use of methadone for cancer
infancy to adolescence were covered. RESULTS: The pain. Hematol Oncol Clin North Am 2002; 16(3):543-
project's final report identifies 38 core desirable 55.
national indicators, citing purpose and evidence for Abstract: Methadone is not a new analgesic drug [69].
each. Of equal importance, it also identifies 17 key Several studies have demonstrated that methadone is a
child health topics on which further research work is valid alternative to morphine, hydromorphone, and
needed in order to identify and validate indicators fentanyl for the treatment of cancer-related pain, and
appropriate across different national settings. extensive reviews on the subject have been published
in recent years [10,23,25,64,70,71]. Most people
Riggs SA, Jacobvitz D. Expectant parents' representations of involved in pain therapy, however, are not well
early attachment relationships: associations with informed about the properties of methadone. The
mental health and family history. J Consult Clin authors believe that the low cost of methadone
Psychol 2002; 70(1):195-204. paradoxically contributes to the limited knowledge of
Abstract: The association between adult representations its characteristics and to the restricted therapeutic use
of early attachment relationships and history of of this drug. The low cost of methadone means there is
individual and family mental health was examined in a little financial incentive for pharmaceutical companies
sample of 233 expectant mothers and fathers. As to invest in research or to disseminate scientific
predicted, security of attachment was linked to mental information. Unfortunately, the lack of scientific
health. Parents classified as Preoccupied were more information from pharmaceutical companies frequently
likely than other parents to report suicidal ideation. results in a lack of knowledge on the part of physicians.
Whereas parents classified as Unresolved more often Unless the existing approach changes, both culturally
reported suicidal ideation, emotional distress, and and politically, ignorance about methadone will persist
substance abuse. With respect to family history. among medical experts. The low cost of methadone,
Unresolved and Preoccupied attachment classifications rather than being an advantage, will result in the
were significantly related to child abuse involving a limited exploitation of an effective drug.
relative and parental separation or divorce. These
findings support theoretical conceptualizations Ripley A. Inside the church's closet. Time 2002; 159(20):60-
regarding the link between adult attachment and mental 4.
health in middle-class American adults.
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![Ritchie A. Nutrition education and promotion in primary experiencing intra-familial violence among Mexican
schools. Aust J Holist Nurs 2001; 8(2):39-44. and Egyptian youth and to describe its associated risk
Abstract: Health promotion with school-age children factors. METHODS: Data from questionnaires applied
can enhance knowledge about nutrition and change to 12,862 Mexican and 5,662 Egyptian youth, aged 10
eating habits when health workers, schools, and to 19, who attended public schools were analyzed.
communities work together for a common goal. A Biviarate and logistic regression analysis were used to
range of options need to be considered when designing determine the relationship between socio-
an effective and appropriate school-based program. demographics, the experience of intra-familial violence
and violence perpetration. RESULTS: The prevalence
Ritchie LD, Welk G, Styne D, Gerstein DE, Crawford PB. of having experienced intra-familial violence was
Family environment and pediatric overweight: what is comparable across the Mexican and Egyptian
a parent to do? J Am Diet Assoc 2005; 105(5 Suppl populations (14% and 17%, respectively). In Mexico,
1):S70-9. young men were more likely to have experienced such
Abstract: Although the causes of pediatric overweight violence (OR=2.36) than women, whereas in Egypt,
are many and the levels of intervention required to young women were at slightly greater risk than young
prevent overweight in children extend from the child's men (OR=1.25). Older age, male gender and urban
immediate environment to the larger societal level, one residence were independent correlates of experiencing
critical intervention target is the parent. Scientific intra-familial violence among Mexican youth. For
evidence points to specific dietary and physical Egyptian adolescents, in contrast, younger age, female
activity/inactivity behaviors that families can adopt to gender and having non-married parents were
encourage healthful weight status. Dietary independent correlates of victimization. Intra-familial
recommendations include providing children with violence victims were also more likely than non-
ample access to nutrient-dense foods and beverages victims to perpetrate violence (Mexico: OR=13.13;
and high-fiber foods, both at meals and snack times, Egypt: OR=6.58). CONCLUSIONS: Mexican and
reducing children's access to high-calorie, nutrient-poor Egyptian youth experienced intra-familial violence at a
beverages and foods both when eating at home and at relatively low prevalence when compared with youth
restaurants, avoiding excessive food restriction or use of other countries. A strong association was found
of food as a reward, and encouraging children to eat between experiencing intra-familial violence and
breakfast on a daily basis. Physical activity perpetrating violence.
recommendations include providing opportunities and
encouragement for children to be physically active Roane KR. The long arm of abuse. US News World Rep
while reducing children's television and video game 2002; 132(15):26-9.
time. Parental modeling of healthful eating and
physical activity practices is recommended to reinforce Robben SG. [Diagnostic image (177). A lifeless infant.
these patterns in youth. Dietetics professionals, Shaken baby syndrome]. Ned Tijdschr Geneeskd 2004;
physicians, and other health care professionals can 148(23):1168; author reply 1168.
assist parents in their efforts to prevent pediatric
overweight by providing information and supporting Robbins H, Hundley V, Osman LM. Minor illness education
these key behaviors, while working to create for parents of young children. J Adv Nurs 2003;
environments that support healthful lifestyle changes. 44(3):238-47.
Abstract: BACKGROUND: A number of previous
Rivera HP. Developing collaborations between child welfare studies on minor illness have concentrated on nurse-led
agencies and Latino communities. Child Welfare 2002; clinics and the role of nurse practitioners. This study
81(2):371-84. examines the effect of a minor illness education
Abstract: Collaborative efforts to achieve permanency programme which aimed to increase parents'
planning and family stability for all children in the confidence and knowledge in managing childhood
child welfare system are increasing. As Latino children illnesses. AIM: The primary aim of this study was to
and families constitute the fastest growing ethnic group evaluate the effectiveness of a home visit and booklet
in the child welfare system, it is important to in providing education to parents about minor infant
understand how to develop culturally sensitive illnesses. DESIGN: A randomized controlled trial was
collaborations with their communities. The purpose of conducted. The intervention involved a home visit to
this article is to suggest helpful guidelines for discuss parents' concerns and provide advice and
developing collaborations between child welfare information, and a booklet advising parents what to do
agencies and Latino communities. and when to consult about infant illnesses. METHOD:
A total of 120 parents of 6 week old babies were
Rivera-Rivera L, Allen B, Thrasher JF et al. Intra-familial identified over a 6 month period, using health visitors'
physical violence among Mexican and Egyptian youth. caseloads, and randomized to an intervention group
Rev Saude Publica 2005; 39(5):709-15. (60), that received a visit and a booklet, or a control
Abstract: OBJECTIVE: To determine the prevalence of group (60) that received standard care. Groups were
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![Robshaw M, Smith J. Concerned about confidentiality? The interviews were tape-recorded, transcribed and
child protection jigsaw. Paediatr Nurs 2004; 16(5):36- analysed using Atlas.Ti. RESULTS: Several main
8. themes were identified in this study. Firstly, when
discussing scheduled health checks for children under
Robson A, Beattie A. Diana Children's Community Service one year of age parents expressed more positive
and service co-ordination. Child Care Health Dev feelings for the eight-week check which was seen to be
2004; 30(3):233-9; discussion 241. comprehensive and informative rather than the eight-
Abstract: BACKGROUND: The Diana Service and the month check which was viewed as bureaucratic and
multi-agency service co-ordination project in Leicester, less reassuring. Secondly, parents clearly articulated a
Leicestershire and Rutland were established to address need for reassurance and support from health
the needs of children with complex needs. The Mary professionals involved in child health surveillance and
Seacole Research Centre at De Montfort University in health promotion programmes. Thirdly, a crucial
Leicester evaluated the services over a period of professional in the delivery of these programmes was
approximately 1 year. METHODS: Predominantly the health visitor. Whilst parents expressed support for
qualitative methods were used. Different approaches to the concept of health visitors some health visitors were
sampling were employed and in both cases a range of seen as bureaucratic and as making judgements of need
data collection tools were utilized, e.g. written based on socio-economic factors. Finally, some parents
questionnaires, personal face-to-face interviews, focus spoke of feeling excluded from accessing support as
group, non-participant observation and information they were deemed not to be 'in need'.
from professional records. RESULTS: The findings CONCLUSIONS: Wider concepts of partnership
suggest that both services are making a considerable working between health professionals and parents, and,
contribution towards ensuring that effective needs assessment are important to this study. Crucial
collaboration within and between services occurs. This elements of the partnership appear to be missing and
makes a real difference to the lives of children and this coupled with needs assessments that leave parents
families. feeling excluded mean that there are discrepancies
between expectations and experiences of parents.
Roca I, Simo M, Sanchez de Toledo J. [Clinical impact of These issues require consideration in order to improve
PET in pediatrics]. Rev Esp Med Nucl 2004; services and experiences.
23(5):359-68; quiz 369-71.
Rodgers CS, Lang AJ, Laffaye C, Satz LE, Dresselhaus TR,
Roche B, Cowley S, Salt N et al. Reassurance or judgement? Stein MB. The impact of individual forms of childhood
Parents' views on the delivery of child health maltreatment on health behavior. Child Abuse Negl
surveillance programmes. Fam Pract 2005; 22(5):507- 2004; 28(5):575-86.
12. Abstract: OBJECTIVE: This study examines the
Abstract: BACKGROUND: The first year of a child's unique contribution of five types of maltreatment
life is a crucial time for child development. Current (sexual abuse, physical abuse, emotional abuse,
guidance about child health surveillance and health physical neglect, emotional neglect) to adult health
promotion programmes emphasises a partnership behaviors as well as the additive impact of exposure to
approach between health professionals and parents different types of childhood maltreatment. METHOD:
when it comes to child health care. Parents' voices have Two hundred and twenty-one women recruited from a
been largely absent from discussions about local child VA primary care clinic completed questionnaires
health programmes. For partnership working to be assessing exposure to childhood trauma and adult
effective and for local services to be able to evolve health behaviors. Regression models were used to test
effectively parents' views are vital. OBJECTIVES: the relationship between childhood maltreatment and
This study aimed to explore parents' views on the child adult health behaviors. RESULTS: Sexual and physical
health surveillance and health promotion programmes abuse appear to predict a number of adverse outcomes;
offered during the first year of their child's life. The when other types of maltreatment are controlled,
study aimed to be consumer-led through the however, sexual abuse and physical abuse do not
involvement of lead parents in all stages of the research predict as many poor outcomes. In addition, sexual,
process. METHODS: This study employed a physical, and emotional abuse and emotional neglect in
qualitative methodology of focus groups and individual childhood were all related to different adult health
interviews. 35 participants were drawn from three behaviors. The more types of childhood maltreatment
general practices using a snowball sampling technique. participants were exposed to the more likely they were
Eligibility was determined as parents with a child to have problems with substance use and risky sexual
under the age of one year or expecting a baby within behaviors in adulthood. IMPLICATIONS: The results
the study timescale and registered at one of the 3 indicate that it is important to assess a broad
general practices. Focus groups were led by three maltreatment history rather than trying to relate
'parent-researchers' and individual interviews were specific types of abuse to particular adverse health
conducted by a researcher. All focus groups and behaviors or health outcomes.
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![Rodrigues SS, de Almeida MD. Portuguese household food 7.
availability in 1990 and 1995. Public Health Nutr 2001; Abstract: PURPOSE: In the course of a high-risk study
4(5B):1167-71. for alcoholism, the middle-latency auditory evoked
Abstract: OBJECTIVE: To examine the changes in potentials (MAEPs) of children of alcoholics were
Portuguese household food availability from 1990 to explored. MATERIAL AND METHODS: A series of
1995. DESIGN: Using the DAta Food NEtworking auditory clicks (0.1 ms, 60 dB SL, 1.1/s) were used to
(DAFNE) classification scheme for nutritional and record the Pa and Pb peaks of the MAEPs in 15
socio-economic variables, data from the Portuguese children of alcoholics with a multigenerational family
Household Budget Surveys collected in 1989/90 and history of alcoholism, and 17 control subjects, ranging
1994/95 were analysed. The mean availability (quantity from 10 to 14 years of age. RESULTS: The latency of
person(-1) day(-1)) for the total population, by locality Pb was shorter in the high-risk than in the control
and by level of education of the household head, was group, and there was also a significant risk group by
computed for each of the main food and beverage age interaction on Pa latency. The amplitude of Pa was
groups. SETTING: Portugal, 1989 to 1995. RESULTS: smaller in the children of alcoholics. CONCLUSIONS:
Although still among one of the countries with high The characteristics of the MAEPs of the high-risk
availability of cereals, pulses, fish and seafood and subjects did not match the pattern of abnormalities
olive oil, Portugal is gradually moving away from the previously observed in chronic alcoholics, which are
traditional 'Mediterranean diet'. Between 1989 and supposed to be a consequence of the neurotoxic effects
1995, the availability of complex carbohydrates and of ethanol. Nonetheless, the results showed significant
olive oil was reduced, while the availability of protein- differences in MAEPs between children of alcoholics
supplying food groups increased. Considerable and controls, pointing to an anomalous pattern of
disparities can be observed by locality and by the level information transmission from thalamus to cortex that
of education of the household head. Households in should be further analyzed using larger samples in a
urban areas and of higher socio-economic status are the broader age range.
main actors of the changes in 'traditional' food habits.
CONCLUSION: Although these findings are based on Rodriguez J, De La Torre A, Miranda CT. [Mental health in
household food availability rather than consumption, situations of armed conflict]. Biomedica 2002; 22
they indicate the direction of the changes taking place Suppl 2:337-46.
in the Portuguese diet and can be used effectively by Abstract: Mental health is a serious problem in Latin
agriculture specialists, nutrition experts and policy America where many communities have been directly
makers. affected by armed conflict, communities in which large
population groups have been displaced or have sought
Rodriguez GM, Luis MA. [Descriptive study of drug use refuge. Research studies and epidemiological statistics
among adolescents in higher middle education in are summarized to emphasize the psychosocial
Monterrey, Nueva Leon, Mexico]. Rev Lat Am consequences of traumatic events associated with
Enfermagem 2004; 12 Spec No:391-7. armed conflict. In addition to specific psychological
Abstract: We aimed to establish the consumption disorders, other more generalized are considered such
profile of licit and illicit drugs, consumption patterns as fear, affliction, diseases, social disorder, violence
and strategies for coping and resisting alcohol, tobacco and psychoactive substance consumption. Finally, the
and other drugs among adolescents in higher middle main points of a mental health plan for emergency
education. This study was based on concepts developed situations are described which include the following:
by specialized authors and considered the subject's (1) preliminary diagnosis, (2) increase, decentralize
behavioral, psychological and normative and strengthen mental health public services, (3)
characteristics. The non-probabilistic sample consisted psychosocial attention to the prevailing disorders--with
of 325 adolescents. Results indicated that 67%, 65% emphasis on childhood problems, (4) initiate training
and 7% of the adolescents, respectively, accepted they and use of non-specialized personnel, and (5)
had already used alcohol, tobacco and marijuana at identification of special needs requiring attention by
some time in their life and that 33%, 38% and 3%, psychologists and psychiatrists. Other aspects
respectively, had used these same substances over the emphasized were community education, training, social
last month; 65% consider most of their colleagues have communication, community organization, social
used these substances; 56% had to reject an offer to participation, interinstitutional coordination, flexibility,
consume alcohol, 64% tobacco and 51% marijuana sustainability, and specific actions in accordance with
over the last month. On the basis of these findings, we local needs.
recommend the implementation of a prevention
program aimed at supporting the adolescent's resources Roe KV. Relationship between male infants' vocal responses
to resist pressure towards consumption. to mother and stranger at three months and self-
reported academic attainment and adjustment measures
Rodriguez Holguin S, Corral M, Cadaveira F. Middle- in adulthood. Psychol Rep 2001; 89(2):255-8.
latency auditory evoked potentials in children at high Abstract: This study explored whether 3-mo.-old male
risk for alcoholism. Neurophysiol Clin 2001; 31(1):40- infants' differential vocal response to mother vs a
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![Rogstad KE, Holkar S, Dewdney A. Sexual health needs of absent or sparse in the aganglionic bowel and sparse in
the under-16s attending an STI clinic: what are they the transitional zone. The expression of myenteric
and are they being addressed? Int J STD AIDS 2003; ICCs in the ganglionic bowel in HD was reduced
14(4):266-9. compared to that in the normal bowel, and they formed
Abstract: A retrospective analysis was performed on only sparse networks. Muscular ICCs were found in the
case notes of patients aged less than 16 years who aganglionic bowel, transitional zone, and
attended a Department of Genito-Urinary Medicine as normoganglionic bowel of HD in a reduced density
a new case in 1998. Seventy-four case notes were compared to the normal bowel. CONCLUSION: This
reviewed. There was a high rate of sexually transmitted study demonstrates altered distribution of ICCs in the
infection (STI) (gonorrhoea six [8%], chlamydia 23 entire resected bowel of HD patients. This finding
[31%], genital warts nine [12%], trichomonas seven suggests that persistent dysmotility problems after pull-
[10%]) and low condom (30, 41%) and other through operation in HD may be due to altered
contraceptive use (21 females [35%], six males [60%]). distribution and impaired function of ICCs.
Many female attendees were victims of current or
previous sexual abuse (eight, 8%) and/or exploitation, Rosen C. Liberty, privacy, and DNA databases. New
and for a further eight (8%) abuse/exploitation was Atlantis 2003; (1):37-52.
considered possible; little reference was made to this in Notes: GENERAL NOTE: KIE: KIE Bib: DNA
the notes. Thirty-three (45%) attendees were seen by fingerprinting; genetic research
junior members of staff, and only 49 (60%) were seen
by a health adviser (42 females, seven males [60%]). Rosen L. Conjoined twins: 2000 version. British Supreme
Young attendees have a high STI rate, low Court's decision. Assia Jew Med Ethics 2001; 4(1):28-
contraceptive use and a significant minority are victims 9.
of abuse. Genitourinary medicine clinics need to Notes: GENERAL NOTE: KIE: Rosen, Leora
provide a full sexual health service to this vulnerable GENERAL NOTE: KIE: KIE Bib: patient care/minors;
group and have guidelines in place to assess for sexual treatment refusal/minors
abuse. Recommendations on how to achieve this are GENERAL NOTE: KIE: Case No: B1/2000/2696,
given. 22nd September
2000.http://news.findlaw.com/cnn/docs/siamesetwins/s
Rohde DL. Learnability, stochastic input, and connectionist iamesetwins1.html
networks: a response to Brian MacWhinney's 'A
multiple process solution to the logical problem of Rosen LN, O'Sullivan CS. Outcomes of custody and
language acquisition'. J Child Lang 2004; 31(4):954-8; visitation petitions when fathers are restrained by
discussion 963-8. protection orders: the case of the New York family
courts. Violence Against Women 2005; 11(8):1054-75.
Rolle U, Piotrowska AP, Nemeth L, Puri P. Altered Abstract: A random sample of custody and visitation
distribution of interstitial cells of Cajal in Hirschsprung petitions filed in New York City Family Courts in 1995
disease. Arch Pathol Lab Med 2002; 126(8):928-33. was used to examine outcomes of mothers' Order of
Abstract: CONTEXT: Constipation or recurrent Protection (OP) Petitions in relation to parents' custody
intestinal dysmotility problems are common after and visitation petitions. Fathers restrained by OPs were
definitive surgical treatment in Hirschsprung disease more likely to secure visitation orders (64%) than not.
(HD). c-Kit-positive interstitial cells of Cajal (ICCs) In contrast, 80.8% of fathers' custody petitions were
play a key role in the motility function and dismissed when they were restrained by OPs. Fathers'
development of the gastrointestinal tract. Interstitial custody petitions were most likely to be ordered when
cells of Cajal that carry the tyrosine kinase receptor (c- mothers' OP petitions were withdrawn. Mothers were
Kit) develop as either myenteric ICCs or muscular most likely to secure custody when their OP petitions
ICCs under the influence of the kit ligand, which can were ordered or withdrawn. Courts rarely denied
be provided by neuronal and nonneuronal cells, for petitions. Those that did not result in court orders were
example, smooth muscle cells. OBJECTIVE: To either withdrawn by the petitioner or dismissed by the
investigate the distribution of myenteric and muscular court (most likely because of failure of the petitioner to
ICCs in different parts of the colon in HD. appear in court). This pattern has negative implications
METHODS: Resected bowel specimens from 8 for battered women who may be vulnerable to pressure
patients with rectosigmoid HD were investigated using or threats from abusive ex-partners.
combined staining with c-Kit enzyme and fluorescence
immunohistochemistry and acetylcholinesterase and Rosenberg AD, Abell SC, Mackie JK. An examination of
nicotinamide adenine dinucleotide phosphate the relationship between child sexual offending and
(NADPH) histochemistry in whole-mount preparations psychopathy. J Child Sex Abus 2005; 14(3):49-66.
and conventional frozen sections. RESULTS: In the Abstract: The participants in this study were adult
normal bowel, ICCs formed a dense network males (N = 111) who were accused of various sexual
surrounding the myenteric plexus and at the innermost crimes against children 16 years of age or younger, and
part of the circular muscle. Myenteric ICCs were
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![applicable to other public health and medical care 26.22), being wounded (AOR, 3.22; 95% CI, 0.95-
initiatives. Health information systems projects should: 10.89), and experiencing 7 to 12 traumatic events
(1) involve stakeholders from the beginning, (2) (AOR, 2.67; 95% CI, 1.14-6.27) and 13 to 19 traumatic
recognize the complexity of establishing a population- events (AOR, 2.26; 95% CI, 0.65-7.89). Elevated
based information system, (3) develop the symptoms of depression were associated with being a
policy/business/value case for information systems, (4) woman (AOR, 3.64; 95% CI, 1.47-9.04), being
define the requirements of the system to support users' widowed (AOR, 27.55; 95% CI, 2.54-299.27), being
needs, (5) develop information systems according to married (AOR, 1.93; 95% CI, 0.59-6.33), witnessing
current standards, (6) address common problems disappearances (AOR, 2.68; 95% CI, 1.16-6.19),
collaboratively, (7) plan for change, (8) plan boldly but experiencing 7 to 12 traumatic events (AOR, 1.57;
build incrementally, (9) develop a good 95% CI, 0.64-3.88), or experiencing 13 to 19 traumatic
communications strategy, and (10) use the information events (AOR, 7.44; 95% CI, 2.18-25.37).
(even if not perfect). Opportunities exist for public CONCLUSION: Psychiatric morbidity related to
health agencies to share their experiences from human rights violations, traumatic events, and refugee
developing immunization registries and integrated status was common among Guatemalan refugees
child health information systems and to develop surveyed 20 years after the Guatemalan civil conflict.
collaborative approaches to improving the nation's
health information infrastructure. Sabol WJ, Coulton CJ, Korbin JE. Building community
capacity for violence prevention. J Interpers Violence
Sabin M, Lopes Cardozo B, Nackerud L, Kaiser R, Varese 2004; 19(3):322-40.
L. Factors associated with poor mental health among Abstract: The capacity of communities to prevent
Guatemalan refugees living in Mexico 20 years after violence is examined from three perspectives: youth
civil conflict. JAMA 2003; 290(5):635-42. violence, child maltreatment, and intimate partner
Abstract: CONTEXT: From 1981 to 2001, 46 000 violence. The analysis suggests that community social
refugees who fled the 36-year civil conflict in control and collective efficacy are significant
Guatemala for Chiapas, Mexico were under the protective factors for all three types of violence, but
protection of the United Nations High Commissioner these need to be further distinguished for their
for Refugees. OBJECTIVES: To estimate the relationships to private, parochial, and state controls. It
prevalence of mental illness and factors associated with is argued that strong interpersonal ties are not the only
poor mental health of underserved Guatemalan refugee contributor to collective efficacy and violence
communities located in Chiapas, Mexico, since 1981 prevention. Weak ties, including those outside the
and to assess need for mental health services. DESIGN, community, and organizational ties are also seen as
SETTING, AND PARTICIPANTS: Cross-sectional necessary. Violence prevention programs should be
survey of 183 households in 5 Mayan refugee camps in structured in ways that contribute to the communities'
Chiapas representing an estimated 1546 residents own capacity to prevent violence.
(adults and children) conducted November-December
2000. MAIN OUTCOME MEASURES: Symptom Sachs BC, Gaillard WD. Organization of language networks
criteria of Posttraumatic Stress Disorder (PTSD), in children: functional magnetic resonance imaging
anxiety, and depression as measured by the Harvard studies. Curr Neurol Neurosci Rep 2003; 3(2):157-62.
Trauma Questionnaire and Hopkins Symptom Abstract: Functional magnetic resonance imaging
Checklist-25 (Hopkins-25). RESULTS: One adult (fMRI) is a relatively new neuroimaging procedure that
(aged > or =16 years) per household (n = 170 has been used to study a wide variety of cognitive
respondents) who agreed to participate was included in phenomena in adults, including attention, language,
the analysis, representing an estimated 93% of and memory. More recently, this technique has been
households. All respondents reported experiencing at successfully applied to pediatric populations as well. In
least 1 traumatic event with a mean of 8.3 traumatic particular, many investigators have employed fMRI as
events per individual. Of the respondents, 20 (11.8%) a tool to study language development in normal
had all symptom criteria for PTSD. Of the 160 who children. This paper reviews the current imaging
completed the Hopkins Symptom Checklist-25, 87 research on the identification of cortex subserving
(54.4%) had anxiety symptoms and 62 (38.8%) had components of language processing in young children.
symptoms of depression. Witnessing the disappearance The literature suggests that fMRI can successfully
of family members (adjusted odds ratio [AOR], 4.58; identify regions of language cortex in children in much
95% confidence interval [CI], 1.35-15.50), being close the same capacity as it can with adults, and that
to death (AOR, 4.19, 95% CI, 1.03-17.00), or living generally, adults and children show fundamental
with 9 to 15 persons in the same home (AOR, 3.69; similarities in the patterns of activation. However,
95% CI, 1.19-11.39) were associated with symptoms of special considerations with pediatric imaging,
PTSD. There was a protective factor found for lacking paradigm design, and image analysis are also
sufficient food (AOR, 0.08; 95% CI, 0.01-0.59). discussed.
Elevated anxiety symptoms were associated with
witnessing a massacre (AOR, 10.63; 95% CI, 4.31-
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![planned, complications occurred in 2.9 per cent. The among nouns in the early productive vocabulary. Data
operation date was delayed in 20 patients, in 11 from a 4-layer Hopfield network suggested that the
patients no cause for the delay was given in the case statistical regularities in the early noun vocabulary are
notes. As a result of this audit, the Senior House strong enough to create a shape bias, and that the shape
Officer sees the patient on the day of admission rather bias is overgeneralized to nonsolid stimuli. A 2nd
than in the pre-admission clinic, which is staffed by simulation suggested that this overgeneralization is due
nurses. to the dominance of names for shape-based categories
in the early noun vocabulary. Two subsequent
Samuelson JL, Buehler JW, Norris D, Sadek R. Maternal longitudinal experiments tested whether it is possible to
characteristics associated with place of delivery and create word learning biases in children. Children 15-20
neonatal mortality rates among very-low-birthweight months old were given intensive naming experiences
infants, Georgia. Paediatr Perinat Epidemiol 2002; with 12 noun categories typical of the types of
16(4):305-13. categories children learn to name early. The children
Abstract: To determine whether the Healthy People developed a precocious shape bias that was
2000 objective to deliver very-low-birthweight overgeneralized to naming nonsolid substances; they
(VLBW) infants at subspecialty perinatal care centres also showed accelerated vocabulary development.
was met, and if improvements in the regional perinatal Children taught an atypical set of nouns or no new
care system could reduce neonatal mortality further for nouns did not develop a shape bias and did not show
2010, we examined place of delivery for VLBW accelerated vocabulary development.
infants, associated maternal characteristics and the
potential impact on neonatal mortality. We used linked Sanchez-Gimeno J, Martin-Carpi J, Martinez-Laborda S,
birth and death records for the 1994-96 Georgia Carrasco-Lorente S, Abenia-Uson P, Lopez-Pison J.
VLBW (i.e. 500-1499 g) birth cohorts. Among 4770 [Lumbar puncture and early neuroimaging in complex
VLBW infants, 77% were delivered at hospitals febrile seizures. Report of a case of shaken infant
providing subspecialty perinatal care. The strongest syndrome]. Rev Neurol 2003; 36(4):351-4.
predictor of birth hospital level was the mother's Abstract: INTRODUCTION: Febrile convulsions are
county of residence, defined using three levels: one of the most frequent pathologies seen in paediatric
residence in a county with a subspecialty hospital, emergencies. The diagnosis of febrile seizures is
residence in a county adjacent to one with such a clinico evolutionary and is easily established once the
hospital or residence in a non-adjacent county. Eighty- acute process is overcome and a normal state is
nine per cent of infants born to women who resided in restored in the child. The differential diagnosis is
counties with subspecialty care hospitals delivered at established with the processes that associate fever and
such hospitals, compared with 53% of infants born to convulsions in children between the ages of 1 month
women who resided in a non-adjacent county. Women and 6 years, many of which require specific treatment.
were also more likely to deliver outside subspecialty Certain complementary examinations, essentially a
care if they had less than adequate prenatal care blood test, lumbar puncture and neuroimaging, are
[adjusted odds ratio (AOR) 1.5, P-value = 0.0001]. The needed to identify them. Shaken infant syndrome is a
neonatal mortality rate varied by level of perinatal care form of physical abuse which includes the presence of
at the birth hospital from 132.1/1000 to 283/1000 live intracranial traumatic injury, retinal haemorrhage and,
births, with the highest death rate for infants born at in general, the absence of other physical signs of
hospitals offering the lowest level of care. Assuming traumatic injury in the child. CASE REPORT: An 8
that the differences in mortality were due to care level month old infant who presented a convulsive seizure
of the birth hospital, potentially 16-23% of neonatal on the left side of the body which coincided with an
deaths among VLBW infants could have been axillary temperature of 38 C that remitted with
prevented if 90% of infants born outside subspecialty intravenous diazepam 40 minutes after onset. An early
care were delivered at the recommended level. These cranial computerised tomography (CT) scan led to a
findings suggest that a state's support of strong, diagnosis of shaken infant syndrome. DISCUSSION:
collaborative, regional perinatal care networks is This case constitutes an argument in favour of
required to ensure that high-risk women and infants performing an early cranial CT scan in complex febrile
receive optimal health care. Improved access to convulsions and in prolonged or partial non provoked
recommended care levels should further reduce seizures. We highlight the risks involved in performing
neonatal mortality until interventions are identified to a lumbar puncture in the absence of suspected non
prevent VLBW births. complicated acute bacterial meningitis. The diagnostic
usefulness of an early CT scan in diagnosing such an
Samuelson LK. Statistical regularities in vocabulary guide important problem as shaken infant syndrome must
language acquisition in connectionist models and 15- also be noted, due to the risk of repetition and its high
20-month-olds. Dev Psychol 2002; 38(6):1016-37. morbidity and mortality rates.
Abstract: This research tested the hypothesis that
young children's bias to generalize names for solid Sanders LM, Robinson TN, Forster LQ, Plax K, Brosco JP,
objects by shape is the product of statistical regularities Brito A. Evidence-based community pediatrics:
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![building a bridge from bedside to neighborhood. benzodiazepines. In terms of illicit drugs, males
Pediatrics 2005; 115(4 Suppl):1142-7. preferred cocaine and marijuana, while females only
Abstract: The American Academy of Pediatrics policy reported amphetamine use. An analysis of adolescent
statement "The Pediatrician's Role in Community functioning showed differences among alcohol users
Pediatrics" encourages all pediatricians to partner with and nonusers in behavior patterns and peer
their communities to create and disseminate innovative relationships. However, no significant differences were
programs that improve child health. This article found regarding rebellion, depression, and social
describes 4 pillars of a bridge to evidence-based isolation. The implications of these results are
community pediatrics for pediatricians interested in discussed, along with the importance of enhancing
pursuing effective community action: (1) collaborate prevention, as well as early detection and intervention.
with the community to establish a specific, short-term,
health-related goal; (2) identify evidence-based best Sandoval-Priego AA, Reyes-Morales H, Perez-Cuevas R,
practice(s) for achieving the shared goal; (3) Abrego-Blas R, Orrico-Torres ES. [Family life
collaborate with the community to adapt this best strategies and their relation with malnutrition in
practice to the community's unique assets and children under 2 years old]. Salud Publica Mex 2002;
constraints; and (4) evaluate the project by using 44(1):41-9.
appropriate expertise. Practical elements of each pillar Abstract: OBJECTIVE: To identify the role of family
are described and illustrated by specific examples from life strategies on malnutrition in children aged 6-23
community-based efforts of pediatricians and are months of age. MATERIAL AND METHODS: This
accompanied by specific resources to aid pediatricians case-control study was conducted in 1998 in the
in their future community health work. municipality of Teolocholco, State of Tlaxcala,
Mexico, among families with children aged 6-23
Sanders MR. Parenting interventions and the prevention of months of age. The sample was conformed by 105
serious mental health problems in children. Med J Aust cases and 210 controls. Family life strategies were
2002; 177 Suppl:S87-92. grouped into five types: family composition, means
Abstract: The reduction of coercive or inadequate and distribution of family income, family and social
parenting is essential if the mental health status of networks, and life preservation strategies. Malnutrition
Australian children and adolescents is to be improved. was classified according to height for age. Data were
Of the available approaches that address parenting analyzed using logistic regression to obtain odds ratios
practices, behavioural family interventions have the and 95% confidence intervals. RESULTS: Data were
strongest empirical support and are effective in collected from 605 families, for a total of 445 controls
reducing parenting practices that contribute to the and 160 cases. The predictive model included mother's
development of behavioural and emotional problems in schooling, overcrowding, time elapsed between
children. However, only a small proportion of parents childbirths, per capita monthly income, and time
access such interventions. A comprehensive multilevel, devoted to child-rearing activities. CONCLUSIONS:
evidence-based parenting and family support strategy Family life strategies determine children's nutritional
needs to be implemented on a wide scale to reduce the status; understanding the influence of the family on the
prevalence of mental health problems in children and children's health status is necessary to develop effective
youth. The Triple P - Positive Parenting Program is an programs aimed at improving the nutritional status of
example of a population-level strategy that can be used children.
to improve the mental health status of children and
their parents. Sankoorikal T. Using scientific advances to conceive the
"perfect" donor: the Pandora's box of creating child
Sandi L, Diaz A, Uglade F. Drug use and associated factors donors for the purpose of saving ailing family
among rural adolescents in Costa Rica. Subst Use members. Seton Hall Law Rev 2003; 32(3):581-615.
Misuse 2002; 37(5-7):599-611.
Abstract: The objectives of this study, carried out in Sant'Anna A, Aerts D, Lopes MJ. [Adolescent homicide
1995, were to assess both licit and illicit substance use victims in Southern Brazil: situations of vulnerability
among rural male and female Costa Rican adolescents, as reported by families]. Cad Saude Publica 2005;
and associated health, psychological, and psychosocial 21(1):120-9.
problems. A sample of 304 students from rural schools Abstract: This study focused on homicide deaths of
was randomly selected. The mean age for females was adolescents (ages 10 to 19 years) in Porto Alegre, Rio
14.7 years (S.D. = 1.71), and for males was 14.4 years Grande do Sul, Brazil, in 1997. Data were obtained
(S.D. = 1.62). The data were collected using the Latin- from the Mortality Information System (SIM) of the
American version of Drug Use Screening Inventory Municipal Health Department. Families were visited at
(DUSI). Results showed a high prevalence of past-year the addresses found on death certificates and were
alcohol use for both males and females (56.6% and interviewed by two researchers. Of the 68 cases
47.4%, respectively), and a lower prevalence of past- selected, 57 families were visited; eight families
year tobacco use (44.0% and 7.7%). There results also refused to be interviewed, and three addresses were not
showed a low level of use of solvent inhalants and
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![found. Most of the adolescents were socially assistance), eight were placed in a school for children
vulnerable, as indicated by low per capita income and with learning disabilities, nine children attended other
parental educational level; 78.9% had dropped out of special schools. Social contact problems and anxious
school. Males were the predominant victims of behaviour were reported as the most prominent
adolescent homicide deaths (91.2%). Behavioral characteristics of children with Sotos syndrome. Some
vulnerability was demonstrated as follows: 40.4% of implications for psychological counselling and
the adolescents consumed alcoholic beverages and educational support are discussed.
45.6% illicit drugs, and 58.6% had criminal records or
a history of custody at FEBEM (the State Juvenile Sariola H. [Has sexual abuse of children increased?].
Custody Facilities) or police arrests. The study Duodecim 2005; 121(20):2135-7.
highlights the importance of coordinating actions
among different sectors to reach adolescents both at Sarna K. Female foeticide on the rise in India. Nurs J India
home and in the schools and communities. 2003; 94(2):29-30.
Sant'Anna AR, Lopes MJ. Homicides among teenagers in Sarnaik AP, Daphtary K, Sarnaik AA. Ethical issues in
the city of Porto Alegre, Rio Grande do Sul State, pediatric intensive care in developing countries:
Brazil: vulnerability, susceptibility, and gender combining western technology and eastern wisdom.
cultures. Cad Saude Publica 2002; 18(6):1509-17. Indian J Pediatr 2005; 72(4):339-42.
Abstract: The authors present a quantitative and Abstract: Application of traditional ethical principles in
qualitative study on homicides among teenagers in developing countries may not, indeed should not,
Porto Alegre, Rio Grande do Sul State, Brazil, based conform to the western philosophy and ideology. The
on a historical series during the 1990s and the life and principle of distributive justice is of utmost importance
death histories in this group, with a special focus on when critical resources are scarce. There is no ethical
1997. In that year there were 68 homicides in which the imperative, nor is one followed even in the most
victims were from 10 to 19 years old. Of the 68, 62 advanced countries, that every citizen is entitled to the
were males and only 6 females, or a ratio of 10:1, very best available care. However, a society must
showing that young males are more vulnerable and establish a uniform code of ethics that can be applied
susceptible to being murdered. The data indicate that nationally, whereby all citizens are eligible for a
cause of death is influenced by gender culture and that minimum acceptable level of care. The traditional
homicides are based on power and status symbols principles of autonomy, beneficence, nonmaleficence
characterizing a kind of virility. This expression of and justice are still applicable in structuring an ethical
virility in the shaping of violence also appears in the framework that is most suited for the country's needs
domination of the female body observed in homicides and resources.
with young women as the victims. The life and death
histories of these teenagers highlight the pertinence of Sass JO, Crazzolara R, Heinz-Erian P. Mechanisms of brain
the gender-based analysis as a theoretical-analytical injury in infantile child abuse. Lancet 2001;
category, in addition to analyses considering 358(9298):2082-3.
socioeconomic aspects and social inequity.
Satcher D, Fryer GE Jr, McCann J, Troutman A, Woolf SH,
Santos y Vargas L. [Casuistic-inductive approximation to Rust G. What if we were equal? A comparison of the
bioethics]. P R Health Sci J 2001; 20(3):277-82. black-white mortality gap in 1960 and 2000. Health
Aff (Millwood) 2005; 24(2):459-64.
Saraswat A. Child abuse and trichotillomania. BMJ 2005; Abstract: The United States has made progress in
330(7482):83-4. decreasing the black-white gap in civil rights, housing,
education, and income since 1960, but health
Sarimski K. Behavioural and emotional characteristics in inequalities persist. We examined trends in black-white
children with Sotos syndrome and learning disabilities. standardized mortality ratios (SMRs) for each age-sex
Dev Med Child Neurol 2003; 45(3):172-8. group from 1960 to 2000. The black-white gap
Abstract: In contrast to physical characteristics, the measured by SMR changed very little between 1960
developmental and behavioural characteristics of and 2000 and actually worsened for infants and for
children with Sotos syndrome are not well African American men age thirty-five and older. In
documented. Data from a survey of 27 children (17 contrast, SMR improved in African American women.
males and 10 females; mean age 10 years 7 months; Using 2002 data, an estimated 83,570 excess deaths
range 6 to 15 years) with mild and moderate learning each year could be prevented in the United States if
disabilities were obtained concerning school this black-white mortality gap could be eliminated.
placement, social networks, adaptive competence, and
behavioural problems and compared with a control Sathiaseelan S, Rayar U. The mystery of the broken bones.
group matched for cognitive level and age. Ten CMAJ 2003; 169(11):1189-90.
children attended a mainstream school (with remedial
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![Notes: GENERAL NOTE: KIE: 224 fn. survivability for reasonable medical judgment. Indeed,
GENERAL NOTE: KIE: KIE Bib: patient care/minors under a straightforward reading of the instruction, a
family member could conceivably trigger an
Saxton R. Psychiatry's missing link--mental injury. Aust investigation after observing a relative deliver a 20-
Fam Physician 2002; 31(12):1122, 1125. week fetus who maintains a heartbeat for an hour
before its death. Most physicians would not consider
Sayeed SA. Baby doe redux? The Department of Health and this an emergency medical condition and, rather than
Human Services and the Born-Alive Infants Protection perform a screening examination, would provide
Act of 2002: a cautionary note on normative neonatal comfort for the newborn and support for the family.
practice. Pediatrics 2005; 116(4):e576-85. The guideline, however, does not state that professional
Abstract: The Born-Alive Infants Protection Act acumen trumps the layperson's observations in these
(BAIPA), passed by Congress in 2002, has attracted instances; thus, physicians are left unclear about
little publicity. Its purposes were, in part, "to repudiate whether screening examinations are required for all
the flawed notion that a child's entitlement to the newborns regardless of a priori, reasoned
protections of the law is dependent on whether that considerations of survivability. In this context, the NRP
child's mother or others want him or her." Understood Steering Committee opinion states that "at the time of
as antiabortion rhetoric, the bill raised little concern delivery... the medical condition and prognosis of the
among physicians at the time of legislative hearings newly born infant should be assessed. At that point
and passed in both Houses by overwhelming decisions about withholding or discontinuing medical
majorities, hardly suggesting contentious legislation. treatment that is considered futile may be considered
After its signing into law, the Neonatal Resuscitation by... providers in conjunction with the parents acting in
Program (NRP) Steering Committee issued an opinion the best interest of their child." However, most
stating that "[BAIPA] should not in any way affect the pediatricians skilled in screening and resuscitation are
approach that physicians currently follow with respect not currently called on to perform this function when
to the extremely premature infant." This interpretation the gestational age of a nonviable fetus is reasonably
of the law, however, may have been short sighted. In certain before delivery. If under the law screening is
April 2005, the US Department of Health and Human now required at any gestational age, professional
Services (DHHS) brought life to the BAIPA, procedure immediately after previable births may need
announcing: "As a matter of law and policy, [DHHS] modification. More worrisome, threatened aggressive
will investigate all circumstances where individuals investigations of alleged EMTALA violations at the
and entities are reported to be withholding medical care soft edges of viability, where futility remains a matter
from an infant born alive in potential violation of of debate, jeopardize the normative ethical practice of
federal statutes." The agency issued instructions to offering discretionary palliative care. The DHHS sent
state officials on how the definitional provision within its other instruction to state child protective services
the BAIPA interacts with the Emergency Medical agencies responsible for implementing CAPTA
Treatment and Labor Act (EMTALA) and the Child regulations; it reiterates the limited situations in which
Abuse Prevention and Treatment Act (CAPTA). These physicians may withhold medical treatment from
interagency memoranda potentially resurrect dormant infants and reemphasizes the local role of "individuals
governmental oversight of newborn-treatment within health care facilities" to notify authorities of
decisions and thus may have influence over normative suspected infractions. Its real import, however, is
neonatal practice. Under the BAIPA, the DHHS insistence on local execution of legal remedies to
interprets EMTALA to protect all "born-alive" infants; prevent nontreatment decisions deemed impermissible
hospitals and physicians violating regulatory by the 1984 Baby Doe rules. Because this new
requirements face agency-sanctioned monetary directive encourages governmental oversight of
penalties or a "private right of action by any individual treatment decisions involving imperiled newborns, a
harmed as a direct result." According to its period of benign regulatory neglect seems to be over.
memorandum, the DHHS will investigate allegations of The federal CAPTA rules arguably remove quality-of-
EMTALA violations whenever it finds evidence that a life considerations from the decision-making calculus
newborn was not provided with at least a medical and therefore may conflict with the best-interests
screening examination under circumstances in which a paradigm advocated by the American Academy of
"prudent layperson observer" could conclude from the Pediatrics and NRP. How courts will respond to the
infant's "appearance or behavior" that it was "suffering DHHS interpretation of EMTALA and CAPTA under
from an emergency medical condition." The the BAIPA remains unclear. Federal courts have yet to
memorandum fails to clarify which observers qualify authoritatively examine alleged EMTALA violations
as prudent, what infant appearance or behavior is involving newborn treatment decisions at the limits of
relevant, or what defines an emergency medical viability. The Wisconsin Supreme Court has permitted
condition. Because these evaluative criteria are not an EMTALA claim to go to trial where physicians
constrained by reference to relevant standards of allegedly did not screen or resuscitate a 22-week
medical care, the agency arguably substitutes a newborn delivered in an emergency department, and a
nonprofessional's presumed sagacious assessment of lower appellate court has relied on CAPTA to hold that
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![2003; 28(6):362-70. Measures of symptomatology indicated that children
Abstract: PURPOSE: To describe mothers' perceptions reported low levels of depressive symptoms, whereas
of the diabetes-related self-care abilities and practices caregivers reported the children were experiencing
of their school-age children with Type 1 diabetes. significant psychological problems. Children used
STUDY DESIGN AND METHOD: Qualitative study avoidant coping strategies more often than emotion-
using the naturalistic inquiry method. Mothers of focused coping strategies, which, in turn, were used
school-age children with diabetes were interviewed by more than problem-focused coping strategies. Results
means of a semi-structured interview guide. The are discussed in terms of helping children cope with
children were between the ages of 11 and 12 and had parental loss.
been diagnosed with diabetes for a minimum of 2
years. Twelve mothers were interviewed, generating 20 Schnitzer PG, Ewigman BG. Child injury deaths: comparing
hours of qualitative data. RESULTS: Mothers reported prevention information from two coding systems. J
that their children with diabetes had learned skills in a Pediatr Psychol 2005; 30(5):413-23.
predictable sequence, were usually motivated by events Abstract: OBJECTIVES: The International
in the here and now, and did not consistently perform Classification of Disease (ICD) external cause of injury
all diabetes-related skills of which they were capable. E-codes do not sufficiently identify injury
Most of the children were becoming embarrassed about circumstances amenable to prevention. The researchers
having diabetes. There were considerable gender developed an alternative classification system (B-
differences in the children's self-care codes) that incorporates behavioral and environmental
development.CLINICAL IMPLICATIONS: Nurses factors, for use in childhood injury research, and
can use this study to help with anticipatory guidance compare the two coding systems in this paper.
for parents. It may be helpful for parents to know the METHODS: All fatal injuries among children less than
sequence in which many children learn diabetes-related age five that occurred between January 1, 1992, and
skills, and to learn that even though a child is capable December 31, 1994, were classified using both B-codes
of task performance, he or she may not necessarily be and E-codes. RESULTS: E-codes identified the most
ready for the independent practice or daily execution of common causes of injury death: homicide (24%), fires
the skill. Encouraging parents to stay involved with (21%), motor vehicle incidents (21%), drowning
their children's self-care practices past the early (10%), and suffocation (9%). The B-codes further
adolescent years may be effective in improving self- revealed that homicides (51%) resulted from the child
care practices, and helping children to identify reasons being shaken or struck by another person; many fires
to meet the self-care demands associated with diabetes deaths (42%) resulted from children playing with
can be beneficial. matches or lighters; drownings (46%) usually occurred
in natural bodies of water; and most suffocation deaths
Schmidt LS, Nielsen JE, Blichfeldt SS, Lund AM. (68%) occurred in unsafe sleeping arrangements.
[Metabolic disease or shaken baby syndrome?]. Ugeskr CONCLUSIONS: B-codes identify additional
Laeger 2003; 165(35):3323-4. information with specific relevance for prevention of
Abstract: We describe two children with subdural childhood injuries.
haematoma and glutaricacidaemia type 1, who were
diagnosed late because of initial suspicion of shaken Schoenhofer SO. Choosing personhood: intentionality and
baby syndrome. the theory of nursing as caring. Holist Nurs Pract 2002;
16(4):36-40.
Schneider BA. Child welfare: court may determine whether Abstract: Drawing on a story of a nursing situation for
life-sustaining treatment should be withdrawn. J Law practical context, this article explores the meaning of
Med Ethics 2003; 31(2):316-7. intentionality within the theoretical context of Nursing
as Caring. May's definition of intentionality as the
Schneider JA. Janus-faced resilience in the analysis of a structure that gives meaning to experience is
severely traumatized patient. Psychoanal Rev 2003; interwoven with the concepts of the theory of Nursing
90(6):869-87. as Caring to explore the topic. Mayeroff's concepts of
hope and commitment contribute to an understanding
Schneider KM, Phares V. Coping with parental loss because of intentionality in relation to Nursing as Caring. The
of termination of parental rights. Child Welfare 2005; major thesis of this article, that intentionality is
84(6):819-42. consistently choosing personhood as a way of life and
Abstract: This article addresses the process by which the aim of nursing, is demonstrated in the practice
children and adolescents cope with severe acute stress situation.
of parental loss from causes other than divorce or
death. Participants were 60 children and adolescents Schoening AM, Greenwood JL, McNichols JA, Heermann
from a residential treatment facility. Most had JA, Agrawal S. Effect of an intimate partner violence
experienced neglect, physical abuse, and sexual abuse, educational program on the attitudes of nurses. J Obstet
and their parents had their parential rights terminated. Gynecol Neonatal Nurs 2004; 33(5):572-9.
833](https://image.slidesharecdn.com/bibliografiasobreabusoinfantil-100828161737-phpapp01/85/Bibliografia-sobre-abuso-infantil-841-320.jpg)
![and German-speaking children and adults assigned ANN and 87 to validate it. We calculated the
male and female voices to inanimate objects. Results sensitivity, specificity, positive (PPV) and negative
from Spanish and French speakers indicated effects of predictive values (NPV), and the success rate (%) of
grammatical gender on classification; results from the system. RESULTS: In the training group the ANN
German speakers did not. A connectionist model gave a sensitivity of 86.4%, a specificity of 89.5%, a
simulated the contradicting findings. The connectionist PPV of 76% and NPV of 94%, with a success rate of
networks were also used to investigate which aspect of 88.6%. In the same training group logistic regression
grammatical gender was responsible for the different (LR) gave respective values of 68.2%, 58.8%, 39%,
pattern of findings. The predictions from the 82.7% and 61.4%. In the validation group the
connectionist simulations were supported by the results respective values for the ANN were 71.4%, 81.6%,
from an artificial language-learning task. The results 58.8%, 88.6% and 78.9%, and in the same validation
from this work demonstrate how connectionist group the LR gave 64.4%, 50%, 32.1%, 79.2% and
networks can be used to identify the differences 53.9%. The Wilcoxon test confirmed the independence
between languages that affect categorization. of both methods (P < 0.001). CONCLUSION: The
ANN is an effective tool for assisting the urologist in
Sergi C, Linderkamp O. Pathological case of the month: indicating and applying endoscopic treatments for
classic rickets in a setting of significant psychosocial VUR.
deprivation. Arch Pediatr Adolesc Med 2001;
155(8):967-8. Sevecke K, Krischer MK, Schonberg T, Lehmkuhl G. [The
psychopathy-concept and its psychometric evaluation
Serhatlioglu S, Hardalac F, Guler I. Classification of in childhood and adolescence]. Prax Kinderpsychol
transcranial Doppler signals using artificial neural Kinderpsychiatr 2005; 54(3):173-90.
network. J Med Syst 2003; 27(2):205-14. Abstract: In accordance with Robert Hare's concept,
Abstract: Transcranial Doppler signals, recorded from over twenty years the word psychopathy is used to
the temporal region of brain on 110 patients were describe a specific combination of affective and
transferred to a personal computer by using a 16-bit interpersonal traits in adults as subtype of antisocial
sound card. The fast Fourier transform (FFT) method personality disorder. Recently in North America
was applied to the recorded signal from each patient. personality traits of psychopathy have also been
Since FFT method inherently can not offer a good studied in juveniles (and children). The Psychopathy
spectral resolution at jet blood flows, it sometimes Checklist: Youth Version (PCL-YV) was developed to
causes wrong interpretation of transcranial Doppler take the special conditions of adolescents into account
signals. To do a correct and rapid diagnosis, and focuses on assessing personality dimensions from
transcranial Doppler blood flow signals were age 12 upwards. In juveniles with a high score,
statistically arranged so that they were classified in research with the PCL-YV demonstrated for example a
artificial neural network. Back propagation neural lack of empathy, impulsivity and social adjustment
network and self-organization map algorithms of disorder. Furthermore, researchers found associations
artificial neural network were used for training, between the number and severity of violent offences,
whereas momentum and delta-bar-delta algorithms early drug abuse and heightened recidivism. This paper
were used for learning. The results of these algorithms discusses the concept of psychopathy for adolescents
were compared in the case of classification and on the basis of 3 case reports. Biological determinants,
learning. experimental results and diagnostic aspects are
described.
Serrano-Durba A, Serrano AJ, Magdalena JR et al. The use
of neural networks for predicting the result of Sewell AC, Gebhardt B, Herwig J, Rauterberg EW.
endoscopic treatment for vesico-ureteric reflux. BJU Acceptance of extended newborn screening: the
Int 2004; 94(1):120-2. problem of parental non-compliance. Eur J Pediatr
Abstract: OBJECTIVE: To create an artificial neural 2004; 163(12):755-6.
network (ANN) to aid in predicting the results of Notes: GENERAL NOTE: KIE: 7 refs.
endoscopic treatment for vesico-ureteric reflux (VUR). GENERAL NOTE: KIE: KIE Bib: genetic screening;
MATERIALS AND METHODS: During 1999-2001 mass screening; treatment refusal/minors
we used endoscopic treatment in 261 ureteric units
with VUR of all grades and causes. An ANN based on Shaham R. Revealing the secrets of the body: medical tests
multilayer perceptron architecture was created using an as legal evidence in personal status disputes in modern
11 x 6 x 1 structure, taking the following as variables: Egypt. Med Law 2003; 22(1):131-54.
the cause and grade of VUR, the patient's age and sex, Abstract: The study seeks to answer the following
the type of implanted substance and its volume, the question: In the field of personal status, what kinds of
number of treatments, the affected ureter, the medical tests have been considered reliable and
endoscopic findings, and the type of cystography used. acceptable by Egyptian courts of law, what kinds have
In all, 174 cases were used as training samples for the been less accepted, and why? The main finding is that,
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![for learning phenomena such as habituation is CONCLUSION: The findings highlight the importance
reviewed. The contribution of these networks to of social factors in children's disclosure of sexual
discussions about infant cognition is highlighted. A abuse.
new, modular approach is presented in a third section.
In the discussion, a role for these learning models in a Skene L. Ownership of human tissue and the law. Nat Rev
broader developmental framework is proposed. Genet 2002; 3(2):145-8.
Notes: GENERAL NOTE: KIE: 23 refs.
Sirois S, Mareschal D. An interacting systems model of GENERAL NOTE: KIE: KIE Bib: biomedical
infant habituation. J Cogn Neurosci 2004; 16(8):1352- research; informed consent; organ and tissue donation
62. Abstract: Genetic researchers and medical practitioners
Abstract: Habituation and related procedures are the often need to obtain access to stored human tissue
primary behavioral tools used to assess perceptual and without consent from the people concerned. But the
cognitive competence in early infancy. This article laws that relate to the ownership of, and control over,
introduces a neurally constrained computational model stored human tissue are at present unclear, especially in
of infant habituation. The model combines the two the light of recent cases and inquiries. Here, I discuss
leading process theories of infant habituation into a how the law might be clarified, and argue that the law
single functional system that is grounded in functional should allow stored human tissue to be used without
brain circuitry. The HAB model (for Habituation, consent, providing that this occurs with ethical
Autoassociation, and Brain) proposes that habituation approval and that the confidentiality of the donor is
behaviors emerge from the opponent, complementary protected.
processes of hippocampal selective inhibition and
cortical long-term potentiation. Simulations of a Skinner H, Biscope S, Poland B. Quality of internet access:
seminal experiment by Fantz [Visual experience in barrier behind internet use statistics. Soc Sci Med
infants: Decreased attention familiar patterns relative to 2003; 57(5):875-80.
novel ones. Science, 146, 668-670, 1964] are reported. Abstract: The rapid growth of the Internet is
The ability of the model to capture the fine detail of increasingly international with young people being the
infant data (especially age-related changes in early adopters in most countries. However, the quality
performance) underlines the useful contribution of of Internet access looms as a major barrier hidden
neurocomputational models to our understanding of behind Internet use statistics. The goal of this study
behavior in general, and of early cognition in was to provide an in-depth evaluation of young
particular. people's perspectives on using the Internet to obtain
health information and resources (e-health). Using an
Sjoberg RL. [The Cleveland case as a lesson. Single cases inductive qualitative research design, 27 focus groups
and case series can be simple to take in but they are not were conducted in Ontario, Canada. The 210 young
suitable to secure the cause-effect relationship]. participants were selected to reflect diversity in age,
Lakartidningen 2004; 101(41):3166-7. sex, geographic location, cultural identity and risk. A
major finding was how the quality of Internet access
Sjoberg RL. [Satanic ritualistic murders and child abuse-- influenced young people's ability to obtain health
evidence-basing versus ideology]. Lakartidningen information and resources. Quality of Internet access
2005; 102(40):2824-5. was affected by four key factors: 1. Privacy, 2. Gate-
keeping, 3. Timeliness and 4. Functionality. Privacy
Sjoberg RL. [Sexual experiences in connection with sexual was particularly relevant to these young people in
abuse can delay the disclosure]. Lakartidningen 2003; getting access to sensitive health information (e.g.
100(17):1549. sexual activities). Variations in access quality also
impacted participation in mutual support, fostering
Sjoberg RL, Lindblad F. Delayed disclosure and disrupted social networks and getting specific health questions
communication during forensic investigation of child answered. These results serve as a warning about using
sexual abuse: a study of 47 corroborated cases. Acta Internet penetration statistics alone as a measure of
Paediatr 2002; 91(12):1391-6. access. Concerted attention is needed on improving the
Abstract: AIM: To study factors of relevance for the quality of Internet access for achieving the potential of
understanding of disclosure of child sexual abuse. e-health. This is imperative for addressing the digital
METHODS: Cases from a Swedish district court divide affecting populations both within countries and
involving 47 children in which allegations of child globally between countries.
sexual abuse had been corroborated by a confession
from the defendant were studied. RESULTS: Delayed Skopp NA, McDonald R, Manke B, Jouriles EN. Siblings in
disclosure was related to a close relationship with the domestically violent families: experiences of
perpetrator and young age at the first experience of interparent conflict and adjustment problems. J Fam
abuse. Disrupted communication during the police Psychol 2005; 19(2):324-33.
interview was related to less violent abuse. Abstract: This research examines whether siblings in
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![Smetana JG, Daddis C. Domain-specific antecedents of (1microCi/well) incorporation after stimulation in
parental psychological control and monitoring: the role primary culture with phytohaemagglutinin (PHA) (1
of parenting beliefs and practices. Child Dev 2002; microg/mL), house dust mite [HDM] extract (30
73(2):563-80. microg/mL), immunopurified Der p 1 (30 microg/mL),
Abstract: This research examined the effects of Tetanus toxoid (TT) (aluma free, 30 Lf/mL) or vehicle.
domain-differentiated beliefs about legitimate parental Blood was collected from 144 infants at the age of 1
authority and ratings of restrictive parental control on years and stimulated proliferative responses were
adolescent- and mother-reported psychological and assessed using the same procedure. RESULTS: PHA-
behavioral control. The influence of parenting beliefs stimulated lymphoproliferative response was
and practices regarding socially regulated (moral and significantly lower in HR compared to LR neonates
conventional) and ambiguously personal (multifaceted (mean difference 38%, 95% CI 15%-54%; P = 0.003);
and personal) issues was examined in 93 middle-class significantly lower proportion of positive CBMC
African American early adolescents (M = 13.11 years, responses to HDM occurred in LR than in HR neonates
SD = 1.29) and their mothers, who were followed (30.4% vs. 46.6%; P = 0.034). There was no
longitudinally for 2 years. Domain-specific parenting relationship between Der p 1 levels in maternal bed and
beliefs and ratings predicted adolescent-reported CBMC immunoproliferative responses, despite the 21
maternal psychological control and parental 000-fold range of maternal Der p 1 exposure. No
monitoring, but the nature and direction of the relations significant differences in magnitude, or in proportion
differed. Adolescents who rated parents as more of positive responses to any stimulant were observed
restrictive in their control of personal issues and who between the neonates at low, medium or high tertile of
believed that parents should have less legitimate allergen exposure. Immunoproliferative responses at
authority over these issues rated their mothers as higher birth were not predictive of 1-year PBMC responses.
in psychological control. In contrast, more adolescent- There was no relationship between maternal allergen
reported parental monitoring was associated with exposure in pregnancy and 1-year PBMC proliferative
gender (being female) and adolescents' beliefs that responses. However, the proportion of positive
parents have more legitimate authority to regulate proliferative responses at 1 years significantly
personal issues. As expected, adolescent age and increased with increasing infant Der p 1 exposure at 1
gender influenced mother-reported monitoring and years. CONCLUSION: These results indicate that the
psychological control; in addition, the effects of magnitude of immunoproliferative responses are
mothers' ratings of restrictive control on both unrelated to maternal mite allergen exposure and
psychological control and monitoring were moderated cannot be used as evidence for in utero sensitization to
by gender. The results indicate that psychological inhalant allergens. The immunoproliferative responses
control and monitoring can be understood in terms of at 1 year seem to shift away from the genetically
the particular behaviors that are controlled, as well as influenced responses at birth towards responses to
the style in which control is exercised. specific stimulants which correlate with environmental
exposure to those specific stimulants. These data
Smillie FI, Elderfield AJ, Patel F et al. Lymphoproliferative support the concept of sensitization to inhalant
responses in cord blood and at one year: no evidence allergens occurring in early life, but not in utero.
for the effect of in utero exposure to dust mite
allergens. Clin Exp Allergy 2001; 31(8):1194-204. Smith A, Coveney J, Carter P, Jolley G, Laris P. The Eat
Abstract: BACKGROUND: Maternal allergen Well SA project: an evaluation-based case study in
exposure beyond the 22nd week of pregnancy may be building capacity for promoting healthy eating. Health
important in foetal T cell priming. Allergen-specific Promot Int 2004; 19(3):327-34.
cord blood mononuclear cell (CBMC) Abstract: The term 'capacity building' is used in the
immunoproliferative responses without corresponding health promotion literature to mean investing in
bacterial antigen responses (tetanus toxoid), have been communities, organizations and structures to enhance
suggested as evidence of in utero sensitization. access to knowledge, skills and resources needed to
OBJECTIVES: To investigate the relationship between conduct effective health programs. The Eat Well SA
lymphoproliferative responses at birth and at 1 year project aimed to increase consumption of healthy food
with maternal and 1-year infants house dust mite by children, young people and their families in South
allergen exposure. METHODS: Home visits and dust Australia. The project evaluation demonstrated that
sampling were performed by the 20th week of awareness about healthy eating among stakeholders
pregnancy, immediately after birth, and then at 1 years across a range of sectors, coalitions and partnerships to
of age. Der p 1 was assayed using a two-site promote healthy eating and sustainable programs had
immunometric ELISA. CBMC immunoproliferative been developed. The project achievements were
responses (AIM V serum-free medium; 1 x 105 analysed further using a capacity-building framework.
cells/well) were measured for 225 neonates (171 had a This analysis showed that partnership development was
high risk of atopy (HR)--both parents skin test positive; a key strategy for success, leading to increased
59 had a low risk of atopy (LR) - both parents skin test problem-solving capacity among key stakeholders and
negative, no history of atopy) by 3H-Thymidine workers from education, child care, health, transport
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![psychiatric clinic. A logistic regression analysis was to adulthood psychopathic traits and personality
used to assess the specific influence of the covariates disorders. Compr Psychiatry 2005; 46(2):111-6.
borderline personality disorder, gender and reported Abstract: Childhood conduct disorder (CD) and adult
childhood sexual abuse on the outcome variables. psychopathic traits according to the Psychopathy
RESULTS: Univariate regression analysis showed Checklist Revised (PCL-R) were the closest psychiatric
higher odds ratios for borderline personality disorder, covariates to repeated violent crimes and aggression
female gender and childhood sexual abuse regarding among offenders under forensic psychiatric
prolonged psychiatric contact and repeated investigation in Sweden. As psychopathy is not
parasuicides. A combined logistic regression model included in the present psychiatric diagnostic systems,
found significantly higher odds ratios only for we compared total and factor PCL-R scores to Axis I
childhood sexual abuse with regard to suicidal ideation, disorders, including childhood-onset neuropsychiatric
repeated parasuicidal acts and more extensive disorders, and to Axis II personality disorders, to
psychiatric support. CONCLUSION: The findings establish the convergence of psychopathic traits with
support the growing body of evidence linking the other psychiatric diagnoses, and to identify possible
characteristic symptoms of borderline personality unique features. Psychopathic traits were positively
disorder to childhood sexual abuse, and identify sexual correlated with bipolar mood disorder and negatively
abuse rather than a diagnosis of borderline personality with unipolar depression. The total PCL-R scores as
disorder as a predictor for poor outcome after a well as the Factor 2 (unemotionality) and Factor 3
parasuicide. The findings are relevant to our (behavioral dyscontrol) scores were significantly
understanding and treatment of parasuicide patients, correlated with attention-deficit/hyperactivity disorder,
especially those who fulfil the present criteria for Asperger's syndrome/high-functioning autistic traits,
borderline personality disorder. CD, substance abuse, and the Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition Cluster B
Soderstrom H, Blennow K, Sjodin AK, Forsman A. New personality disorders. The interpersonal Factor 1
evidence for an association between the CSF HVA:5- showed none of these correlations and may capture
HIAA ratio and psychopathic traits. J Neurol features that are specific to psychopathy, distinguishing
Neurosurg Psychiatry 2003; 74(7):918-21. core psychopathy from other diagnostic definitions.
Abstract: OBJECTIVES: To replicate the relation
between the CSF HVA:5-HIAA ratio and psychopathic Soderstrom H, Sjodin AK, Carlstedt A, Forsman A. Adult
traits previously reported in a pilot group of 22 psychopathic personality with childhood-onset
perpetrators of violent crimes. METHODS: CSF hyperactivity and conduct disorder: a central problem
monoamine metabolite concentrations in another 28 constellation in forensic psychiatry. Psychiatry Res
violent and sexual offenders, aged 45 or below, 2004; 121(3):271-80.
referred to pretrial forensic psychiatric investigation, Abstract: To describe lifetime mental disorders among
were compared to features of psychopathy according to perpetrators of severe inter-personal crimes and to
the Psychopathy Checklist-Revised (PCL-R). identify the problem domains most closely associated
RESULTS: Our previous finding was repeated in the with aggression and a history of repeated violent
new study group, where the HVA:5-HIAA ratio was criminality, we used structured interviews, clinical
strongly associated with psychopathic traits (r = 0.50, p assessments, analyses of intellectual functioning,
= 0.010), particularly its behavioural aspects (r = 0.523, medical and social files, and collateral interviews in
p = 0.004). In subsamples of individuals from both 100 consecutive subjects of pretrial forensic psychiatric
study groups who had no medication (n = 25) or no investigations. Childhood-onset neuropsychiatric
current axis I disorder, including a history of mood disorders [attention-deficit/hyperactivity disorder
disorder or substance dependence (n = 21), the HVA:5- (AD/HD), learning disability, tics and autism spectrum
HIAA ratio remained strongly associated with all disorders] affected 55% of the subjects and formed
psychopathy factors but most closely with the complex comorbidity patterns with adult personality
behavioural features. Retrospective assessments of disorders [including psychopathic traits according to
childhood disruptive symptomatology, such as the Psychopathy Checklist (PCL-R)], mood disorders
attention deficit hyperactivity disorder or conduct and substance abuse. The closest psychiatric covariates
disorder, analysed in relation to the monoamine to high Lifetime History of Aggression (LHA) scores
metabolites, showed the same association with the and violent recidivism were the PCL-R scores and
HVA:5-HIAA ratio. CONCLUSIONS: Violent and childhood conduct disorder (CD). Behavioral and
aggressive behavioural traits with childhood onset and affective PCL-R factors were closely associated with
adult expression as psychopathic features are childhood AD/HD, CD, and autistic traits. The results
associated with changed activity in the brain support the notion that childhood-onset social and
dopaminergic system, possibly as a result of behavioral problems form the most relevant psychiatric
serotonergic dysregulation. symptom cluster in relation to pervasive adult violent
behavior, while late-onset mental disorders are more
Soderstrom H, Nilsson T, Sjodin AK, Carlstedt A, Forsman often associated with single acts of violent or sexual
A. The childhood-onset neuropsychiatric background aggression.
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![Solagberu BA, Ayorinde RO. Tuberculosis of the spine in [Use of psychotropics drugs among students:
Ilorin, Nigeria. East Afr Med J 2001; 78(4):197-9. prevalence and associated social factors]. Rev Saude
Abstract: BACKGROUND: Data on tuberculosis (TB) Publica 2004; 38(2):277-83.
of the spine from Nigeria is scanty despite the Abstract: OBJECTIVE: To determine the prevalence of
endemicity of the disease. OBJECTIVE: To highlight the heavy use of drugs among elementary and high
hospital data on spinal tuberculosis. DESIGN: A ten- school students in a sample of public and private
year retrospective study of records on spinal TB from schools, and to identify associated demographic,
the medical records, orthopaedic and medical wards psychological, cultural and social factors. METHODS:
was done. The clinical notes, radiographs and This report describes a cross-sectional study using an
haematology results of the patients were analysed. intention-type sampling technique that compared
SETTING: University of Ilorin Teaching Hospital, public schools in central and peripheral areas and
Ilorin, Nigeria. SUBJECTS: All patients treated for private schools. An anonymous self-administered
spinal TB in the hospital from January 1990 to questionnaire was applied. The sample consisted of
December 1999 were studied. RESULTS: Fifty 2,287 elementary and high school students in the city
patients were seen, 24 males and 26 females, age range of Campinas in 1998. Heavy use of drugs was defined
1.5-70 years (mean 27.1 +/- 22.8 years). Peak as the use of drugs on 20 or more days during the 30
prevalence (30%) was in the first decade. Twenty days preceding the survey (WHO, 1981). For the
seven patients had complete clinical data in their case statistical analysis, polytomic logistic regression
notes. Twelve patients had paraplegia and three had analysis (logit model) was utilized to identify factors
concomitant pulmonary TB. The lumbar spine was the that influenced this manner of using drugs. RESULTS:
commonest site of involvement. Two thirds (18 Heavy use of legal and illegal drugs was found as
patients) had positive mantoux test. Twenty three follows: alcohol (11.9%), tobacco (11.7%), marijuana
patients had chemotherapy but a third was lost to (4.4%), solvents (1.8%), cocaine (1.4%), medications
follow up within two months. Twenty one patients (1.1%) and ecstasy (0.7%). The heavy use of drugs was
(77.8%) had difficulty obtaining the prescribed drugs greatest among students at the city-center public school
due to financial difficulties. No patient had surgical who had daytime jobs and studied in the evenings.
intervention. CONCLUSION: Spinal TB is still a These students were in the A and B socioeconomic
common disease in Nigeria with unacceptable laxity in classes and had had little religious education during
control measures. There is need for patient health childhood. CONCLUSIONS: Greater availability of
education, contact tracing, provision of free anti-TB cash and specific socialization patterns were identified
drugs and a general improvement in the economy to as factors associated with the heavy use of drugs
reduce the prevalence of spinal TB in the country. among students.
Solbakk JH. Use and abuse of empirical knowledge in Solodiuk J, Curley MA. Pain assessment in nonverbal
contemporary bioethics. Med Health Care Philos 2004; children with severe cognitive impairments: the
7(1):5-16. Individualized Numeric Rating Scale (INRS). J Pediatr
Notes: GENERAL NOTE: KIE: KIE Bib: Nurs 2003; 18(4):295-9.
AIDS/human experimentation; human Abstract: Children's Hospital Boston began a major
experimentation/foreign countries; human pain assessment and management initiative 3 years
experimentation/research design ago: Pain assessment and management are considered
Abstract: In 1997 a debate broke out about the ethical one of the institution's primary standards of care. The
acceptability of using placebo as a comparative initiative included State of the Science meetings with
alternative to establish effective treatment in trials internationally renowned nursing pain researchers and
conducted in developing countries for the purpose of clinicians. These meetings generated nursing staff
preventing perinatal HIV-transmission. The debate has interest in specific applications of what is known about
now been going on for more than five years. In spite of pain; how evidence-based knowledge can be used to
extensive and numerous attempts at resolving the ask population-specific clinical questions; and how an
controversy, the case seems far from being settled. The evidence-based approach can be applied to
aim of this paper is to provide an updated account of systematically develop, implement, and assess
the debate, by identifying empirical arguments interventions that suit a population's clinical needs.
employed in the controversy and by critically assessing This article is an example of an evidence-based pain
their use in the debate. A notion of resolution of moral assessment project at Children's Hospital Boston that
conflicts will be introduced that makes it possible to focused on nonverbal children with cognitive
give a more positive verdict on the moral results of this impairments. After developing a clinical question, the
controversy. Finally, the procedural problem of authors did a literature review and a benchmarking
safeguarding the selection of empirical arguments analysis of best practice. The pilot of an adapted,
against undue forms of normative bias will be existing pain assessment tool is described in this
addressed. article.
Soldera M, Dalgalarrondo P, Correa Filho HR, Silva CA. Solum LL, Schaffer MA. Ethical problems experienced by
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![interviewed the child and caretaker. Data were is the presentation of an overview regarding the
collected on a broad range of control variables known radiology of the battered child. Typical examples will
to influence childhood behavior and/or to be associated be shown.
with prenatal alcohol exposure. These included
perinatal factors of maternal age, education, cigarette, Sorensen J, Abbott E. The maternity and infancy revolution.
cocaine, and other substances of abuse and the Matern Child Health J 2004; 8(3):107-10.
gestational age of the baby. Postnatal factors studied
included maternal psychopathology, continuing alcohol Soto Mas F, Villalbi JR, Balcazar H, Valderrama Alberola J.
and drug use, family structure, socioeconomic status, [Smoking initiation: epidemiology, research, and
children's whole blood lead level, and exposure to behavioral sciences]. An Esp Pediatr 2002; 57(4):327-
violence. Data were collected only from black women 33.
as there was inadequate representation of other racial Abstract: Becoming a regular smoker is a process that
groups. STATISTICAL ANALYSES: Statistical begins even before the first cigarette, and ends in
analyses were performed using the SPSS statistical lifelong physical and psychological dependence.
package. Frequency distribution, cross-tabulation, odds Various psychological and behavioral factors
ratio, and chi(2) tests were used for analyzing contribute to this process. This article discusses
categorical data. Continuous data were analyzed using t smoking initiation from a comprehensive perspective,
tests, analyses of variance (ANOVAs) with posthoc including the physiological and addictive effects of
tests, and regression analysis. RESULTS: Testing was nicotine, and the personal and environmental factors
available for 501 parent-children dyads. Almost one that lead to smoking. Because smoking usually begins
fourth of the women denied alcohol use during in adolescence, special emphasis is placed on this
pregnancy. Low levels of alcohol use were reported in developmental stage and on the situations that
63.8% and moderate/heavy use in 13% of pregnancies. encourage teenagers to smoke the first cigarette.
Increasing prenatal alcohol exposure was associated Finally, this article analyzes the importance of the
with lower birth weight and gestational age, higher lead initiation process in the epidemiology and prevention
levels, higher maternal age, and lower education level, of smoking. This approach may prove to be particularly
prenatal exposure to cocaine and smoking, custody useful to clinicians interested in interventions aimed to
changes, lower socioeconomic status, and paternal curb smoking.
drinking and drug use at the time of pregnancy.
Children with any prenatal alcohol exposure were more Soulier J, Clappier E, Cayuela JM et al. HOXA genes are
likely to have higher CBCL scores on Externalizing included in genetic and biologic networks defining
(Aggressive and Delinquent) and Internalizing human acute T-cell leukemia (T-ALL). Blood 2005;
(Anxious/Depressed and Withdrawn) syndrome scales 106(1):274-86.
and the Total Problem Score. The odds ratio of scoring Abstract: Using a combination of molecular
in the clinical range for Delinquent behavior was 3.2 cytogenetic and large-scale expression analysis in
(1.3-7.6) in children with any prenatal exposure to human T-cell acute lymphoblastic leukemias (T-
alcohol compared with nonexposed controls. The ALLs), we identified and characterized a new recurrent
threshold dose was evaluated with the 3 prenatal chromosomal translocation, targeting the major
alcohol exposure groups. One-way ANOVA revealed a homeobox gene cluster HOXA and the TCRB locus.
significant between group difference for Externalizing Real-time quantitative polymerase chain reaction (RQ-
(Aggressive and Delinquent) and the Total Problem PCR) analysis showed that the expression of the whole
Score. (ABSTRACT TRUNCATED) HOXA gene cluster was dramatically dysregulated in
the HOXA-rearranged cases, and also in MLL and
Sorantin E, Lindbichler F. [Nontraumatic injury (battered CALM-AF10-related T-ALL cases, strongly
child)]. Radiologe 2002; 42(3):210-6. suggesting that HOXA genes are oncogenic in these
Abstract: The recognition of a battered child represents leukemias. Inclusion of HOXA-translocated cases in a
a challenge for all groups of adults dealing with general molecular portrait of 92 T-ALLs based on
children. Radiology plays a special role in this setting. large-scale expression analysis shows that this
By detection typical injuries, imaging is able to rearrangement defines a new homogeneous subgroup,
confirm the suspicion of a battered child. Recognition which shares common biologic networks with the
of those injuries on films, taken for other reasons, gives TLX1- and TLX3-related cases. Because T-ALLs
the caretaker an important hint, thus maybe preventing derive from T-cell progenitors, expression profiles of
a fatal outcome for the child. One of the most the distinct T-ALL subgroups were analyzed with
important injury types is represented by the so called respect to those of normal human thymic
"shaken baby syndrome". The infant is held by the subpopulations. Inappropriate use or perturbation of
thorax and shaken. Thus causing a repetitive specific molecular networks involved in thymic
acceleration-deceleration trauma, which leads to the differentiation was detected. Moreover, we found a
typical paravertebral rib fractures, intracranial bleeding significant association between T-ALL oncogenic
and eye injuries. After shaking the child is thrown subgroups and ectopic expression of a limited set of
away, with subsequent injuries. The aim of this article
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![genes, including several developmental genes, namely where the 2nd-order statistical information on the
HOXA, TLX1, TLX3, NKX3-1, SIX6, and TFAP2C. background EEG and on the unknown EP, necessary
These data strongly support the view that the abnormal for the optimal filtering of each sweep in a Bayesian
expression of developmental genes, including the estimation framework, is, respectively, estimated from
prototypical homeobox genes HOXA, is critical in T- pre-stimulus data and obtained through a multiple
ALL oncogenesis. integration of a white noise process model. The latter
model is flexible (i.e. it can be employed for a large
Southam-Gerow MA, Weisz JR, Kendall PC. Youth with class of EP) and simple enough to be easily identifiable
anxiety disorders in research and service clinics: from the post-stimulus data thanks to a smoothing
examining client differences and similarities. J Clin criterion. The mean EP is determined as the weighted
Child Adolesc Psychol 2003; 32(3):375-85. average of the filtered sweeps, where each weight is
Abstract: Compared 2 groups of children with anxiety inversely proportional to the expected value of the
disorders: those treated in a university-based research norm of the correspondent filter error, a quantity
clinic (RC) and those treated in community-based determinable thanks to the employment of the Bayesian
service clinics (SCs). A widely endorsed goal in approach. The performance of the new approach is
intervention research is to disseminate evidence-based shown on both simulated and real auditory EP. A
treatments from RCs to SCs. Attaining this goal signal-to-noise ratio enhancement is obtained that can
requires an understanding of the similarities and allow the (possibly automatic) identification of peak
differences between clients in these 2 settings. Youth latencies and amplitudes with less sweeps than those
from SCs showed more comorbid externalizing required by CA. For cochlear EP, the method also
diagnoses and externalizing problems and were more allows the audiology investigator to gather new and
likely to come from low-income and single-parent clinically important information. The possibility of
families. On measures of internalizing symptomatology handling single-sweep analysis with further
and diagnoses, youth from RCs were very similar to development of the method is also addressed.
SC youth. To facilitate development of treatments with
real-world applicability, we describe a model involving Spencer TJ, Biederman J, Wozniak J, Faraone SV, Wilens
the testing of treatments in real-world settings. We also TE, Mick E. Parsing pediatric bipolar disorder from its
discuss limitations to this project. associated comorbidity with the disruptive behavior
disorders. Biol Psychiatry 2001; 49(12):1062-70.
Spak F, Allebeck P, Spak L, Thundal KL. [The Gothenburg Abstract: The unique pattern of comorbidity found in
study of women and alcohol: problems during pediatric mania greatly complicates accurate diagnosis,
childhood and adolescence important risk factors]. the course of the disorder, and its treatment. The
Lakartidningen 2001; 98(10):1109-14. pattern of comorbidity is unique by adult standards,
Abstract: This is a part of longitudinal study especially its overlap with attention-
concerning women and alcohol in Gothenburg. The deficit/hyperactivity disorder (ADHD), aggression, and
aim was to find out more about risk factors for alcohol conduct disorder. Clinically, symptoms of mania have
dependence and abuse (ADA) among women in the been discounted as severe ADHD or ignored in the
general population, as well as social conditions and life context of aggressive conduct disorder. This atypicality
style among these women. Several indicators of may lead to neglect of the mood component. The
dissatisfactory childhood conditions, and particularly addition of high rates of additional disorders
sexual abuse before age 13, were related to ADA in contributes to the severe morbidity, dysfunction, and
adulthood. Early substance abuse, such as having been incapacitation frequently observed in these children. A
intoxicated before age 15 and having used narcotics comprehensive approach to diagnostic evaluation is the
before 18, was strongly related to future ADA. Our keystone to establishing an effective treatment program
findings point to the need of paying attention to mental because response to treatment differs with individual
health problems in childhood and youth, and to prevent disorders. Recognition of the multiplicity of disorders
early use of alcohol and drugs. guides therapeutic options in these often refractory
conditions. What was previously considered refractory
Sparacino G, Milani S, Arslan E, Cobelli C. A Bayesian ADHD, oppositionality, aggression, and conduct
approach to estimate evoked potentials. Comput disorder may respond after mood stabilization. We
Methods Programs Biomed 2002; 68(3):233-48. review these issues in this article.
Abstract: Several approaches, based on different
assumptions and with various degree of theoretical Spike J. The sound of chains: a tragedy. J Clin Ethics 2005;
sophistication and implementation complexity, have 16(3):212-7.
been developed for improving the measurement of Notes: GENERAL NOTE: KIE: 4 fn.
evoked potentials (EP) performed by conventional GENERAL NOTE: KIE: KIE Bib: allowing to
averaging (CA). In many of these methods, one of the die/infants; ethicists and ethics committees
major challenges is the exploitation of a priori
knowledge. In this paper, we present a new method Spittal PM, Schechter MT. Injection drug use and despair
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![Abstract: BACKGROUND: The effects of violence been framed within the discourse of juvenile
upon young people are relatively poorly understood. In delinquency rather than family violence. Thus, unlike
2001 the London Borough of Ealing conducted a large- other forms of family violence, it has escaped close
scale survey of primary school pupils, which included examination by health and welfare workers. A
questions on levels of violence at home. The aim of literature review was conducted to examine current
this study was to measure the association of violence at knowledge of child-to-mother violence. Study of the
home with measures of health, health care use and literature reveals only partial understandings of this
health-related behaviours in primary school pupils aged neglected aspect of family pathology. Directions for
9 and 11 in West London. METHODS: A total of 3007 research to address these gaps in knowledge are drawn
pupils from 28 primary schools were given a self- from the findings of this literature review.
complete health questionnaire; 2083 completed a
question on violence at home. RESULTS: Pupils Stith R. Location and life: how Stenberg v. Carhart undercut
reporting violence were more likely to have needed Roe v. Wade. William Mary J Women Law 2003;
medical attention in the last year. Violence was also 9(2):255-78.
associated with greater need of dental care, drinking Notes: GENERAL NOTE: KIE: 89 fn.
and spending money on alcohol, spending money on GENERAL NOTE: KIE: KIE Bib: abortion/legal
cigarettes, not eating or drinking before school, less aspects
willingness to speak to parents and siblings about
drugs, and less communication with teachers about Stoddard FJ, Saxe G. Ten-year research review of physical
puberty and growing up. Violence was positively injuries. J Am Acad Child Adolesc Psychiatry 2001;
associated with increased communication with relatives 40(10):1128-45.
about puberty. CONCLUSION: Pupils who report Abstract: OBJECTIVE: To review the past 10 years of
violence at home are more likely to have more injuries, research relevant to psychiatry on injuries in children
riskier health behaviours and less social support than and adolescents. METHOD: A literature search of
those reporting no violence at home. databases for "wounds and injuries, excluding head
injuries," was done with Medline and PsycINFO,
Stewart JL, Pyke-Grimm KA, Kelly KP. Parental treatment yielding 589 and 299 citations, respectively. Further
decision making in pediatric oncology. Semin Oncol searching identified additional studies. RESULTS:
Nurs 2005; 21(2):89-97; discussion 98-106. Progress is occurring in prevention, pain management,
Abstract: OBJECTIVE: To review progress and future acute care, psychiatric treatment, and outcomes. The
plans for a research program about parents' making emotional and behavioral effects of injuries contribute
treatment decisions for their children with cancer. to morbidity and mortality. Psychiatric assessment,
DATA SOURCES: Theoretical papers, review articles, crisis intervention, psychotherapy,
and research reports. CONCLUSION: Three important psychopharmacological treatment, and interventions
questions need to be addressed to achieve the goal of for families are now priorities. Research offers new
supporting parents in treatment decision making: 1) interventions for pain, delirium, posttraumatic stress
Whatfactors predict a parent's preferred role iln disorder, depression, prior maltreatment, substance
decision making? 2) What are the critical outcomes abuse, disruptive behavior, and end-of-life care. High-
from parental decision making that nurses could help to risk subgroups are infants, adolescents, maltreated
improve? 3) Is it role choice, actual role assumed, or children, suicide attempters, and substance abusers.
congruence between preferred and actual role in Staff training improves quality of care and reduces
decision making that predicts decision outcomes for the staff stress. CONCLUSIONS: Despite the high priority
parents? IMPLICATIONS FOR NURSING that injuries receive in pediatric research and treatment,
PRACTICE: Research-based responses to the psychiatric aspects are neglected. There is a need for
remaining questions about parent treatment decision assessment and for planning of psychotherapeutic,
making will help nurses develop and test interventions psychopharmacological, and multimodal treatments,
designed to support parents in their decision making based on severity of injury, comorbid
experiences. psychopathology, bodily location(s), and prognosis.
Psychiatric collaboration with emergency, trauma, and
Stewart M, Jackson D, Mannix J, Wilkes L, Lines K. rehabilitation teams enhances medical care. Research
Current state of knowledge on child-to-mother should focus on alleviating pain, early psychiatric case
violence: a literature review. Contemp Nurse 2004- identification, and treatment of children, adolescents,
2005; 18(1-2):199-210. and their families, to prevent further injuries and
Abstract: Child-to-mother violence is a common aspect reduce disability.
of family violence, and presents nurses and health
workers with continuing challenges. Though noted in Stoffels H, Ernst C. [Recall and pseudo-memory. On the
the literature as early as the 1950's, this phenomenon yearning to be a trauma victim]. Nervenarzt 2002;
remains poorly understood. A number of reasons for 73(5):445-51.
the lack of research scrutiny are proposed, the most Abstract: Memories are not called up from "storage"
compelling being that child-to-mother violence has
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![(3.6) did not vary significantly with duration, but other sensitive to individual variation in DSM-IV symptom
symptoms were more commonly reported in the longer counts, suggesting the physiological components were
episodes. However, when the data were analysed by not strongly related to the predominantly cognitive and
day of the episode, rather than the episode's overall behavioral components of the DSM-IV nicotine
duration, the reported frequency of fever and vomiting dependence syndrome. However, the mFTQ relative to
declined significantly with time. During the course of the DSM-IV consistently showed stronger relationships
an episode, rehydration, medication and care-seeking to the immediate consequences of nicotine deprivation
also showed a decline in frequency after the first or (urge, craving), supporting the conceptualization of the
second week. As episodes continue, less rehydration mFTQ as measuring nicotine exposure. These analyses
and medical care are provided by carers, whereas they provide us with some preliminary understanding of the
ought to be maintained because of the continued severity of particular symptoms and the order in which
purging and cumulative effect of the symptoms. Since symptoms are likely to be expressed across levels of
most cases of diarrhoea are managed at home, it is nicotine dependence.
important to understand how to encourage better
management of the longer episodes, which cause an Struffert T, Grunwald I, Reith W. [Craniocerebral trauma in
increasing proportion of mortality in some countries. childhood]. Radiologe 2003; 43(11):967-76.
Abstract: This article describes typical head injuries in
Stritzke WG, Dandy J, Durkin K, Houghton S. Use of infants and children. In comparison with adults there
interactive voice response (IVR) technology in health are distinct differences in the etiology of trauma and in
research with children. Behav Res Methods 2005; the kind of reaction of the skull and brain. In infants
37(1):119-26. and children there are three different types of trauma:
Abstract: This article reports on the feasibility of using birth trauma, accidental and non-accidental injury. The
interactive voice response (IVR) technology to obtain typical injuries in these three groups are described.
daily reports of attitudes toward alcohol and tobacco
use among children 9-13 years of age. Two studies Stuhlmiller DF, Cudnik MT, Sundheim SM, Threlkeld MS,
were conducted. The first was an investigation of the Collins TE Jr. Adequacy of online medical command
use of IVR technology to obtain daily data from a communication and emergency medical services
sample of primary school children over a period of 8 documentation of informed refusals. Acad Emerg Med
weeks. The second was an extension of the research to 2005; 12(10):970-7.
a large sample of primary and secondary school Abstract: BACKGROUND: In the out-of-hospital
children in urban and rural areas who provided daily setting, when emergency medical services (EMS)
data over a 4-week period. Retention and compliance providers respond to a 9-1-1 call and encounter a
rates comparable to those obtained with adults were patient who wishes to refuse medical treatment and/or
evident in both studies, supporting the feasibility of this transport to the hospital, the EMS providers must
technology with children. The results are discussed in ensure the patient possesses medical decision-making
relation to the benefits of this methodology for health capacity and obtain an informed refusal. In the city of
research, particularly for studies of sensitive topics Cleveland, Ohio, Cleveland EMS completes a
conducted with children and adolescents. nontransport worksheet that prompts the paramedics to
evaluate specific patient characteristics that can
Strong DR, Brown RA, Ramsey SE, Myers MG. Nicotine influence medical decision-making capacity and then
dependence measures among adolescents with discuss the risks of refusing with the patient. Cleveland
psychiatric disorders: evaluating symptom expression EMS then contacts an online medical command
as a function of dependence severity. Nicotine Tob Res (OLMC) physician to authorize the refusal. OLMC
2003; 5(5):735-46. calls are recorded for review. OBJECTIVES: To assess
Abstract: Using methods based in item response the ability of EMS to determine medical decision-
theory, we examined a structured interview assessment making capacity and obtain an informed refusal of
of Diagnostic and Statistical Manual of Mental transport. METHODS: This study was a retrospective
Disorders, 4th edition (DSM-IV) nicotine dependence review of a cohort of recorded OLMC refusal calls and
and the Modified Fagerstrom Tolerance Questionnaire of the accompanying written documentation by
(mFTQ) symptoms to explore the expression of Cleveland EMS. The completeness of the verbal
particular symptoms as a function of level of nicotine communication between the paramedic and OLMC
involvement in a sample of 191 adolescents with physician and the written documentation on the
psychiatric disorders. Despite our attempts to capture a nontransport worksheet were measured as surrogate
broad range of smokers, 64% of teens were daily markers of the adequacy of determining medical
smokers and 68% met DSM-IV criteria for nicotine decision-making capacity and obtaining an informed
dependence. This paper describes the relative severity refusal. RESULTS: One hundred thirty-seven OLMC
of DSM-IV and mFTQ items, as well as each item's calls for patient-initiated refusals were reviewed. Vital
ability to discriminate among individuals at various signs and alertness/orientation were verbally
levels of nicotine involvement. Comparisons across communicated more than 83% of the time. The
measures revealed that the mFTQ was not particularly presence of head injury, presence of alcohol or drug
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![intoxication, and presence of hypoglycemia were of psychosocial problems in both cases and controls.
verbally communicated less than 31% of the time. The associations between health behaviour,
Verbal communication stating that the risks of refusing psychosocial factors, and asthma death are varied and
had been discussed with the patient occurred 44.5% of complex with a limited number of factors showing
the time. The written documentation of the refusal positive relationships.
encounter was more complete, exceeding 95% for vital
signs and alertness/orientation, and exceeding 80% for Su B, Macer DR. Chinese people's attitudes towards genetic
the remaining patient characteristics. The rate of diseases and children with handicaps. Law Hum
written documentation that the risks of refusing had Genome Rev 2003; (18):191-210.
been discussed with the patient was 48.7%. Notes: GENERAL NOTE: KIE: 53 refs.
Discrepancies between the verbal and written GENERAL NOTE: KIE: KIE Bib: eugenics
paramedic reports were clinically insignificant.
CONCLUSIONS: Paramedic and OLMC physician Suarez-Orozco C, Todorova IL. The social worlds of
communication for patients refusing out-of-hospital immigrant youth. New Dir Youth Dev 2003; (100):15-
medical treatment and/or transport is inadequate in the 24.
Cleveland EMS system. A written nontransport Abstract: This introductory chapter uses a detailed case
worksheet improves documentation of the refusal study to illustrate the interconnection of multiple social
encounter but does not ensure that every patient who influences on one particular youth's path of migration.
refuses possesses medical decision-making capacity It further identifies some of the major influences on
and the capacity to provide an informed refusal. immigrant youth development, including the stresses of
migration, separations and reunifications, changing
Sturdy PM, Victor CR, Anderson HR et al. Psychological, networks of relations, poverty and segregation, and
social and health behaviour risk factors for deaths identity formation.
certified as asthma: a national case-control study.
Thorax 2002; 57(12):1034-9. Subkowski P. [Harry Potter--the trauma as a drive for
Notes: CORPORATE NAME: Mortality and Severe psychic development]. Prax Kinderpsychol
Morbidity Working Group of the National Asthma Kinderpsychiatr 2004; 53(10):738-53.
Task Force Abstract: The Harry Potter books are centered around
Abstract: BACKGROUND: Uncontrolled studies the psychic development of a traumatised young boy
suggest that psychosocial factors and health behaviour starting from his internalised early experience of being
may be important in asthma death. METHODS: A loved by his mother to the sudden loss of both of his
community based case-control study of 533 cases, parents at the anal stage and the later cumulative
comprising 78% of all asthma deaths under age 65 traumatisation by being negleced and mistreated by his
years and 533 hospital controls individually matched relatives up to the present times. By identifying with
for age, district and asthma admission date his father and other father replacements Harry Potter
corresponding to date of death was undertaken in seven finally acquires self-assurance and wins new friends.
regions of Britain (1994-98). Data were extracted blind Harry goes through different stages of initiation into
from anonymised copies of primary care records for the adult world with all its conflicts and rivalries but
the previous 5 years and non-blind for the earlier also friendships. He stands up to his fears and
period. RESULTS: 60% of cases and 63% of controls symptoms resulting from his early childhood traumata
were female. The median age in both groups was 53. and thereby helps to encourage readers of all ages to
Cases had an earlier age of asthma onset, more chronic handle their own conflicts. On the oedipal level Harry
obstructive lung disease, and were more obese. 48% of Potter finally has to deidealize his father and
cases and 42% of controls had a health behaviour Dumbledore, but also their opponent the dark Lord
problem; repeated non-attendance/poor inhaler Voldemort, who thereby becomes more human,
technique was related to increased risk of death. understandable and in the long run probably defeatable.
Overall, 85% and 86%, respectively, had a The reader can identify himself with Harry and/ or a
psychosocial problem. Four psychosocial factors were wide range of other characters. He can recognize his
associated with increased risk of death (psychosis, own experiences in life and conflicts in the story and
alcohol/drug abuse, financial/employment problems, argue internally with the demonstrated conflict solving
learning difficulties) and two with reduced risk patterns on different levels. It is the skillfully displayed
(anxiety/prescription of antidepressant drugs and and logically constructed story of the psychic
sexual problems). While alcohol/drug abuse lost development of a child that is traumatised at an early
significance after adjustment for psychosis, other age and the possibilities the reader has to identify
associations appeared independent of each other and of selectively with the different characters that constitutes
indicators of severity and co-morbidity. None of the the attractiveness of the Harry Potter novels.
remaining 13 factors including family problems,
domestic abuse, bereavement, and social isolation were Suchman N, Mayes L, Conti J, Slade A, Rounsaville B.
significantly related to risk of asthma death. Rethinking parenting interventions for drug-dependent
CONCLUSION: There was an apparently high burden
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![the Environmental Threats to the Health of Children visits between general practices than adjusting for age
meeting held in Manila in April 2000, provided and sex alone. METHODS: The setting was 60 general
participants with the latest scientific data on children's practices in England and Wales taking part in the 1
vulnerability to environmental hazards and models for year Fourth National Morbidity Survey. The
future policy and public health discussions on ways to participants comprised 349 505 patients who were
improve children's health. The Bangkok Statement, a registered with one of the participating general
pledge resulting from the conference proceedings, is an practices for at least 180 days, and who had at least one
important first step in creating a global alliance consultation during the period. The outcome measure is
committed to developing active and innovative national whether or not a patient received a home visit in that
and international networks to promote and protect year. A clinical case mix category (morbidity class)
children's environmental health. based on 1 year's diagnostic information was assigned
to each patient using the Johns Hopkins Adjusted
Sullivan A. They know not what they do. Even in Rome, the Clinical Groups (ACG) Case Mix System. The social
U.S. cardinals still forgot the children. Time 2002; class measure was derived from occupation and
159(18):31. employment status and is similar to that of the 1991
UK census. Variations in home visits between practices
Sullivan A. Who says the church can't change? Time 2002; were examined using multilevel logistic regression
159(24):63-4. models. The variability between practices before and
after adjusting for clinical case mix and social class
Sullivan-Bolyai S, Grey M, Deatrick J, Gruppuso P, Giraitis was estimated using the intracluster correlation
P, Tamborlane W. Helping other mothers effectively coefficient (ICC). RESULTS: The overall percentage
work at raising young children with type 1 diabetes. of patients receiving a home visit over the 1 year study
Diabetes Educ 2004; 30(3):476-84. period was 17%, and this varied from 7 to 31% across
Abstract: PURPOSE: This study examined the the 60 practices. The percentage of the total variation
feasibility of a postdiagnosis parent mentoring in home visits attributable to differences between
intervention for mothers of young children (1-10 years practices was 2.5% [95% confidence interval (CI) 1.4-
old) newly diagnosed with type 1 diabetes. 3.2%] after adjusting for age and sex. This reduced to
METHODS: A mixed-method, prospective, 1.6% (95% CI 1.1-2.4%) after taking into account
randomized, controlled clinical trial design was used. morbidity class. The results were similar when social
Parent mentors (experienced mothers who have class was included instead of morbidity class.
successfully raised young children with type 1 Morbidity and social class together reduced variation in
diabetes) and mother participants with young children home visits between practices to 1.5% (95% CI 1.1-
newly diagnosed with type 1 diabetes were recruited 2.2%). CONCLUSIONS: Age, sex, social class and
from 2 regional pediatric diabetes centers. The mentors clinical case mix are strong determinants of home visits
were trained to provide informational, affirmational, in the UK. Adjusting for morbidity and social class
and emotional support using Ireys' modified parent results in a small improvement in explaining the
mentor curriculum. During a 6-month trial, mentors variability in home visits between practices compared
provided home visits and phone call support to the with adjusting for age and sex alone. There is far more
mothers who were randomized to the experimental variation between patients within practices; however, it
group. The control group had the option of receiving is not straightforward to examine the factors
the intervention after the 6-month trial. RESULTS: influencing this variation. In addition to morbidity and
Mothers in the experimental group had fewer concerns, social class, there could also be other unmeasured
more confidence, identified more resources, and factors such as varying patient demand for home visits,
perceived diabetes having less of a negative impact on disability or differences in GP home visiting practice
their family compared with mothers in the control style that could influence the large within-practice
group. Parent mentors provided important, practical variability observed in this study.
day-to-day management information, reassurance, and
emotional support during times of crises. Sumanen M, Koskenvuo M, Sillanmaki L, Mattila K.
CONCLUSIONS: A postdiagnosis parent mentoring Childhood adversities experienced by working-aged
intervention for mothers of children with diabetes coronary heart disease patients. J Psychosom Res 2005;
appears to be feasible and potentially effective. 59(5):331-5.
Abstract: OBJECTIVE: The aim of this study is to
Sullivan CO, Omar RZ, Forrest CB, Majeed A. Adjusting investigate associations between childhood adversities
for case mix and social class in examining variation in and coronary heart disease (CHD). METHODS: This
home visits between practices. Fam Pract 2004; was a case-control study based on a postal
21(4):355-63. questionnaire addressed to randomly selected working-
Abstract: OBJECTIVES: The purpose of this study was aged Finns, and response rate was 39% (N = 15,477).
to investigate whether adjusting for clinical case mix The sample comprised 319 CHD patients. Four age-
and social class explains more of the variation in home and gender-matched controls were selected for every
patient. The participants were asked in six questions to
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![think about their childhood adversities. RESULTS: be a positive turning point for women with drug
Fear of some family member and someone in the problems.
family being seriously or chronically ill were more
common during childhood among working-aged CHD Sutherland I, Sivarajasingam V, Shepherd JP. Recording of
patients than among controls. Likewise, among female community violence by medical and police services.
CHD patients, serious conflicts in the family and Inj Prev 2002; 8(3):246-7.
someone in the family having had alcohol problems Abstract: OBJECTIVES: To determine the extent to
and, among male CHD patients, long-lasting financial which community violence that results in injury treated
problems were more common than among controls. in emergency departments appears in official police
Odds ratios (OR) varied between 1.27 and 2.66. records and to identify age/gender groups at particular
Adjustment for education had no influence among risk of under-recording by the police. METHODS:
women, but it had an influence among men. Upon Non-confidential data for patients with assault related
adjustment for conventional risk factors (smoking, injury treated in the emergency departments of two
obesity, and hypertension), the association mostly hospitals in one South Wales city (Swansea) during a
disappeared. A family member having been seriously six month period were compared with data relating to
or chronically ill was statistically significant after full all recorded crimes in the category "Violence against
adjustment among both genders. CONCLUSION: the person" in the police area where the hospitals were
Working-aged CHD patients have experienced more located. RESULTS: Over the six month period a total
dramatic events during their childhood than did the of 1513 assaults were recorded by Swansea emergency
control population. This issue cannot be solved in departments and the police (1019, 67.3% injured males
doctors' offices. Health-promoting social policies are of and 494, 32.7% injured females). The majority of these
vital importance. assaults (993, 65.6%) were recorded exclusively by
emergency departments; 357 (23.6%) were recorded
Sundfaer A. [31 women with drug problems got children-- only by the police and 163 (10.8%) were recorded by
what happened after that?]. Tidsskr Nor Laegeforen both emergency departments and the police. Equal
2001; 121(1):73-5. proportions of males (67.3%) and females (67.5%)
Abstract: BACKGROUND: The intention of this study injured in assaults were recorded by both emergency
was to increase the knowledge concerning the departments and the police, but men were more likely
rehabilitation of women with drug problems after the to have their assault recorded exclusively in emergency
birth of a child and to find out how the children departments (odds ratio (OR) 2.1, 95% confidence
developed. MATERIAL AND METHODS: A follow- interval (CI) 1.7 to 2.7) while women were more likely
up study of 31 women, former drug and alcohol to have their assault recorded exclusively by the police
abusers and their children, 19 girls and 12 boys born in (OR 2.5, 95% CI 2.0 to 3.2). There were no significant
1982-1983. The first survey took place when the relationships between exclusive emergency department
children were 2-3 years of age, then when they were 7- recording and increasing age (OR 1.0, 95% CI 0.9 to
9 and at last when they were 15-17. The biological 1.2), exclusive police recording and increasing age (OR
mothers, foster or adoptive mothers, the children and 1.1, 95% CI 1.0 to 1.2), or between age and dual
their teachers were interviewed. RESULTS: The recording (OR 0.9, 95% CI 0.8 to 1.0).
women got more support and control during the CONCLUSIONS: Most assaults leading to emergency
pregnancy than afterwards. Most of the mothers department treatment, particularly in which males were
became single. Women with the shortest drug history, a injured, were not recorded by the police. Assaults on
good social network and a stable partner without drug the youngest group (0-10, particularly boys) were those
problems kept the care of their children. By the first least likely to be recorded by police and females over
survey (1985), seven children had been placed in foster age 45, the most likely. Emergency department derived
homes, in the second (1992) two further children had assault data provide unique perspectives of community
been taken away from their mothers, and in the third violence and police detection.
(1999) only one third of the children were living with
their biological mothers. Most of the children did well Suzuki K, Morita S, Muraoka H, Niimi Y. [Fetal alcohol
at school and in their families, had friends and leisure spectrum disorders (FASD) among Japanese children
activities despite still living by their mothers or in of alcoholic mothers]. Nihon Arukoru Yakubutsu
foster/adoption homes. None of the youngsters had Igakkai Zasshi 2005; 40(3):219-32.
been in conflict with the law or were drug abusers, but Abstract: OBJECTIVE: This study was carried out to
every second teenage girl needed psychological examine fetal alcohol spectrum disorders (FASD)
support. Children who had been stable by their drug- among Japanese children of alcoholic mothers. This is
free biological mothers functioned best. the first report concerning FASD in Japan.
INTERPRETATION: Mothers with drug problems do METHODS: The subjects were 30 alcoholic women
not get sufficient attention after the delivery and when who were inpatients in the Kurihama Alcoholism
the children grow up. A supporting family should be Center and had given birth to children. They were
brought in contact with mother and child after the subjected to a semi-structured interview by the author.
delivery. Under special circumstances pregnancy can Sixty healthy women who had not drunk during
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![implications of these results for conducting components contribute to desired outcomes, and to
ecologically valid research on sensitive issues with learn more about processes that underlie changes in
adolescents and for family support program planning behaviour.
are discussed.
Sylvestre A, Payette H, Tribble DS. [The prevalence of
Swick SD, Jellinek MS, Dechant E, Jellinek MS, Belluck J. communication problems in neglected children under
Children of victims of September 11th: a perspective three years of age.]. Can J Public Health 2002;
on the emotional and developmental challenges they 93(5):349-52.
face and how to help meet them. J Dev Behav Pediatr Abstract: OBJECTIVE: Estimate the prevalence of
2002; 23(5):378-84. communication problems in children under three taken
into care by Youth Centres in Quebec for negligence.
Sword W, Niccols A, Fan A. "New Choices" for women Prevalence is calculated for the pragmatic aspect,
with addictions: perceptions of program participants. receptive and expressive language, according to age
BMC Public Health 2004; 4:10. and sex. METHOD: This is a cross-sectional study. A
Abstract: BACKGROUND: Substance use in representative sample of 84 children was drawn
pregnancy is a major public health problem. It can have consecutively from the lists of new children registered
profound effects on pregnancy outcomes, and at the Youth Centres. RESULTS: 46.4% of the children
childhood health and development. Additionally, present a problem in at least one area of
women who use substances have their own health- communication. The prevalence and seriousness of the
related issues. Although intervention is important, problems increase significantly with age. Boys are
these women often have difficulty using traditional significantly more affected than girls. CONCLUSION:
systems of care. The New Choices program is a Negligence constitutes a threat to the development of
centralized, multi-sector approach to service delivery communication. According to the data reported in this
that has attempted to overcome barriers to care by study, there is substantial justification for early
offering one-stop shopping in a supportive intervention, promotion and prevention programs with
environment. As part of an evaluation of this program regard to communication problems among neglected
designed for women who are pregnant and/or parenting children.
young children, interviews were conducted with
participants to gain insight into their experiences in Szilagyi PG, Schaffer S, Shone L et al. Reducing
New Choices and perceptions of any changes attributed geographic, racial, and ethnic disparities in childhood
to program involvement. METHODS: A qualitative, immunization rates by using reminder/recall
exploratory design was used to guide data collection interventions in urban primary care practices.
and analysis. Four women participated in a focus group Pediatrics 2002; 110(5):e58.
interview and seven women agreed to individual Abstract: CONTEXT: An overarching national health
interviews over the course of the program evaluation goal of Healthy People 2010 is to eliminate disparities
(N = 11). A semi-structured interview guide was used in leading health care indicators including
to explore women's experiences in New Choices and immunizations. Disparities in US childhood
their perceptions of the program and its impact. The immunization rates persist, with inner-city, black, and
interview data were analyzed using NVivo software Hispanic children having lower rates. Although
and an inductive approach to data analysis. RESULTS: practice or clinic-based interventions, such as patient
The emergent themes captured women's motivations reminder/recall systems, have been found to improve
for attending New Choices, benefits of participation, immunization rates in specific settings, there is little
and overall quality of the program. Children were the evidence that those site-based interventions can reduce
primary motivating factor for program enrollment. disparities in immunization rates at the community
Perceived benefits included decreased substance use, level. OBJECTIVE: To assess the effect of a
improved maternal health, enhanced opportunity for community-wide reminder, recall, and outreach (RRO)
employment, increased access to other resources, system for childhood immunizations on known
enhanced parenting skills, and improved child disparities in immunization rates between inner-city
behaviour and development. Women highly valued the versus suburban populations and among white, black,
comprehensive and centralized approach to service and Hispanic children within an entire county.
delivery that provided a range of informal and formal SETTING: Monroe County, New York (birth cohort:
supports. CONCLUSIONS: Interview findings endorse 10 000, total population: 750 000), which includes the
the appropriateness and potential efficacy of a city of Rochester. Three geographic regions within the
collaborative, centralized approach to service provision county were compared: the inner city of Rochester,
for women with substance use issues. Although the which contains the greatest concentration of poverty
findings provide insight into an alternative model of (among 2-year-old children, 64% have Medicaid); the
service delivery for women with addictions, future rest of the city of Rochester (38% have Medicaid); and
research is needed to evaluate the effectiveness of the the suburbs of the county (8% have Medicaid).
intervention. Research also is needed to determine INTERVENTIONS: An RRO system was implemented
which program components or constellation of in 8 city practices in 1995 (covering 64% of inner-city
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![risks. Subfactors of DSM-IV conduct disorder: evidence and
connections with syndromes from the Child Behavior
Szpurek D, Moszynski R, Smolen A, Sajdak S. Artificial Checklist. J Abnorm Child Psychol 2003; 31(6):647-
neural network computer prediction of ovarian 54.
malignancy in women with adnexal masses. Int J Abstract: Is conduct disorder (CD) as defined in the
Gynaecol Obstet 2005; 89(2):108-13. Diagnostic and Statistical Manual of Mental Disorders
Abstract: OBJECTIVE: Assessment of the usefulness (DSM-IV; American Psychiatric Association, 1994) a
of a neural model to predict which ovarian tumors are unitary entity, or do variants of CD exist? We
malignant. METHOD: Age, menopausal status, body addressed this question, using data collected from the
mass index, grayscale and Doppler ultrasonographic parents of 1,669 Australian boys, aged 6-17. Parents
features, as well as levels of specific markers (CA 125, were interviewed to assess DSM-IV Conduct Disorder
tissue polypeptide specific antigen) were examined in (DSM-IV CD) criteria. Results revealed 2 subfactors of
686 women with adnexal masses. The probability of DSM-IV CD symptoms, made up of overt behaviors
malignancy was calculated using an artificial neural (e.g., initiating physical fights) and covert behaviors
network software and the diagnostic efficiency of the (e.g., stealing without confrontation). Ordinary least
received model was estimated using a receiver- squares regressions showed the 2 CD subfactors to be
operating characteristics (ROC) curve. RESULT: Of significantly and uniquely predicted by Child Behavior
the 686 women, 431 (62.8%) had a benign and 255 Checklist (CBCL; T. M. Achenbach, 1991a, 1991b)
(37.2%) had a malignant ovarian tumor. The significant syndromes labeled Aggressive Behavior and
malignancy predictors are age, menopausal status, Delinquent Behavior, respectively. The results are
maximum tumor diameter, internal wall structure of discussed in terms of the utility of differentiating these
tumor, presence of septa and/or solid elements, tumor 2 variants of CD in future editions of the DSM.
location, location of vessels, and blood flow indexes.
The best network provided 96.0% sensitivity and Taft A, Broom DH, Legge D. General practitioner
97.7% specificity. The area under the curve for the management of intimate partner abuse and the whole
received model was 0.9716. CONCLUSIONS: An family: qualitative study. BMJ 2004; 328(7440):618.
artificial neural network model based on clinical and Abstract: OBJECTIVE: To explore management by
ultrasonographic data allows to calculate the general practitioners of victimised female patients,
probability of tumor malignancy. male partners who abuse, and children in the family.
DESIGN: Triangulated qualitative study comparing
Szwarcwald CL, Bastos FI, Andrade CL. [Health inequality doctors' reported management with current
indicators: a discussion of some methodological recommendations in the literature. PARTICIPANTS:
approaches as applied to neonatal mortality in the 28 general practitioners attending continuing medical
Municipality of Rio de Janeiro, 2000]. Cad Saude education about management of domestic violence.
Publica 2002; 18(4):959-70. RESULTS: Doctors perceived partner abuse in diverse
Abstract: Epidemiology has investigated the ways. Their gender, perceptions, and attitudes could all
relationship between health status and different social affect identification and management of this difficult
and economic factors ever since the field emerged. problem. A few doctors practised in recommended
Studies have consistently shown that the population's ways, but many showed stress and aversion, difficulties
health status bears a strong social gradient, invariably in resolving the tensions involved in managing all
unfavorable to the less privileged groups. Increasing family members, and neglect of the risks to children.
interest in understanding and characterizing health Some doctors used contraindicated practices, such as
inequalities has broadened the discussion in the recent breaking confidentiality and undertaking or referring
literature on appropriate concepts and methodological for couple counselling. Doctors who were not familiar
procedures for measuring differences in health status with community based agencies were reluctant to use
according to socioeconomic level. This study presents them. A lack of expertise and support could have a
a critical assessment of health inequality indicators, negative impact on doctors themselves.
focusing on the following: the redistribution principle CONCLUSIONS: General practitioners managing
and its application to health status; the influence of partner abuse need to be more familiar with and apply
income inequality; epidemiological and statistical the central principles of confidentiality and safety of
approaches to the problem; and evaluation of health women and children. Recommended guidelines for
system performance in reducing health inequalities. As managing the whole family should be developed.
an example, inequalities in the neonatal mortality rate Doctors should consider referring one partner
are analyzed in the city of Rio de Janeiro, Brazil, 2000, elsewhere and avoid couple counselling; always ask
according to the mother's level of schooling, reviewing about and act on the children's welfare; refer to
the minimum requisites for defining an adequate health specialist family violence agencies; and seek training,
inequality indicator. supervision, and support for the inherent stress.
Medical education and administration should ensure
Tackett JL, Krueger RF, Sawyer MG, Graetz BW. comprehensive training and support for doctors
undertaking this difficult work.
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![which prefrontal cortex dysfunction is hypothesized to Taylor D. Unnatural eye injuries. Trans Med Soc Lond
underlie the risk for these two outcomes. 2001-2002; 118:43-53.
Taveras EM, Capra AM, Braveman PA, Jensvold NG, Taylor JS. The story catches you and you fall down: tragedy,
Escobar GJ, Lieu TA. Clinician support and ethnography, and "cultural competence". Med
psychosocial risk factors associated with breastfeeding Anthropol Q 2003; 17(2):159-81.
discontinuation. Pediatrics 2003; 112(1 Pt 1):108-15. Abstract: Anne Fadiman's The Spirit Catches You and
Abstract: OBJECTIVE: Breastfeeding rates fall short You Fall Down: A Hmong Child, Her American
of goals set in Healthy People 2010 and other national Doctors, and the Collision of Two Cultures (Noonday
recommendations. The current, national breastfeeding Press, 1997) is widely used in "cultural competence"
continuation rate of 29% at 6 months lags behind the efforts within U.S. medical school curricula. This
Healthy People 2010 goal of 50%. The objective of this article addresses the relationship between theory,
study was to evaluate associations between narrative form, and teaching through a close critical
breastfeeding discontinuation at 2 and 12 weeks reading of that book that is informed by theories of
postpartum and clinician support, maternal physical tragedy and ethnographies of medicine. I argue that
and mental health status, workplace issues, and other The Spirit Catches You is so influential as ethnography
factors amenable to intervention. METHODS: A because it is so moving as a story; it is so moving as a
prospective cohort study was conducted of low-risk story because it works so well as tragedy; and it works
mothers and infants who were in a health maintenance so well as tragedy precisely because of the static,
organization and enrolled in a randomized, controlled reified, essentialist understanding of "culture" from
trial of home visits. Mothers were interviewed in which it proceeds. If professional anthropologists wish
person at 1 to 2 days postpartum and by telephone at 2 our own best work to speak to "apparitions of culture"
and 12 weeks. Logistic regression modeling was within medicine and other "cultures of no culture," I
performed to assess the independent effects of the suggest that we must find compelling new narrative
predictors of interest, adjusting for sociodemographic forms in which to convey more complex
and other confounding variables. RESULTS: Of the understandings of "culture."
1163 mother-newborn pairs in the cohort, 1007 (87%)
initiated breastfeeding, 872 (75%) were breastfeeding Taylor KI. Understanding communities today: using
at the 2-week interview, and 646 (55%) were matching needs and services to assess community
breastfeeding at the 12-week interview. In the final needs and design community-based services. Child
multivariate models, breastfeeding discontinuation at 2 Welfare 2005; 84(2):251-64.
weeks was associated with lack of confidence in ability Abstract: Matching Needs and Services (MNS) is a
to breastfeed at the 1- to 2-day interview (odds ratio practice tool intended to help people who work with
[OR]: 2.8; 95% confidence interval [CI]: 1.02-7.6), vulnerable children use rigorously assembled
early breastfeeding problems (OR: 1.5; 95% CI: 1.1- information on needs as a guide to design, implement,
1.97), Asian race/ethnicity (OR: 2.6; 95% CI: 1.1-5.7), and evaluate more-effective services. To do this, MNS
and lower maternal education (OR: 1.5; 95% CI: 1.2- focuses on needs but links them to outcomes and
1.9). Mothers were much less likely to discontinue thresholds before dealing with the services to achieve
breastfeeding at 12 weeks postpartum if they reported those outcomes.
(during the 12-week interview) having received
encouragement from their clinician to breastfeed (OR: Taylor SG. Orem's general theory of nursing and families.
0.6; 95% CI: 0.4-0.8). Breastfeeding discontinuation at Nurs Sci Q 2001; 14(1):7-9.
12 weeks was also associated with demographic factors
and maternal depressive symptoms (OR: 1.18; 95% CI: Tcheremissine OV, Lane SD, Lieving LM, Rhoades HM,
1.01-1.37) and returning to work or school by 12 weeks Nouvion S, Cherek DR. Individual differences in
postpartum (OR: 2.4; 95% CI: 1.8-3.3). aggressive responding to intravenous flumazenil
CONCLUSIONS: Our results indicate that support administration in adult male parolees. J
from clinicians and maternal depressive symptoms are Psychopharmacol 2005; 19(6):640-6.
associated with breastfeeding duration. Attention to Abstract: Nonhuman and human studies have shown
these issues may help to promote breastfeeding that benzodiazepine (BZD) receptor agonists can
continuation among mothers who initiate. Policies to modify aggressive behaviour. However, it is unknown
enhance scheduling flexibility and privacy for whether flumazenil, a BZD receptor antagonist,
breastfeeding mothers at work or school may also be enhances or inhibits aggressive behaviour.The present
important, given the elevated risk of discontinuation study was designed to investigate the effects of acute
associated with return to work or school. administrations of flumazenil on aggressive responding
in adult humans.Six adult males with histories of
Tay ET, Levin TL. Suspected abuse. Clin Pediatr (Phila) childhood conduct disorder (DSM IV R) participated in
2004; 43(6):583-5. experimental sessions. Aggression was measured using
the Point Subtraction Aggression Paradigm (PSAP;
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![Abstract: BACKGROUND: We examined the strongest socioeconomic predictor of post-traumatic
prevalence and nature of comorbid post-traumatic stress reactions (odds ratio 0.25 [95% CI 0.12-0.53],
stress reactions and depressive symptoms, and the p=0.0008). By contrast, children exposed to other
impact of exposure to traumatic events on both types of events, mainly through the media and adults, reported
psychopathology, among Palestinian children during more anticipatory anxiety and cognitive expressions of
war conflict in the region. METHODS: The 403 distress (p=0.001) than children who were directly
children aged 9-15 years, who lived in four refugee exposed. INTERPRETATION: Children living in war
camps, were assessed by completing the Gaza zones can express acute distress from various traumatic
Traumatic Events Checklist, the Child Post Traumatic events through emotional problems that are not usually
Stress Reaction Index (CPTSD-RI), and the Short recognised. Health professionals and other agencies
Mood and Feelings Questionnaire (MFQ). RESULTS: coming in contact with children who have been
Children reported experiencing a wide range of affected by war and political violence need to be
traumatic events, both direct experience of violence trained in detection and treatment of such
and through the media. CPTSD-RI and MFQ scores presentations.
were significantly correlated. Both CPTSD-RI and
MFQ scores were independently predicted by the Thadani PV. The intersection of stress, drug abuse and
number of experienced traumatic events, and this development. Psychoneuroendocrinology 2002; 27(1-
association remained after adjusting for socioeconomic 2):221-30.
variables. Exposure to traumatic events strongly Abstract: Use or abuse of licit and illicit substances is
predicted MFQ scores while controlling for CPTSD-RI often associated with environmental stress. Current
scores. In contrast, the association between traumatic clinical evidence clearly demonstrates neurobehavioral,
events and CPTSD-RI scores, while controlling for somatic growth and developmental deficits in children
MFQ scores, was weak. The CPTSD-RI items whose born to drug-using mothers. However, the effects of
frequency was significantly associated with total MFQ environmental stress and its interaction with prenatal
scores were: sleep disturbance, somatic complaints, drug exposure on a child's development is unknown.
constricted affect, impulse control, and difficulties in Studies in pregnant animals under controlled
concentration. However, not all remaining CPTSD-RI conditions show drug-induced long-term alterations in
items were significantly associated with exposure to brain structures and functions of the offspring. These
traumatic events, thus raising the possibility that the cytoarchitecture alterations in the brain are often
association between depression and PTSD was due in associated with perturbations in neurotransmitter
part to symptom overlap. CONCLUSIONS: Children systems that are intimately involved in the regulation
living in war zones are at high risk of suffering from of the stress responses. Similar abnormalities have
PTSD and depressive disorders. Exposure to trauma been observed in the brains of animals exposed to other
was not found to have a unique association with PTSD. adverse exogenous (e.g., environmental stress) and/or
The relationship between PTSD and depressive endogenous (e.g., glucocorticoids) experiences during
symptomatology requires further investigation. early life. The goal of this article is to: (1) provide
evidence and a perspective that common neural
Thabet AA, Abed Y, Vostanis P. Emotional problems in systems are influenced during development both by
Palestinian children living in a war zone: a cross- perinatal drug exposure and early stress exposure; and
sectional study. Lancet 2002; 359(9320):1801-4. (2) identify gaps and encourage new research
Abstract: BACKGROUND: Children living in war examining the effects of early stress and perinatal drug
zones are at high risk of developing post-traumatic exposure, in animal models, that would elucidate how
stress and other emotional disorders, but little is known stress- and drug-induced perturbations in neural
about the effect of traumatic events during war. We systems influence later vulnerability to abused drugs in
aimed to assess the nature and severity of emotional adult offspring.
problems in Palestinian children whose homes had
been bombarded and demolished during the crisis in Therrell BL Jr. U.S. newborn screening policy dilemmas for
Palestine, compared with children living in other parts the twenty-first century. Mol Genet Metab 2001; 74(1-
of the Gaza strip. METHODS: 91 children exposed to 2):64-74.
home bombardment and demolition during Al Aqsa Abstract: Newborn screening has traditionally referred
Intifada and 89 controls who had been exposed to other to biochemical testing for inherited disorders, generally
types of traumatic events related to political violence metabolic in origin, that are usually correctable by
completed self-report measures of post-traumatic dietary or drug interventions. As new tests have been
stress, anxiety, and fears. FINDINGS: Significantly developed, state public health newborn screening
more children exposed to bombardment and home systems have slowly evolved without the benefit of
demolition reported symptoms of post-traumatic stress national policies. Thus, newborn screening program
(p=0.0008) and fear (p=0.002) than controls. 54 (59%) changes, when viewed nationally, have been
of 91 exposed children and 22 (25%) of 89 controls uncoordinated. The net result has been unequally
reported post-traumatic stress reactions of clinical applied mandated screening and, consequently, unequal
importance. Exposure to bombardment was the availability of related public health disease prevention
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![implications of our findings for the delivery of care, with ACD to formaldehyde, formaldehyde-releasing
families, healthcare systems, and further research are agents, and potassium dichromate in Kansas City were
discussed. RESULTS: Findings that have broad likely caused by the referral of greater numbers of
implications are as follows: (1) developmental and work-related cases. However, occupationally acquired
behavioral services can be delivered successfully in ACD to MCI/MI and glutaraldehyde were not more
practice using dedicated professionals to deliver and frequent in Kansas City than nationally, suggesting that
integrate services; (2) the "planned care model" was other factors might be operative. Although awareness
useful in program implementation for making "the right of national trends is important, dermatologists must be
thing to do, the easy thing to do"; (3) the added focus cognizant of regional variations in allergen sources
on satisfaction and cost helps to develop the "business within their communities and referral networks.
case" for broad scale implementation; (4) bonding of
parents to organizations has marketing implications; Thomson CC, Roberts K, Curran A, Ryan L, Wright RJ.
(5) the program provides positive effects for all Caretaker-child concordance for child's exposure to
parents, not just high-risk parents; and (6) several violence in a preadolescent inner-city population. Arch
research questions emerge, including persistence of Pediatr Adolesc Med 2002; 156(8):818-23.
effects on health outcomes, costs, and utilization. Abstract: BACKGROUND: Effective screening for
CONCLUSIONS: The authors conclude that study exposure to violence (ETV) in the pediatric setting
results have implications for preventive services, depends on informant reliability and recognition of
families, child healthcare in office practice, healthcare patients at increased risk. Pediatricians screening for
systems, and healthcare policy. In this ongoing study, children's ETV often rely on parent reporting.
examination of intervention effects at 30 months of age HYPOTHESIS: That there would be poor caretaker-
shoud be informative. Further research is warranted as child concordance given that children would report
it remains to be seen whether or not these interventions events occurring outside the home not witnessed by the
can become viable ongoing programs. caretaker and that ETV would be higher among
immigrant families. OBJECTIVES: To examine
Thompson TR, Belsito DV. Regional variation in prevalence concordance between caretaker and child self-report of
and etiology of allergic contact dermatitis. Am J the child's ETV in a preadolescent population and to
Contact Dermat 2002; 13(4):177-82. explore factors related to increased risk. DESIGN:
Abstract: BACKGROUND: The 1994-1996 North Community-based survey. SETTING: Urban
American Contact Dermatitis Group (NACDG) patch community health center. PARTICIPANTS: One
test results were the first, since the inception of the hundred sixty-five caretaker-child pairs. METHODS:
NACDG in 1970, to include results from a medium- The ETV was assessed by means of a standardized
sized metropolitan city in the Midwest. OBJECTIVE: interview questionnaire on location and frequency of
The aim of this study was to determine whether the ETV. A Rasch model was used to develop summary
causative allergens of allergic contact dermatitis scores of ETV (frequency and severity). RESULTS:
(ACD) in the Midwest differ from those in other Caretaker-child concordance on reports of child's ETV
regions of the United States and, if so, whether was poor. The kappa statistics ranged from -0.04 for
occupational or other factors account for the observed seeing someone knifed to 0.39 for witnessing a
differences. METHODS: Retrospective analyses of shooting. Children reported ETV more often in their
patch test data collected at the University of Kansas neighborhood or at school, whereas caretakers reported
Medical Center (Kansas City, KS) were compared with more events near or at home. Univariate predictors of
the data collected by the other NACDG centers. child's self-reported ETV were female sex (beta +/- SE,
RESULTS: Patients in Kansas City were statistically -10.1 +/- 4.6; P =.03) and caretaker being divorced
more likely to react to potassium dichromate, (beta +/- SE, 12.6 +/- 6.0; P =.04). In multivariate
formaldehyde and its releasers, analyses, country of origin predicted child's ETV,
methylchloroisothiazolinone/methylisothiazolinone adjusting for child's age and sex, and caretaker
(MCI/MI), and glutaraldehyde. Occupational exposures educational status and marital status. CONCLUSIONS:
to chromium and formaldehyde were increased Caretakers and their children have poor agreement on
significantly among patients from Kansas City, reports of the child's ETV. Intervention strategies
although the percentages of the local population around ETV should include assessment of the child
engaged in these occupations did not differ from those independent of caretaker report for preadolescents.
in other NACDG cities. Equal percentages of workers Screening may be more effective if pediatricians are
in Kansas City and nationally had occupationally aware of factors related to increased risk, including
related allergy to glutaraldehyde, although the overall immigration status and caretaker marital status.
rate of glutaraldehyde was higher among patients from
Kansas City. Most cases of relevant allergy to MCI/MI Thun-Hohenstein L. [The work of child protection groups in
were cosmetically induced both in Kansas City and Austria]. Wien Med Wochenschr 2005; 155(15-
nationally. CONCLUSIONS: The current findings 16):365-70.
show significant regional differences in causal Abstract: AIM: To document the number of child
allergens. The increased percentages of patients seen protection groups (CPG) in children's hospitals and
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![district-level care before discharge home. CCPs Abstract: Studies on health effects of air pollutants
received formal notification of the injured child in only ideally define exposure through the collection of air
32% of cases by discharge, and 54% of cases by 6 samples in the participants' homes. Concentrations
months. Sixty-five per cent of children required early derived from these samples are then considered as an
educational support but structured help reached only estimate for the average concentration of air pollutants
55% of these children by the end of the study. in the homes. Conclusions drawn from such studies
Integrated planning between health and education was therefore depend very much on the validity of the
achieved in about half of the study population. Good measured air pollution concentrations. In this paper we
physical recovery was achieved by the majority of analysed repeated BTEX and NO(2) measurements
children but parents said they did not feel prepared for with a time period of several months lying between the
the degree of help which their child still required 12 two conducted home visits. We investigated the
months after discharge. Children who required variability of their concentrations over time by
anticonvulsants at 12 months' follow-up scored determining correlation coefficients and calculating
significantly lower on cognitive potential. Psychosocial within- and between-home variances. Our population
family functioning deteriorated in a substantial number consisted of 631 homes of participants from two cohort
of families according to parental perception. studies within the framework of the German study on
Prevalence of this perception did not diminish over the Indoor Factors and Genetics in Asthma. Air pollutants
study period. Aspects of caregivers' understanding and were measured using passive samplers both indoors
the child's language deficits, self-care skills, fine and and outdoors. The measured BTEX concentrations
gross motor performance, as well as family, social, and were poorly correlated, with Pearson's correlation
financial consequences were assessed. A dedicated and coefficient r ranging from -0.19 to 0.27. Additionally, a
integrated approach to assessment and provision of considerable seasonal effect could be observed. A
care across the domains of hospital, education, and higher correlation was found for the NO(2)
community is discussed. concentrations with r ranging between 0.24 and 0.55.
For the BTEX, the between-home variance was bigger
Tong Y, Frize M, Walker R. Extending ventilation duration than the within-home variance, for NO(2) both
estimations approach from adult to neonatal intensive variances were of about the same order. Our results
care patients using artificial neural networks. IEEE indicate that in a setting of moderate climate like in
Trans Inf Technol Biomed 2002; 6(2):188-91. Germany, the variability of BTEX and NO(2)
Abstract: In earlier work, the research group concentrations over time is high and a single
successfully used artificial neural networks (ANNs) to measurement is a poor surrogate for the long-term
estimate ventilation duration for adult intensive care concentrations of these air pollutants.
unit (ICU) patients. The ANNs performed well in terms
of correct classification rate (CCR) and average Tornqvist K, Kallen B. Risk factors in term children for
squared error (ASE) classifying the outcome into two visual impairment without a known prenatal or
classes: whether patients were ventilated for less postnatal cause. Paediatr Perinat Epidemiol 2004;
than/equal to or for more than 8 h (< or >). The 18(6):425-30.
objective of new work was to apply this adult model to Abstract: Risk factors were studied for visual
the estimation of ventilation with neonatal ICU (NICU) impairment in children without known pre- or postnatal
patient records. The performance obtained with the cause, for a decrease of visual acuity. Children born at
neonatal patients was comparable to that previously term 1979-98 and with a visual impairment were
found with the adult database, again as measured in identified from the Swedish Register of Visually
terms of a maximum CCR and a minimum ASE. The Impaired Children and data were linked with the
effectiveness of using the weight-elimination technique Swedish Medical Birth Registry. Maternal
in controlling overfitting was again validated for the characteristics such as maternal age, parity, maternal
neonatal patients as it had been for our adult patients. It smoking habits in early pregnancy, maternal education,
was concluded that the approach developed for ICU nationality, and subfertility were studied as well as
adult patients was also successfully applied to a maternal diagnoses such as pre-eclampsia, prolonged
different medical environment: neonatal ICU patients. second stage of labour, abruptio placentae, and
placenta praevia. Mode of delivery was analysed as
Topley J, Thomas A, Hobbs C, Wynne J. Detection of child well as birthweight, and birthweight in relation to
sexual abuse. Am J Obstet Gynecol 2001; 184(5):1043- gestational age. Abruptio placentae turned out to be the
5. strongest risk factor (OR = 8.24 [95% CI 5.01, 13.51]).
Smoking did not give a statistically significant
Topp R, Cyrys J, Gebefugi I et al. Indoor and outdoor air increased risk. There is an increased risk with breech
concentrations of BTEX and NO2: correlation of delivery (OR = 2.01 [95% CI 1.28, 3.17]). Pre-
repeated measurements. J Environ Monit 2004; eclampsia was associated with an increased risk (OR =
6(10):807-12. 2.22 [95% CI 1.46, 3.38]). There is also an increase in
Notes: CORPORATE NAME: INGA Study Group risk at low birthweight and small-for-gestational-age as
well as birthweight > 4 kg and large-for-gestational-
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![age. In this study we found that risk factors particularly research: the National Implementing Evidence-Based
worth noticing in term children with a presumed Practice Project. Child Adolesc Psychiatr Clin N Am
perinatal cause of visual impairment are abruptio 2005; 14(2):297-306, ix.
placentae, pre-eclampsia, excessively low as well as Abstract: The National Implementing Evidence-Based
excessively high birthweight, and breech delivery, a Practice Project is an ongoing effort to promote the
fact worth noticing in current discussion on risks, implementation of effective practices for adults who
advantages or excessive exploitation of caesarean have severe mental illnesses. The project members
section. designed and developed integrated packages of
materials and services to help practice sites implement
Torres C, Mujica OJ. [Health, equity, and the Millennium evidence-based practices and is field-testing the
Development Goals]. Rev Panam Salud Publica 2004; approach in eight states. These implementations are
15(6):430-9. being evaluated carefully to learn how to make the
Abstract: In September 2000 representatives of 189 technology transfer process more efficient in the future.
countries met for the Millennium Summit, which the This article describes the project and provides some
United Nations convened in New York City, and early reflections on the implementation experience.
adopted the declaration that provided the basis for
formulating the Millennium Development Goals Totet A, Latouche S, Lacube P et al. Pneumocystis jirovecii
(MDGs). The eight goals are part of a long series of dihydropteroate synthase genotypes in
initiatives that governments, the United Nations immunocompetent infants and immunosuppressed
system, and international financial institutions have adults, Amiens, France. Emerg Infect Dis 2004;
undertaken to reduce world poverty. Three of the eight 10(4):667-73.
goals deal with health, so the health sector will be Abstract: To date, investigations of Pneumocystis
responsible for implementing, monitoring, and jirovecii circulation in the human reservoir through the
evaluating measures proposed to meet targets that have dihydropteroate synthase (DHPS) locus analysis have
been formulated: to reduce by two-thirds the mortality only been conducted by examining P. jirovecii isolates
rate in children under 5 years of age between 1990 and from immunosuppressed patients with Pneumocystis
2015; to reduce by three-quarters the maternal pneumonia (PCP). Our study identifies P. jirovecii
mortality rate between 1990 and 2015; and to halt and genotypes at this locus in 33 immunocompetent infants
begin to reverse the spread of HIV/AIDS by the year colonized with P. jirovecii contemporaneously with a
2015, as well as to halt and begin to reverse the bronchiolitis episode and in 13 adults with PCP; both
incidence of malaria, tuberculosis, and other major groups of patients were monitored in Amiens, France.
diseases. The health sector must also work with other The results have pointed out identical features of P.
parties to achieve targets connected with two other of jirovecii DHPS genotypes in the two groups,
the goals: to improve access to affordable essential suggesting that in these groups, transmission cycles of
drugs, and to reduce the proportion of persons who do P. jirovecii infections are linked. If these two groups
not have safe drinking water. Adopting a strategy represent sentinel populations for P. jirovecii
focused on the most vulnerable groups-ones infections, our results suggest that all persons
concentrated in locations and populations with the parasitized by P. jirovecii, whatever their risk factor for
greatest social exclusion-would make possible the infection and the form of parasitism they have, act as
largest total reduction in deaths among children, thus interwoven circulation networks of P. jirovecii.
reaching the proposed target as well as producing
greater equity. In the Region of the Americas the Towner E, Dowswell T. Community-based childhood injury
principal challenges in meeting the MDGs are: prevention interventions: what works? Health Promot
improving and harmonizing health information Int 2002; 17(3):273-84.
systems; designing health programs related to the Abstract: Unintentional injury, with its broad range of
MDGs that bring together the set of services and injury types, possible countermeasures, and great
interventions that have the greatest impact, according number of agencies involved in its prevention, lends
to the special characteristics of the populations who are itself to community-based approaches. In this paper we
intended to be the beneficiaries; strengthening the examine 10 community-based injury prevention
political will to support the MDGs; and guaranteeing programmes that have targeted childhood injury
funding for the measures undertaken to attain the prevention and have been evaluated using some
MDGs. measure of outcome. We investigate the nature of the
intervention, targeting, the length of programmes and
Torrey EF. Early physical and sexual abuse associated with multi-agency involvement. We also consider how the
an adverse course of bipolar illness. Biol Psychiatry programmes have been evaluated, and what outcome,
2002; 52(8):843; author reply 843-5. impact and process measures have been used. The
information on the intervention and how it was
Torrey WC, Lynde DW, Gorman P. Promoting the evaluated, how effective the programme was, and the
implementation of practices that are supported by strength of the evidence, is summarized in tabular
form. There is increasing evidence emerging about the
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![Tupola S, Kivitie-Kallio S, Viheriala L, Kallio P. [What explosiveness, cognitive and learning problems, and
should a doctor do when suspecting child abuse?]. poor social skills. The rate of comorbidity is high, with
Duodecim 2005; 121(20):2215-20. attention-deficit hyperactivity disorder (ADHD) and
oppositional defiant disorder (ODD) being the most
Turgay A. Aggression and disruptive behavior disorders in common; comorbid anxiety and depressive disorders
children and adolescents. Expert Rev Neurother 2004; are also seen, especially in adolescents. The diagnostic
4(4):623-32. process should include the use of structured interviews,
Abstract: Aggression is a common symptom of many and scores from reliable and valid rating scales that
psychiatric disorders including attention deficit cover all psychiatric disorders must be considered in
hyperactivity disorder, oppositional defiant disorder, the differential diagnosis, because CD alone is an
conduct disorder, Tourette's disorder, mood disorders extreme rarity and multiple disorders are almost always
(including bipolar disorder), substance-related the rule rather than exception. Treatment should
disorders, alcohol-related disorders, mental retardation, include parenting skills training combined with training
pervasive developmental disorders, intermittent of the child to improve his or her relationships with
explosive disorder and personality disorders peers, academic performance, and compliance with
(particularly antisocial personality disorder). Many legitimate demands of authority figures. The
forms of organic brain disorders may present with appropriate use of medications and integration of
aggressive behavior. Aggression is common in some patient/parent education and support, as well as
epileptic patients and some endocrinological diseases individual, group, family, residential, and inpatient
(e.g., diabetes and hyperthyroidism) may be associated treatment may be beneficial for patients with CD and
with aggressive behavior. Physicians need to rule out ADHD. The article describes a number of
many medical and psychiatric disorders before psychopharmacological agents that are used in patients
diagnosing aggressive behavior. A thorough diagnostic with CD with ADHD and other comorbid disorders.
work up is the most important step in determining the Drugs that may be useful include psychostimulants;
nature of comorbid disorders associated with the atomoxetine (Strattera); antidepressants (imipramine
behavioral problem. Structured interviews and rating [Tofranil], desipramine [Norpramin]); Selective
scales completed by patients, parents, teachers and Serotonin Reuptake Inhibitors (SSRIs); atypical
clinicians may aid the diagnosis and provide antipsychotics such as risperidone (Risperdal); or mood
quantification for the change process related to regulators including lithium (Eskalith).
treatment. The integration of medication, individual
and family counseling, educational and psychosocial Turner M, McCrory P. Child protection in sport. Br J Sports
interventions including the school and community, may Med 2004; 38(2):106-7.
increase the effectiveness of interventions. Due to the
common association of aggression and disruptive Tursz A, Crost M, Gerbouin-Rerolle P. [Child abuse in
behaviors with attention deficit hyperactivity disorder, France: how much, how reliable are the numbers?].
psychostimulants including new generation long-acting Rev Epidemiol Sante Publique 2003; 51(4):439-44.
medications and other nonstimulant medications are
considered the drug of choice for managing aggressive Tursz A, Gerbouin-Rerolle P, Crost M. ["Suspicious deaths"
behavior and disruptive behavior disorders. Severe in infants: national study]. Rev Infirm 2003; (93):27-9.
aggressive behavior not responding to these
medications may require the single or combined use of Twemlow SW, Fonagy P, Sacco FC. A developmental
mood regulators including lithium and/or antispychotic approach to mentalizing communities: I. A model for
medications. Drugs such as risperidone (Risperdal, social change. Bull Menninger Clin 2005; 69(4):265-
Janssen-Cilag) have documented effectiveness and 81.
safety in children and adolescents, and can be used in Abstract: A developmental model is proposed applying
treatment. attachment theory to complex social systems to
promote social change. The idea of mentalizing
Turgay A. Treatment of comorbidity in conduct disorder communities is outlined with a proposal for three
with attention-deficit hyperactivity disorder (ADHD). projects testing the model: ways to reduce bullying and
Essent Psychopharmacol 2005; 6(5):277-90. create a peaceful climate in schools, projects to
Abstract: Conduct disorder (CD) is one of the most promote compassion in cities by a focus of end-of-life
common psychiatric disorders in childhood and care, and a mentalization-based intervention into
adolescence. It is characterized by a variety of chronic parenting style of borderline and substance abusing
antisocial behaviors, a repetitive and persistent pattern parents.
of behavior that violates the basic rights of others,
major age-appropriate societal norms, or both. Twetman S, Petersson L, Axelsson S et al. Caries-preventive
Aggressive behavior, lying, stealing, fire-setting, and effect of sodium fluoride mouthrinses: a systematic
running away from home and school are the most review of controlled clinical trials. Acta Odontol Scand
frequent manifestations of CD and are often 2004; 62(4):223-30.
accompanied by hyperactivity, impulsive behavior,
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![abducted, coerced or persuaded to join armed forces, population may have had little contact with HIV core
often in brutal circumstances. These children are groups in Central America and in the Soconusco and
usually involved in internal conflicts, where poverty no history of blood transfusion or intravenous drug use.
and exclusion leave very few other viable options--
becoming soldiers may appear to be their only means Uscinski RH, Thibault LE, Ommaya AK. Rotational injury.
of survival. Many, however, sustain physical injuries J Neurosurg 2004; 100(3):574-5; author reply 575.
and permanent disabilities as a result of combat and it
is impossible to know how many are killed. A large V Essen H, Schlickewei W, Dietz HG. [Child abuse].
number encounter health problems such as sexually Unfallchirurg 2005; 108(2):92-101.
transmitted diseases, including HIV/AIDS. Lack of Abstract: Child abuse is most often diagnosed by an
data on the health of child soldiers means that emergency doctor on call who sometimes "feels" more
appropriate medical care and treatment may be than knows what he is confronted with. He should
inadequate or inaccessible, even during a planned nevertheless always take a medical history and make a
demobilization. There is an urgent need for systematic physical and radiological examination. X-ray imaging
research and data collection in order to better and an ophthalmologic retinal examination are the most
understand and provide for the healthcare of all important diagnostic steps. Typical findings are
children leaving armed groups. multiple and/or dorsal rib fractures, complex skull
fractures, physeal fractures, all fractures within the first
Uribe-Salas F, Conde-Glez CJ, Juarez-Figueroa L, 12 months, multiple fractures in different localisations
Hernandez-Castellanos A. Sociodemographic and stages of healing, all injuries with uncommon
dynamics and sexually transmitted infections in female distributions, all patterned bruises, immersion burns,
sex workers at the Mexican-Guatemalan border. Sex intramural hematoma and every unexplained loss of
Transm Dis 2003; 30(3):266-71. consciousness. The first step towards victim protection
Abstract: BACKGROUND: If the predominant means is always the removal of the abused child from its
of HIV transmission is heterosexual in the Soconusco caregivers by admitting it to hospital, as 95% of all
region of Mexico, then the female sex workers (FSWs) cases of reported child abuse take place within the
from Central America who work in this region may be child's family.
playing a significant role in the heterosexual
transmission of HIV. GOAL: The goal was to estimate Vain N, Prudent L, Szyld E, Wiswell T. A difficult ethics
the prevalence of several sexually transmitted issue. Lancet 2004; 364(9447):1751; author reply
infections (STIs), including HIV infection, and to 1752.
evaluate the population mobility of Mexican and Notes: GENERAL NOTE: KIE: 5 refs.
Central American FSWs in the Soconusco region in GENERAL NOTE: KIE: KIE Bib: human
Chiapas State, Mexico. METHODS: A cross-sectional experimentation/informed consent
study was conducted upon the construction of a
sampling frame of sex work-related bars in the Valdizan JR, Abril-Villalba B, Mendez-Garcia M et al.
municipalities of the Soconusco region. Consenting [Cognitive evoked potentials in autistic children]. Rev
participants answered a questionnaire that recorded Neurol 2003; 36(5):425-8.
sociodemographic characteristics, previous and current Abstract: AIMS: The aim of this study was to examine
experience in commercial sex, and risk indicators for the latency, amplitude and distribution of N400
STI. Women also provided blood and endocervical potential in order to evaluate the semantic processing
swab specimens to be analyzed. RESULTS: A sample capacity in autistic children and in children suffering
of 484 women were enrolled, who were characterized from Asperger s syndrome (AS), and to compare them
as follows: the average age was 25.6 years, and a high with a control group. PATIENTS AND METHODS:
proportion had children, were single, had started sexual 24 autistic children, six boys with AS and 25 controls,
activity at an early age, and had a low level of aged between 6 and 14 years old. The cases were
education and low earnings. The global prevalences of examined using the DSM IV diagnostic criteria.
infections with Treponema pallidum, HSV-2, HIV, Auditory stimulation was performed with pairs of
Neisseria gonorrhoeae, and Chlamydia trachomatis congruent and incongruent words: two lists of 20 pairs
were 9.4%, 85.7%, 0.6%, 11.6%, and 14.4%, of semantically related words (congruent) and 20 pairs
respectively. Frequencies of HBcAb and HBsAg of words with no semantic relationship whatsoever
hepatitis B markers were 17.7% and 1.3%. The (incongruent). RESULTS: The most striking parameter
cumulative prevalence of treatable gonorrhea, is the increase in latency in N400 for the group of
chlamydia, and syphilis was 27.4%. CONCLUSION: autistic children, which did not occur in the group of
The data on women's mobility illustrate that the children with AS. Maximum N400 negativity for the
Soconusco region attracts Central American women to children with autism was found in the left frontocentral
enter the commercial sex trade. The women's region. No significant differences were observed for
sociodemographic characteristics were consistent with the amplitude of N400 between the three groups that
high prevalences of STI, except HIV infection. The were studied. CONCLUSION: Neurophysiologically,
low frequency of HIV infection suggests that this
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![euthanasia; suicide; terminal care Abstract: In a 4-months-old male infant who had been
Abstract: BACKGROUND: Empirical data about end- discovered in his bed pale, apnoeic and cold,
of-life decision-making practices are scarce. We aimed fundoscopy revealed multiple retinal haemorrhages due
to investigate frequency and characteristics of end-of- to shaken baby syndrome.
life decision-making practices in six European
countries: Belgium, Denmark, Italy, the Netherlands, van der Velden VH, Hochhaus A, Cazzaniga G, Szczepanski
Sweden, and Switzerland. METHODS: In all T, Gabert J, van Dongen JJ. Detection of minimal
participating countries, deaths reported to death residual disease in hematologic malignancies by real-
registries were stratified for cause (apart from in time quantitative PCR: principles, approaches, and
Switzerland), and samples were drawn from every laboratory aspects. Leukemia 2003; 17(6):1013-34.
stratum. Reporting doctors received a mailed Abstract: Detection of minimal residual disease (MRD)
questionnaire about the medical decision-making that has prognostic value in many hematologic
had preceded the death of the patient. The data- malignancies, including acute lymphoblastic leukemia,
collection procedure precluded identification of any of acute myeloid leukemia, chronic myeloid leukemia,
the doctors or patients. All deaths arose between June, non-Hodgkin's lymphoma, and multiple myeloma.
2001, and February, 2002. We weighted data to correct Quantitative MRD data can be obtained with real-time
for stratification and to make results representative for quantitative PCR (RQ-PCR) analysis of
all deaths: results were presented as weighted immunoglobulin and T-cell receptor gene
percentages. FINDINGS: The questionnaire response rearrangements, breakpoint fusion regions of
rate was 75% for the Netherlands, 67% for chromosome aberrations, fusion-gene transcripts,
Switzerland, 62% for Denmark, 61% for Sweden, 59% aberrant genes, or aberrantly expressed genes, their
for Belgium, and 44% for Italy. Total number of deaths application being dependent on the type of disease.
studied was 20480. Death happened suddenly and RQ-PCR analysis can be performed with SYBR Green
unexpectedly in about a third of cases in all countries. I, hydrolysis (TaqMan) probes, or hybridization
The proportion of deaths that were preceded by any (LightCycler) probes, as detection system in several
end-of-life decision ranged between 23% (Italy) and RQ-PCR instruments. Dependent on the type of MRD-
51% (Switzerland). Administration of drugs with the PCR target, different types of oligonucleotides can be
explicit intention of hastening death varied between used for specific detection, such as an allele-specific
countries: about 1% or less in Denmark, Italy, Sweden, oligonucleotide (ASO) probe, an ASO forward primer,
and Switzerland, 1.82% in Belgium, and 3.40% in the an ASO reverse primer, or germline probe and primers.
Netherlands. Large variations were recorded in the To assess the quantity and quality of the RNA/DNA,
extent to which decisions were discussed with patients, one or more control genes must be included. Finally,
relatives, and other caregivers. INTERPRETATION: the interpretation of RQ-PCR MRD data needs
Medical end-of-life decisions frequently precede dying standardized criteria and reporting of MRD data needs
in all participating countries. Patients and relatives are international uniformity. Several European networks
generally involved in decision-making in countries in have now been established and common guidelines for
which the frequency of making these decisions is high. data analysis and for reporting of MRD data are being
developed. These networks also include
van der Kolk BA. The neurobiology of childhood trauma standardization of technology as well as regular quality
and abuse. Child Adolesc Psychiatr Clin N Am 2003; control rounds, both being essential for the introduction
12(2):293-317, ix. of RQ-PCR-based MRD detection in multicenter
Abstract: During the past decade there has been rapid clinical treatment protocols.
progress in the understanding of the effects of exposure
to traumatic life experiences on subsequent van der Walt JH, Sainsbury DA, Pettifer R. Anaesthesia
psychopathology in children. Trauma exposure affects alert: an integrated, networked, register of paediatric
what children anticipate and focus on and how they anaesthetic problems. Anaesth Intensive Care 2001;
organize the way they appraise and process 29(2):113-6.
information. Trauma-induced alterations in threat Abstract: The Paediatric Register of Anaesthetic
perception are expressed in how they think, feel, Problems (PaedRAP) is a network-based anaesthesia
behave, and regulate their biologic systems. The task of hazard alert system. It is integrated with pre-
therapy is to help these children develop a sense of anaesthesia consultations and patient questionnaires.
physical mastery and awareness of who they are and All files, both electronic and on paper, are available 24
what has happened to them to learn to observe what is hours a day close to the operating theatres. This
happening in present time and physically respond to ensures that pertinent information is readily available
current demands instead of recreating the traumatic when and where it is most needed. The PaedRAP is
past behaviorally, emotionally, and biologically. also linked to the automated theatre booking system to
print warnings on the theatre lists. This minimizes the
van der Maesen K, Moll AC, Imhof SM. [Diagnostic image chance that important information goes unnoticed.
(177). A lifeless infant. Shaken baby syndrome]. Ned Documentation of the progression of the various
Tijdschr Geneeskd 2004; 148(8):377. categories of patient problems and evolving
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![management strategies has been useful both for low levels of aggression. Children following the early-
individuals and groups. onset/increasers trajectory showed physical forms of
aggression at baseline. Male gender and comorbid
Van Dorn RA, Mustillo S, Elbogen EB, Dorsey S, Swanson attention deficit/hyperactivity problems, oppositional
JW, Swartz MS. The effects of early sexual abuse on defiant problems and poor prosocial behavior plus
adult risky sexual behaviors among persons with severe negative life events predicted which children would
mental illness. Child Abuse Negl 2005; 29(11):1265- follow the early-onset/increasers trajectory of
79. aggression. The outcomes associated with the early-
Abstract: OBJECTIVE: There were two aims: first, to onset/increaser children suggest high risk for
examine the relationship between prior sexual abuse chronically high levels of aggressive behavior.
and three types of adult risky sexual behaviors [(1) ever
traded sex for drugs or money, (2) had unprotected sex van Loveren C, Ketley CE, Cochran JA, Duckworth RM,
in the past 6 months, and (3) frequency of unprotected O'Mullane DM. Fluoride ingestion from toothpaste:
sex in the past 6 months] among persons with severe fluoride recovered from the toothbrush, the expectorate
mental illness (SMI), and second, to examine the and the after-brush rinses. Community Dent Oral
potential mediating effects of adult rape, substance use, Epidemiol 2004; 32 Suppl 1:54-61.
and PTSD. METHOD: Using a pooled sample of Abstract: OBJECTIVES: The aim of this study was to
individuals with SMI (N=609), logistic and negative determine the effects of rinsing and spitting on fluoride
binomial regression analyses were used to investigate ingestion from toothpaste during normal oral-hygiene
the impact of prior sexual abuse on these adult risky procedures of younger children, and hence to make
sexual behaviors. RESULTS: Childhood sexual abuse recommendations on rinsing during toothbrushing.
was associated with having ever traded sex for money METHODS: The brushing habits of 166 Dutch and 185
and having engaged in unprotected sex in the past 6 Irish children between 1.5 and 3.5 years were observed
months. However, childhood sexual abuse was during home visits. The weight of the toothpaste tube
inversely associated with the number of times males was determined before and after use. After brushing,
had unprotected sex in the past 6 months. Results the toothbrush and any associated expectorate and
differed between males and females and the impact of rinses, combined with any toothpaste spilled during the
potential mediators also varied by gender and type of brushing procedures, were collected. The amounts of
outcome studied. CONCLUSION: These findings fluoride retained on the toothbrush and in the
suggest a complex link between childhood sexual associated expectorate and rinses were measured.
abuse and adult risky sexual behaviors in persons with RESULTS: Over 90% of the Dutch children used a
SMI. Clinical assessments of child abuse sequelae special toddlers' toothpaste with < or =500 ppm F.
should include a variety of indicators and parameters of Eleven per cent of the younger (<2.5 years) Dutch
adult risky sexual behavior, as persons with SMI are at children and 22% of the older children rinsed after
an increased risk of engaging in high-risk sexual brushing. Of the Irish children approximately 52%
behaviors and tend to have a higher exposure to used a children's toothpaste containing around 500 ppm
childhood sexual abuse than does the general F. Of the younger Irish children 31% spat without
population. rinsing, while another 31% rinsed during or after
brushing. For the older Irish children, these percentages
Van Houdenhove B, Egle UT. Comment on Raphael, K.G., were 14 and 70%, respectively. On average, 22% of the
Widom, C.S., Lange, G., Childhood victimization and fluoride dispensed on the toothbrush was retained on
pain in adulthood: a prospective investigation, PAIN the brush after brushing irrespective of the rinsing and
92 (2001) 283-293. Pain 2002; 96(1-2):215-6; author spitting behaviour of the children. The maximum
reply 216-7. ingestible amount of fluoride from toothpaste assuming
no rinsing or spitting was calculated. CONCLUSIONS:
van Lier PA, Crijnen AA. Trajectories of peer-nominated Fluoride ingestion from toothpaste is significantly
aggression: risk status, predictors and outcomes. J reduced by rinsing and/or spitting during
Abnorm Child Psychol 2005; 33(1):99-112. toothbrushing. Recommendations that younger children
Abstract: Developmental trajectories of peer- use small amounts of toothpaste (< 0.5 g) and that
nominated aggression, risk factors at baseline, and children using toothpaste with > or = 1000 ppm F rinse
outcomes were studied. Peer nominations of aggression their mouths after brushing continue to be valid.
were obtained annually from grades 1 to 3. Three
developmental trajectories were identified: an early- van Manen TG, Prins PJ, Emmelkamp PM. Reducing
onset/increasers trajectory with high levels of peer- aggressive behavior in boys with a social cognitive
nominated aggression at elementary school entry and group treatment: results of a randomized, controlled
increasing levels throughout follow-up; a moderate- trial. J Am Acad Child Adolesc Psychiatry 2004;
persistent trajectory of aggression in which children 43(12):1478-87.
were characterized by moderate levels of physical Abstract: OBJECTIVE: To evaluate the effectiveness
aggression at baseline; and a third trajectory with stable of a social cognitive intervention program for Dutch
aggressive boys and to compare it with a social skills
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![training and a waitlist control group. METHOD: A activity of system opetators for indications of visual
randomized, controlled treatment outcome study with workload and scanning efficiency.
97 aggressive boys (aged 9-13 years) was presented.
An 11-session group treatment, a social cognitive Van Reempts PJ, Van Acker KJ. Ethical aspects of
intervention program (n = 42) based on Dodge's social cardiopulmonary resuscitation in premature neonates:
information-processing theory, was compared with where do we stand? Resuscitation 2001; 51(3):225-32.
social skills training (n = 40) and waitlist control group Notes: GENERAL NOTE: KIE: KIE Bib: allowing to
(n = 15). Measures of aggressive behavior, self-control, die/infants; patient care/minors
social cognitive skills, and appropriate social behavior Abstract: Advances in diagnosis, techniques,
were completed before and after the group treatment therapeutic interventions, organisation of perinatal
and at 1-year follow-up. RESULTS: The outcome of care, and socio-economic factors have all contributed
both treatment conditions indicated (1) a significant to the survival after resuscitation and intensive care of
increase in appropriate social behavior, social cognitive neonates with extremely low birth weight and
skills, and self-control and (2) a significant decrease in gestational age. While morbidity during the first years
aggressive behavior. There was a significant difference of life in those infants does not increase, at school age
between treatment and no treatment and between the multiple dysfunctions may become apparent. What are
social cognitive intervention program and social skills the limits of intensive care for the newborn? Is it right
training on various child, parent, and teacher measures. to use extreme technical and economic measures for
CONCLUSIONS: The expectation that focusing on the neonates with a borderline chance of survival? What is
deficits and distortions in social cognitive processes justifiable for the neonate, the family, the society and
(social cognitive intervention program) instead of how does legislation interfere in a decision process
merely focusing on social skills (social skills training) which involves starting, stopping or continuing
would enhance the effectiveness was supported on intensive care? A short historical overview for the care
child, parent, and teacher measures. At 1-year follow- of the newborn is given, followed by the outcome after
up, the mean effect sizes of the social cognitive resuscitation and treatment of the very low birth weight
intervention program and social skills training were infant. Published management strategies and
0.76 and 0.56, respectively. recommendations are discussed.
Van Orden KF, Limbert W, Makeig S, Jung TP. Eye activity van Rossum AM, Oudesluys-Murphy AM. [Diagnostic
correlates of workload during a visuospatial memory image (177). A lifeless infant. Shaken baby syndrome].
task. Hum Factors 2001; 43(1):111-21. Ned Tijdschr Geneeskd 2004; 148(23):1169; author
Abstract: Changes in six measures of eye activity were reply 1169.
assessed as a function of task workload in a target
identification memory task. Eleven participants van Uden CJ, Zwietering PJ, Hobma SO et al. Follow-up
completed four 2-hr blocks of a mock anti-air-warfare care by patient's own general practitioner after contact
task, in which they were required to examine and with out-of-hours care. A descriptive study. BMC Fam
remember target classifications (friend/enemy) for Pract 2005; 6(1):23.
subsequent prosecution (fire upon/allow to pass), while Abstract: BACKGROUND: Little is known about the
targets moved steadily toward two centrally located care process after patients have contacted a GP
ship icons. Target density served as the task workload cooperative for out-of-hours care. The objective of this
variable; between one and nine targets were study was to determine the proportion of patients who
simultaneously present on the display. For each seek follow-up care after contact with a GP cooperative
participant, moving estimates of blink frequency and for out-of-hours care, and to gain insight into factors
duration, fixation frequency and dwell time, saccadic that are related to this follow-up care. METHODS: A
extent, and mean pupil diameter, integrated over total of 2805 patients who contacted a GP cooperative
periods of 10 to 20 s, demonstrated systematic changes for out-of-hours care were sent a questionnaire. They
as a function of target density. Nonlinear regression were asked whether they had attended their own GP
analyses found blink frequency, fixation frequency, within a week after their contact with the cooperative,
and pupil diameter to be the most predictive variables and for what reason. To investigate whether other
relating eye activity to target density. Participant- variables are related to follow-up care, a logistic
specific artificial neural network models, developed regression analysis was applied. Variables that entered
through training on two or three sessions and in this analysis were patient characteristics (age,
subsequently tested on a different session from the gender, etc.) and patient opinion on correctness of
same participant, correlated well with actual target diagnosis, urgency and severity of the medical
density levels (mean R = 0.66). Results indicate that complaint. RESULTS: The response rate was 42%. In
moving mean estimation and artificial neural network total, 48% of the patients received follow-up care from
techniques enable information from multiple eye their own GP. Only 20% were referred or advised to
measures to be combined to produce reliable near-real- attend their own GP. Others attended because their
time indicators of workload in some visuospatial tasks. medical condition worsened or because they were
Potential applications include the monitoring of visual
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![other factors. study examined parenting practices in 2-parent families
of Mexican, MD, and Caucasian-non-Hispanic (CNH)
Vane DW, Sartorelli KH, Reese J. Emotional considerations parents. Parents in all groups reported using
and attending involvement ameliorates organ donation authoritative practices more often than authoritarian
in brain dead pediatric trauma victims. J Trauma 2001; strategies. MD parents reported greater use of
51(2):329-31. authoritarian practices than Mexican and CNH parents.
Abstract: PURPOSE: The purpose of this study was to Results suggest that previously found cultural
ascertain a strategy for maximizing parental consent for variations in parenting between MD parents and CNH
organ donation in traumatically injured children parents may be more related to the ecological context
suffering from brain death. Our hypothesis was that of MD families than to an affiliation with Mexican
appropriate attending surgeon involvement and delay culture. Clinicians should explore the positive qualities
in evaluating children for brain death leads to an of authoritative parenting in MD families along with
increased percentage of organ donors. METHODS: the potential motivations for using authoritarian
From January 1993 to August 1999, the records of all strategies.
children who died in a Level I trauma center were
evaluated. Those children suffering brain death that Varns JL, Mulik JD, Sather ME, Glen G, Smith L, Stallings
were suitable for organ donation were entered into the C. Passive ozone network of Dallas: a modeling
study. Cases were reviewed for patient demographics, opportunity with community involvement. 1. Environ
time to entry into brain death protocol (measured from Sci Technol 2001; 35(5):845-55.
time of admission), time to parent notification about Abstract: Despite tremendous efforts toward regulating
brain death (measured from time of admission), and controlling tropospheric ozone (O3) formation, a
specific attending involved in the case (with level of large portion of the U.S. population presently lives in
involvement), and success of organ donation request. environments where air quality exceeds both 1- and 8-h
In all, 43 charts were reviewed. RESULTS: Of 43 National Ambient Air Quality Standards (NAAQS) set
deaths, 33 were deemed suitable for donation. Age of for O3. High O3 concentrations annually cost the
suitable donors ranged from 1 month to 18 years. In all, United States billions of dollars in excessive human
11 attending physicians were involved in the care of health costs, reduced crop yields, and ecological
these children. Overall, 20 of 33 were organ donors damage. This paper describes a regional networking of
(60%). When the attending surgeon was involved, O3 monitoring sites, operated by the public, that used
donation success for organ retrieval was 86%, whereas simplified passive sampling devices (PSDs). In
if the attending was not involved personally, the collaboration with EPA Region 6, a lay network (i.e.,
success rate dropped to 23% (p < 0.04). One senior Passive Ozone Network of Dallas, acronym POND),
pediatric surgeon obtained a success rate of 12 of 12 consisting of 30 PSD sites in the Dallas-Fort Worth
children. It was this surgeon's policy to not initiate (DFW) Metroplex, a region representing 16 counties,
brain death protocols in children immediately on entry successfully measured daily ozone during 8 weeks of
into the emergency room, but rather to delay initiation the 1998 high ozone season. It was demonstrated that
until family could be gathered and spend time with the the concerned public, when properly trained, could
affected child in order that the family could recover successfully operate a large PSD network that requires
from the initial shock of trauma (always at least daily sample handling and weekly mailing procedures,
overnight). When time to initiation of brain death even from remote sites. Data treatment of the 2880
protocol was examined, success was obtained when a POND measurements included (i) high correlations
delay of 15.5 hours was respected, versus 7.0 hours with collocated continuous monitoring data [r range =
when donation was requested but denied (p < 0.03). 0.95-0.97], (ii) daily O3 contour mapping of the 24,000
CONCLUSION: These data indicate that attending km2 area, and (iii) a ranking of O3 severity in 12 peri-
involvement is important when parents of brain dead urban counties for guidance in sitting additional
children are asked about organ retrieval (p < 0.04). monitors. With a new 8-h NAAQS standard now in
Delay in initiating brain death protocols in order for place, a cost-effective network such as POND could
family members to deal with the shock of the initial aid regional airshed models in generating meaningful
trauma appears to increase willingness to participate in guidance for O3 state implementation plans (SIPs) by
organ donation. providing input that is representative of both rural and
urban sites.
Varela RE, Vernberg EM, Sanchez-Sosa JJ, Riveros A,
Mitchell M, Mashunkashey J. Parenting style of Vassal G, Mery-Mignard D, Caulin C. Clinical trials in
Mexican, Mexican American, and Caucasian-non- paediatric oncology. Recommendations for the
Hispanic families: social context and cultural development of new anticancer agents. Therapie 2003;
influences. J Fam Psychol 2004; 18(4):651-7. 58(3):229-46.
Abstract: To begin accounting for cultural and Abstract: Childhood and adolescent cancers are rare
contextual factors related to child rearing in Mexican- diseases. Despite the progress in treatment (more than
descent (MD; Mexican American and Mexican two-thirds of all cases are cured), cancer remains the
immigrant) families in the United States, the current leading cause of death by disease in children older than
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![non-supportive or even dangerous. This essay is a significantly related to the crude mortality rate but
reflection on some accomplishments of the Minnesota were not significantly related to the age-standardized
study as these have helped shape how developmental mortality rate. Two of the inequality measures were
scientists think about social and emotional related to mortality rates for males aged 0-44 and for
development and more generally about how theory has males aged 45-64 before but not after controlling for
guided the conceptual, empirical, and measurement mean household income. DISCUSSION: Health
plans for the study from its beginning. researchers have yet to report a meaningful relationship
between income inequality and population health
Vaught W, Fleetwood J. Covert video surveillance in within Canada. At the risk of committing the ecological
pediatric care. Hastings Cent Rep 2002; 32(6):10-1; fallacy, these findings provisionally support a psycho-
discussion 11-2. social interpretation of the individual-level relationship
Notes: GENERAL NOTE: KIE: KIE Bib: patient between income and health wherein members of these
care/minors communities compare themselves to an encompassing
community, e.g., all Canadians.
Veenema TG, Schroeder-Bruce K. The aftermath of
violence: children, disaster, and posttraumatic stress Vega J, Bedregal P, Jadue L, Delgado I. [Gender inequity in
disorder. J Pediatr Health Care 2002; 16(5):235-44. the access to health care in Chile]. Rev Med Chil 2003;
Abstract: Terrorist attacks, situations of armed conflict, 131(6):669-78.
and all forms of catastrophe tax our abilities to cope, Abstract: BACKGROUND: In the last two decades,
understand, and respond. Because of their Chile has experienced advances in economical
developmental status, children are even more development and global health indicators. However,
emotionally vulnerable to the devastating effects of a gender inequities persist in particular related to access
disaster. When tragedy strikes a family, community, or to health services and financing of health insurance.
the nation, helping children cope and regain a sense of AIM: To examine gender inequities in the access to
safety is critical. A child with posttraumatic stress health care in Chile. MATERIAL AND METHODS:
disorder (PTSD) develops symptoms such as intense An analysis of data obtained from a serial national
fear, disorganized and agitated behavior, emotional survey applied to assess social policies (CASEN)
numbness, anxiety, or depression after being directly carried out by the Ministry of Planning. During the
exposed to or witnessing an extreme traumatic situation survey 45,379 and 48,107 dwellings were interviewed
involving threatened death or serious injury. Victims of in 1994 and in 1998, respectively. RESULTS: Women
repeated abuse or children who live in violent use health services 1.5 times more often, their salaries
neighborhoods or war zones, or who have witnessed are 30% lower in all socioeconomic strata. Besides, in
extensive media coverage of violent events, may the private health sector, women pay higher insurance
experience PTSD. premiums than men. Men of less than two years of age
have 2.5 times more preventive consultations than
Veenstra G. Income inequality and health. Coastal girls. This difference, although of lesser magnitude, is
communities in British Columbia, Canada. Can J also observed in people over 60 years. Women of high
Public Health 2002; 93(5):374-9. income quintiles and users of private health insurance
Abstract: OBJECTIVE: An imbalance in the have a better access to preventive consultations but not
distribution of economic resources, i.e., income to specialized care. CONCLUSIONS: An improvement
inequality, is a characteristic of a community that may in equitable access of women to health care and
influence the aggregate health of the population. In financing is recommended. Also, monitoring systems
North America, income inequality seems to be strongly to survey these indicators for women should improve
related to mortality rates among American their efficiency.
communities such as states and metropolitan areas but
largely irrelevant for health at similar levels of Vehmas S. Just ignore it? Parents and genetic information.
geopolitical aggregation in Canada. This article Theor Med Bioeth 2001; 22(5):473-84.
summarizes relevant international and North American Notes: GENERAL NOTE: KIE: Vehmas, Simo
evidence and then explores relationships between GENERAL NOTE: KIE: KIE Bib: genetic counseling;
income inequality and mortality rates among coastal genetic screening
communities in the province of British Columbia, Abstract: This paper discusses whether prospective
Canada. METHODS: Cross-sectional analysis was parents ought to find out about their genetic
conducted among twenty-four coastal communities in constitution for reproductive reasons. It is argued that
British Columbia, utilizing four measures based on the ignoring genetic information can be in line with
1996 Census to measure income inequality and crude, responsible parenthood or perhaps even
age-standardized and age- and gender-specific recommendable. This is because parenthood is
mortality rates averaged over the five-year period essentially an unconditional project in which parents
1994-98 to measure health. RESULTS: The three valid ought to commit themselves to nurturing any kind of
measures of income inequality were positively and child. Besides, the traditional reasons offered for the
unfortunateness of impairments and the tragic fate of
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![surfaces and to compare access to a safe crib, and the expression of FasL in Hodgkin lymphoma (HL) on
space available for it, in the sleeping rooms of both protein and RNA level, while considering the Epstein-
groups of infants. METHODS: Home visits were made Barr virus status of the Hodgkin and Reed-Sternberg
at approximately age 2 weeks to the homes of serially (HRS) cells. Tumor tissue from 47 patients with classic
enrolled African American infants born between July HL (32 nodular sclerosis [NS], 11 mixed cellularity
15, 2001, and November 1, 2001. Questionnaires were [MC], and 4 lymphocyte-rich [LR]) was analyzed by
used to survey sleep practices, especially sleep surface immunohistochemistry for FasL, Fas, CD21, and CD23
used. The area of the floor space of rooms used for and by Western blotting for FasL. FasL mRNA was
sleeping was calculated. A portable crib was provided detected by an exon 4-specific oligonucleotide and
for infants lacking access to safe sleep surfaces. Epstein-Barr virus infection by in situ hybridization for
RESULTS: Of these infants, 42 (41%) usually bed Epstein-Barr virus early RNAs (EBER). Western
shared and 60 (59%) slept alone. The areas of the floor blotting showed soluble and membrane-bound forms of
spaces were similar (mean +/- SD, 13.8 +/- 3.3 m(2) for FasL. Immunohistochemistry showed FasL expression
bed sharers vs 12.7 +/- 3.7 m(2) for those who slept in virtually all HRS of 94% of NS cases and 82% of
alone; 95% CI for difference, -0.34 to 2.51 m(2)). MC cases. FasL expression did not correlate with the
Infants sleeping alone were much more likely to have Epstein-Barr virus status of the HRS. Low FasL protein
access to a safe crib (51 of 60 vs 13 of 42; P<.001), and expression was found in some HRS of LR cases. FasL
53 cribs were provided. Follow-up telephone calls mRNA was detected in 39% of NS, 46% of MC, and
made at approximately age 7 months to 43.4% of 33% of LR cases. Seventy percent to 90% of the HRS
recipients suggested that the cribs were used on most cells expressed Fas. CD21 immunohistochemistry
nights, were durable, and were enthusiastically showed disrupted FDC networks in the tumor tissue
received. CONCLUSIONS: Crowding is not a strong with reduced and virtually absent expression of CD23
explanation for bed sharing among impoverished and FasL. These observations suggest that FasL
African American infants in St Louis, Mo, who often expression in HRS cells and the absence of FasL in the
bed share because there is not a safe crib available. FDC cluster represent a disturbed microenvironment
Providing safe cribs may reduce the prevalence of bed that may be involved in the pathogenesis of HL.
sharing.
Verburg G, Borthwick B, Bennett B, Rumney P. Online
Ventura DE, Herbella FA, Schettini ST, Delmonte C. support to facilitate the reintegration of students with
Rapunzel syndrome with a fatal outcome in a neglected brain injury: trials and errors. NeuroRehabilitation
child. J Pediatr Surg 2005; 40(10):1665-7. 2003; 18(2):113-23.
Abstract: The "Rapunzel" syndrome (a trichobezoar Abstract: The reintegration of students after
with a long tail extending from the stomach to the acquired/traumatic brain injury (ABI/TBI) continues to
small bowel) is an uncommon disease. It is related to be fraught with difficulties. Presented are (1) case
severe complications but rarely associates to a fatal studies exploring the potential of online support for
outcome. We report a case of a 5-year-old girl admitted teachers of students with ABI after returning from a
at the emergency department in cardiorespiratory arrest paediatric rehabilitation centre; (2) results of Internet-
whose autopsy disclosed an ileal perforation that is based courses about reintegrating students with ABI;
caused by a long bezoar extending from the stomach to (3) outcomes of videoconferencing-based and Internet
the small bowel. The authors discuss a possible link email-based support; (4) development of an online
between Rapunzel syndrome and child neglect. support process that uses Questions and Answers as a
quick and immediate resource for teachers. The authors
Ventura-Junca P. A commentary on the Consensus recommend that a collaborative process be instituted,
Statement of the Working Group on Roman Catholic in order to generate a relatively small number of high
Approaches to Determining Appropriate Critical Care. quality online resources about re-integrating students
Christ Bioeth 2001; 7(2):271-89. into their school and community. A second
Notes: GENERAL NOTE: KIE: Ventura-Junca, recommendation focuses on the development of online
Patricio support network which may be text or email based or
GENERAL NOTE: KIE: 28 refs. which may use videoconferencing over the Internet.
GENERAL NOTE: KIE: KIE Bib: patient care; Such networks allow students with ABI to maintain
resource allocation/biomedical technologies contact with their family and friends in the home
community and facilitate their reintegration. An
Verbeke CS, Wenthe U, Grobholz R, Zentgraf H. Fas ligand Internet-based support structure also allows
expression in Hodgkin lymphoma. Am J Surg Pathol professionals to provide consultation, collaboration and
2001; 25(3):388-94. continuing input.
Abstract: Because previous investigations suggested
involvement of the Fas ligand (FasL) in the selection Vereecken CA, Keukelier E, Maes L. Influence of mother's
process in the follicular dendritic cell (FDC)-associated educational level on food parenting practices and food
cell cluster of the germinal center, we investigated the habits of young children. Appetite 2004; 43(1):93-103.
Abstract: The main purpose of the present study is to
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![associated with negative outcomes of children in the adolescence and young adult life, that have been shown
area of nonverbal intelligence but even more so in to be effective in improving many outcomes in
verbal intelligence, behavior and overall development, health and well-being. Much remains to
dysmorphology (physical anomalies). Significantly be done to enable the promise of effective universal
more FAS exists among children of women who were and targeted early intervention to be translated into
rural residents (odds ratio: 7.36, 95% confidence policies, programs and practices that could be life-
interval: 3.31-16.52), usually among workers on local changing for citizens bogged in the mire of substance
farms. CONCLUSION: A high rate of FAS was misuse and their children. Realistic, timely investment,
documented in this community. Given social and influenced by the best scientific evidence indicating
economic similarities and racial admixture, we suspect what works, for whom, under what circumstances, an
that other communities in the Western Cape have rates increased degree of collaboration within and between
that also are quite high. governments and their agencies to enable "whole of
government" responses in partnership with community-
Villarreal LR. California's Healthy Start: A solid platform based initiatives are essential along with investments in
for promoting youth development. New Dir Youth Dev multidisciplinary program evaluation research that will
2005; (107):89-97, table of contents. enable evidence-informed policy decisions to be
Abstract: A school in Los Angeles County reports tailored to the needs of individual countries.
absences down by 30 percent and disciplinary actions
down by 10 percent. A town near Fresno reports Vinchon M, Defoort-Dhellemmes S, Noule N, Duhem R,
having 99 percent of their new kindergartners ready to Dhellemmes P. [Accidental or non-accidental brain
start school on the first day of class because their injury in infants. Prospective study of 88 cases]. Presse
immunization and school readiness outreach was so Med 2004; 33(17):1174-9.
thorough. A school in San Diego reports youth tobacco Abstract: OBJECTIVE: To study the epidemiology of
use down from 15 percent to 3 percent, absences down head injury (HI) in infants, the factors favouring the
by 10 percent, and detentions down by over 50 percent. occurrence of a subdural haematoma (SDH), the
Schools in Humboldt report a 30 percent improvement prevalence of retinal haemorrhages (RH) and the
in math scores and a 40 percent improvement in prognostic factors, by comparing the non-accidental
reading scores. Young adults report that the assistance (NAHI) and accidental (AHI) head injuries. RH, in
they received as teens through their school's Healthy particular, are of fundamental value in the diagnosis of
Start program saved their lives and enabled them to be NAHI but, in the absence of systematic studies, their
successful parents today. These are results from one of sensitivity and specificity for the diagnosis of the
California's most successful education mandates- NAHI have rarely been assessed. METHOD: We
SB620 1991-California's Healthy Start. prospectively collected the clinical, ophthalmologic
and radiological data of HI occurring in children under
Vimpani G. Getting the mix right: family, community and 24 months old, notably by distinguishing essential
social policy interventions to improve outcomes for macrocrania and symptomatic macrocrania of an SDH,
young people at risk of substance misuse. Drug by classifying the HI according to its severity.
Alcohol Rev 2005; 24(2):111-25. RESULTS: We observed 88 cases over a period of 22
Abstract: Societal responses to the existence of months. It 28 cases it was NAHI and in the 60 others,
substance misuse fluctuate between harm minimisation AHI. The SDH was often correlated with the presence
and prohibition. Both approaches are predominantly of retinal haemorrhages and the absence of signs of
downstream reactions to substance misuse that focus cranial impact, but not with child abuse or with
on the supply of harmful substances and the essential macrocrania. The RH were of great
containment of misuse through treatment, rehabilitation importance in the diagnosis of NAHI; however, non-
or punishment. Until recently, little attention has been severe RH was noted in 4 cases of AHI. The
paid to the upstream individual, family, relationship, neurological prognosis was essentially correlated with
community or societal antecedents of substance misuse the initial clinical severity. CONCLUSION: Although
(which often overlap with those for other adverse life only representing 33% of cases, child abuse was
outcomes, such as unemployment, antisocial responsible for 2/3 of the deaths and for the totality of
personality disorder and mental health problems) that the severe morbidity in our series. The infants
have operated during earlier life. A growing body of exhibiting perinatal problems represented an important
evidence highlights the overlapping biological and group at risk of abuse, which justified their regular
experiential antecedents for substance abuse and other medical-social follow-up.
poor outcomes as well as the trajectory-changing
protective factors that can prevent risks being Vinter A, Perruchet P. Implicit motor learning through
translated into destiny. Risk minimisation and observational training in adults and children. Mem
protection enhancement embedded in family and social Cognit 2002; 30(2):256-61.
systems are the essential building blocks of a set of Abstract: Although evidence of implicit motor learning
early intervention strategies that begin antenatally and on the basis of observation alone has been reported,
continue through the developing years of childhood, there is some data to suggest that the phenomenon
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![PTSD, more preventive measures should be directed smaller sample size, user-friendliness, robustness, and
towards them. The same is true for trauma victims (of speed. Expert knowledge for spectral interpretation is
both sexes) who feel that their life was in danger minimized by the combination of a library search and
ANN prediction, but visual inspection remains
Vogler SD, Davidson AJ, Crane LA, Steiner JF, Brown JM. necessary.
Can paraprofessional home visitation enhance early
intervention service delivery? J Dev Behav Pediatr von Salis T. ["Violence and psychotherapy": what transfers?
2002; 23(4):208-16. Some experiences in private practice]. Rev Med Suisse
Abstract: A 1-year randomized trial compared Romande 2001; 121(7):517-20.
intensive case management (ICM) versus basic case
management (BCM) in facilitating early intervention Vora A, Makris M. Personal practice: An approach to
(EI) service use among children in an urban health investigation of easy bruising. Arch Dis Child 2001;
system. Of 159 participating families with delayed or 84(6):488-91.
at-risk preschool-aged children, 88 received ICM from
paraprofessionals versus 71 families who received less Vostanis P. Patients as parents and young people
comprehensive BCM from a nurse. In the ICM versus approaching adulthood: how should we manage the
BCM group, a shorter interval to assessment (98 vs 140 interface between mental health services for young
d, p =.05) but similar assessment rate (86% vs 80%, p people and adults? Curr Opin Psychiatry 2005;
=.29) was observed. The ICM group had more services 18(4):449-54.
recommended per child (1.64 vs 1.16, p < .004) and Abstract: PURPOSE OF REVIEW: The present review
initiated (1.20 vs 0.85, p < .04). There was no discusses critically recent research findings (published
difference in median time to EI program initiation for during the period 2003-2004) on the mental health
ICM versus BCM (228 vs 200 d, p = .88) or initiation needs of young people in transition (old adolescents
and visit compliance rate for EI services. Specific and young adults), including those of young parents.
efforts to improve outcomes (e.g., decrease initiation Also, the evidence on effective interventions and
time and increase use of EI services) are still needed. service models is considered. RECENT FINDINGS:
Emerging evidence indicates that young people have
Volmer M, de Vries JC, Goldschmidt HM. Infrared analysis high rates of mental health needs (in addition to high
of urinary calculi by a single reflection accessory and a prevalence of psychiatric disorders) that may be related
neural network interpretation algorithm. Clin Chem to life transitions. These needs often fall between the
2001; 47(7):1287-96. remit of adolescent/adult and mental health/social care
Abstract: BACKGROUND: Preparation of KBr tablets, services, and therefore are not adequately met. With
used for Fourier transform infrared (FT-IR) analysis of the exception of mental health interventions for early
urinary calculus composition, is time-consuming and psychosis and psychosocial programmes for teenage
often hampered by pellet breakage. We developed a parents, there is very limited knowledge on how best to
new FT-IR method for urinary calculus analysis. This meet the mental health needs of young people in
method makes use of a Golden Gate Single Reflection transition. SUMMARY: It is widely recognized that
Diamond Attenuated Total Reflection sample holder, a young people in transition require services and
computer library, and an artificial neural network interventions tailored to their characteristics, rather
(ANN) for spectral interpretation. METHODS: The than a mere extension to either child/adolescent or
library was prepared from 25 pure components and 236 adult services. Recent policies and research findings
binary and ternary mixtures of the 8 most commonly have led to the development of early psychosis
occurring components. The ANN was trained and interventions, with initial encouraging messages.
validated with 248 similar mixtures and tested with 92 Similar initiatives are required for young people with
patient samples, respectively. RESULTS: The optimum nonpsychotic disorders.
ANN model yielded root mean square errors of 1.5%
and 2.3% for the training and validation sets, Votruba-Drzal E, Coley RL, Chase-Lansdale PL. Child care
respectively. Fourteen simple expert rules were added and low-income children's development: direct and
to correct systematic network inaccuracies. Results of moderated effects. Child Dev 2004; 75(1):296-312.
92 consecutive patient samples were compared with Abstract: A large literature has documented the
those of a FT-IR method with KBr tablets, based on an influence of child care on young children's
initial computerized library search followed by visual development, but few studies have examined low-
inspection. The bias was significantly different from income children in community care arrangements.
zero for brushite (-0.8%) and the concomitantly Using data from Welfare, Children, and Families: A
occurring whewellite (-2.8%) and weddellite (3.8%), Three-City Study (N = 204), this study examined the
but not for ammonium hydrogen urate (-0.1%), influence of child care quality and the extent of care on
carbonate apatite (0.5%), cystine (0.0%), struvite low-income children's (ages 2-4 years) cognitive and
(0.4%), and uric acid (-0.1%). The 95% level of socioemotional development over time. Higher levels
agreement of all results was 9%. CONCLUSIONS: of child care quality were modestly associated with
The new Golden Gate method is superior because of its
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![Abstract: The epidemiology of tuberculosis is changing can be so striking, another element may need to be
in the United States as a result of immigration, yet the incorporated into risk characterization: a process of
extent to which different classes of immigrants ethics assessment. A scheme for doing so can be
contribute to overall morbidity is unknown. derived from the procedures of fuzzy logic, which
Tuberculosis in nonimmigrant visitors is of particular allow rules to be formulated that are applicable to
interest as they are currently exempt from screening ethical principles. Such an approach incorporates some
requirements. We conducted a prospective survey of all of the tenets of the precautionary principle.
culture-positive tuberculosis patients in Tarrant
County, Texas from 1/98 to 12/00. Immigration status Weiss HB, Little PM, Bouffard SM. More than just being
of foreign-born patients was classified as permanent there: balancing the participation equation. New Dir
residents, undocumented, or nonimmigrant visitors. Of Youth Dev 2005; (105):15-31, 9-10.
274 eligible participants, 114 (42%) were foreign-born; Abstract: The research and evaluation evidence is
of these, 67 (59%) were permanent residents, 28 (25%) mounting: out-of-school-time (OST) programs can
were undocumented, and 19 (17%) were nonimmigrant keep young people safe, support working families, and
visitors. Among the foreign-born, we observed improve academic achievement and social
significant differences by immigration status in development. Over 6 million children are enrolled in
multidrug resistance (p = 0.02), human after-school programs nationwide, but an estimated
immunodeficiency virus (HIV) infection (p = 0.0007), 14.3 million children still care for themselves in the
and hospitalization (p = 0.03 for ever/never, 0.01 for nonschool hours. Because of this discrepancy, OST
duration). Compared with other immigrants, more stakeholders need information about how to maximize
nonimmigrant visitors were multi-drug-resistant (16 % participation in OST programs. The Harvard Family
versus 11% of undocumented residents and 1% of Research Project (HRFP) has developed a conceptual
permanent residents), were HIV-positive (32% versus model, based on scholarly theory, empirical research,
0% of undocumented and 5% of permanent residents), and knowledge gained from providers, that describes
were hospitalized (47% versus 36% of undocumented the characteristics that predict participation in OST
and 19% of permanent residents), and had lengthy programs as well as the potential benefits of that
hospitalizations (median [midspread] days = 87 [25 to participation. In the center of the model, participation
153] versus 8.5 [4 to 28] for undocumented and 10 [7 is conceived as a three-part construct of enrollment,
to 24 d] for permanent residents). We found attendance, and engagement. This equation serves as
nonimmigrant visitors to be an important source of the basis for framing this issue of New Directions for
tuberculosis morbidity in Tarrant County. Further Youth Development. The chapter provides an overview
studies in other regions of the U.S. are needed to of why participation in OST programs matters for
determine if screening and treatment recommendations young people, describes some of the barriers and
of persons who spend extended periods in the U.S. challenges to youth participation, teases out more
should be raised to the standards set for permanent precise definitions of participation, and presents
residents. HFRP's conceptual model of participation. It focuses
on the participation equation and concludes by
Weiss B. Ethics assessment as an adjunct to risk assessment highlighting some overarching themes that recur
in the evaluation of developmental neurotoxicants. throughout the issue and that have an impact on future
Environ Health Perspect 2001; 109 Suppl 6:905-8. directions for research and evaluation.
Abstract: The conduct of experimental studies in
humans is governed by a body of principles whose Weiss K. Authority as coercion:when authority figures abuse
main precepts have evolved over the past few decades. their positions to perpetrate child sexual abuse. J Child
Three of these provide the foundations for judging the Sex Abus 2002; 11(1):27-51.
ethical adequacy of such an experiment. One addresses Abstract: ABSTRACT. This article discusses child
the question of who receives the benefits of the sexual abuse by a person in a position of authority,
research and who bears its burdens (justice). A second such as the child's teacher, guardian, relative, sports
requires that the research maximize the potential coach, or other person with authority over a child
benefits to the subjects and minimize the risk of harm because of his/her particular position. The article tracks
(beneficence). The third, the source of guidelines for the recent trend toward recognizing position of
informed consent, requires that subjects enter into the authority in both state legislation and judicial
research voluntarily and with adequate information precedent. Understanding the confusion and
(respect for persons). Unlike research conducted to intimidation surrounding a child's experiences as a
evaluate drugs, however, environmental exposures to result of being sexually abused by a person in a
potentially toxic chemicals do not survey those position of authority often explains why children often
exposed for their consent, nor do they provide an fail to report or delay in reporting such abuse. Thus,
appropriate calculus for measuring risks and benefits, existence of a perpetrator's position of authority in a
which typically involve two different populations. particular case of child sexual abuse should influence a
Especially for exposure to developmental court's rulings on the elements of sexual abuse or
neurotoxicants, where the risk-benefit incompatibility assault in particular state statutes, as well as what
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![until school age, when more boys than girls cease the the use of pulsed-field gel electrophoresis (PFGE).
practice. This is an important finding, because much of RESULTS: From 1 October 2001 through 24 March
the literature suggests that this practice exists primarily 2002, an estimated excess of 439 S. Oranienburg
for infants in non-Western cultures who co-sleep with notifications was registered in Germany.
their mothers. Co-sleeping in Sweden is perceived as a Simultaneously, an increase in S. Oranienburg
normal family activity, which differed from the other infections was noted in other European countries in the
societies studied. Thus, the study of practice has Enter-net surveillance network. In a multistate matched
important methodological implications. When a family case-control study in Germany, daily consumption of
practice is studied, carefully documented and chocolate (matched odds ratio [MOR]: 4.8; 95%
understood in its many dimensions, it provides a confidence interval [CI]: 1.3-26.5), having shopped at a
window into the culture in which the practice is large chain of discount grocery stores (MOR: 4.2; CI:
embedded and may explain how gender relates to the 1.2-23.0), and consumption of chocolate purchased
practice. For health-care professionals who encounter there (MOR: 5.0; CI: 1.1-47.0) were associated with
families from diverse cultural backgrounds, this illness. Subsequently, two brands from the same
methodological approach illustrates how parenting company, one exclusively produced for that chain,
practices relate to health-care issues. tested positive for S. Oranienburg. In two other
European countries and in Canada chocolate from
Welsh JP, Ahn ES, Placantonakis DG. Is autism due to brain company A was ascertained that also contained S.
desynchronization? Int J Dev Neurosci 2005; 23(2- Oranienburg. Isolates from humans and from
3):253-63. chocolates had indistinguishable PFGE profiles. No
Abstract: The hypothesis is presented that a disruption source or point of contamination was identified.
in brain synchronization contributes to autism by Epidemiological identification of chocolate as a vehicle
destroying the coherence of brain rhythms and slowing of infections required two months, and was facilitated
overall cognitive processing speed. Particular focus is by proxy measures. CONCLUSIONS: Despite the use
on the inferior olive, a precerebellar structure that is of improved production technologies, the chocolate
reliably disrupted in autism and which normally industry continues to carry a small risk of
generates a coherent 5-13 Hz rhythmic output. New manufacturing Salmonella-containing products.
electrophysiological data reveal that the continuity of Particularly in diffuse outbreak-settings, clear
the rhythmical oscillation in membrane potential associations with surrogates of exposure should suffice
generated by inferior olive neurons requires the to trigger public health action. Networks such as Enter-
formation of neuronal assemblies by the connexin36 net have become invaluable for facilitating rapid and
protein that mediates electrical synapses and promotes appropriate management of international outbreaks.
neuronal synchrony. An experiment with classical
eyeblink conditioning is presented to demonstrate that Werneck GL, Rodrigues L, Santos MV et al. The burden of
the inferior olive is necessary to learn about sequences Leishmania chagasi infection during an urban outbreak
of stimuli presented at intervals in the range of 250-500 of visceral leishmaniasis in Brazil. Acta Trop 2002;
ms, but not at 700 ms, revealing that a disruption of the 83(1):13-8.
inferior olive slows stimulus processing speed on the Abstract: First noted in the city of Teresina in 1981, the
time scale that is lost in autistic children. A model is last decades have witnessed a remarkable increase in
presented in which the voltage oscillation generated by urban transmission of American visceral leishmaniasis
populations of electrically synchronized inferior (VL) in many Brazilian cities. Teresina, the site of this
olivary neurons permits the utilization of sequences of study, has faced two large outbreaks of VL. The first
stimuli given at, or faster than, 2 per second. It is occurred from 1981-1985 when almost 1000 new cases
expected that the disturbance in inferior olive structure were reported. The second started in the 1990s, and
in autism disrupts the ability of inferior olive neurons between 1993 and 1996 more than 1200 new cases
to become electrically synchronized and to generate were detected. This report describes the prevalence of
coherent rhythmic output, thereby impairing the ability infection with Leishmania chagasi in Teresina at the
to use rapid sequences of cues for the development of end of the second outbreak and gives estimates of the
normal language skill. Future directions to test the number of people who became infected during the
hypothesis are presented. epidemic. Between June 1995 and May 1996, 200
households were chosen at random from a list of
Werber D, Dreesman J, Feil F et al. International outbreak of addresses covering about 93% of Teresina's urban
Salmonella Oranienburg due to German chocolate. households. In each household, one person over the age
BMC Infect Dis 2005; 5(1):7. of 1 year was screened for Leishmania antibodies and
Abstract: BACKGROUND: This report describes a skin-tested. Nearly 50% of persons had a positive
large international chocolate-associated Salmonella leishmanin reaction, but only 13.9% had detectable
outbreak originating from Germany. METHODS: We antibodies to L. chagasi. While prevalence estimates
conducted epidemiologic investigations including a based on the leishmanin skin-test increased with age
case-control study, and food safety investigations. (P<0.001), those based on serological tests showed a
Salmonella (S.) Oranienburg isolates were subtyped by lesser, and non significant, variation with age (P=0.31).
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![There is considerable evidence from animal studies that carried out that yielded three components of infidelity:
posthypoxic mild hypothermia reduces brain injury. sexual infidelity, emotional infidelity, and
One small randomized trial of mild hypothermia found pornography. More importantly, this study revealed
no adverse effects but was too small to examine death that online acts of betrayal do not fall into a discrete
or disability. One large randomized trial of selective category of their own. A MANOVA was performed
head cooling has finished recruitment and a number of and revealed a statistically significant difference on the
large trials of systemic mild hypothermia are ongoing. combined dependent variables for the interaction of
As time is critical with post-hypoxic interventions, the gender by age, age by relationship status, and Internet
delay involved in obtaining informed parental consent sexual experience. The hypotheses were, in part,
for such trials might obscure a clinically important supported. However, counter to what was predicted, in
therapeutic effect. the main younger people were more likely to rate
sexual acts as acts of betrayal than older individuals. It
Whitfield A. The conjoined twins. Transcript of the speeches is concluded here that individuals do perceive some
given at the BAFS annual dinner on 28 February 2002. online interactions to be acts of betrayal. In contrast to
British Academy of Forensic Sciences. Med Sci Law some researchers' claims, it is suggested here that we
2002; 42(4):277-80. do need to consider how bodies are reconstructed
online. Moreover, these results have important
Whitfield CL, Dube SR, Felitti VJ, Anda RF. Adverse implications for any treatment rationale for infidelity
childhood experiences and hallucinations. Child Abuse (both online and offline).
Negl 2005; 29(7):797-810.
Abstract: OBJECTIVE: Little information is available Wicks E. The greater good?: issues of proportionality and
about the contribution of multiple adverse childhood democracy in the doctrine of necessity as applied in Re
experiences (ACEs) to the likelihood of reporting A. Common Law World Rev 2003; 32(1):15-34.
hallucinations. We used data from the ACE study to Notes: GENERAL NOTE: KIE: 70 fn.
assess this relationship. METHODS: We conducted a GENERAL NOTE: KIE: KIE Bib: patient care/minors
survey about childhood abuse and household Abstract: This article examines the criminal law
dysfunction while growing up, with questions about doctrine of necessity as applied in the conjoined twins
health behaviors and outcomes in adulthood, which case (Re A (Children) (Conjoined Twins: Surgical
was completed by 17,337 adult HMO members in Separation) [2000] 4 All ER 961). It determines that
order to assess the independent relationship of 8 the public law principle of proportionality underlies the
adverse childhood experiences and the total number of doctrine, but identifies the preservation of life as the
ACEs (ACE score) to experiencing hallucinations. We guiding principle behind the Court of Appeal's use of
used logistic regression to assess the relationship of the necessity in Re A. The article is critical of this
ACE score to self-reported hallucinations. RESULTS: elevation of the preservation of life under the doctrine
We found a statistically significant and graded of necessity and argues for an alternative conception of
relationship between histories of childhood trauma and necessity based upon fundamental constitutional
histories of hallucinations that was independent of a principles such as human rights and democracy. The
history of substance abuse. Compared to persons with 0 principle of democracy has particular pertinence to the
ACEs, those with 7 or more ACEs had a five-fold issue of necessity because it may be endangered by this
increase in the risk of reporting hallucinations. common law justificatory defence. This conflict
CONCLUSION: These findings suggest that a history between democracy and necessity, it is argued, further
of childhood trauma should be looked for among supports the need for the constitutional value of
persons with a history of hallucinations. democracy to play a key role in any application of
necessity in future cases.
Whitfield L. e-novation. Child in mind. Health Serv J 2003;
113(5882):suppl 8-9. Widom CS, Czaja SJ. Reactions to research participation in
vulnerable subgroups. Account Res 2005; 12(2):115-
Whiting L, Whiting M, Whiting T, Whiting L. Smacking: a 38.
family perspective. Paediatr Nurs 2004; 16(8):26-8. Notes: GENERAL NOTE: KIE: 27 refs.
GENERAL NOTE: KIE: KIE Bib: behavioral
Whitty MT. Pushing the wrong buttons: men's and women's research/special populations
attitudes toward online and offline infidelity. Abstract: This paper describes the extent to which
Cyberpsychol Behav 2003; 6(6):569-79. vulnerable individuals (defined by economic, social,
Abstract: Despite current researchers' interest in the psychological, physical health, and child maltreatment
study of online sexual addiction, there is a dearth of status) react to research participation. As part of an
research available on what constitutes online infidelity. ongoing longitudinal study, participants (N=896)
This paper attempts to redress this balance by completed a lengthy and intrusive in-person interview
comparing 1,117 participants' attitudes toward online and provided a small amount of blood through finger
and offline acts of infidelity. A factor analysis was pricks. At the end of the interview, participants were
asked eight questions about their reactions to the
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![Williams O, Forster G, Robinson A. Screening for sexually point in time when we should extend care to patients in
transmitted infections in children and adolescents in the under serviced emerging countries. Development of
United Kingdom: British Co-operative Clinical Group. local expertise will be required within those countries
Int J STD AIDS 2001; 12(8):487-92. that are willing to commit resources to an organized
Abstract: Our objectives were (1) to assess the number program of caring for people with congenital heart
of young people aged under 16 years attending disease. Database technology is an essential tool for
genitourinary medicine (GUM) departments in the UK ensuring and improving quality of care in every
in 1998; (2) to identify clinical activity and policy; (3) congenital heart centre. Both Registry and Academic
to determine the knowledge and training needs of databases have much to offer in improving care for
healthcare professionals within GUM providing care future patients. Yet overzealous privacy laws threaten
for this client group. In July 1999 a questionnaire was the knowledge base provided by computerized
circulated via the 18 regional British Co-operative databases. We need to guide our legislators in ensuring
Clinical Group (BCCG) representatives to the that the valuable resource provided by database
consultants in charge of all 197 main GUM technology is not lost.
departments in the UK. One hundred and sixty out of
197 (81%) completed questionnaires were returned and Williamson MA, Johnston CA, Symes SA, Schultz JJ.
analysed. The reported number of under-16-year-olds Interpersonal violence between 18th century Native
attending in 1998 varied considerably between clinics; Americans and Europeans in Ohio. Am J Phys
for females ranging from 0 to 256 and for males Anthropol 2003; 122(2):113-22.
between 0 and 50, with a male to female ratio of 1:4.4. Abstract: During the winter of 1778-1779, a garrison of
The majority of responding clinics, 139/160 (87%) had 176 individuals lived within the walls of a
been involved in the screening of abused Revolutionary era stronghold named Ft. Laurens on the
children/adolescents for sexually transmitted infections banks of the Tuscarawas River, near the present-day
(STIs). Most clinics were prepared to screen for STI town of Bolivar, Ohio. At least 21 individuals were
(86%), HIV test (79%) and assess contraceptive needs buried in the fort's cemetery during its occupation, 13
(50%) in this age group. Staff involved in care included of whom were supposedly killed and scalped by Native
health advisers (74), nurses (59), and doctors (138) in Americans while gathering firewood and foraging
the responding clinics. Only 31/160 clinics (19%) had a horses. The purpose of this study is to build on
written policy for the management of previous work by Sciulli and Gramly ([1989] Am J.
children/adolescents attending their clinic. The Phys. Anthropol. 80:11-24) by adding a more detailed
majority of respondents were aware of their child analysis of the traumatic lesions, in order to better
protection policy [122/154 (79%)] and designated child understand what happened to the victims. Lesions were
sexual abuse doctor, [125/157 (80%)] in their district. analyzed based on type, location, and dimensions, as
When questioned on previous and current training well as their overall pattern on the skeleton. Results
needs, 134/160 (84%) respondents identified their need indicate that multiple blows to the cranium were
for further training in the area of adolescent sexual common. Out of 12 observable crania, the order of
health and 124/160 (78%) in child sex abuse. The blows could be determined in only one case. Eleven of
publication Physical Signs of Sexual Abuse in 12 of the observable crania from ambush victims and
Children, was known to 112/160 (70%) respondents, of four of the seven nonambush victims exhibited lesions
whom 58/112 (52%) who answered this question had consistent with scalping. Evidence of postcranial
read the publication. Genitourinary physicians in the trauma was noted on four individuals: one was an
UK are aware of the increasing number of children and ambush victim, and the other three were killed at other
adolescents accessing their services, and recognize the times. No evidence of gunshot wounds was found.
need to identify those in abusive situations. Written
policies dealing with children and adolescents in GUM Williamson R. The balance between privacy, safety and
clinics in the UK are lacking. This needs to be rectified community health. J Paediatr Child Health 2003;
urgently. This survey identifies that further training in 39(7):507-8.
the field of child sexual abuse and adolescent sexual
health would be welcomed by the respondents. Willock J, Askew C, Bolland R, Maciver H, James N.
Multicentre research: lessons from the field. Paediatr
Williams WG. Surgical outcomes in congenital heart Nurs 2005; 17(10):31-3.
disease: expectations and realities. Eur J Cardiothorac Abstract: Multicentre research can be used to explore
Surg 2005; 27(6):937-44. and generate significant data in aspects of care that
Abstract: The past 50 years of congenital heart surgery affect small numbers of children. This article describes
has produced enormous progress. Current results the problems and benefits encountered by a group of
surpass expectations. Yet there are important residual nurses from 11 hospitals undertaking a multicentre
problems in patients growing up after heart surgery for study of pressure ulcers in children and young people
congenital heart disease. Our system of care must in England and Wales. Multicentre research can
evolve to care for these people throughout their lives. generate a large amount of useful data contributing to
The evolution of congenital heart surgery has reached a
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![Witte C. Cord blood storage: property and liability issues. J have helpful aspects.
Leg Med 2005; 26(2):275-92.
Wolchik SA, Sandler IN, Millsap RE et al. Six-year follow-
Wocial LD. Neonatal care for premature infants. Hastings up of preventive interventions for children of divorce: a
Cent Rep 2005; 35(1):6-7; author reply 7. randomized controlled trial. JAMA 2002;
Notes: GENERAL NOTE: KIE: KIE Bib: allowing to 288(15):1874-81.
die/infants; patient care/minors Abstract: CONTEXT: Compared with their peers with
nondivorced parents, adolescents with divorced parents
Wolak J, Finkelhor D, Mitchell K. Internet-initiated sex are more likely to have mental health problems, drop
crimes against minors: implications for prevention out of school, and become pregnant. The long-term
based on findings from a national study. J Adolesc effects of intervention programs for this population are
Health 2004; 35(5):424.e11-20. unknown. OBJECTIVE: To evaluate the long-term
Abstract: PURPOSE: To describe the characteristics of effectiveness of 2 programs designed to prevent mental
episodes in which juveniles became victims of sex health problems in children with divorced parents.
crimes committed by people they met through the DESIGN AND SETTING: Six-year follow-up of a
Internet. METHODS: A national survey of a stratified randomized controlled trial of 2 intervention programs
random sample of 2574 law enforcement agencies (mother program: 11 group and 2 individual sessions;
conducted between October 2001 and July 2002. mother plus child program: mother program and 11
Telephone interviews were conducted with local, state, group sessions for children) and a control condition
and federal law enforcement investigators concerning (books on postdivorce adjustment), which was
129 sexual offenses against juvenile victims that conducted in a large metropolitan US city from April
originated with online encounters. RESULTS: Victims 1998 through March 2000. PARTICIPANTS: A total
in these crimes were primarily 13- through 15-year-old of 218 families (91% of the original sample) with
teenage girls (75%) who met adult offenders (76% adolescents aged between 15 and 19 years were
older than 25) in Internet chat rooms. Most offenders reinterviewed. MAIN OUTCOME MEASURES:
did not deceive victims about the fact that they were Externalizing and internalizing problems, diagnosed
adults who were interested in sexual relationships. mental disorders, drug and alcohol use, and number of
Most victims met and had sex with the adults on more sexual partners. RESULTS: Eleven percent of
than one occasion. Half of the victims were described adolescents in the mother plus child program (95%
as being in love with or feeling close bonds with the confidence interval [CI], 3.8%-18.2%) had a 1-year
offenders. Almost all cases with male victims involved prevalence of diagnosed mental disorder compared
male offenders. Offenders used violence in 5% of the with 23.5% (95% CI, 13.8%-33.2%) of adolescents in
episodes. CONCLUSIONS: Health care professionals the control program (P =.007). Adolescents in the
and educators, parents and media need to be aware of mother plus child program had fewer sexual partners
the existence, nature and real life dynamics of these (mean [SE], 0.68 [0.16]) compared with adolescents in
online relationships among adolescents. Information the control program (1.65 [0.37]; P =.01). Adolescents
about Internet safety should include frank discussion with higher initial mental health problems whose
about why these relationships are inappropriate, families were in the mother plus child program had
criminal, and detrimental to the developmental needs lower externalizing problems (P =.007) and fewer
of youth. symptoms of mental disorder (P =.02) compared with
those in the control program. Compared with controls,
Wolak J, Mitchell KJ, Finkelhor D. Escaping or connecting? adolescents whose mothers participated in the mother
Characteristics of youth who form close online program and who had higher initial mental health
relationships. J Adolesc 2003; 26(1):105-19. problems had lower levels of externalizing problems
Abstract: We used data from a US national sample of (P<.001); fewer symptoms of mental disorder (P
Internet users, ages 10-17 (N=1501), to explore the =.005); and less alcohol (P =.005), marijuana (P =.02),
characteristics of youth who had formed close and other drug use (P =.01). CONCLUSIONS: In
relationships with people they met on the Internet adolescents of divorced parents, the mother program
(n=210). Girls who had high levels of conflict with and the mother plus child program reduced symptoms
parents or were highly troubled were more likely than of mental disorder; rates of diagnoses of mental
other girls to have close online relationships, as were disorder; levels of externalizing problems; marijuana,
boys who had low levels of communication with alcohol, and other drug use; and number of sexual
parents or were highly troubled, compared to other partners.
boys. Age, race and aspects of Internet use were also
related. We know little about the nature or quality of Wolf LE, Lo B, Beckerman KP, Dorenbaum A, Kilpatrick
the close online relationships, but youth with these SJ, Weintrub PS. When parents reject interventions to
sorts of problems may be more vulnerable to online reduce postnatal human immunodeficiency virus
exploitation and to other possible ill effects of online transmission. Arch Pediatr Adolesc Med 2001;
relationships. At the same time, these relationships may 155(8):927-33.
Abstract: In a recent Oregon case, the state successfully
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![sued for custody of an infant to prevent his human between child maltreatment, clinically relevant
immunodeficiency virus (HIV)-infected mother from adjustment problems, and dating violence in a
breastfeeding him and to require antiretroviral community sample of adolescents. METHOD:
prophylaxis. As more HIV-infected women give birth, Adolescents from 10 high schools (N= 1,419; response
pediatricians may increasingly face dilemmas when rate = 62%) in southwestern Ontario completed
parents reject medical recommendations to forego questionnaires that assessed past maltreatment, current
breastfeeding and to administer antiretroviral adjustment, and dating violence. Logistic regression
prophylaxis to the infant. Such disagreements create was used to compare maltreated and nonmaltreated
ethical dilemmas because pediatricians have an youths across outcome domains. RESULTS: One third
obligation to both protect the infant and respect (n = 462) of the school sample reported levels of
parental decision making. Pediatricians need to balance maltreatment above the cutoff score on the Childhood
these obligations in deciding whether to ask the courts Trauma Questionnaire. Girls with a history of
to intervene on the infant's behalf. To that end, we maltreatment had a higher risk of emotional distress
analyze the legal and ethical issues that arise when an compared with girls without such histories (e.g., odds
HIV-infected mother refuses interventions to reduce ratios [OR] for anger, depression, anxiety, and
neonatal transmission of HIV to her infant, provide an posttraumatic stress-related problems were 7.1, 7.2,
approach for addressing these disagreements, and 9.3, and 9.8, respectively). They were also at greater
present illustrative scenarios in which pediatricians risk of violent and nonviolent delinquency (OR = 2.7)
should, may, and should not seek a court order to and carrying concealed weapons (OR = 7.1). Boys with
intervene. histories of maltreatment were 2.5 to 3.5 times as likely
to report clinical levels of depression, posttraumatic
Wolf RC, Bond KC. Exploring similarity between peer stress, and overt dissociation as were boys without a
educators and their contacts and AIDS-protective maltreatment history. They also had a significantly
behaviours in reproductive health programmes for greater risk of using threatening behaviors (OR = 2.8)
adolescents and young adults in Ghana. AIDS Care or physical abuse (OR = 3.4) against their dating
2002; 14(3):361-73. partners. CONCLUSIONS: Maltreatment is a
Abstract: This analysis explores the similarity between significant risk factor for adolescent maladjustment and
peer educators and their contacts. To examine shows a differential pattern for male and female
interpersonal communication in the context of peer adolescents.
education, this study tested a new approach using
multiple semi-structured interviews and network Wolfersdorf M. [Post-traumatic stress disorder in police with
analysis to collect data from 106 peer educators and long-term exposure to homicide and child abuse. A
526 of their contacts. These evaluation activities were previously unrecognized occupational disease
conducted at three sites in Ghana during April 1998, in exemplified by 2 case reports]. Psychiatr Prax 2003; 30
peri-urban and rural locations, and in in-school and Suppl 2:S88-9.
out-of-school targeted settings. It was found that in Abstract: In this paper we discuss two cases of PTSD
their peer counselling and peer promotion activities of policemen according to their occupational duties.
peer educators tend to reach people who are like
themselves (53% within 2 years of age, 59% same sex, Wolfram-Gabel R, Sery FG, Sick H. Microvascularisation of
70% same ethnicity, and 65% same school status) the male urethra in neonates and infants. Surg Radiol
however, this trend is not uniform among all youth and Anat 2004; 26(6):488-93.
varies by demographic characteristics and their cultural Abstract: The microvascularisation of the male urethra
environment. By examining the social networks of peer was studied in neonates and infants by injection of
educators, it is possible to gain a better understanding agarised China ink into the circulation. The purpose of
of the process of peer education counselling in the this study was to specify the angioarchitecture of each
context in which it occurs. The study also shows that tunic of the urethral wall. The disposition of the
controlling for other factors, contacts of peer educators microvascularisation networks varies depending on the
who are highly similar regarding age, sex, ethnicity, urethral parts considered: only the mucous membrane
and school status, are 1.74 times more likely (95% CI: networks are uniform throughout the entire urethra.
1.18, 2.56) to have done something to protect The sub-mucous networks are significantly increased
themselves from AIDS in the past three months. The in the spongy part. The muscular networks disappear in
results have relevance for programme managers and the spongy part.
planners, researchers, and international agencies
serving youth. Wolfram-Gabel R, Sick H. Microvascularization of the
mucocutaneous junction of the eyelid in fetuses and
Wolfe DA, Scott K, Wekerle C, Pittman AL. Child neonates. Surg Radiol Anat 2002; 24(2):97-101.
maltreatment: risk of adjustment problems and dating Abstract: The aim of this study was to specify the
violence in adolescence. J Am Acad Child Adolesc microvascularization of the junctional region between
Psychiatry 2001; 40(3):282-9. the integuments of the superficial surface of the free
Abstract: OBJECTIVE: To examine the relationship
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![margin of the eyelid and the palpebral conjunctival Inst Mech Eng [H] 2005; 219(1):63-70.
mucosa. The study was carried out using histological or Abstract: Recent reassessment of the literature on the
transparified slices of upper and lower eyelids taken shaken baby syndrome (SBS) has revealed a lack of
from fetuses and neonates, in which the vascular scientific evidence and understanding of all aspects of
system was injected with agarized China ink. The the syndrome. In particular, studies have been unable
mucocutaneous junction of the eyelid is located at the to clarify the mechanisms of injury, indicating that
posterior border of the free margin and extends to its impact, rather than shaking alone, is necessary to cause
deep surface. It has vascular similarities to the oral the type of brain damage observed. Rigid-body
cavity and the nasal pyramid. Under a thickened modelling (RBM) was used to investigate the effect of
avascular epithelium, there is a papillary network neck stiffness on head motion and head-torso impacts
composed of characteristic loops that are less raised as a possible mechanism of injury. Realistic shaking
than in the lips but more developed than in the nose. data obtained from an anthropometric test dummy
The superficial and deep vascular reticular networks (ATD) was used to simulate shaking. In each study
are comparable in fundamental arrangement to those of injury levels for concussion were exceeded, though
other junctional zones. Thus, the palpebral impact-type characteristics were required to do so in
mucocutaneous junction shows cutaneous-type the neck stiffness study. Levels for the type of injury
microvascularization, just like the other junctional associated with the syndrome were not exceeded. It is
zones of the head. unlikely that further gross biomechanical investigation
of the syndrome will be able to significantly contribute
Wolfram-Gabel R, Sick H. Microvascularization of the to the understanding of SBS. Current injury criteria are
mucocutaneous junction of the nose. Surg Radiol Anat based on high-energy, single-impact studies. Since this
2002; 24(1):27-32. is not the type of loading in SBS it is suggested that
Abstract: The aim of this study was to describe the their application here is inappropriate and that future
microvascularization of the area of junction located studies should focus on injury mechanisms in low-
between the integuments of the nasal ala and the energy cyclic loading.
respiratory mucosa. This study is part of an overall
study on the microvascularization of the Wolke D, Samara MM. Bullied by siblings: association with
mucocutaneous junctions of the head. It was peer victimisation and behaviour problems in Israeli
undertaken on histological or clarified sections of noses lower secondary school children. J Child Psychol
from fetuses, newborns and adults whose vascular Psychiatry 2004; 45(5):1015-29.
system was injected with Indian ink agar. The Abstract: BACKGROUND: The association of
mucocutaneous junction of the nose shows similarities bullying victimisation by siblings with a) involvement
with the mucocutaneous junction of the oral cavity. in bullying at school and b) behaviour problems among
Under a well-defined avascular and thick epithelium lower secondary school children in Israel was
lies a vascular papillary network with typical loops less investigated. METHOD: Self-report questionnaires of
high than in the lips. The angioarchitectonics of sibling victimisation, peer bullying experiences and
superficial and deep vascular reticular networks is behaviour problems were completed by 921 pupils
similar to that of the lips but they are less dense. aged 12-15 (mean age 13.7 years). RESULTS: Of the
sample, 16.2% were directly bullied by their siblings at
Wolfram-Gabel R, Sick H. Microvascularization of the home and 11.9% were direct victims of bullying by
mucocutaneous junctions of the head in fetuses and peers at school every week. More than half of victims
neonates. Cells Tissues Organs 2002; 171(4):250-9. of bullying by siblings (50.7%) were also involved in
Abstract: The mucocutaneous junctions of the head bullying behaviour at school compared to only 12.4%
(oral, nasal and palpebral) are transitional zones of those not victimised by siblings, indicating a strong
between the integuments and the mucosa. Their link between intrafamilial and extrafamilial peer
microvascularization is studied in the heads of fetuses relationships. Children with poor sibling and peer
and neonates by injection of agarized China ink into relationships were at a highly increased risk for
the vascular system. These zones are situated deep with behaviour problems. Ethnic (Israeli Jewish vs. Arab)
respect to the free edge of the oral or nasal cavity or and sex differences were small compared to the effects
relative to the free margin of the eyelid. They present of sibling relationship on behaviour problems.
cutaneous-type microvascularization with a papillary CONCLUSION: Intervention strategies directed at
network and reticular networks. Long capillary loops reducing bullying in school should take into account
connected to the deep reticular network are their main pupils' experiences of victimisation by siblings at
feature. In the lips and eyelids, the morphology of the home.
networks and their relationship with the orbicular
muscles are suggestive of a functional structure. Wolke D, Woods S, Stanford K, Schulz H. Bullying and
victimization of primary school children in England
Wolfson DR, McNally DS, Clifford MJ, Vloeberghs M. and Germany: prevalence and school factors. Br J
Rigid-body modelling of shaken baby syndrome. Proc Psychol 2001; 92(Pt 4):673-96.
Abstract: Differences in definitions and methodologies
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![for assessing bullying in primary school children interest were formed: 96 youths reported both self-
between countries have precluded direct comparisons injurious behaviors and the intent to hurt or kill
of prevalence rates and school factors related to themselves, and formed the "suicidal behaviors" group;
bullying. A total of 2377 children in England (6-year- and, 1213 adolescents reported neither self-injurious
olds/Year 2: 1072; 8-year-olds/Year 4: 1305) and 1538 behaviors nor intent to hurt self or die, and formed the
in Germany (8-year-olds/Year 2) were questioned control group. The participants also responded to
individually using an identical standard interview. In questions about depressive symptoms, anxiety, suicidal
both countries the types of bullying to victimize others ideation and attempt, alcohol/drug use, stressful life
were similar: boys were most often perpetrators, most events, and family relationships. They indicated
bullies were also victims (bully/victims), most bullying whether anyone they knew had attempted or completed
occurred in playgrounds and the classroom, and SES suicide in the previous 12 months. Logistic regression
and ethnicity only showed weak associations with indicated that depressive symptoms, stressful life
bullying behaviour. Major differences were found in events, suicidal ideation and exposure to suicide
victimization rates with 24% of English pupils attempt (but not completed suicide) contributed unique
becoming victims every week compared with only 8% variance to the presence of suicidal behaviors, after
in Germany. In contrast, fewer boys in England controlling for demographic variables. Depression (and
engaged every week in bullying (2.5-4.5%) than at trend levels, suicidal ideation) moderated the effect
German boys (7.5%), while no differences were found of exposure to suicide attempt by others on suicidal
between girls. In England, children in smaller classes behaviors. Our results indicate that completed suicide
were more often victimized. Further study of the group in the social network increases risk for suicidal
of bully/victims, schooling differences in England vs. behaviors, but not when other risk factors are
Germany and implications for prevention of bullying controlled. By contrast, a suicide attempt
are discussed. independently increases risk for suicidal behaviors.
Furthermore, those youths who experience depressive
Woller W, Kruse J. [Personality disorders and symptoms or suicidal ideation are at particularly high
psychopathology following trauma. Reflection on risk for engaging in suicidal behaviors when an
diagnostic classification]. Nervenarzt 2003; exposure to suicide attempt occurs.
74(11):972-6.
Abstract: Pervasive personality disorders have been Wong WC. Acceptability study of sex workers attending the
shown to be long-term sequelae of cumulative HIV/ AIDS clinic in Ruili, China. Asia Pac J Public
childhood physical and sexual traumatization. This Health 2003; 15(1):57-61.
finding is not reflected in DSM-IV and ICD-10 Abstract: A charitable clinic was set up to provide
classifications where post-traumatic stress disorder is HIV/STD education and care to commercial sex
confined to intrusions, avoidance, numbing, and workers in Ruili. Despite regular promotion of the
hyperarousal. However, there is growing evidence that clinic, few people had utilised the service. Therefore, a
trauma etiology should be taken into account in qualitative study was carried out among 89 sex workers
planning treatment for personality disorders. It is not between March and April 2001 to look at the
yet clear whether childhood traumatization is more background of our target group, their medical-seeking
strongly associated with borderline personality disorder behaviours and the range of services expected. The
than with other personality disorders. The finding of a turnover rates of sex workers were high. They had
substantial overlap between borderline personality good awareness but poor knowledge of STD/HIV.
disorder and dissociative identity disorder gives rise to Many self-medicated or sought advice from peers.
discussions concerning the relationship of these two They had a serious concern for private practitioners or
pathologies. the quality of drugs from pharmacy stores. They found
our clinic inconvenient and did not meet their needs.
Wong JP, Stewart SM, Ho SY, Rao U, Lam TH. Exposure to Subsequently, we refurbished the clinic, implemented
suicide and suicidal behaviors among Hong Kong changes and retrained our staff. The number of patients
adolescents. Soc Sci Med 2005; 61(3):591-9. treated three weeks after re-opening of the clinic has
Abstract: Suicidal behaviors (deliberate self-injury with increased by three folds, with many of them still sex
the intent to hurt or kill oneself) have been little workers, and the clinic's income increased by 58%. Our
examined outside the West. The aims of this study experience has important implications for policymakers
were to (a) determine the correlates of suicidal and other NGOs working with sex workers.
behaviors, and (b) examine whether depression and
suicide ideation moderated the effects of exposure to Woo P. Cytokines and juvenile idiopathic arthritis. Curr
completed and attempted suicide on suicidal behaviors Rheumatol Rep 2002; 4(6):452-7.
among a community sample of Hong Kong youth ages Abstract: Cytokines are a large group of polypeptides
12-17. Adolescents responded to questions regarding and small proteins that are effector molecules for cells
self-injurious behaviors, and also indicated presence of involved in immune and inflammatory responses.
intention to hurt or kill themselves in the past 12 There are agonists and antagonists that interact with
months. Based on their responses, two groups of each other to maintain a dynamic equilibrium, and
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![mean levels of air pollution and were more than twice MEASURES: Frequency of presentations; presentation
as likely to live in the most polluted counties compared characteristics; psychosocial characteristics; and
with white mothers after controlling for maternal risk presence or absence of follow-up. RESULTS: Two
factors, region, and educational status [Hispanic hundred twelve children and adolescents presented to
mothers: adjusted odds ratio (AOR) = 4.66; 95% EDs 216 times. Of the 212 patients, 49 (23%) were 14
confidence interval (95% CI), 1.92-11.32; African- years or younger, and the youngest was aged 10 years.
American mothers: AOR = 2.58; 95% CI, 1.00-6.62; The majority (82%) came after hours and were brought
Asian/Pacific Islander mothers: AOR = 2.82; 95% CI, in by emergency services (77%). In 13% of
1.07-7.39]. Educational attainment was not associated presentations, verbal and/or physical aggression was
with living in counties with highest levels of the air present, and a threat of self-harm was present in 2% of
pollution index (AOR = 0.95; 95% CI, 0.40-2.26) after cases. A mental health worker was consulted about the
adjusting for maternal risk factors, region of the child or adolescent in only 6% of presentations. Most
country, and race/ethnicity. There was a small increase children and adolescents (85%) were discharged from
in the odds of preterm delivery (AOR = 1.05; 95% CI, the ED. Of concern, in 56% of presentations, a follow-
0.99-1.12) but not SGA (AOR = 0.96; 95% CI, 0.86- up plan was not recorded. There was documentation of
1.07) in a county with high air pollution. Additional mental health follow-up in only 14% of presentations
risk of residing in areas with poor air quality may and follow-up from drug and alcohol services in only
exacerbate health problems of infants and children 1%. Forensic history, school functioning, and a history
already at increased risk for poor health. of past mental health problems were not documented in
more than 60% of the medical records examined.
Woods CR. Syphilis in children: congenital and acquired. CONCLUSIONS: When children or adolescents
Semin Pediatr Infect Dis 2005; 16(4):245-57. present to an ED with acute alcohol intoxication/self-
Abstract: Syphilis rates in women and congenital poisoning, their risk factors for psychosocial
syphilis rates have declined steadily in the United dysfunction appear to be inadequately assessed,
States in recent years. However, syphilis remains a documented, and followed up. Clear guidelines for
worldwide public health problem, with more than 12 assessment and referral pathways must be established
million cases in adults and more than half a million in EDs.
pregnancies affected yearly. Prenatal screening and
treatment programs are limited or nonexistent in many Woollard M, Jewkes F. 5 Assessment and identification of
developing countries. The genome of Treponema paediatric primary survey positive patients. Emerg Med
pallidum, one of the smallest among prokaryotes, has J 2004; 21(4):511-7.
been sequenced, but methods for continuous in vitro
cultivation of the microbe remain elusive. There are no Workowski KA, Levine WC. Selected topics from the
promising candidates for future vaccines at this time. Centers for Disease Control and Prevention Sexually
Serologic testing, for both specific treponemal and Transmitted Diseases Treatment Guidelines 2002. HIV
nontreponemal antibodies, continues to be a primary Clin Trials 2002; 3(5):421-33.
means of diagnosis. Penicillin remains the drug of
choice for congenital and acquired syphilis in Worku A, Addisie M. Sexual violence among female high
childhood. The diagnosis of syphilis beyond early school students in Debark, north west Ethiopia. East
infancy raises concerns for possible child sexual abuse, Afr Med J 2002; 79(2):96-9.
although progression of congenital syphilis may Abstract: OBJECTIVES: To assess the prevalence,
account for some cases. Syphilis is a potentially outcome and awareness of sexual violence among high
eradicable disease, but this can be achieved only with school female students. DESIGN: A school-based
sustained international will and cooperation to fund the cross-sectional survey. SETTING: Debark Town,
necessary screening and treatment programs. north-west Ethiopia. SUBJECTS: Two hundred and
sixteen female high school students, grade 9-11 were
Woolfenden S, Dossetor D, Williams K. Children and included for the quantitative study. For the qualitative
adolescents with acute alcohol intoxication/self- data, 16 individuals for the focus group discussion (10
poisoning presenting to the emergency department. well-recognised female figures in the town and six high
Arch Pediatr Adolesc Med 2002; 156(4):345-8. school students) and head of the police department for
Abstract: OBJECTIVE: To describe the presentations, in-depth interview were enrolled. RESULTS: Sixty two
characteristics, and follow-up care of children and per cent of the respondents had heard of sexual
adolescents aged 10 to 18 years who present to violence committed on young females. Sexual violence
emergency departments (EDs) with acute alcohol was reported by 65.3% of the respondents. The
intoxication/self-poisoning. DESIGN: Retrospective prevalence of performed and attempted rape were 8.8%
medical record review. SETTING: Five EDs in and 11.5%, respectively. The age range of performed
Western Sydney, Australia. PARTICIPANTS: Patients rape victims was between 12 and 21 years. Of the 19
aged 10 to 18 years who presented to EDs with acute (8.8%) who reported rape being performed on them,
alcohol intoxication/self-poisoning between January 1, unwanted pregnancy, suicide attempt, vaginal
1996, and December 31, 2000. MAIN OUTCOME
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![respectively. therapy, although the exact mechanism is uncertain.
This case cautions physicians to monitor methionine
Wylie JL, Jolly A. Patterns of chlamydia and gonorrhea levels in CBS-deficient patients on betaine and to
infection in sexual networks in Manitoba, Canada. Sex consider betaine as an adjunct, not an alternative, to
Transm Dis 2001; 28(1):14-24. dietary control.
Abstract: BACKGROUND: The use of sexual network
analysis has the potential to further our understanding Yamada H. Japanese mothers' views of young children's
of sexually tranmitted disease (STD) epidemics and areas of personal discretion. Child Dev 2004;
contribute to the development of more effective 75(1):164-79.
targeted control strategies. GOAL: To use sexual Abstract: Sixty-four Japanese mothers of 3- to 6-year-
network analysis to study transmission patterns of olds were interviewed concerning their conceptions of
chlamydia and gonorrhea in Manitoba, Canada. children's areas of personal control. Mothers granted
STUDY DESIGN: Routinely collected case/contact children choices regarding recreational activities,
information gathered by public health nurses was used clothes, and friends to foster autonomy and
to construct the sexual network. RESULTS: competence, but they set limits around daily routines,
Components within the sexual network ranged in size recreational activities, and interpersonal confrontation
from 2 to 82 people. Two types of components, based on moral, conventional, and prudential concerns.
designated radial and linear, were described. Large Mothers believed in reaffirming children's personal
linear components resembled the theoretical structure boundaries when children failed to follow through with
of STD core groups. Geographic analysis of the largest their initial decisions. Mothers experienced conflict
components demonstrated the potential for STD with children around daily routines and recreational
transmission between isolated rural communities and activities and used various resolution strategies.
within different areas of an urban center. Mothers perceived child resistance as egocentric
CONCLUSIONS: The application of sexual network whereas fewer considered it as establishing personal
analysis on a provincial basis demonstrated the boundaries. Some age and gender differences were
importance of a centralized, coordinated approach to observed. Results supported the heterogeneity of social
STD control. The analysis highlights the need for a judgments and practices of individuals within cultures.
greater understanding of the causative factors
promoting the formation of different component types, Yamawaki S. [Early childhood trauma and stress-related
the homogeneity and heterogeneity of behaviors within psychiatric disorders: neuroscience perspective].
and between components, and the temporal stability of Seishin Shinkeigaku Zasshi 2005; 107(5):506-13.
these patterns. Abstract: Morphometric studies using magnetic
resonance imaging have reported smaller than normal
Yaghmai R, Kashani AH, Geraghty MT et al. Progressive volumes of the hippocampus in stress-related
cerebral edema associated with high methionine levels psychiatric disorders such as major depression, post-
and betaine therapy in a patient with cystathionine traumatic stress disorders (PTSD) etc... On the other
beta-synthase (CBS) deficiency. Am J Med Genet hand, epidemiological studies have suggested that early
2002; 108(1):57-63. childhood trauma including child abuse and sexual
Abstract: Cystathionine beta-synthase (CBS) abuse is associated with markedly elevated rates of
deficiency, the most common form of homocystinuria, major depression and PTSD. Psychoanalysist and child
is an autosomal recessive inborn error of homocysteine psychiatrists have reported that mother-child
metabolism. Treatment of B6-nonresponsive patients relationship and fostering environment in early
centers on lowering homocysteine and its disulfide childhood strongly affect the later mental development
derivatives (tHcy) by adherence to a methionine- and increase the prevalence rate of various psychiatric
restricted diet. However, lifelong dietary control is disorders, but its biological mechanism has not been
difficult. Betaine supplementation is used extensively elucidated. Recent progress of neuroscience research
in CBS-deficient patients to lower plasma tHcy. With has brought a possibility to elucidate molecular
betaine therapy, methionine levels increase over biological mechanism of this developmental
baseline, but usually remain below 1,500 micromol/L, psychological issue. The author reviews recent
and these levels have not been associated with adverse neuroscience researches focused on the effect of early
affects. We report a child with B6-nonresponsive CBS childhood trauma on the stress vulnerability and the
deficiency and dietary noncompliance whose pathogenesis of stress-related psychiatric disorders.
methionine levels reached 3,000 micromol/L on
betaine, and who subsequently developed massive Yancey AK, Siegel JM, McDaniel KL. Role models, ethnic
cerebral edema without evidence of thrombosis. We identity, and health-risk behaviors in urban
investigated the etiology by determining methionine adolescents. Arch Pediatr Adolesc Med 2002;
and betaine metabolites in our patient, and several 156(1):55-61.
possible mechanisms for her unusual response to Abstract: BACKGROUND: The assumption that role
betaine are discussed. We conclude that the cerebral models or mentors constructively influence adolescent
edema was most likely precipitated by the betaine
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![psychological functioning has prompted societal (Madr) 2004; 32(4):197-203.
investment in mentoring programs. However, there has Abstract: BACKGROUND: The contribution of indoor
been little empirical evaluation of the relationship fungal exposure to childhood asthma is not completely
between role model or mentor characteristics and clear. OBJECTIVE: To investigate airborne fungal
health behaviors. OBJECTIVES: To describe role flora within the homes of asthmatic and control
model selection in urban adolescents and examine the children, and to assess the influence of housing
relationships between role model characteristics, characteristics regarding indoor fungi. METHODS:
psychosocial functioning, and health-risk behaviors. Forty-seven atopic asthmatic and 23 nonatopic control
DESIGN: Cross-sectional survey. PARTICIPANTS: A children were studied. Allergen sensitivity was
population-based, multiethnic sample of Los Angeles determined by skin prick tests. A thorough assessment,
County adolescents aged 12 to 17 years was generated using a questionnaire and inspection surveys, was
from a 3-stage, area-probability sampling frame. Of carried out. Home visits were made between October
877 adolescents identified, 749 are included in this 2000 and February 2001. Samples of airborne fungal
analysis. METHODS: In-person, in-home interviews spores were collected from four rooms by the "open
were conducted. MAIN OUTCOME MEASURES: Petri dish" method. Indoor temperature and humidity
Substance use, academic performance, and self- were measured. RESULTS: The total indoor fungal
perception (measures of ethnic identify and self- colony counts from the living rooms and bedrooms
esteem). Ethnic identity was measured by an adaptation were significantly higher in the asthma group than in
of a scale developed by Phinney (J Adolesc Res. controls (p = .012 and p = .003, respectively). The most
1992;7:156-176) to assess commonalities across ethnic commonly isolated genus was Cladosporium. Twelve
groups. RESULTS: Fifty-six percent of adolescents of the asthmatic patients (25.53 %) were found to be
identified a role model. Higher levels of ethnic identity sensitive to fungal allergens. The factors found to be
were associated with moving from identifying no role associated with indoor fungal growth in logistic
model to identifying a figure primarily available regression were visible fungal patches in the bathrooms
through the media to identifying a known individual, [(odds ratio (OR) = 5.75; 95 % CI 1.19 to 27.70)], and
familial or nonfamilial (P<.001). Having a role model, the age of the house [OR = 4.24; 95 % CI 1.34 to
particularly an individual known to the adolescent, was 13.45]. Total fungal colony numbers did not correlate
also associated with higher self-esteem (P<.001) and with indoor temperature or humidity. CONCLUSION:
higher grades (P<.05). For white males without Fungal colony numbers were higher in the homes of
custodial fathers, having a role model was associated asthmatic children than in those of controls. Therefore,
with decreased substance use (P<.05). CONCLUSION: indoor fungal exposure may contribute to childhood
Role model selection is associated with protective asthma. Bathrooms were the main source of fungal
psychosocial characteristics. propagules. Old houses were more prone to fungal
growth.
Yang JW, Kuppermann N, Rosas A. Child abuse presenting
as pseudorenal failure with a history of a bicycle fall. Ybarra ML, Mitchell KJ. Exposure to internet pornography
Pediatr Emerg Care 2002; 18(2):91-2. among children and adolescents: a national survey.
Cyberpsychol Behav 2005; 8(5):473-86.
Yates A. Biologic perspective on early erotic development. Abstract: Estimates suggest that up to 90% or more
Child Adolesc Psychiatr Clin N Am 2004; 13(3):479- youth between 12 and 18 years have access to the
96, vi. Internet. Concern has been raised that this increased
Abstract: Neurobiologic researchers can understand accessibility may lead to a rise in pornography seeking
children's sexuality in less moral and more biologic among children and adolescents, with potentially
terms. Genetically programmed levels of serious ramifications for child and adolescent sexual
neurotransmitters and hormones establish a baseline development. Using data from the Youth Internet
trajectory of erotic interest and activity across the Safety Survey, a nationally representative, cross-
lifespan. Environmental influences also contribute. sectional telephone survey of 1501 children and
Intense early stimulation can affect the brain and create adolescents (ages 10-17 years), characteristics
a condition of hyper eroticism, whereas too little associated with self-reported pornography seeking
stimulation can limit the ability to bond and impair the behavior, both on the Internet and using traditional
sexual response. Children who are erotically methods (e.g., magazines), are identified. Seekers of
challenged or challenging are viewed correctly as pornography, both online and offline, are significantly
having a brain imbalance, rather than as victims or as more likely to be male, with only 5% of self-identified
being morally deficient. This should pave the way for seekers being female. The vast majority (87%) of youth
more humane, objective, and effective interventions. who report looking for sexual images online are 14
years of age or older, when it is developmentally
Yazicioglu M, Asan A, Ones U et al. Indoor airborne fungal appropriate to be sexually curious. Children under the
spores and home characteristics in asthmatic children age of 14 who have intentionally looked at
from Edirne region of Turkey. Allergol Immunopathol pornography are more likely to report traditional
exposures, such as magazines or movies. Concerns
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![about a large group of young children exposing medical records. The survival for each case was
themselves to pornography on the Internet may be determined as the duration between the date of
overstated. Those who report intentional exposure to diagnosis and date of death, date of loss to follow-up or
pornography, irrespective of source, are significantly the closing date of the study (December 31(st), 1999).
more likely to cross-sectionally report delinquent Cumulative observed and relative survival was
behavior and substance use in the previous year. calculated by the Hakulinen Method. For comparison
Further, online seekers versus offline seekers are more of results with other populations, age-standardized
likely to report clinical features associated with relative survival (ASRS) was calculated by directly
depression and lower levels of emotional bonding with standardizing age specific relative survival to the
their caregiver. Results of the current investigation specific age distributions of the estimated global
raise important questions for further inquiry. Findings incidence of major cancers in 1985. The log rank test
from these cross-sectional data provide justification for was used in univariate analysis to identify the
longitudinal studies aimed at parsing out temporal potentially important prognostic variables. The
sequencing of psychosocial experiences. variables showing statistical significance in univariate
analysis were introduced stepwise into a Cox
Ye DQ, Zhu JM, Zhang YQ et al. [A survey on violence Regression model to identify the independent
among primary and secondary school students in Hefei predictors of survival. RESULTS: The 5-year relative
city]. Zhonghua Liu Xing Bing Xue Za Zhi 2004; survival rates were 46.2% for breast, 47.7% for the
25(1):6-8. cervix and 25.4% for the ovary. Higher survival was
Abstract: OBJECTIVE: To explore the features of observed for those younger than 35 years for all these
violence among primary and secondary school students three sites. For each, survival declined with advancing
in Hefei, and to set up intervention measures for age. Single patients who remained unmarried had
violence prevention. METHODS: Four schools in better survival. For all sites Muslims had a better and
Hefei were randomly sampled in the study. A total of Christians a lower survival as compared to Hindus.
3064 students completed a questionnaire. RESULTS: Education did not appear to be of significance. Survival
16.22% of the pupils reported having suffered from decreased rapidly with advancing clinical extent of
violence at least once every month. The rate was higher disease for all sites. With localized cancer, 5-year rates
in boys than that in girls's (chi(2) = 25.13, P = 0.000). ranged from 54.7% to 69.3%, for regional spread
The major assaulters were from classmates (45.80%), 20.4% to 41.6% and distant metastasis not a single site
with hand beating (37.42%), insulting (31.21%), recorded more than 5%. On multivariate analysis, age
threatening (20.88%), and 10.49% using sticks and and extent of disease emerged as independent
sharp weapons. Most violence occurred at school predictors of survival for all the sites. CONCLUSION:
(46.08%), followed by at home (28.41%) and outside All the sites included in the study demonstrated
of schools (25.51%), with significant difference (P = moderate survival rates with significant variation.
0.000). As a result, 3.33% ended up with fractures, and Comparison with other populations revealed lower
0.51% with disability. 97 pupils reported having survival rates as compared to developed countries,
assaulted others frequently (3.21%). Being irritated particularly for breast and ovary. In Indian populations
(47.38%) was the major reason for the violence to survival proportions did not show much variation for
occur. CONCLUSION: Violence among primary and these cancers. Early detection and treatment are clearly
secondary school students in Hefei city was serious important factors to reduce the mortality from these
that called for targeted education be strengthened and cancers.
school environment be improved.
Yeole BB, Sunny L, Swaminathan R, Sankaranarayanan R,
Yeole BB, Kumar AV, Kurkure A, Sunny L. Population- Parkin DM. Population-based survival from colorectal
based survival from cancers of breast, cervix and ovary cancer in Mumbai, (Bombay) India. Eur J Cancer
in women in Mumbai, India. Asian Pac J Cancer Prev 2001; 37(11):1402-8.
2004; 5(3):308-15. Abstract: Survival estimates of patients registered by
Abstract: BACKGROUND: Breast, cervix and ovarian population-based cancer registries reflect the average
cancers contribute more than 45% of the total in prognosis from a given cancer as they are based on
women in Mumbai and survival proportions for these unselected patients with a wide range of natural
neoplasms are very high in most developed populations histories and treatment patterns. In this paper, we
in the World. The authors here report and discuss the report the survival experience of colorectal cancer
population-based survival for these cancers in Mumbai, patients in Mumbai (Bombay), India. Follow-up
India. METHODS: Follow-up information on 4865 information on 1642 colorectal cancer patients
cancers of breast, cervix and ovary, registered in the registered by the Bombay Population-based Cancer
Mumbai Population Based Cancer Registry for the Registry for the period 1987-1991 was obtained by
period 1992-1994 was obtained by a variety of matching with death certificates from the Bombay vital
methods, including matching with death certificates statistics registration system, postal/telephone
from the Mumbai vital statistics registration system, enquiries, home visits and scrutiny of medical records.
postal/telephone enquiries, home visits and scrutiny of Cumulative observed and relative survival proportions
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![were calculated by Hakulinen's method. For income (stability and level) were associated with
comparison of results with other populations, age- preschool children's developmental outcomes
standardised relative survival (ASRS) was calculated (Woodcock-Johnson [W-J] Achievement Test scores
by directly standardising age-specific relative survival and the Behavior Problem Index [BPI]) through
to the specific age distributions of the world standard investment and family process pathways. Results
cancer patient population in 1985. The log-rank test supported the hypothesis that distinct mediating
was used to identify the potential prognostic variables mechanisms operate on the association between
which were introduced step-wise into a Cox regression income and different child outcomes. Much of the
model to identify the independent predictors of association between income and children's W-J scores
survival. The 5-year relative survival was 36.6% for was mediated by the family's ability to invest in
colon and 42.2% for rectal cancer. Age, site of cancer providing a stimulating learning environment. In
and clinical stage of disease emerged as independent contrast, family income was associated with children's
predictors of survival. Age-specific 5-year relative BPI scores primarily through maternal emotional
survival declined with advancing age. Survival at 5 distress and parenting practices. Level of income was
years was 61.2% for localised colon cancer; 31.9% for associated with W-J letter-word scores and income
regional and 9.0% for distant metastatic disease. These stability was associated with W-J applied problem
were 65.7, 25.6 and 4.3%, respectively for rectal scores and BPI, even after all controls were included in
cancers. Comparison of the results with other the models.
populations revealed significant variations, which seem
to be related to differences in detection and treatment. Yin Z, Hanes J Jr, Moore JB, Humbles P, Barbeau P, Gutin
The prognosis from colorectal cancer in Mumbai and B. An after-school physical activity program for
developing countries, may be further improved through obesity prevention in children: the Medical College of
early detection linked with treatment. Georgia FitKid Project. Eval Health Prof 2005;
28(1):67-89.
Yeong EK, Hsiao TC, Chiang HK, Lin CW. Prediction of Abstract: This article describes the process of setting
burn healing time using artificial neural networks and up a 3-year, school-based after-school physical activity
reflectance spectrometer. Burns 2005; 31(4):415-20. intervention in elementary schools. The primary aim of
Abstract: BACKGROUND: Burn depth assessment is the study is to determine whether adiposity and fitness
important as early excision and grafting is the will improve in children who are exposed to a fitogenic
treatment of choice for deep dermal burn. Inaccurate versus an obesogenic environment. Eighteen schools
assessment causes prolonged hospital stay, increased were randomized to the control (obesogenic) or
medical expenses and morbidity. Based on reflected intervention (fitogenic) group. The study design,
burn spectra, we have developed an artificial neural program components, and evaluation of the
network to predict the burn healing time. PURPOSE: intervention are described in detail. The intervention
Our study is to develop a non-invasive objective consists of (a) academic enrichment, (b) a healthy
method to predict burn-healing time. METHODS AND snack, and (c) physical activity in a mastery-oriented
MATERIALS: Burns less than 20% TBSA was environment. Successful implementation would show
included. Burn spectra taken on the third postburn day the feasibility of schools' being able to provide a
using reflectance spectrometer were analyzed by an fitogenic environment. Significant differences between
artificial neural network system. RESULTS: Forty-one the groups would provide evidence that a fitogenic
spectra were collected. With the newly developed environment after school has positive health benefits. If
method, the predictive accuracy of burns healed in less feasibility and efficacy are demonstrated,
than 14 days was 96%, and that in more than 14 days implementing an after-school program like this one in
was 75%. CONCLUSIONS: Using reflectance elementary schools could play a major role in
spectrometer, we have developed an artificial neural preventing and reducing childhood obesity.
network to determine the burn healing time with 86%
overall predictive accuracy. Yip R. Iron supplementation: country level experiences and
lessons learned. J Nutr 2002; 132(4 Suppl):859S-61S.
Yeung WJ, Linver MR, Brooks-Gunn J. How money matters Abstract: Iron supplementation is a commonly used
for young children's development: parental investment strategy to meet the increased requirements of at-risk
and family processes. Child Dev 2002; 73(6):1861-79. groups, such as women of childbearing age, especially
Abstract: This study used data from the Panel Study of during pregnancy. Other at-risk groups for which iron
Income Dynamics and its 1997 Child Development supplementation may be appropriate include infants,
Supplement to examine how family income matters for young children, adolescents and the elderly. There is a
young children's development. The sample included need to consider iron supplementation as part of a
753 children who were between ages 3 and 5 years in comprehensive strategy for the prevention of iron
1997. Two sets of mediating factors were examined deficiency, and not just as a treatment for anemia that
that reflect two dominating views in the literature: (1) is stopped as soon as clinical improvement is noted.
the investment perspective, and (2) the family process Experience in developing countries indicates that often
perspective. The study examined how two measures of the poorest women with the most deficient intakes are
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![Abstract: Much research on the experiences of parents development, even allowing for the coexistence of
of children with cancer has been conducted within a conduct problems. Hyperactivity predicted academic
discourse of psycho-pathology, or has tended to see problems and interpersonal relationship problems.
parents mostly as a proxy source of information on the Relationships with parents, by contrast, were not
well-being of their children. Using empirical data from portrayed to be as problematic as relationships with
semi-structured interviews with 20 mothers of a child peers and the opposite sex. Their psychological, social
with cancer, in one area of the UK, we draw on and occupational functioning was objectively rated to
sociological literatures on motherhood, childhood, be more deviant and their self-report showed them to
caring, and chronic illness to suggest a more helpful be more ambivalent about their future. There was a
and informative way of understanding their trend for hyperactivity to be self-reported as a risk for
experiences. We suggest that mothers, although not ill the development of continuing symptomatology but
themselves, experience many of the consequences of neither hyperactivity nor conduct problems were self-
chronic illness. Biographical disruption begins for them reported to be a risk for antisocial behaviour, substance
when they first notice something wrong with their misuse or low self-esteem in adolescence. However,
child, and intensifies with diagnosis, altering their they were at risk for the development of state anxiety.
sense of self and their social identity. The diagnosis CONCLUSIONS: The results suggested girls' pattern
brings with it a set of new responsibilities and role of functioning may differ from that of boys because
expectations, including an obligation of 'proximity'- girls self-report a more pervasive range of social
being physically close to their child at all times to dysfunction than that previously reported in boys.
provide 'comfort' and 'keep-watch'. For mothers, caring
evokes an intense emotional interdependence with their Young SE, Smolen A, Corley RP et al. Dopamine
sick child, and involves a range of technical tasks and transporter polymorphism associated with externalizing
emotional work, including acting as 'brokers' of behavior problems in children. Am J Med Genet 2002;
information for their child and managing their 114(2):144-9.
cooperation with treatment. Managing these Abstract: Early childhood externalizing behavior is a
obligations was achieved at high cost to the mothers stable and heritable pattern of aggressive and
themselves, and resulted in severe role strain by delinquent behavior that often leads to the development
compromising their ability to function in other roles, of serious psychiatric disorders such as conduct
including their role as the mother of their other disorder and attention deficit hyperactivity disorder.
children. Against the backdrop of a severe and life- We examined the relationship between parent reported
threatening illness, everyday concerns about their externalizing behavior (assessed at ages 4, 7, and 9
child's diet or appropriate discipline take on a new years) and the VNTR polymorphism of the 3'
significance and carry a heightened potential for untranslated region of SLC6A3 (DAT1) in a
generating conflict and distress for mothers. In community sample of 790 children ascertained as part
presenting their accounts, mothers draw on prevailing of our longitudinal twin and adoption studies. We
cultural discourses about motherhood, childhood and applied the sibling-based methodology developed by
cancer, and these clearly influence the context in which Fulker et al. [1999: Am J Hum Genet 64:259-267] for
they care for their child, and shape their reflexive estimating allelic association with quantitative traits,
constructions of their experiences. Caring for a child while controlling for population stratification. An
with cancer had many adverse implications for the extension of these methods allowed for the inclusion of
quality of life of the women we studied. Mothers of a monozygotic twins, dizygotic twins, siblings, and
child with cancer warrant study in their own right, and singletons. We have demonstrated that the 9-repeat
such study benefits from interpretive perspectives. variant of the DAT1 is a significant risk allele for
externalizing behavior at ages 4 (P=0.001) and 7 years
Young S, Heptinstall E, Sonuga-Barke EJ, Chadwick O, (P=0.02). Although the effect size was negligible at age
Taylor E. The adolescent outcome of hyperactive girls: 9 (P=0.92), a formal test of the developmental decrease
self-report of psychosocial status. J Child Psychol in effect across the three ages was non-significant
Psychiatry 2005; 46(3):255-62. (P=0.70).
Abstract: BACKGROUND: The aim of the study was
to clarify the developmental risk associated with Youngstrom E, Weist MD, Albus KE. Exploring violence
hyperactive behaviour in girls in a longitudinal exposure, stress, protective factors and behavioral
epidemiological design. METHODS: This was problems among inner-city youth. Am J Community
investigated in a follow-up study of girls who were Psychol 2003; 32(1-2):115-29.
identified by parent and teacher ratings in a large Abstract: This study examined relationships between
community survey of 6- and 7-year-olds as showing violence exposure, other stressors, family support, and
pervasive hyperactivity or conduct problems or the self-concept on self-reported behavioral problems
comorbid mixture of both problems or neither problem. among 320 urban adolescents (aged 11-18) referred for
They were later investigated, at the age of 14 to 16 mental health treatment. Overall, participants reported
years, with a detailed self-report interview technique. high levels of violence exposure, with a median of six
RESULTS: Hyperactivity was a risk factor for later past encounters with violence as a witness, victim, or
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![through the experiences of associates. All forms of compared to Trondheim concerning the awareness of,
violence exposure (witnessing, being a victim, and positive attitudes towards, safety issues (e.g.
knowing of victims) were correlated with internalizing alcohol and driving, speeding and children's safety in
and externalizing behavioral problems for males and traffic). 56.0% of respondents in Harstad reported
females. Total violence exposure predicted behavioral having acquired information, or good advice, about
problems among participants, even after controlling for traffic safety from the reports. CONCLUSIONS:
the effects of other risk, demographic and protective Traffic injuries in children can be prevented by
factors. Family support and self-concept moderated the community-based interventions. Distributing written
influence of life stress and cumulative risk on problem information may enhance the program's sustainability.
behavior outcomes, but these protective variables did
not significantly moderate violence exposure. Ytterstad B, Norheim AJ. The epidemiology of injuries in
Svalbard compared with Harstad. Int J Circumpolar
Yozwiak JA, Golding JM, Marsil DF. The impact of type of Health 2001; 60(2):184-95.
out-of-court disclosure in a child sexual assault trial. Abstract: STUDY OBJECTIVE: To survey all injuries
Child Maltreat 2004; 9(3):325-34. treated in Longyearbyen hospital, Svalbard and to
Abstract: This study investigated the impact of type of describe the injury epidemiology for Svalbard
out-of-court disclosure in a child sexual assault case (residents and visitors), comparing it with Harstad.
involving a 6-year-old alleged victim. Community SETTING: The Norwegian arctic archipelago,
participants read a fictional criminal trial summary of a Svalbard and the mainland city Harstad during three
child sexual assault case in which the alleged victim's years from 8 March 1997. PARTICIPANTS: The
out-of-court disclosure of the assault was: (a) complete person years of the study were 4211 for Svalbard
on two occasions or (b) incomplete at first, but later residents and 69,014 for Harstad. MEASUREMENTS
included the full account of the incident. The results AND MAIN RESULTS: The variables followed the
showed that there were more guilty verdicts, higher Nordic system. Of 630 recorded injuries, 107 were
ratings of the defendant's guilt, and greater belief of the snowmobile related. Crude injury rates (per 1000
alleged victim when there was full disclosure on two person years) [corrected] for Svalbard residents were
occasions compared to when there was a delay in full for men 100.9 and for women 76.3. Corresponding
disclosure. These results are discussed in terms of the rates were not significantly higher for men in Harstad
impact the nature of out-of-court disclosure can have (115.4, p = 0.19) and for women (80.1, p = 0.56).
when a child testifies in a sexual assault case. Home injuries were more prevalent in Harstad (30.5%)
compared to Svalbard residents (13.1%, p < 0.001) and
Ytterstad B. The Harstad Injury Prevention Study. A decade visitors (8.9%, p < 0.001). Work and leisure related
of community-based traffic injury prevention with injuries were more prevalent for Svalbard visitors
emphasis on children. Postal dissemination of local (38.8% and 48.7%) and residents (27.2% and 41.9%)
injury data can be effective. Int J Circumpolar Health compared to Harstad (13.2% and 34.8%) (both p <
2003; 62(1):61-74. 0.001). 43.5% of Svalbard visitors sustained work
Abstract: OBJECTIVES: To evaluate the outcome of a related injuries at sea. These injuries had higher AIS
community-based program for reducing traffic injury (abbreviated injury scale) mean score (1.83) than
rates with special focus on children and to assess the visitors' work injuries occurring on land (1.41) (p <
impact of a Traffic Injury Report (TIR) in terms of 0.05) and residents' work injuries (1.29) (p < 0.001).
awareness and attitudes about safety issues. SETTING: Harstad had lowest AIS score for work related injuries
The Norwegian cities Harstad (23 000) and Trondheim (1.24). The violence rate (per 1000 person years) was
(140 000), during ten years. METHODS: The outcome 0.9 for Svalbard residents, less than a third of the
was evaluated using hospital-based injury recording. Harstad rate (p < 0.02). There was one Svalbard
Sustainability of the prevention program was promoted resident fatality (drowning).
by disseminating information on the community's
traffic injury profile. Reports containing information Yu BP, Chung HY. Stress resistance by caloric restriction
about traffic injuries were distributed quarterly to all for longevity. Ann N Y Acad Sci 2001; 928:39-47.
Harstad households, containing victim stories and Abstract: Hardly an aspect of aging is more important
statistics on medical data and the location of the than an organism's ability to withstand stress or to
accidents. The impact of the reports was evaluated, resist both internally and externally imposed insults.
using a questionnaire mailed to persons 18-80 years We know that as organisms loose their ability to resist
old. RESULTS: From the first two years (mean rate these insults, aged organisms suffer more than the
116.1/10,000 person years), to last two years, a young. Therefore, a prime strategy for an organism's
significant 59% [confidence interval (CI): 42% to 71%] survival has been the evolutionarily adapted defense
reduction of traffic injury rates was observed for systems that guard against insult. For better
Harstad children. Overall rates for all ages decreased survivability, an organism's defense system must be
37% [CI:47% to 24%] in Harstad increased by 3% maximized to its full effect through well-coordinated
[CI:-4% to 10%] in Trondheim (reference city). networks of diverse biologically responsive elements.
Significantly higher scores were found in Harstad Although terms like stress, resistance, and adaptability
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![have long been used in biology, they remain present within individual lamellae. Elastic fibers
mechanistically and quantitatively poorly defined. In a appeared to be long (>200 microm) and straight in
gerontological context, stress resistance or outer anulus, whereas in inner anulus, they nearly ran
susceptibility are often discussed in association with an parallel to each other and at an angle of approximately
organism's vulnerability to disease and age-related 60 degrees or 120 degrees to those in adjacent
damage. However, to date, there is no clear molecular lamellae. However, in scoliotic discs, elastic fibers
delineation of cellular and molecular mechanisms for were sparse, and the collagen and elastic fiber networks
such complex biological phenomena. The life- were disorganized with loss of lamellar structure. Cell
prolonging action of caloric restriction (CR) seems to clusters, one of typical degenerative feature, were seen
offer an excellent opportunity for investigating the in scoliotic discs but not in age-matched control discs.
interrelationship between stress and the aging process. CONCLUSIONS: Our results reveal an abundant and
As an omnipotent intervention, CR provides a unique organized network of elastic fibers in the adolescent
opportunity to probe the organism's ability to withstand (12 and 17-year-olds) human IVD, and suggest that
age-related stress as a survival strategy. In this context, elastic fiber network plays a significant biomechanical
the antiaging action of CR can be viewed as role. This network is sparse and disrupted in scoliotic
"nutritional stress," because the organism's reduced discs, and could be involved in the progression of the
caloric intake seems to be a stimulatory metabolic spinal deformity.
response for survivability. Recent gerontologic
research has provided sufficient experimental data Zaba R, Bukartyk-Rusek B. [School hygiene in the past,
supporting this antiaging property of CR, of which present and future--in the opinion of the Inspector of
several pertinent, key examples are discussed below. Pediatrics and School Medicine and member of the
European Society for Social Pediatrics (ESSOP)].
Yu J, Fairbank JC, Roberts S, Urban JP. The elastic fiber Wiad Lek 2002; 55 Suppl 1:615-9.
network of the anulus fibrosus of the normal and Abstract: Yesterday. School hygiene acted in a clear
scoliotic human intervertebral disc. Spine 2005; way. Physician, pediatrician, nurse and hygienist were
30(16):1815-20. employed at school and were responsible for carrying
Abstract: STUDY DESIGN: Immunohistochemical out periodic examination, vaccination of school
study of elastic fibers in human intervertebral discs children and youth. They also supervised groups of
(IVD) collected at surgery from patients with scoliosis. children with posture defects, obesity, underweight,
OBJECTIVES: To compare the elastic fiber network in circulatory system and respiratory tract (asthma,
scoliotic discs (idiopathic scoliosis or neuromuscular anaphylaxis), diseases nervous system disorders and
scoliosis) to that of control (normal) discs. To study also propagated health education at school. Inspector of
whether the change in elastic fiber organization could Pediatrics and School Medicine was in charge of
contribute to the progression of spinal deformity. School Medical Care. Today. Reform of the Public
SUMMARY OF BACKGROUND DATA: Elastin and Health System. Medical examination and services have
elastic fibers have been identified previously in human their value in money. A school physician, some
IVD but were believed to contribute little to the tissue's hygienists and school nurses have been dismissed to
mechanical properties. However, a recent decrease the financial costs of school hygiene. All
immunohistochemical study has revealed an abundant medical services must be bought by the National
and organized elastic fiber network in bovine IVD, Health Service. Public and private medical services at
indicating that elastic fibers could play an important doctors and nurses are organized at schools. Each
mechanical role. This article reports the organization of service performs examinations, vaccinations bought by
elastic fibers in human IVD and the changes of elastic the National Health Service or parents. A pupil is a
fiber organization in scoliosis. METHODS: Intact subject of buying medical services. He may be
wedges of IVD were obtained from patients vaccinated by a nurse but a medical examination must
undergoing surgery for scoliosis (aged 12-22 years). be either bought or performed by home doctor. The
Control discs were obtained from a patient (aged 12 supervision of school children with different illnesses
years) with a spinal tumor and a trauma patient (aged is not conducted by a school doctor. At present all the
17 years). The discs were dissected to give radial slices threats of contemporary world such as alcohol,
and were snap frozen. Frozen sections were cut and tobacco, drug addiction, nervous system illnesses and
digested with hyaluronidase to remove allergies which are destructive for youth start when
glycosaminoglycans. Micrographs of the sections were they are teenagers. School is an important place for
examined by polarized light to visualize collagen carrying out on a large scale prophylactic services with
organization. The elastic fiber network was visualized medical teams of paediatricians, rehabilitation
immunohistochemically or by histochemical staining specialists and psychologists. Tomorrow. School
with orcein. RESULTS: A highly organized elastic Hygiene at School. Not at home doctor's.
fiber network, similar to that described in bovine discs, Recommendations, Daily Hygiene: personal, oral, food
was revealed in the control human discs. In the anulus mental.... Hygiene of studying, rest and daily effort.
fibrosus of control discs, dense elastic fibers were Struggle with mass media, alcohol, drug, Internet,
located between adjacent lamellae, with fibers also Computer addiction, violence, stupidity and poverty.
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![Abstract: Nurses caring for children with congenital among Arab girls. CONCLUSIONS: Sexual
heart disease face unique challenges, especially when harassment is prevalent in Israeli schools. The pattern
caring for neonates diagnosed with hypoplastic left of victimization is different for boys and girls and for
heart syndrome (HLHS). The treatment options for students in Jewish and Arab schools. These patterns are
these neonates present difficult choices for the child's a complex phenomenon that must be considered in the
decision makers and are not without significant life- intervention and policy measures addressing sexual
altering consequences. In order to assist in the harassment at school.
decision-making process, nurses as patient and family
advocates should acknowledge the unique role they Zelnik N, Newfield RS, Silman-Stolar Z, Goikhman I.
play in the informed consent process, while Height distribution in children with Tourette syndrome.
simultaneously identifying specific ethical principles J Child Neurol 2002; 17(3):200-4.
that are components of this process. By incorporating Abstract: Tourette syndrome is characterized by motor
the principles of autonomy, beneficence, and veracity and vocal tics, frequently accompanied by attention-
into specific nursing interventions, nurses can assist deficit hyperactivity disorder (ADHD), obsessive-
families in making informed decisions regarding a compulsive disorder, coprolalia, aggressive or self-
treatment option that is best for the child as well as the injurious behavior, and learning disabilities. We
family. investigated the height distribution and clinical
characteristics of 38 consecutive patients with Tourette
Zeira A, Astor RA, Benbenishty R. School violence in syndrome. Seventeen patients with Tourette syndrome
Israel: findings of a national survey. Soc Work 2003; (44.7%) were in the lower height quartile versus 25%
48(4):471-83. from a control group of 44 patients with ADHD (P
Abstract: The authors report preliminary findings of a <.05). The mean standard deviation score differential
national survey on school violence in Israel. The (patient height - [target height]) was -1.12 +/- 0.82 for
national representative sample was stratified on school patients in the first quartile (group A) compared with
type--elementary, middle, and high schools--and 0.42 +/- 0.63 in taller patients with Tourette syndrome
ethnicity--Jewish and Arab students. A total of 15,916 (group B) (P < .001). The mean birthweight of boys in
students from 603 classes and 232 schools participated group A versus group B was 3023 +/- 351 g and 3363
in the study, resulting in a 91 percent response rate. +/- 486 g, respectively (P <.02); birthweight correlated
Findings revealed high rates of violence in all areas and with standard deviation score (r=.43). Current weight
among all age groups, but relatively higher rates of relative to height was normal. Conduct disorder and/or
low-level violent behaviors and lower rates of more self-injurious behavior were more common in group A
severe violent events. The authors report on age- patients (P < .05). Relative short stature appears
related, gender, and cultural differences and discuss common in Tourette syndrome, and its presence with
social workers' roles in shaping national policy and other features may implicate a neurotransmitter system
professional discourse on school violence. that interacts with neuroendocrine pathways,
controlling height.
Zeira A, Astor RA, Benbenishty R. Sexual harassment in
Jewish and Arab public schools in Israel. Child Abuse Zerquera JT, Alonso MP, Bejerano GL, Lopez JO,
Negl 2002; 26(2):149-66. Rodriguez NA. Assessment of the doses received by
Abstract: OBJECTIVE: Current empirical literature on the Cuban population from 40K contained in the body:
sexual harassment in schools is mostly based on modelling based on a neural network. Radiat Prot
nonrepresentative samples of middle-class high-school Dosimetry 2003; 104(3):237-43.
Caucasian female students. Thus the scope of research Abstract: Potassium-40 constitutes the main natural
regarding gender, age, and cultural differences is very source of potassium present in the body, which
limited. This article reports on findings on sexual influences the effective dose received by people. With
harassment in Jewish and Arab schools in Israel with the aim of assessing the contribution of this component
regard to gender, age, and cultural differences. to the doses received by the Cuban population, a study
METHOD: The study is part of the first national survey intended to assess the doses was developed. For this
on school violence in Israel. The representative sample purpose, a representative sample of the Cuban
includes 10,400 students in grades 7 through 11 population was selected according to age and sex. The
attending public schools in Israel. Students were asked measurements were made using the whole-body
to report whether they were victims of specific acts of counter (WBC) of the Center for Radiation Protection
sexual harassment in school during the month before and Hygiene (CPHR). For dose estimations, a uniform
the survey. RESULTS: Overall, 29.1% of the students distribution of potassium for the whole body was
were victims of at least one act of harassment. The assumed. The methodology used was the one
more common acts were to show offensive pictures or recommended by the ICRP. The values of annual
to send obscene letters, to take off or to try to take off effective dose range between 93 and 209 microSv for
part of the student's clothing, and to try to kiss a females and between 123 and 212 microSv for males.
student. The most vulnerable groups are the Arab boys The annual average effective dose for members of the
and 8th grade students. Report rates were the lowest public was estimated as 150 +/- 40 microSv, taking
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![into account the experimental data and the specific Zink T, Elder N, Jacobson J, Klostermann B. Medical
features of the Cuban population. With the dose values management of intimate partner violence considering
obtained, it was possible to model dose estimates by the stages of change: precontemplation and
means of a neural network, which was trained with the contemplation. Ann Fam Med 2004; 2(3):231-9.
results obtained and using as starting data the sex, age, Abstract: BACKGROUND: We undertook a study to
height and corporal weight of people studied. The understand how women who are victims of intimate
modelobtained allows consideration of the anatomical partner violence (IPV) want physicians to manage
features of each person in the estimation of doses. these abusive relationships in the primary care office.
METHODS: Thirty-two mothers in IPV shelters or
Zilberman ML, Blume SB. [Domestic violence, alcohol and support groups in southwestern Ohio were interviewed
substance abuse]. Rev Bras Psiquiatr 2005; 27 Suppl to explore their abuse experiences and health care
2:S51-5. encounters retrospectively. The interviews were taped
Abstract: Domestic violence and substance abuse are and transcribed. Using thematic analysis techniques,
common in primary care patients. Although these transcripts were read for indications of the stages of
problems are associated with severe physical and change and for participants' desires concerning
psychological sequelae, they are often undiagnosed. appropriate physician management. RESULTS:
This article provides an overview of the prevalence of Participants believed that physicians should screen
these problems, the health-related consequences for women for IPV both on a routine basis and when
adults, children and elderly, as well as the challenges symptoms indicating possible abuse are present, even if
for clinicians in screening, assessment and referral. the victim does not disclose the abuse. Screening is an
important tool to capture those women early in the
Zimba EW, McInerney PA. The knowledge and practices of process of victimization. When a victim does not
primary care givers regarding home-based care of recognize her relationship as abusive, participants
HIV/AIDS children in Blantyre (Malawi). Curationis recommended that physicians raise the issue by asking,
2001; 24(3):83-91. but they also warned that doing more may alienate the
Abstract: Knowledge is one of the major factors that victim. Participants also encouraged physicians to
promotes adherence to treatment regimens. With the explore clues that victims might give about the abuse.
current trends worldwide of home and community- In later contemplation, victims are willing to disclose
based services for the management of HIV/AIDS the abuse and are exploring options. Physicians were
patients, knowledge of care givers about the home care encouraged to affirm the abuse, know local resources
of these patients will determine the success of the for IPV victims, make appropriate referrals, educate
programs. The purpose of this descriptive study was to victims about how the abuse affects their health, and
explore the knowledge and practices of primary care document the abuse. Participants identified a variety of
givers of HIV/AIDS children in the provision of home internal and external factors that had affected their
care services. In this study an attempt was made to processes. CONCLUSIONS: In hindsight, IPV victims
describe the factors which are associated with recommended desired actions from physicians that
knowledge. Thirty-six primary care givers were could help them during early stages of coming to terms
randomly selected from three major home based care with their abusive relationships. Stage-matched
centres in Blantyre City, Malawi. A structured interventions may help physicians manage IPV more
interview schedule was used to collect data. Data were effectively and avoid overloading the victim with
analysed manually and by computer, using the information for which she is not ready.
Statistical Package for Social Science (SPSS). The
findings revealed a gap in knowledge since in many Zink T, Kamine D, Musk L, Sill M, Field V, Putnam F.
instances taking a child to the hospital for the What are providers' reporting requirements for children
management of minor ailments was the action of who witness domestic violence? Clin Pediatr (Phila)
choice, thus perpetuating the problem of overburdening 2004; 43(5):449-60.
hospital resources. Lack of prior preparation for home Abstract: Each year, 3.3 to 10 million children are
based care was found to be the major factor exposed to domestic violence/abuse (DV). Providers'
contributing to the lack of knowledge. reporting obligations for these children are unclear.
Recommendations proposed include the need to put The child maltreatment statutes available on state's web
into place mechanisms that will ensure that all the sites (through August 2003) were reviewed. Only
primary care givers are adequately prepared in good Alaska defines DV in the presence of a child as child
time for home care service. Ensuring regular home abuse within its juvenile code. Within their child abuse
visits was also thought to be helpful for efficient and definition and reporting statutes, many states include
effective supervision and reinforcement of information language such as "substantial risk" or "imminent
given to fill the gaps in knowledge wherever necessary. danger" of "physical harm" or "mental injury."
Although knowledge of the state law is an important
Zink T. On my mind: meeting Daniel. Arch Pediatr Adolesc first step, abiding by it may be challenging because
Med 2005; 159(8):704-5. most statutes are open to wide interpretation. As a
result, providers are encouraged to seek advice from
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Bibliografia sobre abuso infantil
- 1. OPS/FCH/CA/06.07 Bibliografía sobre abuso o maltrato infantil CITACIONES DE MEDLINE, LICACS Y OTRAS BASES DE DATOS 2001-2005 Child abuse or maltreament Bibliography CITATIONS FROM MEDLINE, LILACS AND OTHER DATABASES 2001-2005 Editores/Editors Alberto Concha-Eastman Yehuda Benguigui Unidad de Salud del Niño y del Adolescente Área de Salud Familiar y Comunitaria Unidad de Evaluación de Riesgos Área Desarrollo Sostenible y Salud Ambiental
- 2. Biblioteca Sede OPS- Catalogación en la fuente Organización Panamericana de la Salud Bibliografía sobre abuso o maltrato infantil. 2nd ed. Washington, D.C: OPS, © 2007. (Serie OPS/FCH/CA/06.07/E) -- 900 p ISBN 978 92 75 07401 1 I. Título II. Serie 1. MALTRATO A LOS NIÑOS 2. NIÑO ABANDONADO 3. SÍNDROME DEL NIÑO MALTRATADO 4. ABUSO SEXUAL INFANTIL 5. BIBLIOGRAFÍA (TIPO DE PUBLICACIÓN) NLM WA 320 La Organización Panamericana de la Salud dará consideración muy favorable a las solicitudes de autorización para reproducir o traducir, íntegramente o en parte, esta publicación. Las solicitudes deberán dirigirse al Área de Salud Familiar y Comunitaria, Unidad Técnica Salud del Niño y del Adolescente. Organización Panamericana de la Salud 525 Twenty-third Street, N.W. Washington, D.C 20037, EE.UU Las denominaciones empleadas en esta publicación y la forma en que aparecen los datos que contiene no implica, de parte de la Secretaría de la Organización Panamericana de la Salud, juicio alguno sobre la consideración jurídica de ninguno de los países, territorios, ciudades o zonas citados o de sus autoridades, ni respecto de la delimitación de sus fronteras. La mención de determinadas sociedades mercantiles o del nombre comercial de ciertos productos no implica que la Organización Panamericana de la Salud los apruebe o recomiende con preferencia a otros análogos. 2
- 3. Tabla de contenidos/Tableof contents Prólogo/preface…………………………………………………………………………………………..i a) Definición, signos y síntomas/Definition, signs and symptoms.............................................................. i Síndrome del niño golpeado/Battered Child Syndrome ....................................................................... 1 Abuso psíquico/Physical abuse on children ......................................................................................... 5 Maltrato infantil/Child maltreatment..................................................................................................... 6 Agresión física en niños/Physical aggression on children .................................................................. 31 Explotación infantil/Child Exploitation ............................................................................................... 32 Desatención infantil/Children Disregard ............................................................................................ 33 Abuso sexual/Sexual Abuse................................................................................................................ 34 Abuso emocional/Emotional Abuse .................................................................................................... 69 Violencia doméstica/Domestic violence against children .................................................................. 92 Síndrome del niño sacudido/Shaken baby syndrome .......................................................................100 Castigo corporal/Corporal punishment on children..........................................................................104 b) Detección, Diagnóstico y evaluación/Detection, Diagnosis, Evaluation............................................105 Detección/diagnóstico/Child abuse detection/diagnosis..................................................................105 Epidemiología/Epidemiology of Child Maltreatment ........................................................................111 Factores de riesgo/Risk factors on child abuse..................................................................................136 Screening domestic violence .............................................................................................................152 Prevención de abuso en niños /Child abuse prevention....................................................................176 Evaluación de abuso en niños/Child abuse evaluation ......................................................................194 c) Prácticas/ Practices............................................................................................................................203 Disciplina para niños y niñas/Discipline of boys and girls.................................................................203 Visitas en el hogar/Home visitation....................................................................................................206 Prácticas de crianza/Parenting practices ...........................................................................................212 Redes/Networks.................................................................................................................................218 Projectos basados en evidencia/Evidence based projects ................................................................234 d) Situaciones especiales/Special situations..........................................................................................237 Pornografía y prostitución en niños y niñas/Pornography and prostitution of boys and girls............237 Niños de la calle/Street children........................................................................................................240 Niños abandonados por guerra o conflictos/Children displaced by war or conflicts ........................243 Niños como víctima de la violencia/Children as violence victims’ ....................................................248 Tráfico y venta de niños (órganos)Children trafficking and sale (organs) .........................................263 e) Efectos del abuso o maltrato/Effects of abuse and mistreatment.......................................................263 Efecto a largo plazo del abuso infantil/Longterm effect of abuse on children....................................263 Salud mental/Mental Health ...............................................................................................................273 Resiliencia/Resilience ........................................................................................................................279 Transtornos de conducta agresiva/Child aggressive behavior disorders .........................................280 f) Otros/Others.......................................................................................................................................286 Derechos de niños y adolescentes/Rights of children and adolescents.............................................286 Leyes, ética y políticas/Law, ethics and politics.................................................................................302 g) Lista de web sites sobre abuso infantil/Listing of websites on child abuse .......................................302 Sección de autores/Author Section ........................................................................................................304 3
- 4. PREFACE T he World Health Organization (WHO) estimates that globally 40 million children suffer from violence, and in the Region of the Americas and the Caribbean this includes all types of violence. The majority of minors who endure corporal punishment are between the ages of 2 and 7, and of these the most severely affected are between the ages of 3 and 5. Eighty-five percent of the deaths from abuse and maltreatment are reported as accidental or undetermined. For each death, it is estimated that 9 children are incapacitated; 71 million children suffer from serious injuries and innumerable victims with psychological sequelae. Child abuse and maltreatment includes all forms and physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment, commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust, or power. Current data indicates that child abuse affects the physical health and development of thousands of children in Latin America and the Caribbean, beckoning the necessity for increased efforts in its identification, prevention and treatment, as well as in knowledge regarding its magnitude and research methodologies. The Integrated Management of Childhood Illnesses (IMCI) Strategy set forth by the Pan American Health Organization (PAHO) is one of tools currently available to respond to this need. IMCI contains information on prevention, promotion, evaluation, classification, and treatment of the major diseases and health issues that affect children during their first years of life, with the objective to reduce the risk of disease and to promote health, growth, and development during childhood. IMCI adaptable to diverse realities, and therefore its contents can be modified to respond to the particular epidemiological patterns in each country, allowing for the inclusion of additional modules, including child abuse and maltreatment The Child and Adolescent Health Unit of the Family and Community Health Area, in conjunction with the Risk Unit of the Sustainable Development and Environmental Area, of PAHO, has intensified work in capacity building and dissemination of the “Detection and Prevention of Child Abuse and Sexual Abuse of Children en the framework of IMCI” module. This document looks to fill the existing gap in the preparation of health care providers to detect and care for children victims of abuse and maltreatment While there have been advances in advocacy and national and municipal plans to protect children and reduce abuse and, maltreatment it still is not possible to affirm that these have resulted in social, family, and institutional change. In line with the United Nations Report, in which it is stated that “no form of violence against children is acceptable,” PAHO/WHO leads efforts and supports processes and projects. One such effort is the PAHO/GTZ interprogrammatic initiative “Promoting Youth Development and Violence Prevention” which has acted in Nicaragua, El Salvador, Honduras, Colombia, Peru, and Argentina since 2003 with financing by the German government (BMZ). Through this initiative there has been significant progress in the identification of a conceptual framework that supports the promotion of youth development and the prevention of violence, the systematization of effective practices, and the accumulation of evidence in youth development and violence prevention in Latin America. Furthermore, based on these inputs, PAHO/GTZ has developed TEACH VIP Youth, a capacity building program available as a CD-Rom, an online course, or as a workshop. TEACH VIP Youth aims to improve the design and the evaluation of violence prevention programs. In addition, through this initiative national and local networks have been strengthened with participation of young people, training, and guided the decision-making on what interventions should or should not be considered for implementation. The i
- 5. evidence documents elaboratedthrough this initiative and the examples of cases can be reviewed at http: /www.paho.org/CDMEDIA/FCHGTZ/docsregionalesdocs.htm. The Networks of Buen Trato [Good Treatment] that function in several countries have been used to improve the responses to the problem. This type of network includes government and non-governmental entities and tries to strengthen the capacities and efficiency of each entity joining the effort. For example, experiences such as the “Casa Hogar UNACARI” (meaning the “his house” in the Yaqui dialect) in Hermosillo, Sonora, México, where nearly 200 boys and girls between the ages of 0 and 14 years old have suffered violence or have been abandoned by their mothers and fathers, provides shelter and comprehensive assistance that includes formal education, medical services, psychological support and recreation, in addition to the search for adoptive parents who will provide them with an adequate education and attention. (http://www.difson.gob.mx/Sitio/programas_menores.aspx?prog=pUNACARI). Aware of the problem and for the need for information on the subject, in 2002 PAHO published the first bibliographic compendium on child abuse and maltreatment which includes more than 700 references and their respective summaries from publications from 1995 to 2000. Through the publication of this second volume of the Bibliography on Child Abuse and maltreatment, the Units of Child and Adolescent Health and Risk Assessment of PAHO wish continue contributing to the promotion of information and evidence on the situation of the child abuse in the Region of the Americas. For this second edition, publications from the years 2001 to 2005 have been compiled from MEDLINE, LILACS and other sources. The first part of this publication concentrates on articles about the definition, signs, and symptoms of various forms of abuse and maltreatment; the following section contains references on the detection, diagnosis, and evaluation of the utility of these for providers who work with abused children; articles on practices and interventions have been grouped in order to facilitate their search for decision makers and researchers; publications on pornography and child sexual abuse, and other special topics such as street children, displaced persons due to wars and conflicts are listed after a section on the effects of the abuse and neglect, which includes publications on mental health, long-term effects of violence or abuse, resiliency, and aggressive behaviors. The last section compiles publications on human rights, laws, ethics, and policy. A list of Web pages is included at the end of the document. This publication is for physicians, government institutions, and ministries of health, family, and child protection, academics, professors, researchers, and providers. We hope that it will contribute to the health and development of children, adolescents, and their families and provide additional support for efforts to reach the United Nations Millennium Development Goals (MDGs). Yehuda Benguigui Alberto Concha-Eastman. Unit Chief Regional Advisor Child and Adolescent Health Risk Assessment and Management Family and Community Health Sustainable Development and PAHO/WHO Environmental Health PAHO/WHO ii
- 6. PRÓLOGO L a Organización Mundial de la Salud (OMS) estima que 40 millones de niños sufren violencia en el mundo, y en la Región de las Américas y el Caribe ésta se da en todas sus formas. La mayoría de los menores sometidos a castigos corporales tienen entre 2 y 7 años de edad, y de ellos, el grupo más afectado fluctúa entre los 3 y 5. Un 85% de las muertes por maltrato son clasificadas como accidentales o indeterminadas, y por cada muerte, se calculan 9 incapacitados, 71 niños con lesiones graves e innumerables víctimas con secuelas psicológicas. El abuso o maltrato de menores es toda forma de maltrato físico y/o emocional, abuso sexual, abandono o trato negligente, explotación comercial o de otro tipo, del que resulte un daño real o potencial para la salud, la supervivencia, el desarrollo o la dignidad del niño en el contexto de una relación de responsabilidad, confianza o poder. La información disponible indica que el maltrato es un problema que afecta la salud física y el desarrollo de miles de niños y niñas en América Latina y el Caribe, por lo cual es necesario avanzar en su detección, prevención y tratamiento, así como en el conocimiento de su magnitud, metodologías de información e investigación. En este sentido, la estrategia de Atención Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI) de la Organización Panamericana de la Salud es una de las mejores herramientas disponibles en la actualidad, ya que incluye contenidos de prevención, promoción, evaluación, clasificación y tratamiento de las enfermedades y problemas de salud que con mayor frecuencia afectan a los niños durante sus primeros años de vida, con el objetivo de reducir los riesgos de enfermedad y para fomentar un crecimiento y desarrollo saludables durante la niñez. La AIEPI se adapta a cada realidad, lo que contribuye a adecuar sus contenidos básicos a los patrones epidemiológicos de morbilidad y mortalidad de cada país, permitiendo incorporar contenidos adicionales. Entre ellos está el maltrato infantil. Si bien hay avances en materia de abogacía y planes nacionales o municipales para proteger a los niños y niñas y reducir su abuso y maltrato, aún no es posible afirmar que aquello se refleje en transformaciones sociales, familiares e institucionales. Haciendo mención al informe de NNUU que indica que “ninguna forma de violencia contra la niñez es aceptable”, OPS/OMS ha dirigido esfuerzos y ha apoyado procesos y proyectos, como OPS/GTZ que existe desde 2003 con financiamiento del Gobierno Alemán (BMZ). A través de él se ha implementado la iniciativa interprogramática de “Fomento del Desarrollo Juvenil y Prevención de la Violencia” en Nicaragua, El Salvador, Honduras, Colombia, Perú y Argentina, avanzándose significativamente en la identificación de un marco conceptual que apoye la promoción del desarrollo de los jóvenes y la prevención de la violencia, la sistematización de las prácticas exitosas, y la acumulación de evidencias sobre desarrollo juvenil y prevención de violencia en países de América Latina. Asimismo, en base a estos insumos se ha desarrollado el curso de capacitación TEACH VIP Youth (en CD, Internet y presencial), destinado a mejorar el diseño y la evaluación de programas efectivos para la prevención de la violencia. Con esta iniciativa se han reforzado además las redes nacionales y locales con participación de jóvenes, capacitando y orientado la toma de decisiones sobre qué intervenciones deben ser o no consideradas para ser implementadas. Los documentos de evidencia de este proyecto y los ejemplos de casos se pueden revisar en http://www.paho.org/CDMEDIA/FCHGTZ/docsregionalesdocs.htm Las Redes del Buen Trato que existen en varios países han servido para avanzar en la perspectiva de modificar la forma de atender el problema. Este tipo de redes incluyen a entidades de gobierno y no gubernamentales y buscan fortalecer las capacidades y eficiencia de cada entidad sumando esfuerzos. Experiencias como la Casa Hogar UNACARI (que significa "La casa de él" en dialecto Yaqui) en curso en iii
- 7. Hermosillo, Sonora, México,donde cerca de 200 niños y niñas de 0 a 14 años -que han sufrido violencia o han sido abandonados por sus madres y padres- disponen de albergue y asistencia integral que incluye educación formal, servicios médicos, apoyo psicológico y recreación, además de la búsqueda de padres adoptivos que les garanticen una adecuada educación y atención. (http://www.difson.gob.mx/Sitio/programas_menores.aspx?prog=pUNACARI). Por esa razón, la Unidad de Salud del Niño y del Adolescente, Área Salud Familiar y Comunitaria, en conjunto con la Unidad de Riesgos, Programa de Prevención de Violencia y Lesiones, de OPS, ha intensificado el trabajo de capacitación y difusión del Módulo “Detección y prevención del maltrato infantil y abuso sexual en la niñez en el marco de AIEPI”. Este documento busca llenar el vacío que aún existe en la preparación del personal de salud para detectar y tratar los niños víctimas de maltrato o abuso. Asimismo, en 2002 se publicó el primer compendio bibliográfico sobre maltrato y abuso infantil con más de 700 referencias, con sus respectivos resúmenes, correspondientes a publicaciones del período 1995 - 2000. Con este segundo volumen de Bibliografía sobre Maltrato y Abuso Infantil, las Unidades de Salud del Niño y del Adolescente y de Prevención de Violencia de la OPS, desean contribuir a promover información y evidencia sobre la situación del maltrato infantil en la Región de las Américas. Para ello se han recopilado publicaciones de los años 2001 a 2005, tomadas de MEDLINE, LILACS y otras fuentes. La primera parte se concentra en artículos sobre definición, signos y síntomas de diversas formas de abuso y maltrato; en el siguiente bloque se recopilan referencias sobre detección, diagnóstico y evaluación de utilidad práctica para quienes atienden a los niños y niñas maltratados; los artículos sobre prácticas e intervenciones se han agrupado para facilitar su búsqueda a tomadores de decisiones e investigadores; las publicaciones sobre pornografía y abuso sexual infantil, y otros como niños de la calle, desplazados de guerras y conflictos se enumeran después de los efectos del abuso y el maltrato, que recoge publicaciones sobre salud mental, efectos de larga duración en casos de violencia o maltrato, resiliencia y conductas agresivas. En la última parte se agruparon publicaciones sobre derechos humanos, leyes, ética y política. Una lista de páginas de Internet se añade al final. Esta publicación está destinada a médicos, instituciones de gobierno, ministerios de salud, de familia y de protección de la niñez, académicos, profesores, investigadores y proveedores, y esperamos que sea un aporte para el desarrollo y la salud de los niños, adolescentes y sus familias, y una forma de alcanzar los Objetivos de Desarrollo del Milenio (ODM) de las Naciones Unidas. Yehuda Benguigui Alberto Concha-Eastman. Jefe de Unidad Asesor Regional Unidad Salud del Niño y del Adolescente Prevención de Violencia y Lesiones Área Salud Familiar y Comunitaria Unidad de Evaluación de Riesgos OPS/OMS Área Desarrollo Sostenible y Salud Ambiental OPS/OMS iv
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- 312. Author Section ACOG CommitteeOpinion. Committee on Genetics. Choosing deafness. Arch Dis Child 2003; 88(1):24. Genetic evaluation of stillbirths and neonatal deaths. Obstet Gynecol 2001; 97(5 Pt 1):suppl 1-3. Community networks. Youth recreation and self-esteem Notes: CORPORATE NAME: American College of enhancement initiative. Little Falls, MN. Health Prog Obstetricians and Gynecologists Committee on 2001; 82(6):64-5. Genetics. Consent for emergency medical services for children and Anna Climbie. Trusts failed to spot hideous abuse. Nurs adolescents. Pediatrics 2003; 111(3):703-6. Times 2001; 97(3):6. Notes: CORPORATE NAME: Committee on Pediatric Emergency Medicine Appeals court overturns libel ruling in use of infant's photo. GENERAL NOTE: KIE: 30 refs. AIDS Policy Law 2001; 16(20):7. GENERAL NOTE: KIE: KIE Bib: informed consent/minors The assessment and management of acute pain in infants, Abstract: Pediatric patients frequently seek medical children, and adolescents. Pediatrics 2001; 108(3):793- treatment in the emergency department (ED) 7. unaccompanied by a legal guardian. Current state and Notes: CORPORATE NAME: American Academy of federal laws and medical ethics recommendations Pediatrics. Committee on Psychosocial Aspects of support the ED treatment of minors with an identified Child and Family Health emergency medical condition, regardless of consent CORPORATE NAME: Task Force on Pain in Infants, issues. Financial reimbursement should not limit the Children, and Adolescents minor patient's access to emergency medical care or Abstract: Acute pain is one of the most common result in a breach of patient confidentiality. Every adverse stimuli experienced by children, occurring as a clinic, office practice, and ED should develop policies result of injury, illness, and necessary medical and guidelines regarding consent for the treatment of procedures. It is associated with increased anxiety, minors. The physician should document all discussions avoidance, somatic symptoms, and increased parent of consent and attempt to seek consent for treatment distress. Despite the magnitude of effects that acute from the family or legal guardian and assent from the pain can have on a child, it is often inadequately pediatric patient. Appropriate medical care for the assessed and treated. Numerous myths, insufficient pediatric patient with an urgent or emergent condition knowledge among caregivers, and inadequate should never be withheld or delayed because of application of knowledge contribute to the lack of problems with obtaining consent. This statement has effective management. The pediatric acute pain been endorsed by the American College of Surgeons, experience involves the interaction of physiologic, the Society of Pediatric Nurses, the Society of Critical psychologic, behavioral, developmental, and situational Care Medicine, the American College of Emergency factors. Pain is an inherently subjective multifactorial Physicians, the Emergency Nurses Association, and the experience and should be assessed and treated as such. National Association of EMS Physicians. Pediatricians are responsible for eliminating or assuaging pain and suffering in children when possible. Court filings. Intentional exposure charges filed against To accomplish this, pediatricians need to expand their inmate, Canadian. AIDS Policy Law 2005; 20(7):9. knowledge, use appropriate assessment tools and techniques, anticipate painful experiences and Court: HIV testing not intended to gather evidence for trial. intervene accordingly, use a multimodal approach to AIDS Policy Law 2001; 16(17):7. pain management, use a multidisciplinary approach when possible, involve families, and advocate for the Court-ordered HIV testing overturned on appeal. AIDS use of effective pain management in children. Policy Law 2003; 18(5):6. Bill to protect mother's right to breastfeed. Pract Midwife Court-ordered HIV testing upheld for child molester. AIDS 2002; 5(9):7. Policy Law 2004; 19(11):7. Child custody. Neglect of HIV medical care becomes factor Court-ordered testing upheld for child sex offender. AIDS in custody dispute. AIDS Policy Law 2002; 17(18):7. Policy Law 2004; 19(12):6. Custody. Termination of HIV-positive mother's parental rights affirmed. AIDS Policy Law 2004; 19(20):6. 304
- 313. Drugs for thedoctor's bag: 2--children. Drug Ther Bull I was addicted to everything. J Mich Dent Assoc 2004; 2005; 43(11):81-4. 86(10):26-8, 30-1. Abstract: In September 2005, we published Drugs for the doctor's bag: 1--Adults, recognising the fact that The implementation of the Fast Track program: an example there is still a need for most GPs to carry well- of a large-scale prevention science efficacy trial. J equipped bags, even though many have given up Abnorm Child Psychol 2002; 30(1):1-17. responsibility for out-of-hours services. Here we Abstract: In 1990, the Fast Track Project was initiated suggest medicines that a GP might want to have to evaluate the feasibility and effectiveness of a available for use in an emergency or for the acute comprehensive, multicomponent prevention program treatment of children and adolescents, updatingour targeting children at risk for conduct disorders in four previous advice. As with adults, it is not our intention demographically diverse American communities to imply that every GP must carry every drug (Conduct Problems Prevention Research Group mentioned. Some of the drugs will probably only be [CPPRG], 1992). Representing a prevention science used by rural GPs who do not have access to approach toward community-based preventive immediate emergency care. Whenever a medicine is intervention, the Fast Track intervention design was first mentioned, our suggested formulation is included based upon the available data base elucidating the in brackets. Unless otherwise stated, the doses given epidemiology of risk for conduct disorder and are all from the BNF for Children. We enclose with suggesting key causal developmental influences (R. P. this issue a card summarising parenteral doses (for Weissberg & M. T. Greenberg, 1998). Critical adults and children) of drugs for medical emergencies; questions about this approach to prevention center this card includes the BNF table of ideal weight for around the extent to which such a science-based age. program can be effective at (1) engaging community members and stakeholders, (2) maintaining Exposure. Court: HIV-positive hearsay did not prejudice intervention fidelity while responding appropriately to trial outcome. AIDS Policy Law 2004; 19(15):6. the local norms and needs of communities that vary widely in their demographic and cultural/ethnic Exposure. HIV-positive sex offender loses character witness composition, and (3) maintaining community challenge. AIDS Policy Law 2004; 19(3):6. engagement in the long-term to support effective and sustainable intervention dissemination. This paper Exposure. Predator label holds for HIV-positive offender. discusses these issues, providing examples from the AIDS Policy Law 2005; 20(16):8. Fast Track project to illustrate the process of program implementation and the evidence available regarding A genetic defense against child abuse? Harv Ment Health the success of this science-based program at engaging Lett 2003; 19(9):8. communities in sustainable and effective ways as partners in prevention programming. Global group launches U.S. human rights project. AIDS Policy Law 2002; 17(20):1. In Asia, child mortality is not linked to women's autonomy or religion. Int Fam Plan Perspect 2003; 29(4):195-6. The hidden health trauma of child soldiers. Lancet 2004; 363(9412):831. [In children with psychiatrically ill parents the soul suffers]. Krankenpfl J 2004; 42(5-6):153-4. HIV as weapon. Court upholds man's enhanced sentence for HIV exposure. AIDS Policy Law 2005; 20(14):8. Index of suspicion. Pediatr Rev 2003; 24(3):99-105. HIV infection: five face death if guilty. Nurs Times 2001; [Investigating sexual abuse of a child]. Duodecim 2001; 97(38):9. 117(2):224-34. Notes: CORPORATE NAME: Finnish Association of HIV testing order must be challenged at trial. AIDS Policy Child Psychiatrists Law 2004; 19(4):7. Learn to read the signs. Nurs Stand 2003; 17(51):16-7. HIV testing order reversed for convicted sex offender. AIDS Policy Law 2005; 20(20):6. Lecturer struck off after claiming child pornography was a teaching aid. Nurs Times 2001; 97(34):5. HIV testing upheld for man convicted of child sexual abuse. AIDS Policy Law 2004; 19(10):3. Letting live, letting die. Bull Med Ethics 2004; (201):19-22. Notes: GENERAL NOTE: KIE: KIE Bib: allowing to Hospitals tap into database for pediatric intensive care. Data die/infants; allowing to die/legal aspects Strateg Benchmarks 2002; 6(6):85-91. Libyan HIV trial is postponed. Nurs Times 2001; 97(39):7. 305
- 314. Management of childabuse in Hong Kong: results of a Offender loses challenge of court-ordered HIV testing. territory-wide inter-hospital prospective surveillance AIDS Policy Law 2004; 19(17):7. study. Hong Kong Med J 2003; 9(1):6-9. Notes: CORPORATE NAME: Hong Kong Medical Opposing war in southwest Asia. J Public Health Policy Coordinators on Child Abuse 2002; 23(1):9-11. Abstract: OBJECTIVES: To study suspected child Notes: CORPORATE NAME: American Public Health abuse among children in hospital in terms of clinical Association characteristics and the outcome of multidisciplinary case conferences. DESIGN: Prospective observational Order for HIV testing to hinge on fluid transmission. AIDS study. SETTING: All public hospitals in Hong Kong Policy Law 2004; 19(12):8. with a paediatric department. METHODS: Anonymous data were prospectively collected from July 1997 to Out-of-school suspension and expulsion. American June 1999 using a standard report form for each case of Academy of Pediatrics Committee on School Health. suspected child abuse. The characteristics of the Pediatrics 2003; 112(5):1206-9. incidents and factors influencing the conclusion at the Notes: CORPORATE NAME: American Academy of multidisciplinary case conference were studied. Pediatrics Committee on School Health RESULTS: Data for 592 cases of suspected child abuse Abstract: Suspension and expulsion from school are were evaluated. Two hundred and eighty-seven of the used to punish students, alert parents, and protect other children were boys and 305 were girls. The mean age students and school staff. Unintended consequences of was 7.3 years (range, 0-16.7 years). Physical abuse, these practices require more attention from health care alone or in combination with other forms of professionals. Suspension and expulsion may maltreatment, accounted for 277 (86.6%) of the 320 exacerbate academic deterioration, and when students substantiated cases. Either, or both, biological parents are provided with no immediate educational comprised 71.3% of the perpetrators. Seven (1.2%) alternative, student alienation, delinquency, crime, and children died. Of the 540 children about whom a substance abuse may ensue. Social, emotional, and multidisciplinary case conference was held, abuse was mental health support for students at all times in all established for 281 (52.0%) children. Abuse was more schools can decrease the need for expulsion and likely to be established if the victim had been known to suspension and should be strongly advocated by the a childcare agency (odds ratio=2.2; 95% confidence health care community. This policy statement, interval, 1.4-3.5), the abuse was not sexual (odds however, highlights aspects of expulsion and ratio=2.7; 95% confidence interval, 1.4-5.0), or if the suspension that jeopardize children's health and safety. child was seen at a hospital that handled more than 100 Recommendations are targeted at pediatricians, who cases of suspected abuse during the study period (odds can help schools address the root causes of behaviors ratio=3.6; 95% confidence interval, 2.4-5.4). that lead to suspension and expulsion and can advocate CONCLUSION: Child abuse identified in the hospital for alternative disciplinary policies. Pediatricians can setting is predominantly physical in nature and death is also share responsibility with schools to provide not uncommon. Appraisal of suspected child abuse by students with health and social resources. multidisciplinary case conference appears to be influenced by the region of Hong Kong in which the Pathology of nonaccidental brain injury. Arch Dis Child case was handled. 2001; 85(6):473. Miller v. HCA, Inc. Wests South West Report 2003; The Pediatrician's role in family support programs. 118:758-72. Committee on Early Childhood and Adoption, and Notes: CORPORATE NAME: Texas Supreme Court Dependent Care. Pediatrics 2001; 107(1):195-7. GENERAL NOTE: KIE: KIE Bib: allowing to Notes: CORPORATE NAME: American Academy of die/infants; allowing to die/legal aspects; resuscitation Pediatrics. Committee on Early Childhood and orders; treatment refusal/minors Adoption, and Dependent Care Abstract: Children's brain growth, general health, and Mississippi Supreme Court allows patient's identity to be development are directly influenced by emotional revealed. Baptist Memorial Hospital v. Johnson. Hosp relationships during early childhood. Contemporary Law Newsl 2001; 18(11):4-6. American life challenges families' abilities to promote successful developmental outcomes and emotional Nepal legalizes abortion, bans child abuse. NY Times (Print) health for their children. Pediatricians are positioned to 2002; A5. serve as family advisors and community partners in Notes: GENERAL NOTE: KIE: KIE supporting the well-being of children and families. Bib:abortion/foreign countries; abortion/legal aspects This statement recommends opportunities for pediatricians to develop their expertise in assessing the Nurse's hearsay testimony re sexual assault is admissible. strengths and stresses in families, in counseling Nurs Law Regan Rep 2001; 41(8):1. families about strategies and resources, and in 306
- 315. collaborating with othersin their communities to relation between 11 risk factors and these 3 outcomes support family relationships. was examined, with separate regression analyses for the intervention and control groups. Moderate evidence Pedophilia. Who are the men who "love" children in of prediction of outcome effects was found, although intolerable ways? And how can they be helped to none of the baseline variables were found to predict all change? Harv Ment Health Lett 2004; 20(7):1-4. 3 outcomes, and different patterns of prediction emerged for home versus school outcomes. Poison treatment in the home. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevalence of anemia among displaced and nondisplaced Prevention. Pediatrics 2003; 112(5):1182-5. mothers and children--Azerbaijan, 2001. MMWR Notes: CORPORATE NAME: American Academy of Morb Mortal Wkly Rep 2004; 53(27):610-4. Pediatrics Committee on Injury, Violence, and Poison Notes: CORPORATE NAME: Centers for Disease Prevention Control and Prevention (CDC) Abstract: The ingestion of a potentially poisonous Abstract: In the early 1990s, the war between Armenia substance by a young child is a common event, with and Azerbaijan over the Azeri region of Nagorno- the American Association of Poison Control Centers Karabakh resulted in approximately 600,000 internally reporting approximately 1.2 million such events in the displaced persons and 200,000 refugees in Azerbaijan. United States in 2001. The American Academy of After years of displacement and despite sustained Pediatrics (AAP) has long concerned itself with this humanitarian assistance, these internally displaced issue and has made poison prevention an integral persons and refugees (IDP/Rs) are still coping with component of its injury prevention initiatives. A key unfavorable living conditions and limited employment AAP recommendation has been to keep a 1-oz bottle of opportunities. Results of a 1996 CDC survey in syrup of ipecac in the home to be used only on the Azerbaijan revealed high rates of malnutrition and advice of a physician or poison control center. anemia among both the IDP/R and resident populations Recently, there has been interest regarding activated and prompted further study of the nutritional status of charcoal in the home as a poison treatment strategy. these populations. This report summarizes results of a After reviewing the evidence, the AAP believes that 2001 survey of IDP/R and non-IDP/R mothers and ipecac should no longer be used routinely as a home children with anemia in Azerbaijan. Findings indicated treatment strategy, that existing ipecac in the home that more than one third of mothers and children were should be disposed of safely, and that it is premature to anemic, with no significant difference in the overall recommend the administration of activated charcoal in prevalence between IDP/R and non-IDP/R populations; the home. The first action for a caregiver of a child however, among the IDP/R population, anemia was who may have ingested a toxic substance is to consult associated with various socioeconomic factors such as with the local poison control center. education, socioeconomic status (SES), and area of residence. Future studies should focus on identifying Policy statement: physicians should expand knowledge to causes for the high rates of anemia in Azerbaijan and ease children's pain. Dent Today 2001; 20(10):43. developing effective interventions such as iron supplementation and behavior modification. Position statement. Child maltreatment. J Pediatr Health Care 2002; 16(1):30A-1A. Protection of human research subjects. Final rule. Fed Regist 2001; 66(219):56775-80. Predictor variables associated with positive Fast Track Notes: CORPORATE NAME: Department of Health outcomes at the end of third grade. J Abnorm Child and Human Services (DHHS) Psychol 2002; 30(1):37-52. GENERAL NOTE: KIE: KIE Bib: embryo and fetal Abstract: Progress has been made in understanding the research; human experimentation/minors; human outcome effects of preventive interventions and experimentation/regulation; human treatments designed to reduce children's conduct experimentation/special populations problems. However, limited research has explored the Abstract: The Department of Health and Human factors that may affect the degree to which an Services (DHHS) is withdrawing Subpart B of its intervention is likely to benefit particular individuals. human subjects protection regulations published on This study examines selected child, family, and January 17, 2001 and is issuing this replacement rule. community baseline characteristics that may predict These regulations provide additional protections for proximal outcomes from the Fast Track intervention. pregnant women and human fetuses involved in The primary goal of this study was to examine research. The final rule continues the special predictors of outcomes after 3 years of intervention protections for pregnant women and human fetuses that participation, at the end of 3rd grade. Three types of have existed since 1975 and makes limited changes in proximal outcomes were examined: parent-rated terminology referring to neonates, clarifies provisions aggression, teacher-rated oppositional-aggressive for paternal consent when research is conducted behavior, and special education involvement. The involving fetuses, clarifies language that applies to research on newborns of uncertain viability, and 307
- 316. corrects technical errors. injuries, violence, and suicide while at home, at work, at play, in the community, and throughout their lives. Regional Infant and Child Mortality Review Committee This report summarizes school health 2000 final report. S D J Med 2001; 54(11):448-51. recommendations for preventing unintentional injury, violence, and suicide among young persons. These Risperidone treatment of autistic disorder: longer-term guidelines were developed by CDC in collaboration benefits and blinded discontinuation after 6 months. with specialists from universities and from national, Am J Psychiatry 2005; 162(7):1361-9. federal, state, local, and voluntary agencies and Notes: CORPORATE NAME: Research Units on organizations. They are based on an in-depth review of Pediatric Psychopharmacology Autism Network research, theory, and current practice in unintentional Abstract: OBJECTIVE: Risperidone is effective for injury, violence, and suicide prevention; health short-term treatment of aggression, temper outbursts, education; and public health. Every recommendation is and self-injurious behavior in children with autism. not appropriate or feasible for every school to Because these behaviors may be chronic, there is a implement. Schools should determine which need to establish the efficacy and safety of longer-term recommendations have the highest priority based on treatment with this agent. METHOD: The authors the needs of the school and available resources. The conducted a multisite, two-part study of risperidone in guidelines include recommendations related to the children ages 5 to 17 years with autism accompanied following eight aspects of school health efforts to by severe tantrums, aggression, and/or self-injurious prevent unintentional injury, violence, and suicide: a behavior who showed a positive response in an earlier social environment that promotes safety; a safe 8-week trial. Part I consisted of 4-month open-label physical environment; health education curricula and treatment with risperidone, starting at the established instruction; safe physical education, sports, and optimal dose; part II was an 8-week randomized, recreational activities; health, counseling, double-blind, placebo-substitution study of risperidone psychological, and social services for students; withdrawal. Primary outcome measures were the appropriate crisis and emergency response; Aberrant Behavior Checklist irritability subscale and involvement of families and communities; and staff the Clinical Global Impression improvement scale. development to promote safety and prevent RESULTS: Part I included 63 children. The mean unintentional injuries, violence, and suicide. risperidone dose was 1.96 mg/day at entry and remained stable over 16 weeks of open treatment. The Screening HIV-infected persons for tuberculosis--Cambodia, change on the Aberrant Behavior Checklist irritability January 2004-February 2005. MMWR Morb Mortal subscale was small and clinically insignificant. Wkly Rep 2005; 54(46):1177-80. Reasons for discontinuation of part I included loss of Notes: CORPORATE NAME: Centers for Disease efficacy (N=5) and adverse effects (N=1). The subjects Control and Prevention (CDC) gained an average of 5.1 kg. Part II included 32 Abstract: Worldwide, tuberculosis (TB) is one of the patients. The relapse rates were 62.5% for gradual most common causes of death among persons infected placebo substitution and 12.5% for continued with human immunodeficiency virus (HIV). The World risperidone; this difference was statistically significant. Health Organization recommends screening HIV- CONCLUSIONS: Risperidone showed persistent infected persons for TB disease after HIV diagnosis, efficacy and good tolerability for intermediate-length before initiation of highly active antiretroviral therapy treatment of children with autism characterized by (HAART), and during routine follow-up care. In 2003, tantrums, aggression, and/or self-injurious behavior. health officials in Banteay Meanchey Province, Discontinuation after 6 months was associated with a Cambodia, in conjunction with CDC and the U.S. rapid return of disruptive and aggressive behavior in Agency for International Development (USAID), most subjects. began a pilot project to increase TB screening among persons with HIV infection. Subsequently, CDC School health guidelines to prevent unintentional injuries analyzed and evaluated data from the first 14 months of and violence. MMWR Recomm Rep 2001; 50(RR- the project. This report summarizes the results of that 22):1-73. analysis, which determined that, during January 2004-- Notes: CORPORATE NAME: Centers for Disease February 2005, among persons with HIV infection at Control and Prevention voluntary counseling and confidential testing (VCCT) Abstract: Approximately two thirds of all deaths clinics, 37% were screened for TB disease, and 24% of among children and adolescents aged 5-19 years result those screened had TB disease diagnosed. On the basis from injury-related causes: motor-vehicle crashes, all of these findings, the Provincial Health Department other unintentional injuries, homicide, and suicide. (PHD) took action to increase awareness of the risk for Schools have a responsibility to prevent injuries from TB among HIV-infected persons. During the 3 months occurring on school property and at school-sponsored after these measures were implemented, the TB events. In addition, schools can teach students the skills screening rate among persons with HIV infection needed to promote safety and prevent unintentional increased to 61%. Evaluation of projects like the one conducted in Banteay Meanchey Province can help 308
- 317. develop an evidence-basedapproach for removing Abstract: Whilst agencies in many sectors have been barriers to screening HIV-infected persons for TB. encouraged to work together to better meet the needs of service users, multi-agency working is now a central Silver and Bronze Achievement Awards. Psychiatr Serv feature of government policy. In relation to children's 2003; 54(11):1532-8. services, the National Service Framework, the English green paper, 'Every Child Matters' (DfES, 2003) and Simple screen proves highly accurate in identifying children the Children Bill (DfES 2004) give a high priority to an with special needs. Clin Resour Manag 2001; integrated approach to service provision. This paper 2(12):186-8, 177. focuses on multi-agency working for disabled children Abstract: Research shows that the relatively small with complex health-care needs, a group of children group of children with special health care needs who, perhaps even more than most, require the many accounts for more than 80% of all child-related health professionals who support them and their families, to care costs, and there is plenty of evidence that the care work more closely together. Drawing on the findings of these children is a far cry from optimal. See what from a 3-year qualitative research study, this paper steps are being taken to give these children the examines the impact of working in a multi-agency attention they need, and check out a simple new tool service on professionals. Interviews with 115 designed to identify children with special health care professionals concluded that staff were needs. overwhelmingly positive about working as part of a multi-agency service. They reported improvements to Some physical effects of emotional violence. Harv Ment their working lives in areas such as professional Health Lett 2001; 17(10):8. development, communication, collaboration with colleagues, and relationships with families with The spanking debate. Harv Ment Health Lett 2002; 19(5):1- disabled children. However, whilst professionals felt 3. that they were able to offer families a more efficient service, there was concern that the overall impact of Study links childhood incidence of sexual abuse with dental multi-agency working on disabled children and their fears. Dent Today 2003; 22(12):26, 28. families would be limited. Testing order remanded for man who groped Abbott M. Distinguishing SIDS from child abuse fatalities. granddaughters. AIDS Policy Law 2004; 19(16):3. Pediatrics 2001; 108(5):1237. Thirty thousand pregnant women sacked every year. Pract Abramson JM, Wollan P, Kurland M, Yawn BP. Feasibility Midwife 2005; 8(3):8. of school-based spirometry screening for asthma. J Sch Health 2003; 73(4):150-3. Thompson v Connon. (2001) 75 ALJR 1570. J Law Med Abstract: To determine the feasibility and value of 2002; 10(1):25-6. spirometry in school-based asthma screening, spirometry testing was coupled with parent US emergency nurses support colleague in child abuse case. questionnaires in a school-based asthma screening Emerg Nurse 2003; 11(1):2-3. project. Children in grades five to eight of the Catholic school system in Rochester, Minn., performed What have we learnt from the Alder Hey affair? Lack of spirometry with coaching and data acquisition by information on transplant procedures is disturbing. nurses trained for this activity. Most students BMJ 2001; 322(7301):1542. completed three tests. For each student, the best test was selected for interpretation. Tests were considered What is in Maria's best interests? Bull Med Ethics 2002; technically unacceptable for screening purposes if the (176):3-4. FEV1 was less than 85% and the curve showed Notes: GENERAL NOTE: KIE: KIE Bib: informed evidence of cough, delayed start, poor initial effort, consent/minors; treatment refusal/minors incomplete effort, or non-reproducibility. Students with acceptable tests and FEV1 < 85% as predicted for age, Abbing HD. Neonatal screening, new technologies, old and race, and BMI were classified as appropriate for referral for further evaluation of potential asthma. A new legal concerns. Eur J Health Law 2004; 11(2):129- 37. sensitivity analysis was conducted using different Notes: GENERAL NOTE: KIE: 9 refs. FEV1 thresholds for referral. Children (119, 17.6% of all) with known asthma based on parent-completed GENERAL NOTE: KIE: KIE Bib: mass screening questionnaire were not considered for referral. Of the remaining 557 students screened, 535 had technically Abbott D, Townsley R, Watson D. Multi-agency working in acceptable tests, and 498 had normal spirometry services for disabled children: what impact does it have performance. Using a threshold for referral of FEV1 < on professionals? Health Soc Care Community 2005; 85%, 37 children were candidates for referral for 13(2):155-63. further evaluation of potential asthma. Only four (11%) 309
- 318. of these alsohad questionnaire responses that made practices among ethnically and socio-economicall them candidates for referral. School-based spirometry diverse groups. Community Dent Health 2004; 21(1 screening for asthma is technically feasible but there is Suppl):102-11. little overlap between those who are referral candidates Abstract: OBJECTIVE; The aim of this international based on spirometry data and those who are referral study was to develop a valid and reliable psychometric candidates based on parent-reported symptoms on measure to examine the extent to which parents' screening questionnaires. Without further study, attitudes about engaging in twice-daily tooth brushing spirometry cannot be recommended for school-based and controlling sugar snacking predict these respective asthma screening. behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of Abushama M, Ahmed B. Cesarean section on request. Saudi deprivation or children's caries experience impact upon Med J 2004; 25(12):1820-3. the relationships between oral health related Notes: GENERAL NOTE: KIE: 26 refs. behaviours, attitudes to these respective behaviours and GENERAL NOTE: KIE: KIE Bib: patient care to dental caries. CLINICAL SETTING: Nurseries, Abstract: Obstetricians are facing a tide of non- health centres and dental clinics in 17 countries. medically indicated requests for cesarean section. Risks PARTICIPANTS: 2822 children aged 3 to 4 years and and benefits of accepting cesarean section on request their parents. MAIN OUTCOME MEASURES: Dental are discussed. examination of children and questionnaire to parents. RESULTS: Factor analysis identified 8 coherent Acir N, Oztura I, Kuntalp M, Baklan B, Guzelis C. attitudes towards toothbrushing, sugar snacking and Automatic detection of epileptiform events in EEG by childhood caries. Attitudes were significantly different a three-stage procedure based on artificial neural in families from deprived and non-deprived networks. IEEE Trans Biomed Eng 2005; 52(1):30-40. backgrounds and in families of children with and Abstract: This paper introduces a three-stage procedure without caries. Parents perception of their ability to based on artificial neural networks for the automatic control their children's toothbrushing and sugar detection of epileptiform events (EVs) in a snacking habits were the most significant predictor of multichannel electroencephalogram (EEG) signal. In whether or not favourable habits were reported. Some the first stage, two discrete perceptrons fed by six differences were found by site and ethnic group. features are used to classify EEG peaks into three CONCLUSIONS: This study supports the hypothesis subgroups: 1) definite epileptiform transients (ETs); 2) that parental attitudes significantly impact on the definite non-ETs; and 3) possible ETs and possible establishment of habits favourable to oral health. An non-ETs. The pre-classification done in the first stage appreciation of the impact of cultural and ethnic not only reduces the computation time but also diversity is important in understanding how parental increases the overall detection performance of the attitudes to oral health vary. Further research should procedure. In the second stage, the peaks falling into examine in a prospective intervention whether the third group are aimed to be separated from each enhancing parenting skills is an effective route to other by a nonlinear artificial neural network that preventing childhood caries. would function as a postclassifier whose input is a vector of 41 consecutive sample values obtained from Adams AM, Madhavan S, Simon D. Women's social each peak. Different networks, i.e., a backpropagation networks and child survival in Mali. Soc Sci Med multilayer perceptron and two radial basis function 2002; 54(2):165-78. networks trained by a hybrid method and a support Abstract: This paper explores the influence of women's vector method, respectively, are constructed as the social networks on child survival through a postclassifier and then compared in terms of their comparative investigation of two ethnic groups in Mali, classification performances. In the third stage, West Africa. Data are drawn from a study of women's multichannel information is integrated into the system social networks and health conducted during the period for contributing to the process of identifying an EV by 1996-97. Separate samples of 500 ever-married women the electroencephalographers (EEGers). After the aged 15-49 were surveyed at two geographically integration of multichannel information, the overall distinct sites representing Bamanan and Fulbe performance of the system is determined with respect populations respectively. Consistent with known to EVs. Visual evaluation, by two EEGers, of 19 differences in economic risk, household structure, and channel EEG records of 10 epileptic patients showed cultural norms, descriptive analysis reveals a greater that the best performance is obtained with a radial basis probability of child death among the Fulbe, and a support vector machine providing an average larger mean size of total, material, practical and sensitivity of 89.1%, an average selectivity of 85.9%, cognitive networks among the Bamanan. Cox and a false detection rate (per hour) of 7.5. regression models are used to examine the association between social network size, function and composition Adair PM, Pine CM, Burnside G et al. Familial and cultural and the odds of child death (1-5 years). Among the perceptions and beliefs of oral hygiene and dietary various biological, household and community-level variables tested in the basic model, spacing exerts an 310
- 319. expected negative effecton the odds of child death in based clinicians were significantly more likely to both groups, while household SES predicts child address a variety of routine health care maintenance survival only among Fulbe children. When variables topics including: diet (relative risk [RR]: 1.09), sleep representing the educational and psychosocial (RR: 1.46), at least 1 psychosocial issue (RR: 1.42), attributes of the mother are included, no effects are smoking in the home (RR: 15.68), lead risk assessment detected in either group. Controlling for these factors, (RR: 106.54), exposure to domestic or community the size of total, practical, cognitive and emotional violence (RR: 35.19), guns in the home (RR: 58.11), networks are found to significantly increase the odds of behavioral or social developmental milestones (RR: child survival among the Fulbe only. Compositional 2.49), infant sleep position (RR: 9.29), breastfeeding variables, such as the extent to which natal kin, non-kin (RR: 1.99), poison control (RR: 3.82), and child safety or husbands figure in a woman's network, nor the (RR: 1.29). Trends toward improved lead exposure, degree to which networks are located within household vision, and hearing screening were seen; however, yield any significant results for the Fulbe. Among differences were not significant. Users of the system Bamanan women, however, the higher the proportion reported that its use had improved the overall quality of of network members living in the household, the lower care delivered, was well-accepted by families, and the odds of child death. The paper concludes by improved guidance quality; however, 5 of 7 users discussing the methodological, conceptual and reported that eye-to-eye contact with patients was practical implications of these findings. reduced, and 4 of 7 reported that use of the system increased the duration of visits (mean: 9.3 minutes Adams JA. Evaluating children for possible sexual abuse. longer). All users recommended continued use of the Am Fam Physician 2001; 63(5):843-4, 846. system. CONCLUSION: Use of the EMR in this study was associated with improved quality of care. This Adams Larsen M, Tentis E. The art and science of experience suggests that EMRs can be successfully disciplining children. Pediatr Clin North Am 2003; used in busy urban pediatric primary care centers and, 50(4):817-40, viii-ix. as recommended by the Institute of Medicine, must Abstract: A practical guide to working with parents on play a central role in the redesign of the US health care the discipline of their children is provided. Focus is system. specific to provide a practical tool of useful how-to information for the primary care provider who works Adamsbaum C, Rolland Y, Husson B. [Pediatric with children and their families. This article focuses on neuroimaging emergencies.]. J Neuroradiol 2004; basic principles and techniques that can be established 31(4):272-80. within the office setting, so as to model for families, as Abstract: The notion of emergency with regards to well as to teach to families for use at home. This article pediatric neuroimaging requires a strong knowledge of also focuses on common applications to illustrate the clinical indications. In children under 2 years of age, use of these techniques. Finally, the art of consultation head trauma requires a CT scan in case of repeated or and referral is reviewed for situations that are assessed prolonged or rapidly increasing vomiting, focal signs, to be above and beyond the call of the primary loss of consciousness, unusual behavior, seizures, practitioner. clinical signs of skull fracture or polytrauma. The "shaken baby syndrome" is usually suspected in case of Adams WG, Mann AM, Bauchner H. Use of an electronic loss of consciousness or seizures before 8 months of medical record improves the quality of urban pediatric age. The hematomas that are observed are subdural in primary care. Pediatrics 2003; 111(3):626-32. location, diffuse and deeply located. Imaging is only Abstract: OBJECTIVE: To evaluate the quality of mandatory for headache suggesting underlying space pediatric primary care, including preventive services, occupying lesion: permanent or increasing pain, before and after the introduction of an electronic nocturnal headache, headache during postural changes medical record (EMR) developed for use in an urban or efforts, associated to seizures or abnormal pediatric primary care center. METHODS: A pre- neurological examination. No imaging is indicated in postintervention analysis was used in the study. The case of first epileptic seizure associated to normal intervention was a pediatric EMR. Routine health care neurological examination and without any particular maintenance visits for children <5 years old were context. The presence of trauma, intracranial reviewed, and documentation during preintervention hypertension, persisting disturbances of consciousness (paper-based, 1998) and postintervention visits or associated focal sign necessitates urgent (computer-based, 2000) was compared. RESULTS: A neuroimaging. No imaging is indicated in case of total of 235 paper-based visits and 986 computer-based typical febrile seizures, i.e. generalized, brief and visits met study criteria. Twelve clinicians (all occurring between 1 and 5 years of age. Spinal cord attendings or nurse practitioners) contributed an symptoms require immediate MRI evaluation. The average of 19.4 paper-based visits (range: 5-39) and 7 most frequent tumor is neuroblastoma. In the absence of these clinicians contributed an average of 141 of spinal tumor, brain abnormalities must be excluded computer-based visits each (range: 61-213). Computer- (inflammatory disease). In neonates, CT scan or MRI must be readily performed in case of seizures or loss of 311
- 320. consciousness to excludeischemic, traumatic or painful and terrifying process during childhood in infectious lesions. which their self-esteem is downgraded by means of serious degrading traditional active violence such as Addington J, Addington D. Patterns of premorbid female genital mutilation and visible virginity control. functioning in first episode psychosis: relationship to 2- The narratives tell stories in which Somali women are year outcome. Acta Psychiatr Scand 2005; 112(1):40-6. degraded and expected to obey in situations Abstract: OBJECTIVE: To determine how different characterised by their man's arbitrariness. They are patterns of premorbid functioning relate to outcome subject to a very extensive form of social control, longitudinally. METHOD: Premorbid adjustment was which is especially pronounced on issues regarding assessed in 194 first-episode of psychosis subjects. sexuality. Their integrity as women is, consequently set Positive and negative symptoms, depression, substance aside. When Somali refugees came to Sweden some of misuse and social and cognitive functioning were them came to adopt much of the modern lifestyle and assessed over 2 years. RESULTS: Four patterns of cultural norm systems, preferable young people and premorbid adjustment: stable-good, stable- some of the females. Relating to a new culture with its intermediate, poor-deteriorating and deteriorating were new expectations on the norm obedience also created identified. Relative to the stable-good group, the changes in self-esteem. Exile situation tends to deteriorating and poor-deteriorating groups had generate horizontal conflicts, among spouses and significantly more positive symptoms at 1-year follow- between groups of people. It also tends to generate up but not at 2-year follow-up and significantly more vertical conflicts because now generations stand up negative symptoms and significantly poorer social against each other and this is especially pronounced functioning at both 1 and 2-years. Only verbal fluency when it is about issues of sexuality and sexual and memory differentiated between the groups with the relations. The young generations questions their stable-good group having a superior performance. parents authority. They are now living in new social CONCLUSION: Those who demonstrated poor or context and perceive risks, as well as possibilities. deteriorating functioning prior to the onset of acute Their new dreams and choices, however, do not fit psychosis have a poorer outcome up to at least 2 years their parents' expectations, which sometimes leads to in terms of negative symptoms and social functioning. big problems. From a traditional perspective these deviants lack of respect for traditions and the original Adelson PD, Partington MD. Nonaccidental neurotrauma in culture. From a male perspective this means more children. Introduction. Neurosurg Clin N Am 2002; specifically a lack of respect for male dominance and 13(2):ix-x. superiority. Aden AS, Dahlgren L, Tarsitani G. Gendered experiences of Adeoye AO. Eye injuries in the young in Ile-Ife, Nigeria. conflict and co-operation in heterosexual relations of Niger J Med 2002; 11(1):26-9. Somalis in exile in Gothenburg, Sweden. Ann Ig 2004; Abstract: One hundred and seventeen children aged 0- 16(1-2):123-39. 17 years treated for eye injuries at the Obafemi Abstract: Political upheaval and poverty at home has Awolowo University Teaching Hospital Ile-Ife, Nigeria been forcing many Somalis to immigrate. These were studied. Seventy-five were males and 42 were immigrants do not only leave their physical house, females with a mean age of 10 years 4 months. Injuries families, relatives, loved ones, friends, but also occurred with increasing frequency after the age of 4 familiarities, culture, customs, and often they do end up years and were commonly sustained by children at play in no man's land being between their own and new (50.4%); during corporal punishment (10.3%); assault home culture. Available reports suggest that there are (9.4%) and street hawking (9.4%). Causative agents about 15,000 Somalis in Sweden and their majority were mostly sticks and twigs, followed by missiles and came here from late 1989 to 1996. About one third fall. Visual prognosis was best in patients with these immigrants live in and around the city of contusion injuries (48.3%) and worst in those with Gothenburg. This paper explores and describes perforating eye injuries (30.5%). Blindness of the gendered experiences of conflict and co-operation in injured eye occurred in one-third of the patients and heterosexual relations of Somalis in exile in another 17.5% had significant visual impairment. This Gothenburg, Sweden. A qualitative sociological in- study shows a variation in the aetiology and visual depth interviews with 6 women and 7 men was outcome of eye injuries in the young. Strategies for the performed during May 1999 to January 2000. A follow prevention of eye injuries are mainly health education, up focus group interviews with 10 people (2 women improved supervision of children at play, change in the and 8 men) was also carried on. The results show that method of corporal punishment and provision of both the Somali culture and Muslim religion do not protective devices for adolescents at work. Early support the children being taught sex education in diagnosis and prompt management will improve visual schools or the names of the sex organs being prognosis. pronounced other than to be used as metaphors. The girls, unlike their age group males, experience a very Adib Essali M. Intervention in child abuse and neglect: an emerging subspecialty in child and adolescent 312
- 321. psychiatry. World Psychiatry2005; 4(3):160. drug users belonged to either genotype 1a or 2b and the strains in each genotype clustered closely to each other. Agatonovic-Kustrin S, Glass BD, Wisch MH, Alany RG. There was no dual infection with genotype 1a and 2b. Prediction of a stable microemulsion formulation for These results suggest that the HCV infection in the oral delivery of a combination of antitubercular injecting-drug users may be emanating rapidly from drugs using ANN methodology. Pharm Res 2003; limited number individuals in Metro Cebu, Philippines. 20(11):1760-5. Abstract: PURPOSE: The aim of this project was to Aghaji MN. Exclusive breast-feeding practice and associated develop a colloidal dosage form for the oral delivery of factors in Enugu, Nigeria. West Afr J Med 2002; rifampicin and isoniazid in combination with the aid of 21(1):66-9. artificial neural network (ANN) data modeling. Abstract: A cross-sectional questionnaire survey was METHODS: Data from the 20 pseudoternary phase conducted among 235 infant-mother pairs in five Baby triangles containing miglyol 812 as the oil component Friendly pairs in five Baby Friendly Hospitals in and a mixture of surfactants or a surfactant/cosurfactant Enugu-Nigeria in 1998. The aims were to study their blend were used to train, test, and validate the ANN breast-feeding practices and associated factors. The model. The weight ratios of individual components exclusive breast-feeding rate was 33.3% while the were correlated with the observed phase behavior using predominant breast-feeding rate was 50.2%. Factors radial basis function (RBF) network architecture. The associated with exclusive breast-feeding included criterion for judging the best model was the percentage infants' birth order (P = 0.015), fathers' education (P success of the model prediction. RESULTS: The best =0.0244), mothers' education (P = 0.000001), model successfully predicted the microemulsion region occupation (P = 0.0069) and parity (P = 0.004). as well as the coarse emulsion region but failed to However, the infants' age (P = 0.054) and sex (P = predict the multiphase liquid crystalline phase for 0.403), mothers' age (P = 0.2005), number of breast- cosurfactant-free systems indicating the difference in feeding counseling attendances (P = 0.0883) and the microemulsion behavior on dilution with water. breast-feeding initiator (P = 0.473) were comparable CONCLUSIONS: A novel microemulsion formulation irrespective of breast-feeding practice. In the mothers' capable of delivering rifampicin and isoniazid in perspectives, the commonest reasons for not combination was created to allow for their differences breastfeeding exclusively included; insufficient breast in solubility and potential for chemical reaction. The milk (58,37.0%) and the sociocultural practice of developed model allowed better understanding of the giving water to babies because of the hot climate process of microemulsion formation and stability (52,33.1%). For an improvement in the exclusive within pseudoternary colloidal systems. breast-feeding rate of this population, health workers should highlight to mothers the dangers of water Agdamag DM, Kageyama S, Alesna ET et al. Rapid spread supplementation and the dynamics of breastmilk of hepatitis C virus among injecting-drug users in the supply through health education, home visits and the Philippines: Implications for HIV epidemics. J Med formation of community based lactation support Virol 2005; 77(2):221-6. groups. Abstract: From the trends of human immunodeficiency virus (HIV) epidemics in South and Southeast Asia, it Aharonson-Daniel L, Waisman Y, Dannon YL, Peleg K. was postulated that an HIV epidemic would start as a Epidemiology of terror-related versus non-terror- blood-borne infection among injecting-drug users in related traumatic injury in children. Pediatrics 2003; the Philippines. In 2002, 560 individuals were recruited 112(4):e280. in Metro Cebu, Philippines and tested for HIV, Notes: CORPORATE NAME: Members of the Israel hepatitis C virus (HCV), and hepatitis B virus (HBV) Trauma Group infections. The seroprevalence of anti-HCV among Abstract: OBJECTIVE: In the past 2 years hundreds of injecting-drug users (70.1%, 61/87) was significantly children in Israel have been injured in terrorist attacks. higher than those among inhalation drug users (16.3%, There is a paucity of data on the epidemiology of 7/43; P = 0.00; OR = 12), sex workers (0%, 0/130; P = terror-related trauma in the pediatric population and its 0.00; OR = infinity), antenatal clinic attendees (0%, effect on the health care system. The objective of this 0/100; P = 0.00; OR = infinity), and students/health study was to review the accumulated Israeli experience care workers (2%, 4/200; P = 0.00; OR = 115). The with medical care to young victims of terrorism and to seroprevalence of HBsAg among injecting-drug users use the knowledge obtained to contribute to the (10.3%, 9/87) was significantly higher than those preparedness of medical personnel for future events. among sex workers (2.3%, 3/130; P = 0.01; OR = 4.9), METHODS: Data on all patients who were younger and antenatal clinic attendees (3%, 3/100; P = 0.04; OR than 18 years and were hospitalized from October 1, = 3.7), but was not statistically different from those 2000, to December 31, 2001, for injuries sustained in a among inhalation drug users (9.3%, 4/43; P = 0.9) and terrorist attack were obtained from the Israel National students/health care workers (4.5%, 9/200; P = 0.06). Trauma Registry. The parameters evaluated were None of the study population was reactive to anti-HIV patient age and sex, diagnosis, type, mechanism and antibody. The HCV strains obtained from the injecting- severity of injury, interhospital transfer, stay in 313
- 322. intensive care unit,duration of hospitalization, and media with effusion. A case report and review of need for rehabilitation. Findings were compared with audiological assessments in children with otitis media the general pediatric population hospitalized for non- with effusion. J Laryngol Otol 2003; 117(4):307-9. terror-related trauma within the same time period. Abstract: A case of a child with mannosidosis and RESULTS: During the study period, 138 children were bilateral otitis media with effusion (OME) is reported hospitalized for a terror-related injury and 8363 for a here along with some discussion of relevant literature non-terror-related injury. The study group was to emphasize the need for age appropriate audiometric significantly older (mean age: 12.3 years [standard assessment before and after insertion of grommets for deviation: 5.1] v 6.9 years [standard deviation: 5.3]) glue ear (OME). There is a need for multidisciplinary and sustained proportionately more penetrating injuries teamwork in the management of children with hearing (54% [n = 74] vs 9% [n = 725]). Differences were also loss. If OME is treated surgically, age-appropriate noted in the proportion of internal injuries to the torso hearing assessment is required before and after (11% in the patients with terror-related trauma vs 4% insertion of grommets. The need for audiological in those with non-terror-related injuries), open wounds assessments will be relevant even if children had to the head (13% vs 6%), and critical injuries (Injury passed the newborn hearing screening test. Severity Score of 25+; 25% vs 3%). The study group showed greater use of intensive care unit facilities Aitken ME, Rowlands LA, Wheeler JG. Advocating for (33% vs 8% in the comparison group), longer median children's health at the state level: lessons learned. hospitalization time (5 days vs 2 days), and greater Arch Pediatr Adolesc Med 2001; 155(8):877-80. need for rehabilitative care (17% vs 1%). Abstract: This article documents the successful CONCLUSIONS: Terror-related injuries are more creation and promotion of a bill to fund a nurse home severe than non-terror-related injuries and increase the visitation program for high-risk mothers in Arkansas. It demand for acute care in children. illustrates several key factors in successful advocacy by pediatricians working in an academic setting: a realistic Ahmad Z, Balsamo LM, Sachs BC, Xu B, Gaillard WD. time commitment; a community needs assessment, data Auditory comprehension of language in young assimilation, and review of existing resources; the children: neural networks identified with fMRI. identification and incorporation of stakeholders; a Neurology 2003; 60(10):1598-605. narrow focus on the area of greatest need; the backing Abstract: OBJECTIVE: The organization of neuronal of political partners; and favorable opportunities to systems that process language in young children is advance child health issues. poorly understood. The authors used fMRI to identify brain regions underlying auditory comprehension in Ajrouch KJ, Antonucci TC, Janevic MR. Social networks healthy young children. METHODS: Fifteen right- among blacks and whites: the interaction between race handed children (mean age 6.8 years) underwent fMRI and age. J Gerontol B Psychol Sci Soc Sci 2001; at 1.5-T using blood oxygen level dependent 56(2):S112-8. echoplanar imaging. They listened to stories with a Abstract: OBJECTIVES: This study examined the reverse speech control condition. Group data were main and interactive effects of age and race on the core analyzed with statistical parametric mapping. characteristics of social networks including size, Individual subject data were analyzed with a region of frequency of contact, geographical proximity, and interest approach based on t-maps. An asymmetry composition of network. METHODS: Respondents index (AI = [(L-R)/(L+R)]) was calculated for each were drawn from a stratified probability sample of region. RESULTS: Group analysis showed significant people aged 20-93 in the greater Detroit metropolitan activation in the left middle temporal gyrus (Brodmann area. Approximately 30% of the sample were African area [BA] 21) and left superior temporal gyrus (BA 22) American, and people aged 60 and older were over- along the superior temporal sulcus extending back to sampled (n = 1.382). The authors used hierarchical the angular gyrus (BA 39). Individual maps showed regression analysis to estimate the influence of race lateralized activation in temporal regions (AI > 0.49 +/- and age on each component of social network, 0.39). There was minimal activation in the frontal lobe. controlling for marital status, gender, and education. There were no significant correlations between age and An interaction term (Race x Age) was added to explore regional AI. CONCLUSION: Networks for auditory the extent to which age moderates any detected race language processing are regionally localized and differences. RESULTS: Older age was associated with lateralized by age 5. These data may provide a means smaller, less frequently seen, and less proximal to interpret language fMRI studies performed in networks that had a higher proportion of kin. Blacks preparation for brain surgery, and may be employed to and Whites were similar with regard to proximity, but investigate the effect of chronic disease states, such as Blacks had smaller networks, more contact with epilepsy, on language organization during critical network members, and more family members in their periods for plasticity. networks. Race differences in frequency of contact and proportion of kin were moderated by age, such that the Ahmmed AU, O'Halloran SM, Roland NJ, Starkey M, differences in these variables diminished with Wraith JE. Hearing loss due to mannosidosis and otitis increasing age. DISCUSSION: A systematic analysis 314
- 323. of how age,race, and their interaction influence the during post-test counselling. HIV-discordance among characteristics of social networks furnishes important couples may be frequent and should be considered in empirical knowledge about social networks among the formulation of policies on counselling and diverse groups. Such data may provide a context for voluntary testing. how, and some explanation for why, support exchanges occur. Akshoomoff NA, Feroleto CC, Doyle RE, Stiles J. The impact of early unilateral brain injury on perceptual Akid M. Child protection. Baseline training is not enough. organization and visual memory. Neuropsychologia Nurs Times 2002; 98(7):8. 2002; 40(5):539-61. Abstract: Studies of young children with early Akister J, Johnson K. Parenting issues that may be addressed unilateral brain injury have suggested that while through a confidential helpline. Health Soc Care hemispheric differences in visuospatial processing Community 2002; 10(2):106-11. appear to be present early in development, the young Abstract: This study identifies what parents might brain is better able to compensate for injury than when expect from a confidential helpline and highlights areas the injury occurs later, after networks have been of parental concern in the task of child-rearing. A established. The aim of this study was to determine if community sample of 424 families from four schools this pattern continues later in development when these was collected. Although many issues raised concerned children are given a challenging task: the Rey- parents, those particularly cited were behaviour Osterrieth Complex Figure. Experiment 1 included management, school bullying and drug and alcohol longitudinal data from ten children with early left problems. It is clear that there is a perceived need by hemisphere (LH) injury and nine children with early parents for input into the parenting process; parents right hemisphere (RH) injury. Injury was presumed to were seeking information and advice rather than be due to a prenatal or perinatal stroke. Compared with support. The question of which aspects of parenting typically developing children, both groups were poorer can be developed, either through a helpline or other in copying the figure. With development, these services, is discussed. children produced reasonably accurate drawings but continued to use the most immature and piecemeal Akpede GO, Lawal RS, Momoh SO. Perception of voluntary strategy. In Experiment 2, copy and immediate screening for paediatric HIV and response to post-test memory drawings from the 19 children with early counselling by Nigerian parents. AIDS Care 2002; unilateral brain injury were collected at a single age 14(5):683-97. (11-14 years). Eight of the ten children with LH injury Abstract: Nigeria may be taken to represent countries organized their memory reproductions around the core with an evolving HIV/AIDS epidemic. With particular rectangle but included relatively few additional details. reference to paediatric HIV, the voluntary testing of In contrast, only two of the nine children with RH young children and their parents may provide an injury organized their memory reproductions around important entry point for the institution of control the core rectangle and all but one produced the figure measures. However, there is a paucity of knowledge in a piecemeal manner. The results from both studies about how individuals perceive voluntary testing. This demonstrate the continuation of subtle deficits in knowledge is important to the development of visuospatial analysis with development but also the guidelines for counselling. To reduce this gap, 258 continued capacity for compensation. parents of hospitalized children (> 1 month to 15 years of age) were interviewed using a structured Al Abdukareem A. Randomized, placebo-controlled trial. questionnaire. In addition, to complement the data, four Ann Saudi Med 2004; 24(2):145; author reply 145; examples of seropositive mother's responses during discussion 145. post-test counselling are presented and analyzed. In the survey, 223 (86%) parents were HIV/AIDS aware but Al-Mahroos F, Abdulla F, Kamal S, Al-Ansari A. Child only 88 (39%) of these parents could describe one or abuse: Bahrain's experience. Child Abuse Negl 2005; more route(s) of transmission and none described 29(2):187-93. vertical transmission. Among the respondents, 153 (62%) of 248 would consent to the screening of self, Alati R, Najman JM, Kinner SA et al. Early predictors of and 195 (85%) of 230 to the screening of a hospitalized adult drinking: a birth cohort study. Am J Epidemiol child if based on his/her clinical condition. Perceptions 2005; 162(11):1098-107. of good health and lack of exposure, and despair owing Abstract: Few studies have explored early predictors of to lack of a specific treatment, were the common problem drinking in youth, and fewer still have reasons for refusing consent. These represent some of simultaneously considered the role of biologic, the issues which would need to be addressed to familial, and intrapersonal factors. The present study increase the acceptance of voluntary testing. The fear explored early life course and later life course of a break up of families with seropositive mothers but predictors of alcohol abuse and dependence in young seronegative fathers was a major concern expressed adulthood. Data were taken from a cohort of 2,551 315
- 324. mothers and theirchildren recruited as part of the learning approach to gene-expression data longitudinal Mater University Study of Pregnancy and classification. Artif Intell Med 2003; 28(1):75-87. its outcomes (MUSP) carried out in Brisbane, Abstract: We investigate the use of perceptrons for Australia, from 1981 to 1984. Data were collected classification of microarray data where we use two prenatally and then postnatally at 6 months and at 5, datasets that were published in [Nat. Med. 7 (6) (2001) 14, and 21 years. A range of biologic, familial, and 673] and [Science 286 (1999) 531]. The classification intrapersonal factors was considered. A series of problem studied by Khan et al. is related to the logistic regression models with inverse probability diagnosis of small round blue cell tumours (SRBCT) of weighting was used to explore pathways to problem childhood which are difficult to classify both clinically drinking from adolescence to early adulthood. For and via routine histology. Golub et al. study acute males and females, no association was found between myeloid leukemia (AML) and acute lymphoblastic either birth factors or childhood factors and a lifetime leukemia (ALL). We used a simulated annealing-based diagnosis of alcohol disorders at age 21 years. method in learning a system of perceptrons, each Externalizing symptoms and maternal factors at age 14 obtained by resampling of the training set. Our results years were significantly associated with alcohol are comparable to those of Khan et al. and Golub et al., problems. For youth aged 14 years, maternal moderate indicating that there is a role for perceptrons in the alcohol consumption accounted for the highest classification of tumours based on gene-expression percentage of attributable risk among those exposed. data. We also show that it is critical to perform feature Results show that exposure to maternal drinking in selection in this type of models, i.e. we propose a adolescence is a strong risk factor for the development method for identifying genes that might be significant of alcohol problems in early adulthood. for the particular tumour types. For SRBCTs, zero error on test data has been obtained for only 13 out of Alber TS. [Chlamydia trachomatis and Neisseria 2308 genes; for the ALL/AML problem, we have zero gonorrhoeae in sexually abused children in Jutland]. error for 9 out of 7129 genes that are used for the Ugeskr Laeger 2003; 165(5):481; author reply 481. classification procedure. Furthermore, we provide evidence that Epicurean-style learning and simulated Albertyn R, Bickler SW, van As AB, Millar AJ, Rode H. annealing-based search are both essential for obtaining The effects of war on children in Africa. Pediatr Surg the best classification results. Int 2003; 19(4):227-32. Abstract: There is no doubt that the effects of war Albrecht SA, Maloni JA, Thomas KK, Jones R, Halleran J, extend to the most vulnerable members of society, Osborne J. Smoking cessation counseling for pregnant including children. Although armed conflicts occur women who smoke: scientific basis for practice for throughout the world, the African continent seems to AWHONN's SUCCESS project. J Obstet Gynecol be a particular background for civil and international Neonatal Nurs 2004; 33(3):298-305. wars. The aim of this study was to identify causes of Abstract: OBJECTIVES: To review the literature conflict in Africa and to evaluate the effect of war on addressing smoking cessation in pregnant women. To children and their health in order to make practical develop the project protocol for the Association of recommendations to health care workers dealing with Women's Health, Obstetric and Neonatal Nurse's children in the setting of war. All articles written in the (AWHONN) 6th research-based practice project titled past 5 years concerning "war" and "children" were "Setting Universal Cessation Counseling, Education identified by means of a literature search and internet and Screening Standards (SUCCESS): Nursing Care of review. Contrary to common belief, the causes of Pregnant Women Who Smoke." To evaluate the conflict are complicated and multi-factorial. The potential of systematic integration of this protocol in effects of war on childhood are disastrous and include primary care settings in which women seek care at the severe negative effects on general paediatric health preconception, pregnant, or postpartum stages. status. Short-term recommendations for health care LITERATURE SOURCES: Computerized searches in workers working with children in war include supply MEDLINE and CINAHL, as well as references cited in of emergency medical infrastructures, basic health articles reviewed. Key concepts in the searches care, rehabilitation and education. Long-term included low-birth-weight infants and effects of recommendations include orchestrating the relief and prenatal smoking on the infant and the effects of support efforts from both national governments and preconception and prenatal smoking cessation international non-profit organisations and speeding up intervention on premature labor and birth weight. of economic recovery. The causes of conflict in Africa LITERATURE SELECTION: Comprehensive articles, are complex and unlikely to be resolved soon. The reports, and guidelines relevant to key concepts and effects of war on children are horrendous in many published after 1964 with an emphasis on new findings ways, but can be limited by providing timely and from 1996 through 2002. Ninety-eight citations were appropriate health care. identified as useful to this review. LITERATURE SYNTHESIS: Tobacco use among pregnant women Albrecht A, Vinterbo SA, Ohno-Machado L. An Epicurean and children's exposure to tobacco use (secondhand smoke) are associated with pregnancy complications 316
- 325. such as placentaldysfunction (including previa or took their medication but rarely resulted in stopping abruption), preterm labor, premature rupture of prophylaxis. Prescribed antimalarials were sometimes membranes, spontaneous abortions, and decreased birth never given. Appropriate counseling on side effects weight and infant stature. Neonates and children who and reasons for faithful administration should are exposed to secondhand smoke are at increased risk accompany antimalarial prophylaxis. for developing otitis media, asthma, other respiratory disorders later in childhood; dying from sudden infant Alechnowicz K, Chapman S. The Philippine tobacco death syndrome; and learning disorders. The "5 A's" industry: "the strongest tobacco lobby in Asia". Tob intervention and use of descriptive statements for Control 2004; 13 Suppl 2:ii71-8. smoking status assessment were synthesized into the Abstract: OBJECTIVE: To highlight revelations from SUCCESS project protocol for AWHONN's 6th internal tobacco industry documents about the conduct research-based practice project. CONCLUSIONS: The of the industry in the Philippines since the 1960s. literature review generated evidence that brief, office- Areas explored include political corruption, health, based assessment, client-specific tobacco counseling, employment of consultants, resisting pack labelling, skill development, and support programs serve as an and marketing and advertising. METHODS: effective practice guideline for clinicians. Systematic keyword Minnesota depository website Implementation and evaluation of the guideline is searches of tobacco industry internal documents made under way at a total of 13 sites in the United States and available through the Master Settlement Agreement. Canada. RESULTS: The Philippines has long suffered a reputation for political corruption where collusion Albright TA, Binns HJ, Katz BZ. Side effects of and between state and business was based on the exchange compliance with malaria prophylaxis in children. J of political donations for favourable economic policies. Travel Med 2002; 9(6):289-92. The tobacco industry was able to limit the effectiveness Abstract: BACKGROUND: We wanted to determine of proposed anti-tobacco legislation. A prominent the frequency of side effects and compliance with scientist publicly repudiated links between active and mefloquine and chloroquine used for antimalarial passive smoking and disease. The placement of health prophylaxis in children 0 to 13 years compared with warning labels was negotiated to benefit the industry, side effects in same-age children taking prophylactic and the commercial environment allowed it to chloroquine. METHODS: Subjects and treatment were capitalise on their marketing freedoms to the fullest identified by retrospective medical record review for potential. Women, children, youth, and the poor have children < or = 13 years not on other medications who been targeted. CONCLUSION: The politically laissez visited a travel clinic between November 1997 and faire Philippines presented tobacco companies with an January 2000. Parents were interviewed via telephone environment ripe for exploitation. The Philippines has in January through March 2000 regarding compliance seen some of the world's most extreme and and side effects. RESULTS: We reviewed 286 records controversial forms of tobacco promotion flourish. and contacted 190 of 286 parents (66%). Of these, 177 Against international standards of progress, the (93%) parents had first-hand knowledge about the Philippines is among the world's slowest nations to child's compliance with the medication regimen and take tobacco control seriously. were interviewed. Subjects were 47% male (median age 6.3 years), contacted a median of 12.4 months Alemi F, Haack M, Nemes S. Statistical definition of (range 2.8 to 28 months) following their clinic visit. Of relapse: case of family drug court. Addict Behav 2004; these, 148 (84%) were prescribed mefloquine, and 29, 29(4):685-98. chloroquine with 77% (136/177) taking the prescribed Abstract: At any point in time, a patient's return to drug antimalarial. Most children (30 of 41 [73%]) not use can be seen either as a temporary event or as a receiving their prophylaxis traveled unprotected to return to persistent use. There is no formal standard for endemic area. Sixteen subjects (12% of those taking distinguishing persistent drug use from an occasional antimalarials) reported side effects. Eleven of 115 relapse. This lack of standardization persists although subjects (10%) who took mefloquine, and 5 of 22 the consequences of either interpretation can be life subjects (23%) who took chloroquine reported a side altering. In a drug court or regulatory situation, for effect. Side effects for mefloquine included diarrhea, example, misinterpreting relapse as return to drug use anorexia, vivid dreams, headache, changes in sleep, could lead to incarceration, loss of child custody, or hallucinations, and vomiting with 2 subjects stopping loss of employment. A clinician who mistakes a client's mefloquine after seeking medical care. Side effects for relapse for persistent drug use may fail to adjust chloroquine were headache, nausea, and changes in treatment intensity to client's needs. An empirical and sleep. No child stopped taking chloroquine. Groups standardized method for distinguishing relapse from reporting or not reporting a side effect were similar for persistent drug use is needed. This paper provides a gender, age, travel destination, antimalarial prescribed, tool for clinicians and judges to distinguish relapse and elapsed time from clinic visit to telephone contact. from persistent use based on statistical analyses of CONCLUSIONS: Side effects from antimalarial drug patterns of client's drug use. To accomplish this, a administration occurred in 10 to 23% of patients who control chart is created for time-in-between relapses. 317
- 326. This paper showshow a statistical limit can be underestimate the number of vaccinated children. calculated by examining either the client's history or Vaccine safety is a major concern for many parents and other clients in the same program. If client's time-in- needs to be addressed by healthcare professionals at between relapse exceeds the statistical limit, then the institutions offering paediatric vaccinations. client has returned to persistent use. Otherwise, the drug use is temporary. To illustrate the method, it is Alidina S, Jarvis S, Nickoloff B, Tolkin J, Trypuc J. applied to data from three family drug courts. The Connecting for change: networks as a vehicle for approach allows the estimation of control limits based regional health reform the early experiences of the on the client's as well as the court's historical patterns. Child Health Network for the Greater Toronto Area. The approach also allows comparison of courts based Healthc Manage Forum 2002; 15(2):41-5. on recovery rates. Abstract: The Child Health Network (CHN) for the Greater Toronto Area (GTA) is a partnership of Alevizopoulos GA. Mentally disordered offenders as hospital, rehabilitation and community providers victims: from classic Greek poetry to modern committed to developing a regional system to deliver psychiatry. J Am Acad Psychiatry Law 2003; high quality, accessible, family-centred care for 31(1):110-6. mothers, newborns, children and youth. This article reviews the history and model of the CHN, assesses its Alexander T. GPs and child protection. Br J Gen Pract 2002; achievements, and provides insights into the challenges 52(482):764-5. and lessons learned by the network. Stemming from the CHN's commitment to quality, accessibility and Alfredsson R, Svensson E, Trollfors B, Borres MP. Why do efficiency, regionalization of maternal, newborn and parents hesitate to vaccinate their children against children's services is emerging as a success story. measles, mumps and rubella? Acta Paediatr 2004; 93(9):1232-7. Alkan N, Baksu A, Baksu B, Goker N. Gynecological Abstract: BACKGROUND: Thanks to a successful examinations for social and legal reasons in Turkey: voluntary vaccination programme, measles, mumps hospital data. Croat Med J 2002; 43(3):338-41. and rubella are rare diseases in Sweden. Coverage Abstract: AIM: Women in Turkey are subjected to among children 18 mo of age has been 99%, but the gynecologic examinations not only for legal reasons, measles, mumps and rubella vaccination (MMR) has such as sexual assault or violence against pregnant increasingly been questioned among parents. AIM: To women, but also for various social reasons, such as study reasons why parents choose not to vaccinate their suspicions of premarital intercourse, prostitution, loss child against measles, mumps and rubella, and their of virginity, and pregnancy at the time of entering into opinions on vaccines and the diseases themselves. A a new marriage. The examinations are performed by secondary objective was to compare coverage at 18 mo general practitioners, forensic physicians, and of age based on parental report with the national gynecologists. This study presents social reasons for statistics based on patient charts. METHODS: The gynecologic examinations of women in Turkey. official statistics were compared with patient charts for METHOD: We analyzed the reasons for gynecologic two birth cohorts in the city of Goteborg, Sweden. Out examination of 412 women at the 1st Obstetrics and of these children born in 1995 and 1996, 300 Gynecology Department, Sisli Etfal Training and unvaccinated and vaccinated children were identified. Research Hospital, between January 1, 1999 and June Their parents received a postal questionnaire assessing 30, 2001. RESULTS: Out of 27,376 women at the the parent's views on vaccines and childhood diseases. Department, 412 (1.5%) underwent gynecologic RESULTS: The documented vaccine coverage in this examination for social or legal reasons: 82 (19.9%) for study was higher in 1995 and 1996 than official entering into a new marriage, 41 (10.1%) for violence statistics indicated. The major reason, for both groups, against pregnant women, 28 (6.7%) for sexual assault, for accepting respectively declining vaccination was 53 (12.8%) for suspicion of prostitution, and 208 strengthening the child's immune system. Parents with (50.5%) for the determination of virginity. children unvaccinated against MMR were also more CONCLUSION: Gynecologic examinations for legal likely to have declined vaccination against diphtheria, or social reasons in Turkey are still rather common. polio, tetanus, Haemophilus influenzae and pertussis. Medicolegal regulation of gynecological examinations One-third of the parents with a child unvaccinated should be changed to protect women's human rights. against MMR had not yet made their final decision 3 y after the vaccine offer. Few parents, both with Allasio D, Fischer H. Re: Shaken baby syndrome and vaccinated and unvaccinated children, had acquired hypothermia. Child Abuse Negl 2001; 25(11):1413-4. vaccine information from the Internet. Both groups believed that insufficient time was allocated for Allmark P, Mason S, Gill AB, Megone C. Is it in a neonate's vaccine information and discussion at the Child Health best interest to enter a randomised controlled trial? J Centre. CONCLUSION: Our study indicates that Med Ethics 2001; 27(2):110-3. official statistics on MMR vaccination uptake Notes: GENERAL NOTE: KIE: Allmark, Peter; 318
- 327. Mason, Su; Gill,A Bryan; Megone, Christopher reporting childhood or adolescent abuse entered GENERAL NOTE: KIE: 20 refs. perimenopause about 35% slower than women who GENERAL NOTE: KIE: KIE Bib: human reported no abuse (IRR(adj) = 0.65, 95% CI 0.45 to experimentation/minors 0.95) after adjusting for age, age at menarche, ever live Abstract: Clinicians are required to act in the best birth, ability to maintain living standard, smoking, interest of neonates. However, it is not obvious that BMI, and depression. There was a similar association entry into a randomised controlled trial (RCT) is in a among women who reported first abuse during neonate's best interest because such trials often involve adulthood (IRR(adj) = 0.72, 95% CI 0.28 to 1.80). additional onerous procedures (such as intramuscular These findings persisted when the cohort was restricted injections) in return for which the neonate receives to non-depressed women (childhood/adolescent unproven treatment or a placebo. On the other hand, IRR(adj) = 0.57, 95% CI 0.36 to 0.90; adulthood neonatology needs to develop its evidence base, and IRR(adj) = 0.63, 95% CI 0.23 to 1.77). RCTs are central to this task. The solution posited here CONCLUSIONS: This study is the first longitudinal is based on two points. First, "best interest" is not analysis of the timing of perimenopause to show an equivalent to "the best possible interest" only to "best association with a history of physical or sexual abuse. interest within a certain realm". The realm of Further study of the relation between violence and deliberation when asking the title question is the reproductive aging is needed. neonate's health. Deliberating in this realm may involve the exclusion from consideration of some Almogy G, Luria T, Richter E et al. Can external signs of factors that might be thought relevant (such as parental trauma guide management?: Lessons learned from wealth). Furthermore, circumstances may dictate the suicide bombing attacks in Israel. Arch Surg 2005; need to deliberate on other factors that might be 140(4):390-3. thought irrelevant (such as health care resources). Abstract: BACKGROUND: Following a suicide Second, deciding on a neonate's best interest does not bombing attack, scores of victims suffering from a involve "putting oneself in its shoes". Rather, it combination of blast injury, penetrating injury, and involves asking in what it has an interest, or stake. burns are brought to local hospitals. OBJECTIVE: To These will include some things in which we all, as identify external signs of trauma that would assist human beings, have a stake, such as medical progress. medical crews in recognizing blast lung injury (BLI) Putting these two points together, in the realm of health and effectively triaging salvageable and the answer to whether RCT entry is in a neonate's best nonsalvageable victims. DESIGN: Retrospective interest is usually very finely balanced. Where this is analysis of all 15 suicide bombing attacks that occurred the case, it is reasonable to invoke a broader notion of in Israel from April 1994 to August 1997. SETTING: best interest and include a broader range of elements in National survey. PATIENTS: One hundred fifty-three which the neonate has a stake, including medical victims died and 798 were injured as a result of 15 progress. In this way RCT entry can, usually, be said to attacks. Medical records were reviewed for external be in a neonate's best interest. signs of trauma, such as burns and penetrating injuries, and the presence of BLI.Main Outcome Measure The Allsworth JE, Zierler S, Lapane KL, Krieger N, Hogan JW, odds ratio for BLI and death. RESULTS: Three Harlow BL. Longitudinal study of the inception of settings were targeted: buses, semiconfined spaces, and perimenopause in relation to lifetime history of sexual open spaces. Sixty survivors (7.5%) suffered from BLI, or physical violence. J Epidemiol Community Health which was more common in buses (37 of 260) than 2004; 58(11):938-43. semiconfined spaces (14 of 279) and open spaces (9 of Abstract: STUDY OBJECTIVE: To investigate of the 259) (P<.001). Victims with BLI were more likely to extent to which violence over the life course suffer from penetrating injury to the head or torso, accelerates the onset of perimenopause, as measured by burns covering more than 10% of the body surface menstrual changes. DESIGN: Prospective cohort study. area, and skull fractures (odds ratios, 4, 11.6, and 55.8, SETTING: Boston, Massachusetts. PARTICIPANTS: respectively; P<.001). Victims who died at the scene 603 premenopausal women aged 36-45 years at were more likely to suffer from burns, open fractures, baseline who completed a cross sectional survey on and amputations in comparison with survivors (odds childhood and adult violence history. MAIN ratios, 6.5, 18.6, and 50.1, respectively; P<.001). OUTCOME MEASURE: Time to perimenopause, CONCLUSIONS: Following a suicide bombing attack, defined as time in months from baseline interview to a external signs of trauma should be used to triage woman's report of (1) an absolute change of at least victims to the appropriate level of care both at the seven days in menstrual cycle length from baseline or scene and in the hospital. Triage of salvageable and subjective report of menstrual irregularity; (2) a change nonsalvageable victims should take into account the in menstrual flow amount or duration; or (3) cessation presence of amputations, burns, and open fractures. of periods for at least three months, whichever came first. MAIN RESULTS: Experience of abuse was Alpert EJ. Domestic violence and clinical medicine: learning associated with delayed onset of menstrual changes from our patients and from our fears. J Gen Intern Med indicative of onset of perimenopause. Women 2002; 17(2):162-3. 319
- 328. Alter MJ. Dopatients who fail to complete a hepatitis A or Aman MG, De Smedt G, Derivan A, Lyons B, Findling RL. hepatitis B vaccination series have to restart it? Cleve Double-blind, placebo-controlled study of risperidone Clin J Med 2003; 70(3):234. for the treatment of disruptive behaviors in children with subaverage intelligence. Am J Psychiatry 2002; Altshuler SJ. Drug-endangered children need a collaborative 159(8):1337-46. community response. Child Welfare 2005; 84(2):171- Notes: CORPORATE NAME: Risperidone Disruptive 90. Behavior Study Group Abstract: The United States is facing an epidemic of Abstract: OBJECTIVE: The short-term efficacy and the use of methamphetamine drugs. Child welfare has safety of risperidone in the treatment of disruptive not yet addressed the needs of the children living in so- behaviors was examined in a well-characterized cohort called "meth homes." These children are endangered of children with subaverage intelligence. METHOD: In not only from the chemicals involved, but also from this 6-week, multicenter, double-blind, parallel-group parental abuse and neglect. Communities are study of 118 children (aged 5-12 years) with severely recognizing the need for interagency collaboration to disruptive behaviors and subaverage intelligence (IQ address the consequences of this epidemic. Spokane, between 36 and 84, inclusive), the subjects received Washington, has created a Drug-Endangered Children 0.02-0.06 mg/kg per day of risperidone oral solution or Project, whose mission is to implement a collaborative placebo. The a priori primary efficacy measure was the response among law enforcement, prosecutorial, change in score from baseline to endpoint on the medical, and social service professionals to the needs conduct problem subscale of the Nisonger Child of drug-endangered children. This article presents the Behavior Rating Form. RESULTS: The risperidone findings from the evaluation of the first year of the group showed significantly greater improvement than project, including a baseline assessment of the needs of did the placebo group on the conduct problem subscale drug-endangered children and the extent of of the Nisonger Child Behavior Rating Form from community-based collaboration achieved. This article week 1 through endpoint (change in score of -15.2 and makes recommendations for future community-based -6.2, respectively). Risperidone was also associated partnerships to improve the well-being of drug- with significantly greater improvement than placebo on endangered children. all other Nisonger Child Behavior Rating Form subscales at endpoint, as well as on the Aberrant Alvarado BE, Zunzunegui MV, Delisle H. [Validation of Behavior Checklist subscales for irritability, food security and social support scales in an Afro- lethargy/social withdrawal, and hyperactivity; the Colombian community: application on a prevalence Behavior Problems Inventory aggressive/destructive study of nutritional status in children aged 6 to 18 behavior subscale; a visual analogue scale of the most months]. Cad Saude Publica 2005; 21(3):724-36. troublesome symptom; and the Clinical Global Abstract: We conducted a cross-sectional study on 193 Impression change score. The most common adverse mothers of children 6 to 18 months of age in an effects reported during risperidone treatment were African-Colombian community, with the objectives: headache and somnolence. The extrapyramidal (1) to adapt and validate the Community Childhood symptom profile of risperidone was comparable to that Hunger Identification Project scale, the DUKE-UNC- of placebo. Mean weight increases of 2.2 kg. and 0.9 11 social support scale, and the Quebec Longitudinal kg occurred in the risperidone and placebo groups, Study of Child Development (QLSCD) partner support respectively. CONCLUSIONS: Risperidone was scale, and (2) to identify any existent relationship effective and well tolerated for the treatment of between nutritional status in infancy and both food severely disruptive behaviors in children with insecurity and social support. We determined construct subaverage IQ. validity using factor analysis and theoretical models- based non-parametric correlations. Length-for-age and Ambalavanan N, Carlo WA. Comparison of the prediction weight-for-length Z-results were calculated. Factor of extremely low birth weight neonatal mortality by analyses reduced the hunger scale to one factor, the regression analysis and by neural networks. Early Hum DUKE-UNC-11 scale to two factors, and the QLSCD Dev 2001; 65(2):123-37. scale to one factor. The Cronbach's alpha test ranged Abstract: AIMS: To compare the prediction of between 0.70 and 0.90. Both food insecurity and social mortality in individual extremely low birth weight support scales were correlated with mother's social (ELBW) neonates by regression analysis and by conditions, and social support was positively associated artificial neural networks. STUDY DESIGN: A with social networks and mother's self-perceived health database of 23 variables on 810 ELBW neonates status. Food insecurity, emotional-social support, and admitted to a tertiary care center was divided into partner's negative support were associated with lower training, validation, and test sets. Logistic regression height-to-age and therefore a higher ratio of chronic and neural network models were developed on the malnutrition. The study supports the appropriateness of training set, validated, and outcome (mortality) the instruments to measure the expressed concepts. predicted on the test set. Stepwise regression identified significant variables in the full set. Regression models and neural networks were then tested using data sets 320
- 329. with only theidentified significant variables, and then Anagol P. The emergence of the female criminal in India: with variables excluded one at a time. RESULTS: The infanticide and survival under the Raj. Hist Workshop J area under the curve (AUC) of receiver operating 2002; (53):73-93. characteristic (ROC) curves for neural networks and regression was similar (AUC 0.87+/-0.03; p=0.31). Anda RF, Whitfield CL, Felitti VJ et al. Adverse childhood Birthweight or gestational age and the 5-min Apgar experiences, alcoholic parents, and later risk of score contributed most to AUC. CONCLUSIONS: alcoholism and depression. Psychiatr Serv 2002; Both neural networks and regression analysis predicted 53(8):1001-9. mortality with reasonable accuracy. For both models, Abstract: OBJECTIVE: The study examined how analyzing selected variables was superior to full data growing up with alcoholic parents and having adverse set analysis. We speculate neural networks may not be childhood experiences are related to the risk of superior to regression when no clear non-linear alcoholism and depression in adulthood. METHODS: relationships exist. In this retrospective cohort study, 9,346 adults who visited a primary care clinic of a large health Ambalavanan N, Carlo WA, Bobashev G et al. Prediction of maintenance organization completed a survey about death for extremely low birth weight neonates. nine adverse childhood experiences: experiencing Pediatrics 2005; 116(6):1367-73. childhood emotional, physical, and sexual abuse; Notes: CORPORATE NAME: National Institute of witnessing domestic violence; parental separation or Child Health and Human Development Neonatal divorce; and growing up with drug-abusing, mentally Research Network ill, suicidal, or criminal household members. The Abstract: OBJECTIVE: To compare multiple logistic associations between parental alcohol abuse, the regression and neural network models in predicting adverse experiences, and alcoholism and depression in death for extremely low birth weight neonates at 5 time adulthood were assessed by logistic regression points with cumulative data sets, as follows: scenario analyses. RESULTS: The risk of having had all nine of A, limited prenatal data; scenario B, scenario A plus the adverse childhood experiences was significantly additional prenatal data; scenario C, scenario B plus greater among the 20 percent of respondents who data from the first 5 minutes after birth; scenario D, reported parental alcohol abuse. The number of adverse scenario C plus data from the first 24 hours after birth; experiences had a graded relationship to alcoholism scenario E, scenario D plus data from the first 1 week and depression in adulthood, independent of parental after birth. METHODS: Data for all infants with birth alcohol abuse. The prevalence of alcoholism was weights of 401 to 1000 g who were born between higher among persons who reported parental alcohol January 1998 and April 2003 in 19 National Institute of abuse, no matter how many adverse experiences they Child Health and Human Development Neonatal reported. The association between parental alcohol Research Network centers were used (n = 8608). abuse and depression was accounted for by the higher Twenty-eight variables were selected for analysis (3 for risk of having adverse childhood experiences in scenario A, 15 for scenario B, 20 for scenario C, 25 for alcoholic families. CONCLUSIONS: Children in scenario D, and 28 for scenario E) from those collected alcoholic households are more likely to have adverse routinely. Data sets censored for prior death or missing experiences. The risk of alcoholism and depression in data were created for each scenario and divided adulthood increases as the number of reported adverse randomly into training (70%) and test (30%) data sets. experiences increases regardless of parental alcohol Logistic regression and neural network models for abuse. Depression among adult children of alcoholics predicting subsequent death were created with training appears to be largely, if not solely, due to the greater data sets and evaluated with test data sets. The likelihood of having had adverse childhood predictive abilities of the models were evaluated with experiences in a home with alcohol-abusing parents. the area under the curve of the receiver operating characteristic curves. RESULTS: The data sets for Anderson M, Kaufman J, Simon TR et al. School-associated scenarios A, B, and C were similar, and prediction was violent deaths in the United States, 1994-1999. JAMA best with scenario C (area under the curve: 0.85 for 2001; 286(21):2695-702. regression; 0.84 for neural networks), compared with Notes: CORPORATE NAME: School-Associated scenarios A and B. The logistic regression and neural Violent Deaths Study Group network models performed similarly well for scenarios Abstract: CONTEXT: Despite the public alarm A, B, D, and E, but the regression model was superior following a series of high-profile school shootings that for scenario C. CONCLUSIONS: Prediction of death is occurred in the United States during the late 1990s, limited even with sophisticated statistical methods such little is known about the actual incidence and as logistic regression and nonlinear modeling characteristics of school-associated violent deaths. techniques such as neural networks. The difficulty of OBJECTIVE: To describe recent trends and features of predicting death should be acknowledged in school-associated violent deaths in the United States. discussions with families and caregivers about DESIGN, SETTING, AND SUBJECTS: Population- decisions regarding initiation or continuation of care. based surveillance study of data collected from media databases, state and local agencies, and police and 321
- 330. school officials forJuly 1, 1994, through June 30, same primary genetic changes, segregated together, 1999. A case was defined as a homicide, suicide, legal suggesting that pathogenetically important regulatory intervention, or unintentional firearm-related death of a networks remain conserved despite numerous passages. student or nonstudent in which the fatal injury occurred Moreover, primary leukemias cosegregated with cell (1) on the campus of a public or private elementary or lines carrying identical genetic rearrangements, further secondary school, (2) while the victim was on the way supporting that critical regulatory pathways remain to or from such a school, or (3) while the victim was intact in hematopoietic cell lines. Transcriptional attending or traveling to or from an official school- signatures correlating with clinical subtypes/primary sponsored event. MAIN OUTCOME MEASURES: genetic changes were identified and annotated based on National estimates of risk of school-associated violent their biological/molecular properties and chromosomal death; national trends in school-associated violent localization. Furthermore, the expression profile of deaths; common features of these events; and potential tyrosine kinase-encoding genes was investigated, risk factors for perpetration and victimization. identifying several differentially expressed members, RESULTS: Between 1994 and 1999, 220 events segregating with primary genetic changes, which may resulting in 253 deaths were identified; 202 events be targeted with tyrosine kinase inhibitors. The involved 1 death and 18 involved multiple deaths identified conserved signatures are likely to reflect (median, 2 deaths per multiple-victim event). Of the regulatory networks of importance for the transforming 220 events, 172 were homicides, 30 were suicides, 11 abilities of the primary genetic changes and offer were homicide-suicides, 5 were legal intervention important pathogenetic insights as well as a number of deaths, and 2 were unintentional firearm-related deaths. targets for future rational drug design. Students accounted for 172 (68.0%) of these deaths, resulting in an estimated average annual incidence of Andersson N, Cockcroft A, Ansari N et al. Household cost- 0.068 per 100 000 students. Between 1992 and 1999, benefit equations and sustainable universal childhood the rate of single-victim student homicides decreased immunisation: a randomised cluster controlled trial in significantly (P =.03); however, homicide rates for south Pakistan. BMC Public Health 2005; 5:72. students killed in multiple-victim events increased (P Abstract: BACKGROUND: Household decision- =.047). Most events occurred around the start of the makers decide about service use based largely on the school day, the lunch period, or the end of the school costs and perceived benefits of health interventions. day. For 120 (54.5%) of the incidents, respondents Very often this leads to different decisions than those reported that a note, threat, or other action potentially imagined by health planners, resulting in under- indicating risk for violence occurred prior to the event. utilisation of public services like immunisation. In the Homicide offenders were more likely than homicide case of Lasbela district in the south of Pakistan, only victims to have expressed some form of suicidal one in every ten children is immunised despite free behavior prior to the event (odds ratio [OR], 6.96; 95% immunisation offers by government health services. confidence interval [CI], 1.96-24.65) and been bullied METHODS/DESIGN: In 32 communities by their peers (OR, 2.57; 95% CI, 1.12-5.92). representative of Lasbela district, 3344 households CONCLUSIONS: Although school-associated violent participated in a baseline survey on early child health. deaths remain rare events, they have occurred often In the 18 randomly selected intervention communities, enough to allow for the detection of patterns and the we will stimulate discussions on the household cost- identification of potential risk factors. This information benefit equation, as measured in the baseline. The may help schools respond to this problem. reference (control) communities will also participate in the three annual follow-up surveys, feedback of the Andersson A, Eden P, Lindgren D et al. Gene expression general survey results and the usual health promotion profiling of leukemic cell lines reveals conserved activities relating to immunisation, but without molecular signatures among subtypes with specific focussed discussion on the household cost-benefit genetic aberrations. Leukemia 2005; 19(6):1042-50. equations. DISCUSSION: This project proposes Abstract: Hematologic malignancies are characterized knowledge translation as a two-way communication by fusion genes of biological/clinical importance. that can be augmented by local and international Immortalized cell lines with such aberrations are today evidence. We will document cultural and contextual widely used to model different aspects of barriers to immunisation in the context of household leukemogenesis. Using cDNA microarrays, we cost-benefit equations. The project makes this determined the gene expression profiles of 40 cell lines information accessible to health managers, and as well as of primary leukemias harboring 11q23/MLL reciprocally, makes information on immunisation rearrangements, t(1;19)[TCF3/PBX1], effects and side effects available to communities. We t(12;21)[ETV6/RUNX1], t(8;21)[RUNX1/CBFA2T1], will measure the impact of this two-way knowledge t(8;14)[IGH@/MYC], t(8;14)[TRA@/MYC], translation on immunisation uptake. t(9;22)[BCR/ABL1], t(10;11)[PICALM/MLLT10], t(15;17)[PML/RARA], or inv(16)[CBFB/MYH11]. Andrade LO, Bareta IC, Gomes CF, Canuto OM. Public Unsupervised classification revealed that health policies as guides for local public policies: the hematopoietic cell lines of diverse origin, but with the experience of Sobral-Ceara, Brazil. Promot Educ 2005; 322
- 331. Suppl 3:28-31. disorders being 54% for attention-deficit/hyperactivity Abstract: The accelerated urbanisation process that disorder, 77% for conduct disorder, 41% for Brazil has gone through in the last 50 years has given oppositional defiant disorder, 57% for anxiety disorder rise to daunting challenges for public managers, 57, 60% for depressive disorder 60, 63% for illicit drug especially in terms of local public policy management abuse, and 58% for regular alcohol use. Internalizing for the building of "healthy cities". In Sobral, a disorders (depressive disorders, anxiety disorders and municipality of 173,000 inhabitants in Ceara in the phobias) were more prevalent in the female subsample. North-eastern region of Brazil, a number of municipal There was no significant difference in the prevalence policies were initiated beginning in 1997, many in of illicit drug abuse between genders. There were more partnership with the federal and state governments. male than female adolescents on parole and failure to They were inspired by the vision of a healthy and comply with the sentence was significantly more equitable city and were marked by strategic planning frequent in females. The high prevalence of and the implementation of intersectoral projects. This psychopathology suggested by this study indicates the article lays out some of the actions and their results, need for psychiatric treatment as part of the prevention including an increase in the public supply of drinking of juvenile delinquency or as part of the sentence. water from 65% to 97% of households; an increase in However, treatment had never been available for 93% sewage networks from 7% to 65%; an increase in of the sample in this study. public refuse collection from 42% to 90%; the expansion of green areas; the construction of nine Andreassen M, Lajer M, Lau M, Moesgaard K, Poulsen S, kilometres of bicycle paths; the universalisation of Ramsing P. [Recovered memories--agreed and integral health care through the Family Health Strategy disagreed]. Ugeskr Laeger 2004; 166(48):4394. through a network with specialised out-patient and hospital services; and a 148% increase in the number of Andronikou S, Bertelsmann J. CT scanning--essential for children enrolled in primary school. These initiatives conservative management of paediatric blunt also resulted in the improvement of quality of life abdominal trauma. S Afr Med J 2002; 92(1):35-8. indicators, including a reduction in infant mortality from 61.4 to 19.0 per thousand live births, a drop in the Andrzejak RG, Widman G, Lehnertz K, Rieke C, David P, mortality rate from traffic accidents from 33.40 per Elger CE. The epileptic process as nonlinear 100,000 inhabitants in 2001 to 15.25 in 2003; and a deterministic dynamics in a stochastic environment: an jump in literacy rates among children in the first cycle evaluation on mesial temporal lobe epilepsy. Epilepsy of primary school from 40 to 90.7%. In the present Res 2001; 44(2-3):129-40. article, the authors describe some of the successful Abstract: The theory of deterministic chaos addresses strategies and projects initiated between 1997 and simple deterministic dynamics in which nonlinearity 2003, and discuss how this experience could be gives rise to complex temporal behavior. Although reproduced in other communities across Brazil and biological neuronal networks such as the brain are around the world. highly complicated, a number of studies provide growing evidence that nonlinear time series analysis of Andrade RC, Silva VA, Assumpcao FB Jr. Preliminary data brain electrical activity in patients with epilepsy is on the prevalence of psychiatric disorders in Brazilian capable of providing potentially useful diagnostic male and female juvenile delinquents. Braz J Med Biol information. In the present study, this analysis Res 2004; 37(8):1155-60. framework was extended by introducing a new Abstract: The aim of the present investigation was to measure xi, designed to discriminate between nonlinear study the prevalence of psychiatric disorders in a deterministic and linear stochastic dynamics. For the sample of delinquent adolescents of both genders and evaluation of its discriminative power, xi was extracted to compare the prevalence between genders. A total of from intracranial multi-channel EEGs recorded during 116 adolescents (99 males and 17 females) aged 12 to the interictal state in 25 patients with unilateral mesial 19 on parole in the State of Rio de Janeiro were temporal lobe epilepsy. Strong indications of nonlinear interviewed using the screening interview based on the determinism were found in recordings from within the Schedule for Affective Disorders and Schizophrenia epileptogenic zone, while EEG signals from other sites for School-Age Children -- Present and Lifetime mainly resembled linear stochastic dynamics. In all (KSADS-PL). Data were collected between May 2002 investigated cases, this differentiation allowed to and January 2003. Of 373 male and 58 female retrospectively determine the side of the epileptogenic adolescents present in May 2002 in the largest zone in full agreement with results of the presurgical institution that gives assistance to adolescents on parole workup. in the city of Rio de Janeiro, 119 subjects were assessed (three of them refused to participate). Their Angeles-Llerenas A, Bello MA, Dirce G, Salinas MA. average age was 16.5 years with no difference between [Argentina, Brazil and Mexico. Biomedical research genders. The screening interview was positive for and the defense of a single standard of attention in psychopathology for most of the sample, with the developing countries]. Rev Invest Clin 2004; frequencies of the suggested more prevalent psychiatric 323
- 332. 56(5):675-85. critically new findings in this area. RECENT Abstract: In the Helsinki Declaration, which FINDINGS: Research reviews and new studies established the ethical principles for research with continue to highlight the burden of unidentified and human subjects, article 5 states, "...concern about the hence untreated psychopathology among children well-being of human beings should always come attending primary care. Expression of parental concern before the interests of science and of society..." appears to provide important help in improving Research proposals should include this commitment, recognition. Shared protocols have been developed for both in developed and developing countries. In primary care use for clinical conditions such as countries like Argentina, Brazil and Mexico, much of attention deficit hyperactivity disorder, but adherence the population experience situations of great injustice, to protocols is still limited. Randomized controlled including a lack of equal access to health care. In some trials have shown the feasibility and efficacy of cases, sectors of the pharmaceutical industry may see suitably adapted therapeutic interventions for these deficiencies as offering opportunities for carrying adolescent depression in primary healthcare and in out research and achieving economic profits, educational settings. Surveys indicate a significant something which carries the risk of perpetuating and amount of child and adolescent mental health work by even intensifying the unjust situations and violations of social services in countries such as the UK, and attest human rights--these population groups already suffer to the usefulness of protocols to attend to children in from. This situation implies the need for commitment foster care. The new role of primary mental health to and ethical reflection upon human rights related to worker has the potential to help support the interface health. Agreements are needed between the actors between primary and specialist child and adolescent involved in health research: sources of funding, mental health services. SUMMARY: There is researchers, public policy makers, and the study increased interest in further clarifying and enhancing subjects themselves, in order to protect the latter's the role of primary care child and adolescent mental rights, including continuity of medical treatment for health services. research subjects, when necessary. Annas GJ. Conjoined twins--the limits of law at the limits of Angelides S. Historicizing affect, psychoanalyzing history: life. N Engl J Med 2001; 344(14):1104-8. pedophilia and the discourse of child sexuality. J Notes: GENERAL NOTE: KIE: Annas, George J Homosex 2003; 46(1-2):79-109. GENERAL NOTE: KIE: 22 refs. Abstract: Within the last two decades in Australia, GENERAL NOTE: KIE: KIE Bib: informed Britain, and the United States, we have seen a veritable consent/minors; patient care/minors explosion of cultural panic regarding the problem of pedophilia. Scarcely a day passes without some Annas GJ. Extremely preterm birth and parental authority to mention in the media of predatory pedophiles or refuse treatment--the case of Sidney Miller. N Engl J organized pedophile networks. Many social Med 2004; 351(20):2118-23. constructionist historians and sociologists have Notes: GENERAL NOTE: KIE: 13 refs. described this incitement to discourse as indicative of a GENERAL NOTE: KIE: KIE Bib: allowing to moral panic. The question that concerns me in this die/infants; resuscitation orders; treatment article is: If this incitement to discourse is indicative of refusal/minors a moral panic, to what does the panic refer? I begin by detailing, first, how social constructionism requires Annas GJ. The right to health and the nevirapine case in psychoanalytic categories in order to understand the South Africa. N Engl J Med 2003; 348(8):750-4. notion of panic, and second, how a psychoanalytic Notes: GENERAL NOTE: KIE: 20 refs. reading of history might reveal important unconscious GENERAL NOTE: KIE: KIE Bib: AIDS; health forces at work in the current pedophilia "crisis" that our care/foreign countries; health care/rights culture refuses to confront. Here, I will suggest a repressed discourse of child sexuality is writ large. I Annas GJ. Testing poor pregnant patients for cocaine-- will argue that the hegemonic discourse of pedophilia physicians as police investigators. N Engl J Med 2001; is contained largely within a neurotic structure and that 344(22):1729-32. many of our prevailing responses to pedophilia Notes: GENERAL NOTE: KIE: Annas, George J function as a way to avoid tackling crucial issues about GENERAL NOTE: KIE: 19 refs. the reality and trauma of childhood sexuality. GENERAL NOTE: KIE: KIE Bib: prenatal injuries Ani C, Garralda E. Developing primary mental healthcare Anthuber S, Hepp H. [Child and adolescent gynecology. for children and adolescents. Curr Opin Psychiatry Introduction to the focal topic 'Child and adolescent 2005; 18(4):440-4. gynecology']. Gynakol Geburtshilfliche Rundsch 2003; Abstract: PURPOSE OF REVIEW: Governmental 43(3):129-30. initiatives to enhance child and adolescent mental Abstract: Valuable knowledge from the subspecialty of healthcare are giving renewed impetus to work in child and adolescent gynecology is of considerable primary care. This review identifies and discusses 324
- 333. importance for theclinically active pediatrician and consists of a written and a clinical component. Each gynecologist. Focal topics such as sexual violence to candidate at the clinical component sees one long case children and young adults, undesired pregnancies and and two short cases. OBJECTIVES: To assess the pregnancy termination should not only be made known views of the bystanders regarding their sick children in the media, but also to specialists, so that successful participating at a clinical examination, and to evaluate prevention and treatment can be carried out. the children's perceptions of the clinical component. Furthermore, endocrinological problems and genital METHODS: An interviewer-administered malformations in adolescence should be detectable and questionnaire was discussed separately with the treatable. participating children and their bystanders at the final year examination in paediatrics of the Faculty of Aouina H, El Gharbi L, Fakhfakh R et al. [Smoking Medicine, Colombo, in 1999. RESULTS: 116 patients cessation program in Tunisia: experience of a participated at the clinical examination in paediatrics. respiratory service.]. Int J Tuberc Lung Dis 2002; 107 (92%) of the bystanders were the children's 6(12):1123-7. mothers. Informed consent had not been obtained for Abstract: A tobacco cessation programme was recently use in the examination from 59 (51%) of the children's introduced into medical practice in Tunisia. The mothers. Seven (6%) were not satisfied with the way medical staff in the pulmonary disease ward at Charles their children were handled by the candidates, and 25 Nicolle Hospital, Tunis, has been the first to implement (21.5%) showed concern about the number of such a programme for people motivated to quit candidates examining their child. Bystanders who smoking. This programme has been run for 3 years in participated at the long cases were inconvenience more the respiratory disease out-patient department. It acts than those in the short cases. 34 children above the age essentially against psychological and pharmacological of 5 years were also interviewed. An explanation dependence on tobacco. The results obtained were very regarding the examination had not been given to 31 encouraging: 298 smokers have participated in this (92%) of them. Six children (17%) said they were programme. The global success rate at 12 months of examined for too long. A majority of the bystanders tobacco withdrawal was about 25% for people who welcomed the payments received and all of them were were followed up, and 17% for the whole sample. satisfied with the medical students' conduct and Medical help for smoking cessation should be more politeness. All of them agreed that this form of clinical widely promoted in Tunisia to increase the number of examination was a good method of evaluating a smokers who consult and improve the quality of student's professional competence. CONCLUSIONS: medical intervention. Several aspects of the clinical component of the final examination in paediatrics for medical undergraduates Appelbaum PS. Law & psychiatry: Third-party suits against need to be improved to minimise the inconvenience therapists in recovered-memory cases. Psychiatr Serv experienced by the children and their parents. 2001; 52(1):27-8. Arana E, Marti-Bonmati L, Bautista D, Paredes R. Appelbaum PS. The 'quiet' crisis in mental health services. [Diagnosis of calvarial lesions. Feature selection by Health Aff (Millwood) 2003; 22(5):110-6. neural network and logistic regression]. Neurocirugia Abstract: The failure of insurers and managed care (Astur) 2003; 14(5):377-84. organizations to reimburse providers of mental health Abstract: OBJECTIVES: To establish the minimun set services for the costs of care has led to a crisis in of features needed in the diagnosis of calvarial lesions access to these services. Using the situation in using computed tomography (CT) and to assess the Massachusetts as a case example, this paper explores accuracy of logistic regression (LR) and artificial the impact of this defunding. Unable to sustain neural networks (NN) for their diagnosis. MATERIAL continued losses, hospitals are closing psychiatric AND METHODS: 167 patients with calvarial lesions units, and outpatient services are contracting or closing as the only known disease were enrolled. The clinical altogether. The situation has been compounded by the and CT data were used for LR and NN models. Both withdrawal of many practitioners from managed care models were tested with the jacknife method. The final networks and cuts in public-sector mental health results of each model were compared using the area services. Unless purchasers demand effective coverage under ROC curves (A 2 ). RESULTS: The lesions were of mental health treatment, mental health services will 73.1 % benign and 26.9% malignant. There was no likely continue to wither away. statistically significant difference between LR and NN in differentiating malignancy. In characterizing the Arachchi JK, Sumanasena SP, de Silva KS. Clinical histologic diagnoses, NN was statistically superior to examination in paediatrics at final MBBS: views of LR. Important NN features needed for malignancy children and their parents. Ceylon Med J 2003; classification were age and edge definition, and for the 48(1):12-4. histologic diagnoses matrix, marginal sclerosis and Abstract: INTRODUCTION: The final examination in age. CONCLUSIONS: A minimum four features is paediatrics for medical undergraduates in Sri Lanka needed to diagnose these lesions, not being important patients' symptoms. NNs offer wide possibilities over 325
- 334. statistics for thecalvarial lesions study besides a of domestic violence. superior diagnostic performance. Argyropoulos C, Nikiforidis GC, Theodoropoulou M et al. Arana E, Marti-Bonmati L, Bautista D, Paredes R. Mining microarray data to identify transcription factors Qualitative diagnosis of calvarial metastasis by neural expressed in naive resting but not activated T network and logistic regression. Acad Radiol 2004; lymphocytes. Genes Immun 2004; 5(1):16-25. 11(1):45-52. Abstract: Transcriptional repressors controlling the Abstract: RATIONALE AND OBJECTIVES: To expression of cytokine genes have been implicated in a simplify the diagnostic features used by an artificial variety of physiological and pathological phenomena. neural network compared with logistic regression (LR) An unknown repressor that binds to the distal NFAT in the diagnosis of calvarial metastasis with computed element of the interleukin-2 (IL-2) gene promoter in tomography and analyze their accuracy. MATERIALS naive T-helper lymphocytes has been implicated in AND METHODS: Twenty-one of 167 patients with autoimmune phenomena and has emerged as a calvarial lesions were found to have metastasis. potentially important factor controlling the latency of Clinical and computed tomography data were used for HIV-1. The aim of this paper was the identification of LR and neural network models. Both models were this repressor. We resorted to public microarray tested with the leave-one-out method. The final results databases looking for DNA-binding proteins that are of each model were compared using the area under present in naive resting T cells but are downregulated receiver operating characteristic curve (Az). when the cells are activated. A Bayesian data mining RESULTS: The neural network identified metastasis statistical analysis uncovered 25 candidate factors. Of significantly more successfully than LR with an Az of the 25, NFAT4 and the oncogene ets-2 bind to the 0.9324 +/- 0.0386 versus 0.9192 +/- 0.0373, P = .01. common motif AAGGAG found in the HIV-1 LTR and The most important features selected by the LR and IL-2 probes. Ets-2 binding site contains the three G's neural network were age and edge definition. that have been shown to be important for binding of the CONCLUSION: Neural networks offer wide unknown factor; hence, we considered it the likeliest possibilities over statistics for the study of calvarial candidate. Electrophoretic mobility shift assays metastases other than their minimum clinical and confirmed cross-reactivity between the unknown radiologic features for diagnosis. repressor and anti-ets-2 antibodies, and cotransfection experiments demonstrated the direct involvement of Arcos E, Uarac M, Molina I, Repossi A, Ulloa M. [Impact of Ets-2 in silencing the IL-2 promoter. Designing domestic violence on reproductive and neonatal experiments for transcription factor analysis using health]. Rev Med Chil 2001; 129(12):1413-24. microarrays and Bayesian statistical methodologies Abstract: BACKGROUND: Domestic violence can provides a novel way toward elucidation of gene have an important influence on mother and child control networks. health. AIM: To assess the consequences of remote and actual, emotional or physical, domestic violence on the Arie S. WHO takes up issue of child abuse. BMJ 2005; reproductive and newborn health in pregnant women. 331(7509):129. MATERIAL AND METHODS: A longitudinal epidemiological observation from an Urban Primary Ariza AJ, Greenberg RS, Unger R. Childhood overweight: Health Care Center from Valdivia, Chile, in 1998. Two management approaches in young children. Pediatr cohorts were studied: Pregnant women that Ann 2004; 33(1):33-8. experienced domestic violence (index group) and Abstract: Management of overweight in young children pregnant women not exposed to domestic violence may be our best opportunity for confronting the (control group). Women were followed during nationwide epidemic of childhood obesity. Doing so pregnancy and at labor. The newborn was also will require all health care providers to improve their assessed. RESULTS: The index group had a higher identification, assessment, and guidance on this issue. relative risk (RR) for impending abortion (RR 1.44, As a group, we must make it a priority to obtain height 95% confidence interval (CI): 1.07-1.93), hypertensive and weight measurements on every child and to syndrome of pregnancy (RR 1.5, 95% CI: 1.18-1.96), interpret them correctly. We must be comprehensive in intrahepatic cholestasis (RR 1.5, 95% CI: 1.1-1.94). our medical investigation in order to uncover Women that experienced violence during pregnancy identifiable causes and recognize comorbidities. Most had a higher risk of urinary tract infection (RR 2.88, of all, we must motivate families, as a whole, to 95% CI: 1.28-6.43), intrauterine growth retardation confront this issue with us by increasing physical (RR 3.7, 95% CI: 1.77-7.93) and intrahepatic activity, decreasing sedentary behaviors, and cholestasis. Newborns from the index group had lower improving eating practices. As health professionals in a weight, size and gestational age. CONCLUSIONS: society that is not yet poised to fight this epidemic, we Domestic violence is associated with hypertension must lead the way. during pregnancy and intrauterine growth retardation. The incorporation of bio-psychological evaluation and Armour KL, Callister LC. Prevention of triplets and higher monitoring systems could attenuate the consequences 326
- 335. order multiples: trendsin reproductive medicine. J care. These results present important findings for TBI Perinat Neonatal Nurs 2005; 19(2):103-11. rehabilitation professionals. Future studies need to Abstract: In the United States and throughout the investigate whether TBI parents' needs are unmet world, today's healthcare providers are challenged by because of the lack of community resources, or if the risks of multiple gestation pregnancy. Assisted available resources do not adequately target the needs reproductive technologies (ARTs) often used to treat of the TBI parents. infertility raise ethical issues including informed consent, veracity, and nonmalificence. In the United Armstrong TD, Costello EJ. Community studies on States, there is the need to improve maternal and adolescent substance use, abuse, or dependence and fetal/neonatal mortality and morbidity by proposing psychiatric comorbidity. J Consult Clin Psychol 2002; legislation regulating ART and supporting single 70(6):1224-39. embryo transfers with no more than 2 such transfers. Abstract: A literature review on community studies of Beginning with the diagnosis of infertility, providers adolescent substance use, abuse, or dependence have a responsibility to educate, inform, and treat (SU/AID) and psychiatric comorbidity yielded 22 infertile couples. From the moment pregnancy with articles from 15 studies with information on rates, multiples is confirmed, these families are faced with specificity, timing, and differential patterns of incredible stressors including decision making on comorbidity by gender, race/ethnicity, and other multifetal or selective reduction. Full disclosure of factors. Results revealed that 60% of youths with risks involved throughout the course of care should be SU/A/D had a comorbid diagnosis, and conduct discussed and documented in the record and plan of disorder (CD) and oppositional defiant disorder (not care. Currently in the United States, legislation does attention-deficit/hyperactivity disorder) were most not regulate ART, including ovulation commonly associated with SU/A/D, followed by induction/enhancement and in vitro fertilization. depression. Child psychopathology (particularly CD) Although the United States does have self-regulation was associated with early onset of substance use and via limited reporting through their professional abuse in later adolescence. The authors suggest that organization and the Centers for Disease Control and available data relevant to SU/A/D and psychiatric Prevention, an unlimited number of embryos may be comorbidity can be used to better address such transferred. Unfortunately, many healthcare providers questions. have not recognized the responsibility and burden placed on families and society as a whole. Lack of Arnold EM, Kirk RS, Roberts AC, Griffith DP, Meadows K, regulation means women may become pregnant with Julian J. Treatment of incarcerated, sexually-abused high order multiples, which raises serious moral and adolescent females: an outcome study. J Child Sex ethical issues. Abus 2003; 12(1):123-39. Abstract: This study examined the psychosocial Armstrong DB, Cole WG. Can child accidents be prevented functioning of 100 adolescent females (ages 12-17) in your community? Am J Public Health 2004; sentenced to secure care in a southeastern state and the 94(6):940, 942. impact of gender-specific, cognitive-behavioral therapy (CBT) intervention on the psychosocial functioning of Armstrong K, Kerns KA. The assessment of parent needs subjects who reported a history of sexual abuse. The following paediatric traumatic brain injury. Pediatr Multidimensional Adolescent Assessment Scale Rehabil 2002; 5(3):149-60. (MAAS) was used to assess psychosocial functioning. Abstract: The paediatric version of the Family Needs Pre-test scores on the MAAS revealed significantly Questionnaire was administered to parents of children higher scores on 12 of 16 dimensions of psychosocial with traumatic brain injuries (TBI) a year or more post- functioning and higher rates of serious criminal injury. Parents of diabetic children (DIAB) and parents behavior for youth who subsequently disclosed sexual of orthopaedically (ORTHO) injured children were abuse histories as compared to those without such included as control groups. Parents rated items on their histories. At post-test, statistically significant importance and how well these needs have been met. improvements in psychosocial functioning were The ORTHO group rated significantly fewer items as observed on 14 of 16 MAAS subscales for those who important relative to the TBI and DIAB groups (who received the CBT intervention. Thus, incarcerated endorsed a similar number of items). Of those items female adolescents who reported a history of sexual rated as important, TBI parents' needs were more likely abuse demonstrated more impairment in their to remain unmet relative to both the DIAB and the functioning as compared to those without a reported ORTHO groups: out of 28 items rated as important, history of sexual abuse and responded positively to TBI parents report that 19 needs are still unmet. DIAB gender-specific, CBT-based intervention. and ORTHO parents more consistently reported their needs as met. Needs most often rated as unmet for TBI Arnold LE. Turn-of-the-century ethical issues in child parents include the needs for health/medical psychiatric research. Curr Psychiatry Rep 2001; information, professional support, community support 3(2):109-14. networks, and the need to be involved in their child's 327
- 336. Abstract: National concernin 2000 about increased increased during the study period. Post-neonatal psychoactive drug prescription for preschoolers mortality showed a stronger association with social accentuated the 1990s thrust for more pharmacologic indicators than neonatal mortality. Some studies research in children. Preschoolers are prescribed potent showed that neonatal mortality was associated with drugs without adequate evidence for efficacy or safety social indicators in a non-linear fashion, with high rates at this plastic age of the rapidly developing brain. of mortality in both the lowest and highest social strata. Implementation of needed preschool research poses The pattern differed, however, between countries with special ethical complications. Children with mental Finland and Sweden showing consistently less social disorder qualify for special protection under both inequalities than Denmark and Norway. While the rubrics. Parental informed consent is crucial for increased inequality shown in most studies was an preschoolers, who appear incapable of assent because increase in relative risk, a single study from Denmark of their preoperational, magical, animistic, egocentric demonstrated an absolute increase in infant mortality thinking, with inability to comprehend relative risks among children born to less educated women. and benefits. Whether they can dissent is an open CONCLUSIONS: Social inequalities in infant question. Possibly for research with direct benefit mortality are observed in all four countries, irrespective outweighing the risk, parental permission/consent of social indicators used in the studies. It is, however, could override attempted preschooler dissent. Subject difficult to draw inferences from the comparisons recompense should be adjusted for age differences in between countries, since different measures of social perception of amount, although parent reimbursement position and different inclusion criteria are used in the needs to be realistic. Insurance for research risk is studies. Nordic collaborative analyses of social desirable. Placebo controls appear justified for gradients in infant death are needed, taking advantage preschoolers because there is little evidence base to say of the population-covering registers in longitudinal that a proven effective treatment already exists. designs, to explore the mechanisms behind the social Disruptive behavior disorders, including attention- patterns in infant mortality. deficit/hyperactivity, have enough evidence of preschool diagnostic validity to justify therapeutic Arons J. "In a black hole": the (negative) space between trials. In preschool pharmacologic research, a brief trial longing and dread: Home-based psychotherapy with a of a nonpharmacologic treatment should precede the traumatized mother and her infant son. Psychoanal drug trial to ensure that placebo responders and Study Child 2005; 60:101-27. responders to the alternative treatment are not exposed Abstract: This paper offers fragments from the first to drug risk. year of a home-based mother-baby psychotherapy, in which I attempted to help a traumatized and dissociated Arnold RW. Macular hole without hemorrhages and shaken mother to emotionally engage with her infant son. The baby syndrome: practical medicolegal documentation treatment was organized in part around certain of children's eye trauma. J Pediatr Ophthalmol developmental objectives common to both attachment Strabismus 2003; 40(6):355-7. and psychoanalytic theory. These include: The ability to name and metabolize feelings, to evoke a soothing Arntzen A, Nybo Andersen AM. Social determinants for maternal introject, and to relate to the partner's mind as infant mortality in the Nordic countries, 1980-2001. a separate, understandable center of initiative and Scand J Public Health 2004; 32(5):381-9. intention. In addition, attachment theory, with its Abstract: AIM: Social equity in health is an important emphasis on the critical psychobiological role of goal of public health policies in the Nordic countries. containing fear and distress in infancy, was a useful Infant mortality is often used as an indicator of the guide in formulating the treatment. The paper reviews health of societies, and has decreased substantially in research findings on mother-infant pairs described as the Nordic welfare states over the past 20 years. To frightened-disorganized, discusses some of the identify social patterns in infant mortality in this challenges encountered in home-based mother-infant context the authors set out to review the existing psychotherapy and then discusses the case of Mary and epidemiological literature on associations between John. The case illustrates how mother-infant social indicators and infant mortality in Denmark, psychotherapy may interrupt the intergenerational Finland, Norway, and Sweden during the period 1980- transmission of disorganized attachment by working 2000. METHODS: Nordic epidemiological studies in within the couple to name, metabolize and flexibly the databases ISI Web of Science, PubMed, and OVID, respond to painful, dissociated or frightening published between 1980 and 2000 focusing on social experiences. indicators of infant, neonatal, and postneonatal mortality, were identified. The selected keywords on Arseneault L, Cannon M, Murray R, Poulton R, Caspi A, social indicators were: education, income, occupation, Moffitt TE. Childhood origins of violent behaviour in social factors, socioeconomic status, social position, adults with schizophreniform disorder dagger. Br J and social class. RESULTS: Social inequality in infant Psychiatry 2003; 183:520-5. mortality was reported from Denmark, Finland, Abstract: BACKGROUND: People with psychosis Norway, and Sweden, and it was found that these have an elevated risk of violence. AIMS: To examine 328
- 337. whether violent behaviourin adults with psychosis can and non-gang-related victims and significant be accounted for by psychotic symptoms or physical differences in gender, race and age. Occipital entrance aggression in childhood. METHOD: We used data sites were more common in the gang-related vs from a prospective longitudinal study of a complete temporal entrance sites in the non-gang-related. Mean birth cohort born in New Zealand. When cohort transit time to the emergency department for gang- members were 26 years old, information was obtained related shootings was less than non-gang-related on past-year psychiatric diagnosis of schizophreniform shootings (24.4 vs 27.8 minutes). Most shooting disorder and on violent behaviour. Childhood psychotic incidents took place between 6pm and 3am. No symptoms were measured at age 11 years using a difference between survival and outcome was noted diagnostic interview, and childhood physical between gang and non-gang victims. CONCLUSIONS: aggression was assessed by teachers when cohort Significant differences were found between gang- and members were aged 7, 9 and 11 years. RESULTS: non-gang-related shooting victims in terms of Participants with schizophreniform disorder were more demographics, entrance site and transit time. No likely to be violent than participants without, even after difference was found between injury time, survival and controlling for sociodemographic variables and outcome between gang and non-gang populations. concurrent substance dependence disorders. Childhood psychotic symptoms were a strong risk factor for Asamura H, Yamazaki K, Mukai T et al. Case of shaken violence in adults with schizophreniform disorder, as baby syndrome in Japan caused by shaking alone. was childhood physical aggression, although to a lesser Pediatr Int 2003; 45(1):117-9. extent. CONCLUSIONS: Violence by individuals with schizophreniform disorder could be prevented by Ashby SL, Rich M. Video killed the radio star: the effects of monitoring early signs of psychotic symptoms and by music videos on adolescent health. Adolesc Med Clin controlling childhood physical aggression. 2005; 16(2):371-93, ix. Abstract: Since its inception half a century ago, rock Arterburn T. Using hidden cameras to monitor suspected and roll has been the music of youth and rebellion, of parental abuse. J Healthc Prot Manage 2001; 17(2):80- freedom, and of idealism. Popular music has been a 7. reflection of, and inspiration for, youth movements, Abstract: In using hidden cameras to monitor suspected fads, and lifestyles that can include health risk parental abuse a security requirement or an invasion of behaviors, such as sex, drugs, and interpersonal privacy? Covert surveillance of patients suspected of violence. This article summarizes the health-related having Munchausen syndrome by proxy at an Atlanta content of music videos, and discusses associations children's hospital resulted in considerable media between music videos and adolescent health risks. scrutiny when researchers published their findings. This article presents details of the research, the Asherson P. Attention-Deficit Hyperactivity Disorder in the involvement of security officers, and the reactions of post-genomic era. Eur Child Adolesc Psychiatry 2004; local authorities and health officials. 13 Suppl 1:I50-70. Notes: CORPORATE NAME: IMAGE Consortium Aryan HE, Jandial R, Bennett RL, Masri LS, Lavine SD, Abstract: BACKGROUND: ADHD is a common and Levy ML. Gunshot wounds to the head: gang- and non- complex genetic disorder. Genetic risk factors are gang-related injuries and outcomes. Brain Inj 2005; expected to be multiple, have small effect sizes when 19(7):505-10. considered individually and to interact with each other Abstract: PRIMARY OBJECTIVE: This study and with environmental factors. OBJECTIVE: To examined the differences between gang and non-gang- describe the difficulties involved in the genetic related incidents of penetrative missile injuries in terms investigation of such a complex disorder and give a of demographics, motivation, intra-cranial pathology, prospective for the future. METHODS: Review based transit time, injury time and clinical outcome. on empirical literature and project description. RESEARCH DESIGN: Retrospective and prospective RESULTS: Considerable progress has been achieved chart review. METHODS AND PROCEDURES: through the association analysis of candidate gene loci. Between 1985-1992, 349 patients with penetrating Linkage scans using affected sibling pairs have missile injuries to the brain presenting to LAC-USC identified a number of potential loci that may lead to were studied. EXPERIMENTAL INTERVENTIONS: the identification of novel genes of moderate effect Inclusion criteria were implemented to keep the cohort size. Quantitative trait locus (QTL) approaches provide as homogenous as possible. Patients excluded were powerful complementary strategies that have the those with multiple gunshot wounds, non-penetrating potential to link the categorical disorder to gunshot wounds to the head, systemic injuries and continuously distributed traits associated more closely cases in which the motivation for the incident was with underlying genetic liability in the general unknown. MAIN OUTCOMES AND RESULTS: population. Success in identifying some associated Gang-related shooting slightly out-numbered non- genes has been complemented by functional studies gang-related incidents. Demographic analysis showed that seek to understand the mode of action of such both a male and Hispanic predominance for both gang- 329
- 338. genes. CONCLUSION: Progressin understanding the 15(4):961-9. mechanisms involved has not been straightforward and Abstract: The purpose of this study was to devise a many inconsistencies have arisen. In order to take paradigm that stimulates attention using a frequency- advantage of the potential for progress that stems from based analysis of the data acquired during a motor task. the genetic findings it will be important to draw upon a Six adults (30-40 years of age) and one child (10 years) variety of approaches and experimental paradigms. A were studied. Each subject was requested to attend to functional genomic approach to ADHD means that "start" and "stop" commands every 20 s alternatively investigation of gene function is carried out at various and had to respond with the motor task every second levels of analysis, not only at the level of molecular time. Attention was stimulated during a block- and cellular function but also at the level of designed, motor paradigm in which a start-stop psychological processes, neuronal networks, commands cycle produced activation at the fourth environmental interactions and behavioural outcomes. harmonic of the motor frequency. We disentangled the motor and attention functions using statistical analysis Assel MA, Landry SH, Swank PR, Steelman L, Miller- with subspaces spanned by vectors generated by a Loncar C, Smith KE. How do mothers' childrearing truncated trigonometric series of motor and attention histories, stress and parenting affect children's frequency. During our auditory-motor paradigm, all behavioural outcomes? Child Care Health Dev 2002; subjects showed activation in areas that belong to an 28(5):359-68. extensive attention network. Attention and motor Abstract: BACKGROUND: Information is needed to functions were coactivated but with different understand the role of low to moderate levels of frequencies. While the motor-task-related areas were mothers' emotional stress and child characteristics (i.e. activated with slower frequency than attention, the prematurity) on parenting behaviours and their impact activation in the attention-related areas was enhanced on children's behaviour that might be deemed every time the subject had to start or end the motor 'challenging' but not 'disordered'. METHODS: The task. We suggest that although a simple block- direct and indirect relations of maternal childrearing designed, auditory-motor paradigm stimulates the history and emotional stress, and observed parenting attention network, motor preparation, and motor practices when children were 3 years of age on 4-year inhibition concurrently, a frequency-based analysis can child behavioural outcomes was examined in a sample distinguish attention from motor functions. Due to its of low-income families with a term (n=112) or preterm simplicity the paradigm can be valuable in studying (n=180) child. Parenting practices included displays of children with attention deficit disorders. warmth and restrictiveness when interacting with their children. Child outcomes at 4 years included Aszodi I. [Contribution to the publication "Sexual crimes observation of social initiations with their mothers and against minors" by Roland Csorba et al.]. Orv Hetil maternal report of social and attentional problems. 2004; 145(44):2260; author reply 2260-1. RESULTS: A Structural Equation Model building approach guided by specific hypotheses indicated that Ateah CA, Parkin CM. Childhood experiences with, and preterm as compared to full-term children had more current attitudes toward, corporal punishment. Can J maternal reported social and attentional problems but Commun Ment Health 2002; 21(1):35-46. did not differ in observed social initiating skills. Abstract: The purpose of the present study was to Greater negative maternal childrearing history determine, in a Canadian sample, the extent to which indirectly influenced social initiating skills through its corporal or physical punishment use continues, direct influence on maternal emotional stress. Greater personal experiences, and current attitudes. Of the 436 maternal emotional stress directly influenced mothers' participants, 75% reported receiving physical parenting that, in turn, directly influenced social punishment as children. Approximately 40% of initiating. Prematurity and a more negative childrearing participants agreed that corporal punishment is history had a direct negative influence on the maternal necessary as a means of discipline. Since parental report of social and attentional behavioural outcomes. attitude toward physical punishment has been CONCLUSIONS: These findings delineate the effects determined to be an important predictor in its use with of prematurity and maternal parenting on the behaviour children, the authors recommend that parent education of 4-year-old-children and extend current knowledge of programming must include information related to its the influence of parental emotional stress on parenting. risks. Even milder levels can negatively influence parenting, and in turn, contribute to children's less well developed Atinmo T. Nutritional problems of Africa--the future of a social skills. The issues raised in this study could help continent: an overview. Forum Nutr 2003; 56:281-2. with the identification and prioritization of medical and psychological services. August GJ, Hektner JM, Egan EA, Realmuto GM, Bloomquist ML. The early risers longitudinal Astrakas LG, Teicher M, Tzika AA. Activation of attention prevention trial: examination of 3-year outcomes in networks using frequency analysis of a simple aggressive children with intent-to-treat and as-intended auditory-motor paradigm. Neuroimage 2002; 330
- 339. analyses. Psychol AddictBehav 2002; 16(4 problems. Decreases in parent emotional support of the Suppl):S27-39. child were associated with increases in child Abstract: The effects of participation following a 3- internalizing problems. CONCLUSION: Child year preventive intervention trial targeting elementary behavior problems, family environment, and parenting school children with early-onset aggressive behavior behaviors should be assessed when children present to were evaluated. Intent-to-treat analyses revealed that the clinical setting with new-onset seizures. program participants, compared with controls, showed greater gains in social skills, academic achievement, Austin S. Community-building principles: implications for and parent discipline, with mean scores in the professional development. Child Welfare 2005; normative range on the latter two constructs. As- 84(2):105-22. intended participation in the Family Program, which Abstract: This article reviews a Think Tank meeting included separate parent and child education and skills- among child welfare practitioners at the 2003 Building training groups, was associated with improved parent Communities for 21st-Century Child Welfare discipline practices and gains in children's social skills, Symposium. The Child Welfare League of America's with level of child aggression moderating gains in focus on community building is recognition of the vital academic achievement. Recommended level of FLEX importance of promoting and fostering collaboration family support contact time was associated with gains with community members to enhance the well-being of in academic achievement, concentration problems, and children, families, and communities. The Think Tank social skills, with parents of severely aggressive participants responded to four questions concerning the children showing greater reductions in parent distress. knowledge, policies, and strategies that are needed for the development of strategies for community building Augustyn M, Groves BM. Training clinicians to identify the and child welfare. This article highlights several of the hidden victims: children and adolescents who witness findings of the preconference, which addressed the violence. Am J Prev Med 2005; 29(5 Suppl 2):272-8. challenges and opportunities inherent in community- Abstract: In this article, we will provide an overview of building practices and discusses the key principles that the effects of witnessing violence on children and emerged from the Think Tank. The article emphasizes adolescents, discuss the importance of health clinicians implications for professional education and cites inquiring about violence in the lives of children, and selected examples of innovative community-building discuss the role of the clinician in educating parents initiatives with families. about children's responses to violence. In addition, we will describe training resources that improve clinicians' Autti-Ramo I. Foetal alcohol syndrome--a multifaceted skills at identifying and responding to children and condition. Dev Med Child Neurol 2002; 44(2):141-4. their parents. Autti-Ramo I, Autti T, Korkman M, Kettunen S, Salonen O, Augustyn M, Saxe G, McAlister Groves B, Zuckerman B. Valanne L. MRI findings in children with school Silent victims: a decade later. J Dev Behav Pediatr problems who had been exposed prenatally to alcohol. 2003; 24(6):431-3. Dev Med Child Neurol 2002; 44(2):98-106. Abstract: This study examined 17 children (nine males, Austin JK, Dunn DW, Johnson CS, Perkins SM. Behavioral eight females; mean age 13 years) with prenatal issues involving children and adolescents with epilepsy alcohol exposure of various durations. The aim of the and the impact of their families: recent research data. study was to detect specific brain morphological Epilepsy Behav 2004; 5 Suppl 3:S33-41. alterations by means of MRI and to see if findings Abstract: OBJECTIVE: Using data from a larger study correlated with particular cognitive deficits. Of the 17 on new-onset seizures, we reported preliminary children, five had been exposed to heavy maternal findings concerning relationships between family consumption of alcohol (over 10 drinks/week) during factors and child behavioral problems at baseline and the first trimester only; four had been exposed during 24 months. We also explored which baseline and the first and second trimester; and eight had been changes in family factors were associated with changes exposed throughout pregnancy. Five children had in child behavioral problems over the 24-month period. alcohol related neurobehavioural disorder, seven were METHODS: Subjects were 224 children and their diagnosed as having foetal alcohol effects and five primary caregivers. Data were collected using were diagnosed as having foetal alcohol syndrome. structured telephone interviews and analyzed using Hypoplasia of the vermis was observed in 10 children multiple regression. RESULTS: Deficient family and malformed posterior vermis in one additional mastery and parent confidence in managing their child. Five children had hypoplastic cerebellar child's discipline were associated with behavior hemispheres. Hypoplasia of the corpus callosum was problems at baseline and at 24 months; they also observed in two children. Small hippocampi were predicted child behavior problems over time. observed in three children and wide cortical sulci in Decreasing parent confidence in disciplining their child six. No specific structural anomaly correlated with a was associated with increasing child behavior particular neuropsychological deficit. In this study, 331
- 340. deviations in thedevelopment of the vermis was the testing refusal were being in a monogamous most sensitive morphological indicator of the effects of relationship for foreign-born women (41%) and already prenatal alcohol exposure. It was seen in every being tested for U.S.-born women (65%). diagnostic group including children who had been exposed during only the first trimester of pregnancy. Azar ST, Cote LR. Sociocultural issues in the evaluation of the needs of children in custody decision making. What Avery JK. Informed consent lacking? J Ark Med Soc 2005; do our current frameworks for evaluating parenting 101(12):356-7. practices have to offer? Int J Law Psychiatry 2002; 25(3):193-217. Avidan V, Hersch M, Armon Y et al. Blast lung injury: clinical manifestations, treatment, and outcome. Am J Azar ST, Nix RL, Makin-Byrd KN. Parenting schemas and Surg 2005; 190(6):927-31. the process of change. J Marital Fam Ther 2005; Abstract: BACKGROUND: Blast lung injury (BLI) is 31(1):45-58. a major cause of morbidity after terrorist bomb attacks Abstract: Parents' childrearing behaviors are guided by (TBAs) and is seen with increasing frequency schemas of the caregiving role, their functioning in that worldwide. Yet, many surgeons and intensivists have role, what children need in general, and what their own little experience treating BLI. Jerusalem sustained 31 children are like in particular. Sometimes, however, TBAs since 1983, resulting in a local expertise in parenting schemas can be maladaptive because they are treating BLI. METHODS: A retrospective study of too rigid or simple, involve inappropriate content, or clinical and radiologic characteristics, management, are dominated by negative affect. In this article, we and outcome of victims of TBAs sustaining BLI who describe parenting schemas and provide an overview of were admitted to ICU during December 1983 to empirical work documenting the characteristics of February 2004. Long-term outcome was determined by maladaptive parenting schemas. We review how a telephone interview. RESULTS: Twenty-nine intervention practices common to multiple therapeutic patients met inclusion criteria. Hypoxia and pulmonary approaches (cognitive-behavior therapy, family infiltrates in chest x-ray were sine qua non for the therapy, parent training, attachment-based diagnosis. Seventy-six percent required mechanical interventions, and psychoanalytic parent-infant ventilation, all within 2 hours of admission. One psychotherapy) attempt to modify schemas to promote patient died. Seventy-six percent had no long-term more optimal functioning among parents. We highlight sequelae. CONCLUSIONS: Most patients with how research in cognitive science may explain, in part, significant BLI injury require mechanical ventilation. treatment effectiveness. Late deterioration is rare. Death because of BLI in patients who survived the explosion is unusual. Timely Bach KP, Schouten-van Meeteren AY, Smit LM, diagnosis and correct treatment result in excellent Veenhuizen L, Gemke RJ. [Intracranial hemorrhages in outcome. infants: child abuse or a congenital coagulation disorder?]. Ned Tijdschr Geneeskd 2001; 145(17):809- Aynalem G, Mendoza P, Frederick T, Mascola L. Who and 13. why? HIV-testing refusal during pregnancy: Abstract: In children with head injuries the severity of implication for pediatric HIV epidemic disparity. AIDS the neurological symptoms should concord with the Behav 2004; 8(1):25-31. patient's history and signs of neurotrauma on Abstract: To identify characteristics of pregnant examination. Discrepancies between the women who refuse HIV testing and determine (hetero)anamnesis and physical examination on the one predictive factors and the reasons for refusal, we hand and neurological findings on the other may conducted face-to-face interviews of pregnant women indicate child abuse. The presence of both old and new at prenatal clinics of public and private hospitals. We intracranial haemorrhages in the absence of found 8% (n=65) of 826 pregnant women interviewed proportional trauma is generally considered as refused HIV testing. In bivariate analysis, foreign-born evidence for child abuse. However, these symptoms pregnant women residing in Los Angeles County were may also be the first manifestation of a congenital twice more likely to refuse HIV testing than U.S.-born coagulation disorder. Three children, two girls aged 8 pregnant women (odds ratio [OR] = 1.97, 95% and 5 months and a boy aged 6 months were presented confidence interval [CI] 1.11-3.49, p <.05). In a with alarming neurological symptoms due to multivariate stepwise logistic regression model intracranial haemorrhages without external signs of analysis, variables that were independent predictors of head trauma. The first girl had 'shaken baby' syndrome HIV testing refusal during pregnancy were being while the other 2 had congenital coagulation disorders foreign-born (OR = 2.11, 95% CI 1.07-4.38), not (haemophilia B and factor V deficiency, respectively). receiving general information about HIV (OR = 7.48, All three recovered, the last two with remaining one- 95% CI 1.86-30.01), and not receiving specific sided neurological deficits. Child abuse and congenital information about HIV and pregnancy (OR = 3.54, coagulation disorders may present with similar 95% CI 1.91-6.57). The most common reasons for neurological symptoms and radiological findings. In 332
- 341. these patients coagulationtests are mandatory and--if carries unacceptably high mortality. MATERIAL AND abnormal--enable early substitution of deficits and METHODS: We reviewed our experience with prevent inappropriate suspicion or accusation of childhood trauma due to battered child syndrome in our caretakers. hospital to learn the extent, circumstances, presentations, and consequences of this kind of events. Bachanas PJ, Morris MK, Lewis-Gess JK et al. Our hospital is the most important center for Psychological adjustment, substance use, HIV traumatized child care in Mexico. RESULTS: After our knowledge, and risky sexual behavior in at-risk study, mild trauma due to child abuse accounted for 35 minority females: developmental differences during and major trauma accounted for 50 cases. In the former adolescence. J Pediatr Psychol 2002; 27(4):373-84. group, 10 patients with fractures were observed; 21 Abstract: OBJECTIVE: To assess developmental were male patients. Children were abused by father or differences in the psychological functioning, substance stepfather in the 21 cases, and by the mother in six. use, coping style, social support, HIV knowledge, and There was delay in seeking immediate medical risky sexual behavior of at-risk, minority adolescent attention treatment in all patients. In the second group, girls; to assess developmental differences in there were ruptures of small bowel in 27, of the colon psychosocial correlates of risky sexual behavior in in four patients, pancreas in three, and esophagus in older and younger adolescents. METHOD: Participants two. Lung, pleura, bladder, spleen and other anatomic included 164 minority teens, ages 12-19, who were structures also were affected. Five patients died. receiving medical care in an adolescent primary care Similarity between the two patient groups studied clinic. Teens completed measures of psychological indicates both the widespread nature of child abuse and adjustment, substance use, coping style, social support, the need to suspect this diagnosis whenever a child is religious involvement, and HIV knowledge and present with unexplained shock or peritonitis, specially attitudes. In addition, they answered questions if there is anemia or bilious emesis. Delay in diagnosis regarding their sexual history, family situation, school contributed to mortality. status, and psychiatric and legal history. RESULTS: Younger teens (ages 12-15) reported more symptoms Baggens CA. The institution enters the family home: home of depression and earlier sexual debuts than older teens visits in Sweden to new parents by the child health care (ages 16-19). However, older teens reported nurse. J Community Health Nurs 2004; 21(1):15-27. significantly more substance use and were more likely Abstract: The purpose of this study is to investigate to have been pregnant and to have contracted a interactional patterns in the dialogue that occurs during sexually transmitted disease (STD) than younger teens. home visits of the nurse to new parents, to find out Older teens also reported more religious involvement whether there are similarities between home visits and and using more adaptive coping strategies than younger visits to the child health care centers, and to discuss teens. Developmental differences in the correlates of this in relation to what is emphasized as important in risky behaviors were also found between younger and home visits. Audiotaped conversations of encounters older teens. Specifically, conduct problems and during 5 home visits to new parents and interviews substance use were significantly associated with risky with parents and nurses were collected and analyzed sexual behavior for younger teens, but not for older qualitatively. Results show that the interactions were teens. Similarly, younger teens whose peers were orchestrated by the nurse, and operated on an agenda engaging in risky behaviors reported engaging in more that was task-oriented. The interaction was dominated risky sexual behaviors; however, these same relations by the nurse, and thus was asymmetrical. It seemed that were not found for older teens. CONCLUSIONS: the nurse was attentive to what the parents brought up Young minority adolescents exhibiting conduct in the discussions and responded to their worries very problems and using substances seem to be at highest thoroughly, in accordance with the ideology. However, risk for contracting HIV and STDs as a result of risky sometimes the parents were not even involved in the sexual behavior. Prevention interventions should target nurse's activities. teens in high-risk environments during late elementary school or early middle school to encourage teens to Bailey BN, Delaney-Black V, Hannigan JH, Ager J, Sokol delay intercourse, practice safer sex, and avoid drug RJ, Covington CY. Somatic complaints in children and and alcohol use. An interdisciplinary model of care in community violence exposure. J Dev Behav Pediatr primary care settings is clearly indicated to provide 2005; 26(5):341-8. these services to at-risk youths. Abstract: Somatic complaints of children in primary care settings often go unexplained despite attempts to Baeza-Herrera C, Garcia-Cabello LM, Dominguez-Perez determine a cause. Recent research has linked violence ST, Atzin-Fuentes JL, Rico-Mejia E, Mora-Hernandez exposure to stress symptomatology and associated F. [Battered child syndrome. Surgical implications]. somatic problems. Unknown, however, is whether Cir Cir 2003; 71(6):427-33. specific physical symptom complaints can be Abstract: INTRODUCTION: Major trauma, specially attributed, at least in part, to violence exposure. Urban abdominal and thoracic trauma due to child abuse is a African-American 6- and 7-year-old children (N = serious, but fortunately infrequent problem which 268), residing with their biological mothers, recruited 333
- 342. before birth, andwithout prenatal exposure to hard than 5 years of age in a rural area of the Republic of illicit drugs participated. Children and mothers were Guinea. Bull World Health Organ 2001; 79(1):28-32. evaluated in our hospital-based research laboratory, Abstract: OBJECTIVES: To assess the ability of with teacher data collected by mail. Community mothers in a rural area of the Republic of Guinea to violence exposure (Things I Have Seen and Heard), identify fever in their children, and to estimate the stress symptomatology (Levonn), and somatic proportion of children who received antimalarial drugs. complaints (teacher-and self-report items) were METHODS: Children under 5 years of age in 41 assessed. Additional data collected included prenatal villages were selected by a two-step cluster sampling alcohol exposure, socioeconomic status, domestic technique. During home visits we examined the violence, maternal age, stress, somatic complaints and children and questioned their mothers about the child's psychopathology, and child depression, abuse, and symptoms and treatment. FINDINGS: Of 784 children gender. Community violence witnessing and examined, 23% were febrile and more than half of victimization were associated with stress symptoms (r them also had a positive smear result for Plasmodium. = .26 and .25, respectively, p < .001); violence Mothers reported 63% of children with a temperature > victimization was related to decreased appetite (r = .16, or = 37.5 degrees C as sick. Among all children p < .01), difficulty sleeping (r = .21, p < .001), and reported as feverish by their mother, 55% had a normal stomachache complaints (r = .13, p < .05); witnessed temperature (< 37.5 degrees C). In contrast, a violence was associated with difficulty sleeping (r = temperature > or = 37.5 degrees C was found in 38% of .13, p < .05) and headaches (r = .12, p < .05). All children identified as sick but afebrile by their mother associations remained significant after control for and in 13% of children considered healthy. Among confounding. Community violence exposure accounted febrile children, 18% were given chloroquine at home for 10% of the variance in child stress symptoms, and or had consulted at the health centre or a dispensary. children who had experienced community violence CONCLUSION: In areas where malaria is endemic, victimization had a 28% increased risk of appetite recognition of fever and its presumptive treatment with problems, a 94% increased risk of sleeping problems, a antimalarial drugs is an essential part of the strategy of 57% increased risk of headaches, and a 174% increased the World Health Organization (WHO) to reduce the risk of stomachaches. Results provide yet another morbidity due to this disease. This population study possibility for clinicians to explore when treating these shows that mothers often failed to identify fever in physical symptoms in children. their children and to consult or to provide antimalarial treatment. Without great efforts to improve home care, Bailey C, Pain R. Geographies of infant feeding and access it is unlikely that the morbidity and mortality due to to primary health-care. Health Soc Care Community malaria in young children will be greatly reduced. 2001; 9(5):309-17. Abstract: Although the benefits of breastfeeding to Baird JK, Owusu Agyei S, Utz GC et al. Seasonal malaria mother and infant are now well established, within attack rates in infants and young children in northern Britain initiation rates are low and have changed little Ghana. Am J Trop Med Hyg 2002; 66(3):280-6. since 1980. This is despite many health promotion Abstract: The incidence density of infection and initiatives aiming to increase breastfeeding. In this disease caused by Plasmodium falciparum in children paper we discuss some of the findings of an aged six to 24 months living in the holoendemic Sahel exploratory qualitative research study of infant feeding of northern Ghana was measured during the wet and decisions in Newcastle upon Tyne, England, where dry seasons of 1996 and 1997. At the beginning of each health professionals are actively seeking to increase season, a cohort composed of 259 and 277 randomly local breastfeeding initiation and duration rates. Our selected children received supervised curative therapy findings suggest that for health promotion initiatives to with quinine and Fansidar and primaquine for those be effective across all social groups, there needs to be with normal glucose-6-phosphate dehydrogenase (i) a socio-cultural understanding of different social activity. The 20 weeks of post-therapy follow-up groups' access to and interpretation of pre- and consisted of three home visits weekly and examination postnatal formal breastfeeding support health services, of Giemsa-stained blood films once every two weeks. and (ii) more appreciation of how mothers' informal Blood films were also taken from children brought to support networks impact on their access to, clinic with illness. The incidence density of parasitemia interpretation and use of formal breastfeeding support. after radical cure was 4.7 infections/person-year during the dry season and 7.1 during the wet season (relative Bailey R, Rhee KB. Reach Out and Read: promoting risk = 1.51, 95% confidence interval [CI] = 1.25-1.81; pediatric literacy guidance through a transdisciplinary P = 0.00001). Although the mean parasitemia count at team. J Health Care Poor Underserved 2005; time of reinfection in the dry season (3,310/microl) 16(2):225-30. roughly equaled that in the wet season (3,056/microl; P = 0.737), the risk ratio for parasitemia > 20,000/microl Bailo Diallo A, De Serres G, Beavogui AH, Lapointe C, during the wet season was 1.71 (95% CI = 1.2-2.4; P = Viens P. Home care of malaria-infected children of less 0.0025). The risk ratio for parasitemia > 20,000/microl with fever during the wet season was 2.45 (95% CI = 334
- 343. 1.5-4.1; P =0.0002). The risk ratio for anemia increases in the number of reports of physical abuse, (hemoglobin < 8 g/dl) at first post-radical cure witnessing of domestic violence, living in a sexual parasitemia showed no difference between seasons environment, maternal sexual victimization, maternal (1.0; 95% CI = 0.73-1.4; P = 0.9915). We did not see victimization of domestic violence, and fathers being seasonal differences in anemia known to exist in this perpetrators of domestic violence. These data clearly region, probably because the longitudinal cohort design support the hypotheses of the study and have important using first parasitemia as an end point prevented the implications for both clinical practice and future subjects from developing the repeated or chronic research in this area. infections required for anemia induction. These findings bear upon the design of malaria drug and Baker DR. A public health approach to the needs of children vaccine trials in holoendemic areas. affected by terrorism. J Am Med Womens Assoc 2002; 57(2):117-8, 121. Bakare RA, Oni AA, Umar US et al. Pattern of sexually Abstract: The devastating terrorist incidents of Pan Am transmitted diseases among commercial sex workers Flight 103, the Oklahoma City bombing, the bombings (CSWs) in Ibadan, Nigeria. Afr J Med Med Sci 2002; of the embassies in Kenya and Tanzania, and the 31(3):243-7. World Trade Center attack of September 11, 2001, Abstract: The purpose of this study was to determine have forever changed America. These terrorist acts the pattern of STDs among commercial sex workers have deeply shaken the sense of safety, security, and (CSWs) in Ibadan, Nigeria. The subjects were 169 well-being of our surviving children and families. CSWs randomly selected from 18 brothels, majority of These terrorist acts may also have increased the public who were examined and investigated in their rooms. health risks of substance abuse and mental illness for Another 136 women without symptoms who visited the our children. The Substance Abuse and Mental Health special treatment clinic, University College Hospital, Services Administration is responsible for Ibadan were selected as a normal control group. strengthening prevention and treatment of substance Vaginal candidiasis was the most common STD abuse and mental illness in children and families. diagnosed in both CSWs and the control group. The America's children may exhibit a wide range of other STDs in their order of frequency were HIV emotional, physical, and psychological reactions infection 34.3%, non-specific vaginosis 24.9%, following natural and man-made disasters. Large-scale trichomoniasis 21.9% and gonorrhoea and "genital disasters witnessed by children all underscore the need ulcers" had an incidence of 16.6% each. Other for a broad mental health and substance abuse public important conditions were tinea cruris 18.9%, scabies health approach. This approach is critical for our 7.7% genital warts 6.5% and 4.1% of them had syphilis children's well-being. sero-positivity. All the 13 CSWs that had scabies, the 4 (36.4%) with genital warts and the 19 (67.9%) with Baker E, Croot K, McLeod S, Paul R. Psycholinguistic "genital ulcers" had HIV infection. While there was no models of speech development and their application to significant difference between the CSWs with vaginal clinical practice. J Speech Lang Hear Res 2001; candidiasis, gonorrhoea, trichomoniasis and the control 44(3):685-702. group, the HIV positivity was significantly higher (P < Abstract: This article presents an introduction to 0.001) in CSWs than in the control subjects. These psycholinguistic models of speech development. Two findings suggest that women who exchange sexual specific types of models are addressed: box-and-arrow services for money can no longer be ignored, and models and connectionist or neural network models. should therefore be identified and made to participate We review some historical and some current models in STD prevention and control programmes. and discuss recent applications of such models to the management of speech impairment in children. We Baker AJ, Tabacoff R, Tornusciolo G, Eisenstadt M. suggest that there are two ways in which a Calculating number of offenses and victims of juvenile psycholinguistic approach can influence clinical sexual offending: the role of posttreatment disclosures. practice: by directly supplementing a speech-language Sex Abuse 2001; 13(2):79-90. pathologist's repertoire of assessment and treatment Abstract: This research was designed to compare data approaches and by offering a new way to conceptualize obtained from agency records at three treatment speech impairment in children. programs for juvenile male sex offenders with information available from clinicians once youth and Baker-Henningham H, Powell C, Walker S, Grantham- their families had been in treatment for at least 6 McGregor S. The effect of early stimulation on months. Results revealed that over the course of maternal depression: a cluster randomised controlled treatment, youth and their families disclosed trial. Arch Dis Child 2005; 90(12):1230-4. information about additional victims and offenses, Abstract: AIM: To determine the effect of early physical and sexual abuse of the offenders, and several childhood stimulation with undernourished children aspects of a violent and sexualized family environment. and their mothers on maternal depression. METHODS: Over half the boys reported additional victims or Mothers of 139 undernourished children (weight for additional offenses or both. There were significant 335
- 344. age < or=-1.5 z-scores) aged 9-30 months were Balatsouras D, Korres S, Kandiloros D, Ferekidis E, recruited from 18 government health centres in the Economou C. Newborn hearing screening resources on parishes of Kingston, St Andrew, and St Catherine, the Internet. Int J Pediatr Otorhinolaryngol 2003; Jamaica. They received weekly home visits by 67(4):333-40. community health aides for one year. Mothers were Abstract: Starting as a small military and academic shown play activities to do with their child using home network, the Internet has gradually evolved into a made materials, and parenting issues were discussed. worldwide web, which connects most local networks as Frequency of maternal depressive symptoms was well as millions of personal computers from individual assessed by questionnaire. Child development was also users. It is of interest to the medical practitioner, that measured. RESULTS: Mothers in the intervention ever more biomedical resources are becoming available group reported a significant reduction in the frequency on-line to assist in clinical medicine, research and of depressive symptoms (b = -0.98; 95% CI -1.53 to - education. In this paper a detailed list of the World 0.41). The change was equivalent to 0.43 SD. The Wide Web sites accessible through the Internet is number of home visits achieved ranged from 5 to 48. provided, in which data about newborn hearing Mothers receiving > or =40 visits and mothers screening may be found. Web resources of medical receiving 25-39 visits benefited significantly from the equipment and suppliers and sites including intervention (b = -1.84, 95% CI -2.97 to -0.72, and b = otoacoustic emissions topics, are presented as well. -1.06, 95% CI -2.02 to -0.11, respectively) while This review is intended to present the wealth of the mothers receiving <25 visits did not benefit. At follow accessible information on the Internet and to promote up, maternal depression was significantly negatively further presentation on the web of any available correlated with children's developmental quotient for hearing screening data from hospitals and Audiology boys only. CONCLUSIONS: A home visiting Departments in which such programs are implemented. intervention with mothers of undernourished children, with a primary aim of improving child development, Baldry AC. Animal abuse among preadolescents directly had significant benefits for maternal depression. Higher and indirectly victimized at school and at home. Crim levels of maternal depression were associated with Behav Ment Health 2005; 15(2):97-110. poorer developmental levels for boys only. Abstract: BACKGROUND: Animal abuse by preadolescents has been associated with their later Baker JP. Many are giving up trying to hold the space for family violence and/or criminal behaviour; less is women and their babies. Midwifery Today Int Midwife known about animal abuse and concurrent experience 2002; (62):46. of being a victim at home and/or school, or of contemporaneous aggression to peers. AIMS: To Bakshi D, Sharief N. Selective neonatal BCG vaccination. establish the prevalence of animal abuse among Italian Acta Paediatr 2004; 93(9):1207-9. preadolescents and its relationship with experience of Abstract: AIMS: To assess the implementation of the abuse at home and school (direct and witnessed), and "Selective Neonatal BCG Immunisation Policy", and to to peer abuse (bullying). METHOD: An Italian study the causes of non-compliance, or failure of community sample of 268 girls and 264 boys (aged 9- uptake of BCG immunization. METHODS: The Birth 12) completed a self-reported questionnaire about Register data were used to generate a list of babies victimization at home and school, animal abuse and born in the catchment area of Basildon and Thurrock bullying. RESULTS: Two in five preadolescents NHS Trust between 1 January 2001 and 31 December admitted abusing animals at least once in their life, and 2001 who were eligible for BCG immunization. The one in three bullying peers at school, with a higher Community Child Health computer was used to prevalence among boys. Over three-quarters of all generate information about their BCG immunization participants reported at least one type of victim status. RESULTS: 201 children were included in the experience: one-third had experienced inter-parental study. One hundred and seventy-one children had violence; over one-third had themselves been abused received BCG immunization in the neonatal period, out by one or both parents; two in five had been directly or of which 169 had received it before discharge from the indirectly victimized at school. Individual tests of hospital. Two children were immunized in the association suggested gender differences. Multivariate community in the neonatal period. Thus, 85% of the regression analyses conducted separately for boys and newborns eligible for BCG immunization received girls showed that the independent variable accounted their vaccination in the neonatal period. for more than 25% of the variance for the girls, but less CONCLUSIONS: The current "Neonatal BCG than 10% for the boys. Experiences of abuse were the Immunisation Policy" is effective, and there is a high key independent variables for the girls; other uptake of the vaccine in the neonatal period within the expressions of aggression were the key variables for hospital itself. Newborn infants who do not receive the boys. DISCUSSION AND CONCLUSIONS: The BCG immunization in hospital rarely get immunized in results suggest that discovery of animal abuse should the community. prompt further enquiries about other problems that a child may have. Detection of animal abuse by a child could offer an early opportunity for intervention to 336
- 345. alleviate internalized damageor other aggressive Only 18 cases (24%) had analgesia administered within behaviour. 1 to 2 hours of SSE. Twenty-four cases (32%) had anxiolytics administered within 4 hours of SSE. Of the Baldwin A. Nurses must take a stand against violence. Nurs 56 cases of SSE that were witnessed, 43 cases (73% of N Z 2001; 7(3):2. those observed) were considered deliberate rather than accidental. The practice of using intravenous boluses Baleta A. South African government threatens to ban on an "as needed" dosing frequency for administering nevirapine. Move would take away option for treating sedation and analgesia was a common factor in SSE. vertical HIV transmission. Lancet 2003; Adequate doses of sedation and analgesia delivered by 362(9382):451. continuous infusion may prevent SSE in alert, intubated patients. Ball HL. Breastfeeding, bed-sharing, and infant sleep. Birth 2003; 30(3):181-8. Banaschewski T, Brandeis D, Heinrich H, Albrecht B, Abstract: BACKGROUND: Expectations for infant Brunner E, Rothenberger A. Association of ADHD and sleep development and for the appropriate degree of conduct disorder--brain electrical evidence for the parental proximity for infant sleep are culturally existence of a distinct subtype. J Child Psychol weighted and historically shifting aspects of parenting Psychiatry 2003; 44(3):356-76. behavior, and are known to affect breastfeeding Abstract: BACKGROUND: To evaluate the impact of prevalence and duration. This paper examined how psychopathological comorbidity with oppositional new parents managed night-time feeding in the first 4 defiant/conduct disorder (ODD/CD) on brain electrical months, with a particular focus on the relationship correlates in children with attention deficit between breastfeeding, infant sleep location, and sleep hyperactivity disorder (ADHD) and to study the bout duration. METHODS: Sleep logs and pathophysiological background of comorbidity of semistructured interviews were used with a sample of ADHD+ODD/CD. METHOD: Event-related potentials 253 families in North Tees, United Kingdom, to (ERPs) were recorded during a cued continuous explore how parents responded to their infant's sleep performance test (CPT-A-X) in children (aged 8 to 14 patterns, how breastfeeding parents managed night- years) with ICD-10 diagnoses of either hyperkinetic time feeding, and whether bed-sharing was a common disorder (HD; n = 15), hyperkinetic conduct disorder strategy. RESULTS: A clear relationship between (HCD; n = 16), or ODD/CD (n = 15) and normal breastfeeding and parent-infant bed-sharing was children (n = 18). HD/HCD diagnoses in all children demonstrated. Some evidence indicated that bed- were fully concordant with the DSM-IV diagnosis of sharing may promote breastfeeding. CONCLUSIONS: ADHD-combined type. ERP-microstates, i.e., time An understanding of the role of infant feeding practice segments with stable brain electrical map topography on infant sleep and parental caregiving at night is a were identified by adaptive segmentation. Their crucial element in breastfeeding promotion and characteristic parameters and behavioral measures were enhancement of infant health. Health professionals further analyzed. RESULTS: Children with HD but not should discuss safe bed-sharing practices with all comorbid children showed slower and more variable parents. reaction times compared to control children. Children with HD and ODD/CD-only but not comorbid children Ballantyne R. Gastric reflux support network helps parents. displayed reduced P3a amplitudes to cues and certain Nurs N Z 2004; 10(3):4. distractors (distractor-X) linked to attentional orienting. Correspondingly, global field power of the cue-CNV Balon JA. Common factors of spontaneous self-extubation microstate related to anticipation and preparation was in a critical care setting. Int J Trauma Nurs 2001; reduced in HD but not in HCD. Topographical 7(3):93-9. alterations of the HD occurred already in the cue- Abstract: A prospective, concurrent study was P2/N2 microstate. In sum, the comorbid group was less conducted of all patients who self-extubated in a mixed deviant than both the HD-group and the ODD/CD- critical care setting during a 14-month period. The group. CONCLUSIONS: The findings suggest that HD purpose of the study was to identify the incidence and children (ADHD-combined type without ODD/CD) common factors associated with spontaneous self- suffer from a more general deficit (e.g., suboptimal extubation (SSE). A total of 75 cases of SSE occurred energetical state regulation) including deficits of in 68 patients who had an incidence of 38.5 SSEs per attentional orienting and response preparation than just 100 intubated days. The analysis of common factors of a responseinhibitory deficit, backing the hypothesis of the total population found the following: 60 cases an involvement of a dysregulation of the central (80%) were restrained; 44 cases (59%) required noradrenergic networks. The results contradict the reintubation; 66 cases (88%) followed commands or hypothesis that ADHD+ODD/CD represents an localized painful stimuli at the time of SSE; and 67 additive co-occurrence of ADHD and ODD/CD and cases (89%) elicited spontaneous eye opening or strongly suggest that it represents a separate opened eyes to verbal command at the time of SSE. pathological entity as considered in the ICD-10 classification system, which differs from both HD and 337
- 346. ODD/CD-only. visits. A physician checked the data and the morbidities were diagnosed by a computer program. Vital statistics Bandak FA. Shaken baby syndrome: a biomechanics in these villages was independently collected. analysis of injury mechanisms. Forensic Sci Int 2005; RESULTS: Out of 1016 live births, 95% occurred at 151(1):71-9. home and 763 (75&%) neonates were observed. The Abstract: Traumatic infant shaking has been associated agreement between observations by health workers and with the shaken baby syndrome (SBS) diagnosis physician was 92%. Total 48.2& neonates suffered without verification of the operative mechanisms of high risk morbidities (associated case fatality >10%), injury. Intensities for SBS have been expressed only in 72.2% suffered low risk morbidities, and 17.9% gained qualitative, unsubstantiated terms usually referring to inadequate weight (less than 300 g). Seventeen percent acceleration/deceleration rotational injury and relating neonates developed clinical picture suggestive of to falls from great heights onto hard surfaces or from sepsis. Though 54.4% neonates had indications for severe motor vehicle crashes. We conducted an injury health care and 38 out of total 40 neonatal deaths biomechanics analysis of the reported SBS levels of occurred in these, only 2.6% received medical rotational velocity and acceleration of the head for their attention. The neonatal mortality rate was 52.4/1000 injury effects on the infant head-neck. Resulting forces live births. CONCLUSION: Nearly half of the were compared with experimental data on the structural neonates in rural homes developed high risk failure limits of the cervical spine in several animal morbidities ten times the neonatal morbidity rate and models as well as human neonate cadaver models. We needed health care but practically none received it. The have determined that an infant head subjected to the magnitude of care gap suggests an urgent need for levels of rotational velocity and acceleration called for developing home-based neonatal care to reduce in the SBS literature, would experience forces on the neonatal morbidities and mortality infant neck far exceeding the limits for structural failure of the cervical spine. Furthermore, shaking Bang AT, Bang RA, Reddy HM, Deshmukh MD, Baitule cervical spine injury can occur at much lower levels of SB. Reduced incidence of neonatal morbidities: effect head velocity and acceleration than those reported for of home-based neonatal care in rural Gadchiroli, India. the SBS. These findings are consistent with the J Perinatol 2005; 25 Suppl 1:S51-61. physical laws of injury biomechanics as well as our Abstract: OBJECTIVE: We found a high burden of collective understanding of the fragile infant cervical morbidities in a cohort of neonates observed in rural spine from (1) clinical obstetric experience, (2) Gadchiroli, India. We hypothesised that interventions automotive medicine and crash safety experience, and would reduce the incidence of neonatal morbidities, (3) common parental experience. The findings are not, including the seasonal increase observed in many of however, consistent with the current clinical SBS them. This article reports the effect of home-based experience and are in stark contradiction with the neonatal care on neonatal morbidities in the reported rarity of cervical spine injury in children intervention arm of the field trial by comparing the diagnosed with SBS. In light of the implications of early vs late periods, and the possible explanation for these findings on child protection and their social and this effect. METHODS: During 3 years (1995 to 1998), medico-legal significance, a re-evaluation of the trained village-health-workers (VHWs) in 39 villages current diagnostic criteria for the SBS and its prospectively collected data by making home visits application is suggested. during pregnancy, home-delivery and during neonatal period. We estimated the incidence and burden of Bang AT, Bang RA, Baitule S, Deshmukh M, Reddy MH. neonatal morbidities over the 3 years from these data. Burden of morbidities and the unmet need for health In the first year, the VHWs made home visits only to care in rural neonates--a prospective observational observe. From the second year, they assisted mothers study in Gadchiroli, India. Indian Pediatr 2001; in neonatal care and managed the sick neonates at 38(9):952-65. home. Health education of mothers and family Abstract: BACKGROUND: Majority of the neonates members, individually and in group, was added in the in developing countries are born and cared for in rural third year. We measured the coverage of interventions homes but the available information is mostly hospital over the 3 years and evaluated maternal knowledge and based. OBJECTIVES: To estimate: (i) the incidence of practices on 21 indicators in the third year. The effect various neonatal morbidities and associated case on 17 morbidities was estimated by comparing the fatality in home-cared rural neonates, (ii) proportion of incidence in the first year with the third year. neonates with indications for health care, and (iii) the RESULTS: The VHWs observed 763 neonates in the proportion who actually receive it. DESIGN: first year, 685 in the second and 913 in the third year. Prospective observational study. SETTING: Rural The change in the percent incidence of morbidities was homes. METHODS: Neonates in 39 study villages in (i) infections, from 61.6 to 27.5 (-55%; p<0.001), (ii) the Gadchiroli district (Maharashtra, India) were care-related morbidities (asphyxia, hypothermia, observed during one year (1995-96) by 39 trained feeding problems) from 48.2 to 26.3 (-45%; p<0.001); female village health workers at birth and during (iii) low birth weight from 41.9 to 35.2 (-16%; p<0.05); neonatal period (0-28 days) by making eight home (iv) preterm birth and congenital anomalies remained 338
- 347. unchanged. The meannumber of morbidities/100 neonatal morbidities by season and by day of life.To neonates in the 3 years was 228, 170 and 115 (a identify the scope for prevention of morbidities and reduction of 49.6%; p<0.001). These reductions suggest a hypothesis. STUDY DESIGN: A prospective accompanied an increasing percent score of observational study nested in the first year of the field interventions during 3 years: 37.9, 58.4 and 81.3, thus trial in rural Gadchiroli, India. Trained village health showing a dose-response relationship. In the third year, workers in 39 villages observed neonates at the time of the proportion of correct maternal knowledge was birth and in subsequent eight home visits up to 28 days. 78.7% and behaviours was 69.7%. The significant We diagnosed 20 neonatal morbidities by using clinical seasonal increase earlier observed in the incidence of definitions. The data were analyzed for the incidence, five morbidities reduced in the third year. case fatality, and relative risk of death and for the CONCLUSION: The home-based care and health seasonal and day-wise variation in the incidence of education reduced the incidence and burden of neonatal morbidities. RESULTS: We observed total 763 morbidities by nearly half. The effect was broad, but neonates in 1 year. The incidence of morbidities was a was especially pronounced on infections, care-related mean of 2.2 morbidities per neonate. The case fatality morbidities and on the seasonal increase in morbidities. in 13 morbidities was >10%. Only 2.6% neonates were seen or treated by a physician, and 0.4% were Bang AT, Paul VK, Reddy HM, Baitule SB. Why do hospitalized. Hypothermia, fever, upper respiratory neonates die in rural Gadchiroli, India? (Part I): symptoms, umbilical and skin infections, and primary causes of death assigned by neonatologist conjunctivitis showed statistically significant seasonal based on prospectively observed records. J Perinatol variation. Although the morbidities were concentrated 2005; 25 Suppl 1:S29-34. in the first week of life, new cases continued to appear Abstract: OBJECTIVE: To determine the primary throughout the neonatal period. Various morbidities causes of death in home-cared rural neonates by using showed different distribution of incidence during 1 to prospectively kept health records of neonates and a 28 days. CONCLUSIONS: A large burden of disease neonatologist's clinical judgment. STUDY DESIGN: In occurs in rural home-cared neonates, and many the first year (1995 to 1996) of the field trial in morbidities are associated with high case fatality. Some Gadchiroli, India, trained village health workers morbidities show strong seasonal and day-wise observed neonates in 39 villages by attending home variation in incidence, indicating poor care at home. deliveries and making eight home visits during days 0 We hypothesize that changes in practices and better to 28. The recorded data were validated in the field by home-based care will prevent the seasonal and a physician. An independent neonatologist assigned the temporal increase in morbidities. Some morbidities most probable single primary cause of death based on may not be preventable and will need early detection these recorded data. FINDINGS: A total of 763 and treatment. Therefore, frequent home visits by a neonates were observed, of whom 40 died (NMR health worker are necessary to identify sick neonates. 52.4/1000). The primary causes of death were sepsis/pneumonia 21 (52.5%), asphyxia 8 (20%), Banks JB. Childhood discipline: challenges for clinicians prematurity <32 weeks 6 (15%), hypothermia 1 (2.5%), and parents. Am Fam Physician 2002; 66(8):1447-52. and other/not known 4 (10%). Most of the prematurity Abstract: Although childhood discipline is an or asphyxia deaths occurred during the first 3 days of important issue for parents, this topic is seldom life. All 21 sepsis/pneumonia deaths occurred during emphasized by family physicians during well-child days 4 to 28. A similar picture existed in England examinations. Behavior problems are relatively before the antibiotic era. CONCLUSION: common but frequently under-recognized by Sepsis/pneumonia is the primary cause in half the physicians. Opportunities to counsel parents about safe, deaths in rural neonates cared for at home in effective methods of discipline are therefore missed. Gadchiroli, followed by asphyxia and prematurity. Discipline should be instructive and age-appropriate Infections cause a larger proportion of deaths in and should include positive reinforcement for good neonates in the community compared to the reported behavior. Punishment is only one aspect of discipline proportion in hospital-based studies. and, in order to be effective, it must be prompt, consistent, and fair. Time-out is frequently used to Bang AT, Reddy HM, Baitule SB, Deshmukh MD, Bang correct younger children, but because it is often RA. The incidence of morbidities in a cohort of enforced improperly, it loses its effectiveness. Corporal neonates in rural Gadchiroli, India: seasonal and punishment is a controversial but common form of temporal variation and a hypothesis about prevention. J discipline that is less effective than some other types of Perinatol 2005; 25 Suppl 1:S18-28. punishment. Its use is linked to child and spouse abuse, Abstract: BACKGROUND: The incidence of as well as to future substance use, violent crime, poor morbidities among home-cared neonates in rural areas self-esteem, and depression. Despite the possible has not been studied. OBJECTIVES: To estimate the negative effects of corporal punishment, it is still incidence of various neonatal morbidities and the widely accepted in our society. Since discipline plays associated risk of death in home-cared neonates in rural an important role in the social and emotional setting.To estimate the variation in the incidence of development of children, physicians should be trained 339
- 348. to discuss thisissue with parents during routine well- Dissociation was significantly related to both trauma child examinations. exposure and mental health symptoms but did not mediate this relationship. Implications for research and Bannon MJ, Carter YH. Paediatricians and child protection: practice are discussed. the need for effective education and training. Arch Dis Child 2003; 88(7):560-2. Bappal B, George M, Nair R, Khusaiby SA, De Silva V. Factitious hypoglycemia: a tale from the Arab world. Bansal R, John S, Ling PM. Cigarette advertising in Pediatrics 2001; 107(1):180-1. Mumbai, India: targeting different socioeconomic Abstract: The mother is usually the one who narrates groups, women, and youth. Tob Control 2005; the patient's history to the pediatrician. Listening and 14(3):201-6. eliciting the parent's story is an art. One of the essential Abstract: BACKGROUND: Despite a recent surge in attributes of a good pediatrician is the readiness to tobacco advertising and the recent advertising ban believe the parent's story. Mothers are good historians (pending enforcement at the time of this study), there and careful observers. The axiom that the mother is are few studies describing current cigarette marketing always right is true in most instances. However, in India. This study sought to assess cigarette occasionally the clinician is deliberately misled by the companies' marketing strategies in Mumbai, India. storyteller, resulting in numerous and potentially METHODS: A two week field study was conducted in dangerous diagnostic investigations. We describe a boy Mumbai in September 2003, observing, documenting, with recurrent hypoglycemic coma in whom the and collecting cigarette advertising on billboards, diagnosis of factitious hypoglycemia was delayed as it storefronts and at point of sale along two major is believed to be nonexistent in our community. We thoroughfares, and performing a content analysis of emphasize that in all patients with recurrent news, film industry, and women's magazines and three hypoglycemia, estimation of C-peptide and insulin newspapers. RESULTS: Cigarette advertising was should be performed even when the clinical settings are ubiquitous in the environment, present in news and in not in favor of the diagnosis of Munchausen syndrome film magazines, but not in women's magazines or the by proxy.Munchausen syndrome by proxy, newspapers. The four major advertising campaigns all hypoglycemia. associated smoking with aspiration; the premium brands targeting the higher socioeconomic status Barath A. Psychological status of Sarajevo children after market utilised tangible images of westernization and war: 1999-2000 survey. Croat Med J 2002; 43(2):213- affluence whereas the "bingo" (low priced) segment 20. advertisements invited smokers to belong to a league of Abstract: AIM: To make a survey of children's health their own and "rise to the taste" using intangible and psychosocial needs after the 1992-1995 war in images. Women were not depicted smoking, but were Sarajevo, Bosnia and Herzegovina. METHODS: present in cigarette advertisements--for example, a Representative samples of school-age children (n=310) woman almost always accompanied a man in "the man from 6 public schools in the Sarajevo Canton, their with the smooth edge" Four Square campaign. parents (n=280), and teachers (n=156) were surveyed Advertisements and product placements at low heights by means of self-administered questionnaires and and next to candies at point of sale were easily standardized psychometric scale (Ryan-Wengers accessible by children. In view of the imminent Schoolagers Coping Strategies Inventory). The survey enforcement of the ban on tobacco advertisements, was conducted in October-November 1999, cigarette companies are increasing advertising for the approximately four years after the war. RESULTS: At existing brand images, launching brand extensions, and the time of survey, well-being of children in Sarajevo brand stretching. CONCLUSION: Cigarette companies was still heavily impacted by many various unhealthy have developed sophisticated campaigns targeting men, life conditions and psychosocial stressors. Many women, and children in different socioeconomic school-age children lived in unhealthy and dangerous groups. Many of these strategies circumvent the Indian environment, including overcrowded living conditions tobacco advertising ban. Understanding these (40%), unsafe playgrounds (68%), and no access to marketing strategies is critical to minimise the sports fields (52%). Most felt unsafe on streets (74%), exploitation of loopholes in tobacco control legislation. many (73%) coped with one or more school problems, and even 84% were ill at least once during the past 12 Banyard VL, Williams LM, Siegel JA. Understanding links months. General poverty was the prime stressor among childhood trauma, dissociation, and women's (common variance explained: 23.5%), followed by mental health. Am J Orthopsychiatry 2001; 71(3):311- school- and health-related risks (common variance 21. explained: 17.0%). At the third place were family- Abstract: Interrelationships among pathological associated risk factors impacting children's health and dissociation, child and adult trauma exposure, and adult development, such as overcrowded living conditions mental health symptoms were examined in a sample of and lack of social support within their own family low-income, mostly African-American women. (common variance explained: 10.5%). Parents and teachers also lived and worked in stressful life 340
- 349. conditions and wereconcerned for both their children's turnover in the peer group at the beginning of the and their own well-being. Despite all that, most school year, the social network became more children tended to use healthy strategies in coping with structured. Children's strong associations were mostly stressful events in their everyday lives. same sex and small sized. Even if the stability of CONCLUSION: The reinforcement of children with children's connections remained low, it increased over positive (healthy) coping skills and strengthening of time. High-frequency partners as well as same-sex their social support networks seems to be the most partners were more likely to be maintained over time. important intervention strategy to help the war- These findings as well as conceptual and traumatized children in Bosnia and Herzegovina. methodological issues are discussed from a developmental perspective. Barber WH. Psychosocial dynamics of the US Catholic Church sexual abuse crisis. Int J Soc Psychiatry 2005; Barbui T, Barosi G, Grossi A et al. Practice guidelines for 51(4):329-39. the therapy of essential thrombocythemia. A statement Abstract: BACKGROUND: This paper presents open from the Italian Society of Hematology, the Italian systems analysis of the organizational dynamics of the Society of Experimental Hematology and the Italian US Catholic Church sexual abuse crisis. Most of the Group for Bone Marrow Transplantation. current literature on the crisis assigns culpability to Haematologica 2004; 89(2):215-32. various parties involved--in most cases to bishops and Abstract: BACKGROUND AND OBJECTIVES: The Church officials in Rome. This analysis offers a way of Italian Society of Hematology (SIE) and the two understanding events that goes beyond assigning affiliated Societies (SIES and GITMO) commissioned culpability on the part of Church leaders. MATERIAL a project to develop guidelines for the therapy of AND DISCUSSION: As an open system, a church is a essential thrombocythemia (ET) using evidence-based system of interdependent, purposive activities, one that knowledge and consensus formation techniques. survives and develops through interchanges with its DESIGN AND METHODS: Key questions on the environment including the society of which it is a part. optimal management of ET patients were formulated Key elements in this discussion include the dynamics by an Advisory Council (AC) and approved by an that result from the idiosyncratic church structures and Expert Panel (EP) composed of 7 senior hematologists. processes, and the apparent preoccupation with sexual The AC systematically reviewed the published matters, all of which are imbedded in a religious belief literature from 1980 to August 2002, and articles were system and a high dependency culture. graded according to their internal validity and quality. CONCLUSIONS: The picture is of a church Using the Delphi technique, the EP was asked to experiencing the catastrophe of thousands of cases answer the key questions according to the available accusing priests of sexual abuse of young people, of an evidence. From September 2002 to March 2003, four institution that has lost its capacity for openness as it is Consensus Conferences were held in accordance with overwhelmed by the heaped-on needs of members from the Nominal Group Technique with the goal of solving a flood of constituencies. Key elements in this residual disagreement on recommendations. discussion include the description of the Church as an RESULTS: The EP provided recommendations on open system, the notions of primary task, sentient when to start platelet-lowering therapy, the most group life, a high dependency culture and the appropriate platelet-lowering agent, the use of anti- unconscious motivation operating in individuals, platelet therapy, and the management of women in groups and the total Church enterprise. childbearing age and of pregnant women. INTERPRETATION AND CONCLUSIONS: By using Barbour V. Retaining trust. Lancet 2001; 357(9253):328. evidence and consensus, recommendations for the Notes: GENERAL NOTE: KIE: Barbour, Virginia treatment of key problems in ET have been issued. GENERAL NOTE: KIE: 2 refs. Statements are graded according to the strength of the GENERAL NOTE: KIE: KIE Bib: informed consent; supporting evidence and uncertainty is explicitly organ and tissue donation declared. Barbu S. Stability and flexibility in preschoolers' social Barden RC. Commentary: Informed consent in networks: a dynamic analysis of socially directed psychotherapy--a multidisciplinary perspective. J Am behavior allocation. J Comp Psychol 2003; 117(4):429- Acad Psychiatry Law 2001; 29(2):160-6. 39. Notes: GENERAL NOTE: KIE: 31 refs. Abstract: The author studied preschoolers' social GENERAL NOTE: KIE: KIE Bib: informed consent; networks by investigating the allocation of children's mental health social investment within and across time in a classroom of a French nursery school during an academic year. Bardenheier B, Yusuf H, Schwartz B, Gust D, Barker L, Observations of children's social exchanges during free Rodewald L. Are parental vaccine safety concerns play revealed that social behaviors were directed associated with receipt of measles-mumps-rubella, toward particular group members. After an important diphtheria and tetanus toxoids with acellular pertussis, 341
- 350. or hepatitis Bvaccines by children? Arch Pediatr (p=0.002). Males reported being exposed to violence Adolesc Med 2004; 158(6):569-75. more than females, but exposure decreased as Abstract: OBJECTIVES: To identify parental attendance to religious services increased. For these perceptions regarding vaccine safety and assess their 11-12-year-olds, unconventional peer social norms, relationship with the immunization status of such as witnessing violence, increased their intention to children.Design, Setting, and PARTICIPANTS: Case- use violence while involvement in conventional control study based on a survey of a sample of activities, such as church attendance, decreased it. The households participating in the 2000-2001 National protective effect was greater for males than females. Immunization Survey, a quarterly random-digit-dialing sample of US children aged 19 to 35 months. Three Barlow J, Parsons J, Stewart-Brown S. Preventing emotional groups of case children not up-to-date for 3 vaccines and behavioural problems: the effectiveness of were compared with control children who were up-to- parenting programmes with children less than 3 years date for each respective vaccine.Main Outcome of age. Child Care Health Dev 2005; 31(1):33-42. Measure Measles-containing or measles-mumps- Abstract: BACKGROUND: Emotional and rubella, diphtheria and tetanus toxoids and pertussis or behavioural problems in children under 3 years of age diphtheria and tetanus toxoids with acellular pertussis, have a high prevalence, and parenting practices have and hepatitis B vaccination coverage. RESULTS: been shown to be strongly associated with their Among those sampled from the 2000-2001 National development. A number of recent systematic reviews Immunization Survey, the household response rate was have shown that group-based parenting programmes 2315 (52.1%) of 4440. Most respondents (>90%) in all can be effective in improving the emotional and groups believed vaccinations are important. In each behavioural adjustment of older children (aged 3-10 case-control group, there was no significant difference years). The aim of this review was to establish whether between the percentage of case and control parents there is evidence from controlled trials that group- expressing general vaccine safety (range, 53.5%- based parenting programmes are effective in improving 64.1%). However, case parents were more likely to the emotional and behavioural adjustment of children have asked that their child not be vaccinated for less than 3 years of age, and their role in the primary reasons other than illness (range, 10.2%-13.7% vs prevention of emotional and behavioural problems. range, 2.9%-5.3%, respectively) and to believe their METHODS: English and non-English language articles children received too many vaccinations (range, 3.4%- published between January 1970 and July 2001 were 7.6% vs range, 0.8%-1.0%, respectively). Among the retrieved using a keyword search of a number of case-control group receiving a measles-containing or electronic databases. RESULTS: Five studies were measles-mumps-rubella vaccination, only a small included and two meta-analyses were conducted, the percentage of parents knew about the alleged first combining data from parent reports and the second association between autism and measles-mumps- combining data from independent observations of rubella vaccinations (8.2%), and case parents were children's behaviour. The combined parent reports more likely to believe it than control parents (4.4% vs showed a non-significant difference favouring the 1.5%, respectively; chi(2) P =.04). CONCLUSIONS: intervention group, while the combined independent Despite belief in the importance of immunization by a observations showed a significant difference favouring vast majority of parents, the majority of parents had the intervention group. CONCLUSION: It is concluded concerns regarding vaccine safety. Strategies to address that this review points to the potential of parenting important misperceptions about vaccine safety as well programmes to improve the emotional and behavioural as additional research assessing vaccine safety are adjustment of children less than 3 years of age, but that needed to ensure public confidence. there is insufficient evidence from controlled trials to assess whether the short-term benefit is maintained Barkin S, Kreiter S, DuRant RH. Exposure to violence and over time, or the role that such programmes might play intentions to engage in moralistic violence during early in the primary prevention of emotional and behavioural adolescence. J Adolesc 2001; 24(6):777-89. problems. This review points to the need for further Abstract: This study examined young primary preventive research on this important public adolescents'intentions to use moralistic violence and health issue. their violence exposure, examining male-female differences. Sixth-grade students (n=702) from Georgia Barlow K, Thompson E, Johnson D, Minns RA. The middle schools servicing impoverished communities neurological outcome of non-accidental head injury. participated. Data were obtained on the students' Pediatr Rehabil 2004; 7(3):195-203. exposure to violence, family structure and education Abstract: PURPOSE: The literature regarding the level, church attendance, gang interest, drug use, and outcome of non-accidental head injury (NAHI) is depression status. The dependent variable, intention to scarce and lacks specific detail even though it is use moralistic violence, was measured with an 11-item generally considered to be poor. The purpose of this scale. Linear regression models were run separately for study is to review the literature to date and report the males and females. Males had significantly higher neurological outcome of these children in detail. mean intention to use moralistic violence than females METHODS: A cross-sectional and prospective study 342
- 351. of children admittedto hospital with NAHI in as health advocates. Service participants were Scotland. RESULTS: Twenty-five children were predominately African American families. All enrolled and 68% of children were neurologically participants were low-income and resided in inner-city abnormal at an average follow-up of 59 months. A neighborhoods with high unemployment, high teen wide range of abnormalities and outcomes was seen. birth rates, violent crime, and deteriorated Speech and language difficulties were present in 64% neighborhoods. Outcomes for the first 666 participants including autistic spectrum disorder. Cranial nerve are compared to a previous home-visiting program that abnormalities were present in 20%. Visual deficits and used only nurses. Participant retention rates were epilepsy compounded learning difficulties in 25% of equivalent overall and significantly higher in the first survivors. Consent for follow-up was more likely to be months of the REACH-Futures program. There were obtained where the perpetrator was known. two infant deaths during the course of the study, a CONCLUSIONS: The spectrum and degree of severity lower death rate than the previous program or the city. of neurological abnormalities in survivors of NAHI is Infant health problems and developmental levels were extremely variable, with the majority of these children equivalent to the prior program and significantly more being moderate or severely abnormal. These children infants were fully immunized at 12 months. The require the support of a multi-disciplinary team in the authors conclude that the use of community workers as community. Further study regarding the process of a part of the home-visiting team is as effective as the follow-up, where complex medicolegal issues exist, are nurse-only team in meeting the needs of families at needed in order to facilitate maximum neurological high risk of poor infant outcomes. This approach is of development. national interest because of its potential to achieve the desired outcomes in a cost-effective manner. Barnea A, Rassis A, Zaidel E. Effect of neurofeedback on hemispheric word recognition. Brain Cogn 2005; Barnes L. Afghanistan. Midwifery Today Int Midwife 2005; 59(3):314-21. (75):14-6. Abstract: We applied SMR/theta neurofeedback (NF) training at central sites of 20 Israeli children aged 10- Barnes L, Risko W, Nethersole S, Maypole J. Integrating 12 years, half boys and half girls. Half of the subjects complementary and alternative medicine into pediatric received C3 training and the other half C4 training, training. Pediatr Ann 2004; 33(4):256-63. consisting of 20 half-hour sessions. We assessed the Abstract: The Center for Pediatric Integrative Medical effects of training on lateralized lexical decision in Education and Boston Healing Landscape Project Hebrew. The lateralized lexical decision test reveals an represent diverse approaches to integrative medicine independent contribution of each hemisphere to word and its practice. The relationship and collegial recognition (Barnea, Mooshagian, & Zaidel, 2003). collaboration between the two programs illustrates the Training increased accuracy and sensitivity. It extent to which they complement one another. Both increased left hemisphere (LH) specialization under recognize the importance of curriculum geared to some conditions but it did not affect interhemispheric different levels of learners and of interventions transfer. Training did affect psycholinguistic introduced across the full curriculum. Both use case- processing in the two hemispheres, differentially at C3 based learning, although each focuses on different and C4. Training also increased hemispheric kinds of CAM and different case models. The Center independence. There were surprising sex differences in for Pediatric Integrative Medical Education promotes the effects of training. In boys, C4 training improved interactive didactics with hands-on, direct experiential LH accuracy, whereas in girls C3 training improved learning. The BHLP applies active-learning pedagogy, LH accuracy. The results suggest that the lateralized through experiential learning and its teaching case NF protocol activates asymmetric hemispheric control model. Both programs understand that, given the circuits which modify distant hemispheric networks ongoing interaction among medical students, residents, and are organized differently in boys and girls. fellows, and faculty, each group's training in CAM must reinforce the others for a larger system to change. Barnes-Boyd C, Fordham Norr K, Nacion KW. Promoting infant health through home visiting by a nurse- Barnow S, Lucht M, Freyberger HJ. [Alcohol problems in managed community worker team. Public Health Nurs adolescence with reference to high risk children of 2001; 18(4):225-35. alcoholic parents. Results of a family study in Abstract: This article describes the Resources, Mecklenburg Vorpommern]. Nervenarzt 2002; Education and Care in the Home program (REACH- 73(7):671-9. Futures), an infant mortality reduction initiative in the Abstract: In earlier studies, children of alcoholics inner city of Chicago built on the World Health (COAs) reported more alcohol and drug problems and Organization (WHO) primary health care model and higher levels of maladaptive behaviour and psychiatric over a decade of experience administering programs to distress than non-COAs. However, increased exposure reduce infant mortality through home visits. The to drugs and alcohol among COAs does not fully program uses a nurse-managed team, which includes explain this phenomenon. In our family-based study community residents selected, trained, and integrated 343
- 352. design, we wereable to investigate specific risk factors Health in Pomerania (SHIP), in which families were for alcohol problems in adolescence. In a first step, we randomly selected if 12-18 year old biological compared a variety of psychosocial risk factors in 90 offspring were members of the household; a smaller adolescents (12-18 years of age) from families with at group of subjects was selected from local outpatient least one alcohol-abusing parent with those of 90 treatment centers. Members of 133 families, including adolescents of parents without alcohol disorders. In a 180 (50.6% male) offspring who were appropriate for second step, we investigated the meaning of all the current analyses, received personal semistructured included risk factors for alcohol problems of the diagnostic interviews and several self-rating adolescents. Our results give some support to the questionnaires. Analyses compared offspring with existence of a lower extent of emotional warmth and alcohol problems (AP; n = 40) and with no alcohol support by parents of children in the COA sample. problems (NAP; n = 140), and used structural equation Moreover, males of the COA group reported more modeling to test a hypothetical model. RESULTS: The parental rejection and higher values on measures of comparisons revealed that the AP group had attention problems and anxiety/depression than significantly more behavioral problems (e.g., controls, whereas there were no such differences aggression/delinquency), more perceived parental between females of the COA group and their control rejection and less emotional warmth, a higher amount counterparts. Additionally, logistic regression analysis of alcohol consumption, were more likely to associate revealed that only the membership in a substance-using with substance-using peers and more often received a peer group and higher age are important risk factors for diagnosis of conduct disorder or antisocial personality alcohol problems during adolescence. Considering our disorder. Whereas the family history of alcoholism did results, it is of great importance (a) to identify families not differ significantly between groups, parents of at risk at the earliest possible stage and (b) to develop offspring with an alcohol use disorder had significantly intervention and prevention programs further for more additional diagnoses on DSM-IV Axis I. The parents and children to increase social competence and evaluation of the model supported the importance of protect children at risk from later alcohol abuse. aggression/delinquency and association with substance-using peers for alcohol problems in people. Barnow S, Schuckit M, Smith TL, Preuss U, Danko G. The An additional diagnosis in the parents was directly and relationship between the family density of alcoholism indirectly (through aggression/delinquency) related to and externalizing symptoms among 146 children. alcohol problems of the adolescents. CONCLUSIONS: Alcohol Alcohol 2002; 37(4):383-7. The data indicate that alcohol problems in the offspring Abstract: AIMS: To evaluate the prevalence of are associated with several domains of influence in externalizing symptoms, such as attention problems, their environment. Prospective studies measuring both aggression and delinquency in the offspring of biological and environmental factors using sufficient alcoholics. METHODS: A total of 146 children were sample sizes will be needed for optimal understanding divided into three groups with no (group 1, n = 28), one of the development of alcohol problems in youth. or two (group 2, n = 103) and three or more (group 3, n = 15) first- or second-degree relatives with an alcohol Baron JH. Corporal punishment of children in England and use disorder. RESULTS AND CONCLUSIONS: The the United States: current issues. Mt Sinai J Med 2005; group comparisons revealed that the children of group 72(1):45-6. 3 had significantly higher values for the Child Abstract: Proverbs has eight sets of instructions on Behavior Checklist scales of attention and delinquent beating children, but that book does not contain the behavioural problems. The results remained significant often cited proverbial "spare the rod and spoil the after controlling for some additional factors such as child." This form of discipline, which is thousands of antisocial personality disorder and drug dependence in years old, has only recently been abandoned and the parents. forbidden in many states in the US, and in much of Europe. It is still legal in Britain and some US states, Barnow S, Schuckit MA, Lucht M, John U, Freyberger HJ. and remains a controversial issue. The importance of a positive family history of alcoholism, parental rejection and emotional warmth, Barr R, Vieira A, Rovee-Collier C. Bidirectional priming in behavioral problems and peer substance use for alcohol infants. Mem Cognit 2002; 30(2):246-55. problems in teenagers: a path analysis. J Stud Alcohol Abstract: In associative priming, the direct activation 2002; 63(3):305-15. of one concept indirectly activates others that are Abstract: OBJECTIVE: The purpose of this study was associated with it, depending on the directionality of to test a hypothetical model of alcohol problems in the association. We asked whether associative priming German adolescents. Among 180 offspring, family in preverbal infants is bidirectional. Infants associated history of alcoholism, parenting styles, behavioral and a puppet imitation task with an operant train task by emotional problems, peer-group characteristics, watching an adult model target actions on the puppet in feelings of self-esteem, behavioral problems and the incidental context of the train. Later, priming of the psychiatric comorbidity of the parents were examined. forgotten memory of the train task reactivated the METHOD: Data were generated from the Study of infants' memory of the puppet task (Experiment 1), and 344
- 353. priming of theinfants' forgotten memory of the puppet test (BAT), conducted in the home environment, in task reactivated their memory of the train task assessing treatment-outcome effects for children and (Experiment 2). The finding that associative priming adolescents with OCD following a 14-week cognitive- was bidirectional offers new insights into the nature of behavioral therapy (CBT) family intervention, in the mnemonic networks formed early in infancy. comparison to children in an 8-week "waitlist" control Additionally, the fact that the present association was group. The results of the current study strongly support formed rapidly and incidentally suggests that a fast the sensitivity of a standardized BAT in assessing mapping, general learning mechanism, like that posited treatment-related changes in children and adolescents to mediate word-object learning, was responsible for its with OCD. Implications and future directions for encoding. research are discussed. Barrera M Jr, Biglan A, Taylor TK et al. Early elementary Barron CE, Jenny C. Forensic pediatrics. Med Health R I school intervention to reduce conduct problems: a 2005; 88(9):318-20. randomized trial with Hispanic and non-Hispanic children. Prev Sci 2002; 3(2):83-94. Barry CT, Frick PJ, Killian AL. The relation of narcissism Abstract: Children's aggressive behavior and reading and self-esteem to conduct problems in children: a difficulties during early elementary school years are preliminary investigation. J Clin Child Adolesc risk factors for adolescent problem behaviors such as Psychol 2003; 32(1):139-52. delinquency, academic failure, and substance use. This Abstract: Investigated several possible models to study determined if a comprehensive intervention that explain the seemingly discrepant relations between was designed to address both of these risk factors could self-esteem and conduct problems, as both low self- affect teacher, parent, and observer measures of esteem and exaggerated levels of self-esteem, thought internalizing and externalizing problems. European to be captured by narcissism, have been associated with American (n = 116) and Hispanic (n = 168) children aggressive and antisocial behavior. Our sample from 3 communities who were selected for consisted of 98 nonreferred children (mean age = 11.9 aggressiveness or reading difficulties were randomly years; SD = 1.68 years) recruited from public schools assigned to an intervention or no-intervention control to oversample children at risk for severe aggressive and condition. Intervention families received parent antisocial behavior. Results indicated that certain training, and their children received social behavior aspects of narcissism (i.e., those indicating a need to be interventions and supplementary reading instruction evaluated well by, and obtain status over, others) were over a 2-year period. At the end of intervention, particularly predictive of maladaptive characteristics playground observations showed that treated children and outcomes such as low self-esteem, callous- displayed less negative social behavior than controls. unemotional (CU) traits, and conduct problems. In At the end of a 1-year follow-up, treated children addition, the relation between narcissism and conduct showed less teacher-rated internalizing and less parent- problems was moderated by self-esteem level, such rated coercive and antisocial behavior than controls. that children with relatively high levels of narcissism The study's limitations and implications for prevention and low self-esteem showed the highest rates of are discussed. conduct-problem symptoms. Barrett P, Healy L, March JS. Behavioral avoidance test for Barsky AJ, Peekna HM, Borus JF. Somatic symptom childhood obsessive-compulsive disorder: a home- reporting in women and men. J Gen Intern Med 2001; based observation. Am J Psychother 2003; 57(1):80- 16(4):266-75. 100. Abstract: Women report more intense, more numerous, Abstract: Obsessive-compulsive disorder (OCD) is one and more frequent bodily symptoms than men. This of the most debilitating of the anxiety disorders. As our difference appears in samples of medical patients and knowledge about this childhood condition continues to in community samples, whether or not gynecologic and grow, there is a need for controlled treatment-outcome reproductive symptoms are excluded, and whether all trials with precise assessments that are sensitive to bodily symptoms or only those which are medically treatment change, to guide the development of unexplained are examined. More limited, but effective interventions. To evaluate the efficacy of a suggestive, literature on experimental pain, symptom treatment protocol, it is necessary to have reliable and reporting in childhood, and pain thresholds in animals sensitive measures of OCD symptoms, including are compatible with these findings in adults. A number measures of obsessions, compulsions, and related of contributory factors have been implicated, supported levels of distress and avoidance. Whilst structured by varying degrees of evidence. These include innate diagnostic interviews, semistructured clinical differences in somatic and visceral perception; interviews, and self-report measures have been widely differences in symptom labeling, description, and used in the assessment of childhood OCD, related reporting; the socialization process, which leads to levels of behavioral distress and avoidance have not differences in the readiness to acknowledge and been measured in treatment-outcome trials. This study disclose discomfort; a sex differential in the incidence investigated the sensitivity of a behavioral avoidance 345
- 354. of abuse andviolence; sex differences in the exposure and the need to review policies and prevalence of anxiety and depressive disorders; and procedures regarding child abuse reporting. Child gender bias in research and in clinical practice. General Welfare 2001; 80(2):275-96. internists need to keep these factors in mind in Abstract: Research on the outcomes of drug-exposed obtaining the clinical history, understanding the children evinces elevated developmental risks from the meaning and significance that symptoms hold for each interaction of subtle biological vulnerabilities and patient, and providing symptom relief. compromised parenting. States, however, have generally not reviewed the procedures and policies they Bartels A, Zeki S. The neural correlates of maternal and developed in the early 1990s when there was less romantic love. Neuroimage 2004; 21(3):1155-66. research and experience with these children. At that Abstract: Romantic and maternal love are highly time the gravest risks related to perinatal substance rewarding experiences. Both are linked to the exposure seemed to be excessively punitive treatment perpetuation of the species and therefore have a closely of mothers by over-zealous criminal justice linked biological function of crucial evolutionary prosecutors. This article clarifies policy options for importance. Yet almost nothing is known about their reporting and serving children who are born testing neural correlates in the human. We therefore used positive for controlled substances and also calls for fMRI to measure brain activity in mothers while they strengthening existing state policies regarding child viewed pictures of their own and of acquainted abuse reporting and response. children, and of their best friend and of acquainted adults as additional controls. The activity specific to Barton C, Finlay F. Bruising in preschool children with maternal attachment was compared to that associated to special needs. Arch Dis Child 2005; 90(12):1318; romantic love described in our earlier study and to the author reply 1318. distribution of attachment-mediating neurohormones established by other studies. Both types of attachment Bartsch C, Risse M, Nagelmeier IE, Weiler G. [Deaths in activated regions specific to each, as well as preschool and school age--a retrospective analysis from overlapping regions in the brain's reward system that a medicolegal point of view]. Arch Kriminol 2004; coincide with areas rich in oxytocin and vasopressin 214(1-2):30-6. receptors. Both deactivated a common set of regions Abstract: At the Department of Legal Medicine in associated with negative emotions, social judgment and Giessen all forensic autopsies from the years 1990 until 'mentalizing', that is, the assessment of other people's 2001 were investigated under the aspect of "death in intentions and emotions. We conclude that human preschool and school age between 3 and 16 years of attachment employs a push-pull mechanism that age." Out of 69 deaths 19% were due to a natural and overcomes social distance by deactivating networks 81% to an unnatural cause of death. Both groups (3 to used for critical social assessment and negative 6 and 7 to 16 years of age) were analyzed emotions, while it bonds individuals through the retrospectively with regard to age and circumstances of involvement of the reward circuitry, explaining the death and compared with the literature. The purpose of power of love to motivate and exhilarate. the differentiating evaluation is to furnish ideas how to prevent violent deaths of children. Bartels V. [Crisis intervention in child sexual abuse]. Prax Kinderpsychol Kinderpsychiatr 2005; 54(6):442-56. Barzegari M, Ghaninezhad H, Mansoori P, Taheri A, Abstract: The impact of sexual abuse on children's Naraghi ZS, Asgari M. Computer-aided dermoscopy development of attachment behaviour is especially for diagnosis of melanoma. BMC Dermatol 2005; 5:8. disastrous when the abuse happens early in childhood, Abstract: BACKGROUND: Computer-aided and when it lasts over a long period of time, and in case dermoscopy using artificial neural networks has been the abuser is closely related to the child. These early reported to be an accurate tool for the evaluation of traumatic experiences regularly result in damages to pigmented skin lesions. We set out to determine the the mental, physical and emotional development of a sensitivity and specificity of a computer-aided child. The main task of youth welfare is to protect dermoscopy system for diagnosis of melanoma in children against maltreatment. For being able to do so Iranian patients. METHODS: We studied 122 it is significant to emphasize a scientific approach to pigmented skin lesions which were referred for the hypothesis-based risk evaluation and the diagnostic evaluation or cosmetic reasons. Each lesion conceptualization of intervention. In order to come to a was examined by two clinicians with naked eyes and sound conclusion the agencies and professionals all of their clinical diagnostic considerations were involved in a case of child abuse have to collaborate recorded. The lesions were analyzed using a professionally. Potential misunderstandings between microDERM dermoscopy unit. The output value of the the collaborating partners in this procedure will be software for each lesion was a score between 0 and 10. discussed, as well as the way out of the labyrinth. All of the lesions were excised and examined histologically. RESULTS: Histopathological Barth RP. Research outcomes of prenatal substance examination revealed melanoma in six lesions. 346
- 355. Considering only themost likely clinical diagnosis, sleep patterns through daily logs kept by mothers, and sensitivity and specificity of clinical examination for measured family stress and parenting practices through diagnosis of melanoma were 83% and 96%, detailed, multifaceted interviews and incidental respectively. Considering all clinical diagnostic observations of parent-child interactions. Children's considerations, the sensitivity and specificity were adjustment, both positive and negative, was measured 100% and 89%. Choosing a cut-off point of 7.88 for through preschool teacher reports on multiple dermoscopy score, the sensitivity and specificity of the occasions. A structural equation model showed that score for diagnosis of melanoma were 83% and 96%, disrupted child sleep patterns (variability in reported respectively. Setting the cut-off point at 7.34, the amount of sleep, variability in bedtime, and lateness of sensitivity and specificity were 100% and 90%. bedtime) predicted less optimal adjustment in CONCLUSION: The diagnostic accuracy of the preschool, even after considering the roles of family dermoscopy system was at the level of clinical stress and family management practices. examination by dermatologists with naked eyes. This system may represent a useful tool for screening of Battaglia TA, Finley E, Liebschutz JM. Survivors of melanoma, particularly at centers not experienced in intimate partner violence speak out: trust in the patient- the field of pigmented skin lesions. provider relationship. J Gen Intern Med 2003; 18(8):617-23. Bassarath L. Medication strategies in childhood aggression: Abstract: OBJECTIVE: To identify characteristics that a review. Can J Psychiatry 2003; 48(6):367-73. facilitate trust in the patient-provider relationship Abstract: OBJECTIVE: To review studies of among survivors of intimate partner violence (IPV). psychopharmacological management of aggression in DESIGN: Semistructured, open-ended interviews were common childhood psychiatric disorders. METHOD: conducted to elicit participants' beliefs and attitudes Using OVID software, we searched Medline for studies about trust in interactions with health care providers. that were undertaken in the last 30 years. Controlled Using grounded theory methods, the transcripts were and uncontrolled data are summarized for each analyzed for common themes. A community advisory condition. RESULTS: A paucity of evidence-based group, composed of advocates, counselors and IPV information currently exists. Even so, specific survivors, helped interpret themes and interview indications from the existing literature can be excerpts. Together, key components of trust were suggested for several classes of psychotropics, identified. SETTING: Eastern Massachusetts. particularly in conduct disorder (CD), attention-deficit PARTICIPANTS: Twenty-seven female survivors of hyperactivity disorder (ADHD), mood disorders, and IPV recruited from community-based IPV other conditions. CONCLUSIONS: Clinicians can use organizations. MAIN RESULTS: Participants' ages findings from reviewed controlled and, where ranged from 18 to 56 years, 36% were African necessary, uncontrolled studies to inform American, 32% Hispanic, and 18% white. We pharmacologic practice. This review offers suggestions identified 5 dimensions of provider behavior that were for future research directions that will aid clinical uniquely important to the development of trust for practice. these IPV survivors: 1) communication about abuse: provider was willing to openly discuss abuse; 2) Bateman C. A case of national child neglect? S Afr Med J professional competency: provider asked about abuse 2003; 93(10):738-9. when appropriate and was familiar with medical and social histories; 3) practice style: provider was Bates J. Who will protect the innocent from smoke? Nurs consistently accessible, respected confidentiality, and Stand 2005; 20(5):34. shared decision making; 4) caring: provider demonstrated personal concern beyond biomedical role Bates JE, Viken RJ, Alexander DB, Beyers J, Stockton L. through nonjudgmental and compassionate gestures, Sleep and adjustment in preschool children: sleep diary empowering statements, and persistent, committed reports by mothers relate to behavior reports by behaviors; 5) emotional equality: provider shared teachers. Child Dev 2002; 73(1):62-74. personal information and feelings and was perceived Abstract: Prior literature suggests that there may be by the participant as a friend. CONCLUSIONS: These relations between children's sleep disorders or IPV survivors identified dimensions of provider inadequate amounts of sleep and behavioral behavior that facilitate trust in their clinical adjustment. Most relevant studies concern clinical relationship. Strengthening these provider behaviors populations, however, and relatively few concern may increase trust with patients and thus improve community populations. Moreover, previous studies disclosure of and referral for IPV. have not addressed empirically the possible role of family functioning as a factor in the relation between Bauchner H, Sharfstein J. Failure to report ethical approval children's sleep and adjustment. The present study, in child health research: review of published papers. conducted in a predominantly low-income, community BMJ 2001; 323(7308):318-9. sample (N = 202), measured 4- to 5-year-old children's Notes: GENERAL NOTE: KIE: Bauchner, Howard; Sharfstein, Joshua 347
- 356. GENERAL NOTE: KIE: 5 refs. Abstract: SETTING: Two regions of metropolitan GENERAL NOTE: KIE: KIE Bib: human Lima, Peru. OBJECTIVE: To determine the outcomes experimentation/minors of two contact investigation strategies used in therapy enrollment cohorts of patients with multidrug-resistant Baumann TK. Proxy consent and a national DNA databank: tuberculosis (MDR-TB). DESIGN: From 28 August an unethical and discriminatory combination. Iowa 1996 to 31 December 1999, 91 index patients received Law Rev 2001; 86(2):667-701. individualized MDR-TB therapy (Group A), and from Notes: GENERAL NOTE: KIE: Baumann, Teresa K 1 October 1997 to 31 December 1999, another 101 GENERAL NOTE: KIE: 197 fn. index patients received a standardized MDR-TB GENERAL NOTE: KIE: KIE Bib: genetic screening; regimen (Group B). We conducted a retrospective chart informed consent/minors; mass screening review and home visits to identify secondary cases among close contacts of both of these groups. Group A Baxendale J, Hesketh A. Comparison of the effectiveness of secondary cases with MDR-TB received therapy based the Hanen Parent Programme and traditional clinic on the drug susceptibility profile of their infecting therapy. Int J Lang Commun Disord 2003; 38(4):397- strain, while Group B secondary cases received 415. standard short-course therapy. RESULTS: Among 945 Abstract: BACKGROUND: Both direct (clinician to close contacts, 72 secondary TB cases (8%) were child) and indirect (clinician to carer) approaches are found. Of 42 who had drug-susceptibility testing, 35 currently used in the management of children with (84%) were MDR-TB, but only seven (17%) had the language delay, but there is as yet little evidence about same drug susceptibility profile as the index case. Cure their relative effects or resource implications. AIMS: exceeded 80% in Group A secondary cases, while only This research project compared the Hanen Parent half of Group B secondary cases were cured (RR 1.6, Programme (HPP) in terms of its effectiveness and 95%CI 1.1-2.2). CONCLUSION: Contact investigation consequent suitability for an inner-city UK population protocols coupled with enrollment in MDR-TB therapy with clinic-based, direct intervention. METHODS & are a useful means of detecting and promptly treating PROCEDURES: Thirty-seven children aged 2;06-3;06 persons with infectious MDR-TB. In settings with years with a diagnosis of language impairment and endemic MDR strains of Mycobacterium tuberculosis, their parents took part in the research project. The effective therapy of contacts of MDR-TB patients children were allocated on a geographical basis to requires knowledge of drug susceptibility for each receive therapy either as part of an HPP or in a clinic. contact with active disease. Nineteen children and their families took part in one of the five Hanen groups that ran successively over 16 Beard J. Iron deficiency alters brain development and months; 18 children and their families received clinic- functioning. J Nutr 2003; 133(5 Suppl 1):1468S-72S. based intervention. The children's language was Abstract: Iron deficiency anemia in early life is related assessed using the PLS-3 (UK version) and from an to altered behavioral and neural development. Studies analysis of audio-taped parent and child interaction at in human infants suggest that this is an irreversible three assessment points, one pretherapy and two post- effect that may be related to changes in chemistry of therapy over 12 months. Two parent language neurotransmitters, organization and morphology of measures were also analysed. OUTCOMES & neuronal networks, and neurobiology of myelination. RESULTS: Significant gains in language scores were The acquisition of iron by the brain is an age-related shown by 71% of the children over 12 months. There and brain-region-dependent process with tightly were no statistically significant differences in child controlled rates of movement of iron across the blood- language scores between the two therapy groups at any brain barrier. Dopamine receptors and transporters are assessment point. However, the HPP was twice as altered as are behaviors related to this neurotransmitter. intensive (in terms of therapist time) as clinic therapy The growing body of evidence suggests that brain iron based on average group size, which has resource deficiency in early life has multiple consequences in implications. CONCLUSIONS. Results suggest that neurochemistry and neurobiology. there are parent and child factors that need consideration when choosing an appropriate Beauchesne MA, Kelley BR, Patsdaughter CA, Pickard J. intervention programme for a child with language Attack on America: children's reactions and parents' impairment. Parental expectations, existing interaction responses. J Pediatr Health Care 2002; 16(5):213-21. style and the level of child language may be important Abstract: INTRODUCTION: When disaster strikes, as influencing factors. it did September 11, 2001, children react to both the actual event and their parents' distress. The purpose of Bayona J, Chavez-Pachas AM, Palacios E, Llaro K, Sapag this study was to find out how children were affected R, Becerra MC. Contact investigations as a means of by these recent events and how parents responded to detection and timely treatment of persons with their children's concerns. This study is a sequel to a infectious multidrug-resistant tuberculosis. Int J Tuberc previous study on parents' and children's perceptions to Lung Dis 2003; 7(12 Suppl 3):S501-9. the President Clinton situation and the Starr Report. METHOD: Eighty-eight school-aged children and 51 348
- 357. parents were recruitedfor this descriptive, qualitative Belal SY, Taktak AF, Nevill AJ, Spencer SA, Roden D, study that used community-based snowball sampling. Bevan S. Automatic detection of distorted Parents and children were asked a series of questions plethysmogram pulses in neonates and paediatric about the attacks on the World Trade Center and patients using an adaptive-network-based fuzzy Pentagon, including how they heard about it and how it inference system. Artif Intell Med 2002; 24(2):149-65. made them feel. RESULTS: Children's responses Abstract: Despite the fact that pulse oximetry has indicated feelings of fear about their safety and their become an essential technology in respiratory future; wanting to take revenge; feeling sad and monitoring of neonates and paediatric patients, it is still disappointed; and empathy for the victims. Parents fraught with artefacts causing false alarms resulting realized they had to comfort their children in spite of from patient or probe movement. As the shape of the their own feelings of dismay. Many parents reported plethysmogram has always been considered as a useful difficulty in reacting to their child's concerns regarding visual indicator for determining the reliability of fairness and justice. DISCUSSION: Pediatric nurse SaO(2) numerical readings, automation of this practitioners need to understand parents' and children's observation might benefit health care providers at the responses to such events in order to provide optimal bedside. We observed that the systolic upstroke time health care, support, and counseling within the context (t(1)), the diastolic time (t(2)) and heart rate (HR) of normal growth and development. extracted from the plethysmogram pulse constitute features, which can be used for detecting normal and Beck A, Daley D, Hastings RP, Stevenson J. Mothers' distorted plethysmogram pulses. We developed a expressed emotion towards children with and without technique for classifying plethysmogram pulses into intellectual disabilities. J Intellect Disabil Res 2004; two categories: valid and artefact via implementations 48(Pt 7):628-38. of fuzzy inference systems (FIS), which were tuned Abstract: OBJECTIVES: To identify factors associated using an adaptive-network-based fuzzy inference with maternal expressed emotion (EE) towards their system (ANFIS) and receiver operating characteristics child with intellectual disability (ID). DESIGN AND (ROC) curves analysis. Features extracted from a total METHOD: A total of 33 mothers who had a child with of 22,497 pulse waveforms obtained from 13 patients ID and at least one child without disabilities between were used to systematically optimise the FIS. A further the ages of 4 and 14 years participated in the study. 2843 waveforms obtained from another eight patients Mothers completed self-assessment questionnaires were used for testing the system, and visually classified which addressed their sense of parenting competence, into 1635 (58%) valid and 1208 (42%) distorted beliefs about child-rearing practices, and their reports segments. For the optimum system, the area under the of behavioural and emotional problems of their child ROC curve was 0.92. The system was able to classify with ID. Telephone interviews were conducted to 1418 (87%) valid segments and 897 (74%) distorted assess maternal EE towards the child with ID and segments correctly. The calculations of the system's towards a sibling using the Five Minute Speech Sample performance showed 87% sensitivity, 81% accuracy (FMSS; Magana et al. 1986), and also to assess the and 74% specificity. In comparison with the 95% adaptive behaviour of the child with ID using the confidence interval (CI) thresholding method, the fuzzy Vineland Adaptive Behaviour Scale (VABS; Sparrow system showed higher specificity (P=0.008,P<0.01), et al. 1984). RESULTS: Mothers with high EE towards and no significant difference was found between the their child with ID were more satisfied with their two methods in terms of sensitivity (P=0.720,P>0.05) parenting ability, and their children had more and accuracy (P=0.053,P>0.05). We therefore conclude behaviour problems. Analysis of differential maternal that the algorithm used in this system has some parenting, through comparisons of EE towards their potential in detecting valid and distorted two children, showed that mothers were more negative plethysmogram pulse. However, further evaluation is towards their child with ID for all domains of the needed using larger patient groups. FMSS except dissatisfaction. CONCLUSIONS: A small number of factors associated with maternal EE Beling J, Hudson SM, Ward T. Female and male towards children with ID were identified. Differences undergraduates' attributions for sexual offending in maternal EE towards their child with ID and their against children. J Child Sex Abus 2001; 10(2):61-82. other child suggest that EE is child-driven rather than a Abstract: This study examined gender differences in general maternal characteristic. Implications of the data undergraduates' attributions for child sex offending. for future research are discussed. One hundred and sixty-four undergraduates were asked to give the reasons why they think men sexually offend Beckaya A. Reluctance in child protection must be for against children and to rate them using Benson's several reasons. BMJ 2004; 328(7442):767. Attributional Scale across four dimensions: stability, locus, controllability and globality. A Grounded Beech BA. GP involvement in child protection. Br J Gen Theory methodology was applied to these reasons and Pract 2002; 52(481):677-8. a set of nine categories derived from the data. The results showed that undergraduates' reasons for child sexual abuse strongly parallel contemporary scientific 349
- 358. theories of abuse,and that there were significant duty, male, enlisted Army spouse abusers identified in gender differences in the frequency with which the Army's Central Registry who had also completed participants cited various types of reasons given for an Army Health Risk Appraisal Survey (HRA) sexual abuse. Females endorsed significantly more between 1991 and 1998 (N = 9534). Cases were victim reasons than males, and also more power and matched on sex, rank, and marital status with 21,786 control reasons than did males. In contrast, males control subjects who had also completed an HRA. endorsed significantly more sexual reasons for RESULTS: In multivariate logistic regression models, offending than did females. Furthermore, significant heavy drinkers (22 or more drinks per week) were 66% gender differences were found between the ways in more likely to be spouse abusers than were abstainers which participants construed the reasons for sexual (odds ratio 1.66; 95% confidence interval 1.40-1.96). abuse, with females seeing the phenomenon as In addition, self-reported moderate and heavy drinkers significantly more stable and internal than males. No were three times as likely and light drinkers (1-7 drinks significant gender differences were found on the per week) were twice as likely as nondrinkers to be dimensions of controllability and globality. drinking during the time of the abuse event. CONCLUSION: Self-reported heavy drinking is an Belizan JM, Cafferata ML, Belizan M. Child survival. independent risk factor for perpetration of spouse abuse Lancet 2003; 362(9387):916-7. among male, enlisted Army soldiers. Even 5 years or more after ascertainment of typical drinking habits, Bell L. Patterns of interactions in multidisciplinary child there is a significant association between self-reported protection teams in New Jersey. Child Abuse Negl heavy drinking and alcohol involvement at the time of 2001; 25(1):65-80. the spouse abuse event. Personnel who work with Abstract: OBJECTIVE: The objective of this study was perpetrators and victims of spouse abuse should be to gain an understanding of how multidisciplinary team trained carefully to query about current and typical members in child protection worked together within the drinking patterns. team, meeting to provide assessments of, and services to, children and families. METHOD: Fifteen Bellavance M, Beland MJ, van Doesburg NH, Paquet M, multidisciplinary child-protection teams in New Jersey Ducharme FM, Cloutier A. Implanting telehealth were observed during one meeting of each team. The network for paediatric cardiology: learning from the interaction among team members was recorded and Quebec experience. Cardiol Young 2004; 14(6):608- analyzed using a structured observation method, Bales' 14. Interaction Process Analysis. RESULTS: There was a Abstract: The implementation committee of the wide variation in participation among team members, Quebec Child Telehealth Network was formed in 1997, with some contributing nothing to the meeting and with a mandate to build a network dedicated to the others contributing a great deal. In some teams, diagnosis of congenital cardiac disease via participation by members was more equal than others. telemedicine. We devised criterions for selection to Some professional groups and agencies contributed determine which peripheral centres would be linked by very little to any meeting while others contributed a telemedicine to the university-based services for great deal to many meetings. CONCLUSIONS: paediatric cardiology provided in the Canadian Professionals are members of multidisciplinary teams Province of Quebec. The criterions included: distance because they are expected to contribute to the from a university centre, number of births per year, and investigation of child maltreatment cases and to the presence of an already-established outreach clinic for planning for further work with cases. However, the paediatric cardiology. The Quebec Network became findings from this study suggest that there is a operational in 2000, and was composed of 32 considerable degree of inequality in levels of peripheral centres and 4 university centres. A total of participation in multidisciplinary meetings. It is 363 transmissions of echocardiograms occurred over a particularly noticeable that staff from the prosecutor's 3-year period from January 2000 to December 2002. offices participate in every meeting and either the Peripheral centres located at a distance greater than 100 agency as a whole or individual members of it kilometres from a university centre were 8.5 times dominate many of the meetings. more likely to use the network. Criterions other than distance did not influence whether or not a peripheral Bell NS, Harford T, McCarroll JE, Senier L. Drinking and centre used the network. Cardiac abnormalities were spouse abuse among U.S. Army soldiers. Alcohol Clin identified in almost two-thirds of the transmissions. Exp Res 2004; 28(12):1890-7. The use of the Quebec Network resulted in the Abstract: BACKGROUND: This study examines the avoidance of transfers or clinic visits to university relationship between typical weekly drinking and hospitals in seven-tenths of cases. We conclude that perpetration of spouse abuse as well as the relationship distance greater than 100 kilometres from a centre between the perpetrator's typical weekly drinking and offering subspecialty services in paediatric cardiology alcohol use during the abuse event among U.S. Army is the most important criterion for choosing the male soldiers. METHODS: Cases include all active peripheral centres that are most likely to use a telehealth network. In its first three years of operation, 350
- 359. the telehealth networkhad a major impact on the conventional injuries and concomitant nerve agent delivery of paediatric cardiac care, improving access to intoxication. Anesthesiology 2002; 97(4):989-1004. subspecialty services across the province. Notes: CORPORATE NAME: Department of Anesthesiology and Critical Care Medicine, Tel Aviv Bellotti T, Luo Z, Gammerman A, Van Delft FW, Saha V. Sourasky Medical Center and the Sackler Faculty of Qualified predictions for microarray and proteomics Medicine pattern diagnostics with confidence machines. Int J Neural Syst 2005; 15(4):247-58. Benda BB. Gender differences in life-course theory of Abstract: We focus on the problem of prediction with recidivism: a survival analysis. Int J Offender Ther confidence and describe a recently developed learning Comp Criminol 2005; 49(3):325-42. algorithm called transductive confidence machine for Abstract: This study of 300 women and 300 men making qualified region predictions. Its main graduates of a boot camp finds that there are advantage, in comparison with other classifiers, is that noteworthy gender differences in predictors of tenure it is well-calibrated, with number of prediction errors in the community without criminal recidivism in a 5- strictly controlled by a given predefined confidence year follow-up. The Cox proportional hazards models level. We apply the transductive confidence machine to show that urban residence, childhood and recent the problems of acute leukaemia and ovarian cancer abuses, living with a criminal partner, selling drugs, prediction using microarray and proteomics pattern stress, depression, fearfulness, and suicidal thoughts diagnostics, respectively. We demonstrate that the are stronger positive predictors of recidivism for algorithm performs well, yielding well-calibrated and women than for men. Men are more likely to return to informative predictions whilst maintaining a high level prison because of criminal peer associations, carrying of accuracy. weapons, alcohol abuse, and aggressive feelings. Job satisfaction and education lengthen time in the Belsito KM, Law PA, Kirk KS, Landa RJ, Zimmerman AW. community more for men than women, whereas the Lamotrigine therapy for autistic disorder: a number of children and relationships are more randomized, double-blind, placebo-controlled trial. J important to tenure in the community for women. The Autism Dev Disord 2001; 31(2):175-81. implications for the findings for theory are discussed. Abstract: In autism, glutamate may be increased or its receptors up-regulated as part of an excitotoxic process Benda BB. Life-course theory of readmission of substance that damages neural networks and subsequently abusers among homeless veterans. Psychiatr Serv contributes to behavioral and cognitive deficits seen in 2004; 55(11):1308-10. the disorder. This was a double-blind, placebo- Abstract: This study examined outcomes of 310 female controlled, parallel group study of lamotrigine, an and 315 male homeless veterans who were admitted to agent that modulates glutamate release. Twenty-eight a Department of Veterans Affairs inpatient program for children (27 boys) ages 3 to 11 years (M = 5.8) with a dual diagnoses of a substance use disorder and another primary diagnosis of autistic disorder received either mental illness. Participants were surveyed to determine placebo or lamotrigine twice daily. In children on gender differences for types of transforming lamotrigine, the drug was titrated upward over 8 weeks experiences and for types of abuse as predictors of to reach a mean maintenance dose of 5.0 mg/kg per readmission within two years. Predictors were selected day. This dose was then maintained for 4 weeks. primarily from life-course theory and were analyzed Following maintenance evaluations, the drug was with Cox's proportional hazards model. Transforming tapered down over 2 weeks. The trial ended with a 4- experiences, such as enhanced ego identity and week drug-free period. Outcome measures included spiritual well-being, attenuated the effects of childhood improvements in severity and behavioral features of abuses, combat exposure, and depression for both autistic disorder (stereotypies, lethargy, irritability, genders. Transforming experiences also reduced the hyperactivity, emotional reciprocity, sharing pleasures) risk of readmission that was associated with aggression and improvements in language and communication, for men and abuse that occurred either in the military socialization, and daily living skills noted after 12 or recently for women. weeks (the end of a 4-week maintenance phase). We did not find any significant differences in Benecke M, Rodriguez y Rowinski M. [Luis Alfredo improvements between lamotrigine or placebo groups Garavito Cubillos: criminal and legal aspects of serial on the Autism Behavior Checklist, the Aberrant homicide with over 200 victims]. Arch Kriminol 2002; Behavior Checklist, the Vineland Adaptive Behavior 210(3-4):83-94. scales, the PL-ADOS, or the CARS. Parent rating Abstract: This is the first scientific report on the crimes scales showed marked improvements, presumably due of the homosexual paedophile sadist Luis Alfredo to expectations of benefits. Garavito Cubillos, based on a research stay of the authors in Columbia, and including discussions with Ben Abraham R, Rudick V, Weinbroum AA. Practical the investigators, and the offender. Between 1992 and guidelines for acute care of victims of bioterrorism: 1999, Garavito killed more than 200 children in the 351
- 360. core age spanbetween 8 and 13 years (as an exception, increased from 0 to 3%, but failed to reach statistical 6 to 16 years). His modus operandi remained stable. significance. CONCLUSIONS: Prevailing awareness During daytime, he lured children of a lower social and documentation regarding the possibility of NAI status out of crowded parts of the city into hidden areas was found to be poor, but a programme of intervention that were overgrown with high plants. Garavito combining education and the use of a reminder promised either payment for easy work, or drugs, or checklist improved both awareness and documentation made other socially believable offers. The children of NAI, as well as referral rates for further assessment. were tied up, tortured, raped, and killed by at least one This strategy may prove applicable to children of all cut in the lateral part of the neck, or by decapitation. ages and injury types, reducing the number of cases of During the killings, Garavito was drunk. Even after his child abuse that are overlooked in the A&E arrest (for attempted sexual abuse under a wrong department. identity) it was not immediately possible to track his crimes since Garavito had frequently changed his Bensley L, Ruggles D, Simmons KW et al. General places of stay and his jobs. He also grew different population norms about child abuse and neglect and hairdos and used wrong names. During his still associations with childhood experiences. Child Abuse ongoing confessions, he directs the investigators Negl 2004; 28(12):1321-37. correctly to all scenes of crime spread over large parts Abstract: BACKGROUND: A variety of definitions of of Columbia. In our report, we give an overview over child abuse and neglect exist. However, little is known the course of investigations, hint to similarities in the about norms in the general population as to what cases of the German serial killer Denke (1920's) and constitutes child abuse and neglect or how perceived homosexual paedophile serial killer Jurgen Bartsch norms may be related to personal experiences. (1960's), and give preliminary impressions on the METHODS: We conducted a random-digit-dialed offender's personality. Furthermore, the violent telephone survey of 504 Washington State adults. environment and juridical peculiarities in Columbia are Respondents were asked whether they believed each of discussed. In spite of a total penalty of 2600 years in 34 behaviors, identified in focus groups as possibly prison, it is formally well possible that Garavito will be physically, sexually or emotionally abusive or released out of prison within the next 10 to 20 years, neglectful, constituted abuse or neglect. Then, they i.e. even before the maximum sentence of 40 years will were asked whether they had experienced 33 of the be over. behaviors. RESULTS: Five of the six behaviors with the highest levels of consensus were for sexual abuse, Benger JR, McCabe SE. Burns and scalds in pre-school whereas only one emotionally abusive behavior had a children attending accident and emergency: accident or high level of consensus (95% agreement). Consensus abuse? Emerg Med J 2001; 18(3):172-4. that spanking constituted abuse increased with severity. Abstract: OBJECTIVES: To assess how frequently and Those respondents who reported experiencing a adequately information relating to the possibility of particular behavior were significantly less likely to non-accidental injury (NAI) is documented and believe the behavior abusive for 11 of the 33 behaviors considered by doctors assessing pre-school children and more likely to believe the behavior abusive for two with burns and scalds in the accident and emergency of the behaviors. Where comparisons were possible, (A&E) department, and to determine the effect of there was a high level of consensus that behaviors introducing a routine reminder mechanism into the identified as abusive in Child Protective Service A&E notes, coupled with an improved programme of operational definitions constituted abuse. NAI education and awareness. METHODS: The CONCLUSIONS: Self-reported childhood experiences records of 100 pre-school children attending an A&E were associated with perceived norms about child department with a burn or scald were reviewed against abuse. A better understanding of community norms nine pre-determined standards. Changes in policy were about child abuse and neglect may be helpful in instituted, through a programme of education and the communicating with the public or allow for better use of a reminder checklist, and the next 100 cases re- targeting of educational messages through the media, audited against the same checklist. RESULTS: Groups parenting education classes, and so forth. one and two were similar in their demographic characteristics. The reminder checklist was included in Benzies KM, Harrison MJ, Magill-Evans J. Parenting and 60% of group two notes, and when included was childhood behavior problems: mothers' and fathers' completed in 97%. The child protection register was voices. Issues Ment Health Nurs 2004; 25(1):9-24. rarely consulted. There was a statistically significant Abstract: Through thematic analysis of interviews, we increase in recording the following: time that the injury explored parents' perceptions of their child's behaviors had occurred, the consistency of the history, the and their own parenting. A purposive sample of four compatibility of the injury with the history given, the mothers and four fathers who reported behavior consideration of the possibility of NAI, the general problems for their 7(1/2) year-old-child was selected state and behaviour of the child and the presence or from a larger study. Parents appraised their child absence of any other injuries. The rate of referral for a positively despite episodic behavior problems, and further opinion regarding the possibility of NAI described parenting in the context of financial 352
- 361. difficulties, marital conflict,chronic illness, lack of suicidality. Sexually abused girls may be at increased support for parenting, and abuse in the parent's family risk of attempting suicide, independent of other of origin. Data suggest a need for timely mental health psychopathology. services to assist parents with managing their child's behaviors within the context of the family's situation. Bergeret J. Homosexuality or homoeroticism? 'Narcissistic eroticism'. Int J Psychoanal 2002; 83(Pt 2):351-62. Beran TN, Violato C. A model of childhood perceived peer Abstract: It may be dangerous for a psychoanalyst to harassment: analyses of the Canadian National let him/herself be influenced by the social and media Longitudinal Survey of Children and Youth Data. J pressure that proposes the use of the term 'homosexual' Psychol 2004; 138(2):129-47. to describe the affective functioning of a homophile, Abstract: The authors developed a model of childhood for this assumes--from the outset--that it is of a truly perceived peer harassment, using several personality, sexual nature. However, following certain Freudian peer, and familial characteristics of victims, and tested writings and the works of Ferenczi in 1911, we know it with children 10 to 11 years old (N = 3,434) drawn the different mechanisms of the narcissistic register from the Canadian National Survey of Children and that come into play in the quite particular relational Youth, which is a stratified random sample of 22,831 behaviour that should more relevantly be called households in Canada. A 3-step analytic procedure 'homoeroticism'. On the other hand, our diagnostic and with 3 separate subsamples of the children was used to therapeutic approach will benefit from not considering, explore psychosocial correlates of peer harassment. at the outset, all the economically and Results from the latent variable path analysis psychogenetically very different varieties of (comparative fit index = .90) showed that victims are homoeroticism, male or female, latent or manifest, in likely to feel anxious and disliked by their peers. Their too global a fashion, with reference also to the parents reported using high levels of control and low Freudian concept of psychic bisexuality. The French levels of warmth with their children and reported high psychoanalytical research team working with the levels of depression and marital conflict themselves. author has focused on these important issues for a These results are discussed from a social-cognitive number of years now. This article aims to give a fairly perspective. brief account of its work, with the objective of opening up a discussion amongst psycho-analysts, within the Bergen HA, Martin G, Richardson AS, Allison S, Roeger L. framework of Freudian thought. Sexual abuse and suicidal behavior: a model constructed from a large community sample of Berkovitz IH, Sinclair E. Training programs in school adolescents. J Am Acad Child Adolesc Psychiatry consultation. Child Adolesc Psychiatr Clin N Am 2003; 42(11):1301-9. 2001; 10(1):83-92. Abstract: OBJECTIVE: To investigate relationships Abstract: The need to train psychiatrists in school between self-reported sexual abuse, depression, consultation is important to approach mental health and hopelessness, and suicidality in a community sample of psychosocial concerns from the broad perspective of adolescents. METHOD: In 1995, students (mean age addressing barriers to learning and promoting healthy 13 years) from 27 high schools in Australia (n = 2,603) development. There is a major national impetus to completed a questionnaire including measures of improve academic achievement and literacy, which can depressive symptoms (Center for Epidemiologic be amplified by addressing the social, emotional, and Studies Depression Scale), hopelessness, sexual abuse, mental health needs of children and youth. Training in and suicidality. Data analysis included logistic school consultation allows the psychiatrist to better regression. RESULTS: Sexual abuse is associated with understand a critical institution in each child's life and suicidality, both directly and indirectly through also provides technical assistance and training to hopelessness and depressive symptoms in the model school personnel, which facilitates networking between developed. High suicide risk (behavior exceeding programs and individuals involved in or interested in thoughts such as plans and threats, or deliberate self- school mental health. Each of the described programs injury) is strongly correlated with suicide attempts approaches consultation from a specific focus that (odds ratio 28.8, 95% CI 16-52, p <.001). Hopelessness varies in time commitment, placement options, and is associated with high suicide risk only, whereas frequency and order of didactic presentations. There is depressive symptoms are associated with high suicide no conclusive available evidence as to which program risk and attempts. Hopelessness is more strongly is most effective, since such evaluation depends on the associated with sexual abuse in boys than girls. overall goals of the consultation program itself. Depressive symptoms are more strongly associated with high suicide risk in girls than boys. Controlling Berl MM, Balsamo LM, Xu B et al. Seizure focus affects for other variables, sexual abuse is independently regional language networks assessed by fMRI. associated with suicide attempts in girls but not boys. Neurology 2005; 65(10):1604-11. CONCLUSIONS: Clinical assessment should consider Abstract: OBJECTIVE: To investigate the degree of gender differences in relationships between sexual language dominance in patients with left and right abuse, depressive symptoms, hopelessness, and 353
- 362. hemisphere seizure focicompared to normal volunteers shame. using a fMRI reading comprehension task. METHODS: Fifty patients with complex partial Berliner L, Hyman I, Thomas A, Fitzgerald M. Children's epilepsy, aged 8 to 56 years and 33 normal volunteers, memory for trauma and positive experiences. J Trauma aged 7 to 34 had fMRI (1.5 T) and neuropsychological Stress 2003; 16(3):229-36. testing. Participants silently named an object described Abstract: Characteristics of children's memory for a by a sentence compared to a visual control. Data were trauma and for a positive event were compared and analyzed with region of interest (ROI) analysis based relationships of memory characteristics to trauma on t maps for inferior frontal gyrus (IFG), midfrontal symptoms examined in 30 children who experienced a gyrus (MFG), and Wernicke area (WA). Regional traumatic event. Results revealed that memories for asymmetry indices (AIs) were calculated [(L - R)/(L + trauma tended to have less sensory detail and R)]; AI > 0.20 was deemed left dominant and AI < 0.20 coherence, yet have more meaning and impact than did as atypical language. RESULTS: Left hemisphere memories for positive experiences. Sexual traumas, focus patients had a higher likelihood of atypical offender relationship, and perceived life threat were language than right hemisphere focus patients (21% vs associated with memory characteristics. Few 0%, chi2 < 0.002). Left hemisphere focus patients, relationships between memory characteristics and excluding those with atypical language, had lower trauma symptoms were found. Therapist ratings of regional AI in IFG, MFG, and WA than controls. Right child memory characteristics were correlated with hemisphere focus patients were all left language some child trauma memory characteristic reports. dominant and had a lower AI than controls in WA and These results are consistent with other studies. Possible MFG, but not for IFG. AI in MFG and WA were explanations include divided attention during the similar between left hemisphere focus/left language traumatic event and cognitive avoidance occurring patients and right hemisphere focus patients. Patients after the event. activated more voxels than healthy volunteers. Lower AIs were attributable to greater activation in right Bernard-Opitz V, Kwook KW, Sapuan S. Epidemiology of homologous regions. Less activation in the right-side autism in Singapore: findings of the first autism survey. WA correlated with better verbal memory performance Int J Rehabil Res 2001; 24(1):1-6. in right focus/left hemisphere-dominant patients, Abstract: The report describes the results of a survey whereas less strongly lateralized activation in IFG conducted on 176 parents of children with autism in correlated better with Verbal IQ in left focus/left Singapore. The ages of the children ranged from 3 to hemisphere-dominant patients. CONCLUSIONS: 12 years. The survey focused on the child's Patients had lower asymmetry indices than healthy background, behaviour problems and skill profile, the controls, reflecting increased recruitment of home and school situation as well as the linguistic and homologous right hemisphere areas for language social background. It was noted that the Singapore processing. Greater right hemisphere activation may population confirms the international distribution reflect greater cognitive effort in patient populations, regarding a predominance of boys over girls and a low the effect of epilepsy, or its treatment. Regional incidence of birth complications. A positive trend activation patterns reflect adaptive efforts at recruiting noted was the fact that 60% of the children were more widespread language processing networks that diagnosed before the age of 3 years. Discussion focuses are differentially affected based on hemisphere of on possible risk factors and psychosocial adversities for seizure focus. autism such as a high frequency of caregivers who are foreign maids, the use of multiple languages and the Berlin L. Errors of omission. AJR Am J Roentgenol 2005; high level of punitive educational practices. The 185(6):1416-21. possible influence of psychosocial deprivation on child development is discussed. Berlin L. Iodine-131 and the pregnant patient. AJR Am J Roentgenol 2001; 176(4):869-71. Bernstein AE. Interview criteria for assessing allegations of sexual abuse in children and adults. J Am Acad Berliner L. Shame in child maltreatment: contributions and Psychoanal Dyn Psychiatry 2004; 32(2):399. caveats. Child Maltreat 2005; 10(4):387-90. Abstract: This special section is a collection of papers Berntsen D, Rasmussen SR, Smith SF, Willadsen J. that investigates the role of shame in children with [Problematic report about recovered memories]. abuse histories. Relationships are found between Ugeskr Laeger 2004; 166(41):3623. abuse-specific shame or general shame proneness and a variety of outcomes. However, the relationships are not Berntsen D, Smith SF, Rasmussen SR, Willadsen J. consistent. The utility of these findings will be [Recovered memories]. Ugeskr Laeger 2004; enhanced by studies that use common measurement 166(36):3116; author reply 3116-7. approaches and address similar outcomes, as well specific tests of intervention approaches that target Berntsson LT, Kohler L. Quality of life among children aged 354
- 363. 2-17 years inthe five Nordic countries. Comparison formulas within 30 d postpartum [relative risk (RR) = between 1984 and 1996. Eur J Public Health 2001; 2.27; 95% confidence interval (CI) = 1.82-2.82]; 11(4):437-45. breastfeeding of a previous child for less than 6 mo Abstract: BACKGROUND: The aim of the study was (RR = 1.64; 95% CI = 1.32-2.02); delay in the first to analyse children's quality of life (QoL) in the five mother-child contact for over 90 min (RR = 1.50; 95% Nordic countries from 1984 to 1996, a period in which CI = 1.17-1.93); mother's having completed primary or major economic recessions occurred. METHODS: The partially completed secondary education (RR = 1.40; study design was cross-sectional based on a random 95% CI = 1.01-1.92) or completed secondary education sample of 3000 children in each country, aged 2 to 17 or higher (RR = 1.59; 95% CI = 1.14-2.22); years, totalling 15,000 in 1984 and 15,000 in 1996. The primiparous mother (RR = 1.39; 95% CI = 1.12-1.74) data were collected by mailed questionnaires. QoL was and; the mother recalling having been breastfed for less analysed for three spheres of life: external, than 6 mo (RR = 1.27; 95% CI = 1.01-1.61). interpersonal, personal including both factual and CONCLUSIONS: The purpose of strategies to promote perceived variables. The external sphere represented breastfeeding should be to eliminate inappropriate care the socio-economic conditions for the child's family, practices, such as delay in the first mother-child the interpersonal sphere the structure and the function contact, as well as reducing the impact of other factors of the child's social networks and the personal sphere leading to the introduction of artificial milk. Moreover, the psychological well-being of the child. RESULTS: mothers need more and better support from The total QoL for Nordic children from 1984 to 1996 professionals and peers. increased, but there were differences in the development of QoL between the countries. The Berry M, Cash SJ, Mathiesen SG. Validation of the objective QoL became better, at the same time the Strengths and Stressors Tracking Device with a child subjective QoL worsened, except in Denmark and welfare population. Child Welfare 2003; 82(3):293- Iceland. The external QoL became better, whereas the 318. interpersonal QoL was nearly unchanged but there Abstract: The Strengths and Stressors Tracking Device were differences in the development between countries. (SSTD) is a rapid assessment measure of family well- The personal QoL worsened slightly except for being that assesses the particular strengths and needs of children in Iceland. The ranking between countries families at intake to help guide case planning and changed. Danish children had the highest subjective evaluate the effectiveness of treatment. The device and Norwegian children the highest objective and assesses families from an ecological perspective in the external QoL. Swedish children had the highest domains of environmental conditions, social support, personal QoL. Children 7-12 years had the highest caregiver skills, and child well-being, and may be used QoL. Girls had a tendency to higher QoL in all ages. at multiple points during treatment to assess change. CONCLUSION: Nordic children still enjoy a high SSTD has high internal consistency in all domains, standard of living in spite of economic constraints, and distinguishes between physical abuse and neglect, and the prerequisites for a high QoL are fulfilled. Further is sensitive to specific changes made by families across research is suggested for clarifying the complex the duration of treatment. background of these results. Berry RM. Informed consent law, ethics, and practice: from Berra S, Sabulsky J, Rajmil L, Passamonte R, Pronsato J, infancy to reflective adolescence. HEC Forum 2005; Butinof M. Correlates of breastfeeding duration in an 17(1):64-81. urban cohort from Argentina. Acta Paediatr 2003; Notes: GENERAL NOTE: KIE: KIE Bib: informed 92(8):952-7. consent Abstract: AIM: To analyse factors associated with the duration of breastfeeding in a representative cohort of Bertrand D. Staying abreast of the benefits of nursing. J Natl mothers and children, including socio-demographic Med Assoc 2003; 95(2):107-8. and cultural characteristics, breastfeeding antecedents, perinatal factors and perinatal healthcare practices. Bess G, Allen J, Deters PB. The evaluation life cycle: a METHODS: The study was conducted in the city of retrospective assessment of stages and phases of the Cordoba, between 1993 and 1998. Mother-child circles of care initiative. Am Indian Alsk Native Ment binomials from all public and private hospitals were Health Res 2004; 11(2):30-41. asked to participate. Follow-up consisted of home Abstract: A life cycle metaphor characterizes the visits at 30 d, 6, 12, 24, 36, 48 and 50 mo. Information evolving relationship between the evaluator and was obtained on 650 healthy newborns. Cessation of program staff. This framework suggests that common breastfeeding during the first 24 mo of life was developmental dynamics occur in roughly the same analysed using the Kaplan-Meier method, and factors order across groups and settings. There are stage- associated with weaning were studied using Cox's specific dynamics that begin with Pre-History, which proportional risk regression. RESULTS: The median characterize the relationship between the grantees and duration of breastfeeding was 4 mo. Factors associated evaluator. The stages are: (a) Pre-History, (b) Process, with weaning were: the introduction of artificial 355
- 364. (c) Development, (d)Action, (e) Findings- significantly improve physical growth between 4 and Compilation, and (f) Transition. The common 12 mo of age. In a controlled trial, 418 infants 4 mo of dynamics, expectations, and activities for each stage age were individually randomized to one of the four are discussed. groups and followed until 12 mo of age. The first group received a milk-based cereal and nutritional Bhagavan SV, Raghu V. Utility of check dams in dilution of counseling; the second group monthly nutritional fluoride concentration in ground water and the resultant counseling alone. To control for the effect of twice- analysis of blood serum and urine of villagers, weekly home visits for morbidity ascertainment, Anantapur District, Andhra Pradesh, India. Environ similar visits were made in one of the control groups Geochem Health 2005; 27(1):97-108. (visitation group); the fourth group received no Abstract: High levels of fluoride (beyond 1.5 ppm) in intervention. The median energy intake from nonbreast ground water as source of drinking water are common milk sources was higher in the food supplementation in many parts of Andhra Pradesh, India, causing group than in the visitation group by 1212 kJ at 26 wk fluorosis. The study carried out in endemic Nalgonda (P < 0.001), 1739 kJ at 38 wk (P < 0.001) and 2257 kJ District, Andhra Pradesh, has indicated that the at 52 wk (P < 0.001). The food supplementation infants fluoride-rich ground water present in the wells located gained 250 g (95% confidence interval: 20--480 g) down stream and close to the surface water bodies is more weight than did the visitation group. The getting diluted by the low-fluoride surface water. difference in the mean increment in length during the Encouraged by this result, check dams were study was 0.4 cm (95% confidence interval: -0.1--0.9 constructed upstream of the identified marginally high cm). The nutritional counseling group had higher fluoride bearing ground water zones in Anantapur energy intakes ranging from 280 to 752 kJ at different District to reduce fluoride levels as an alternate ages (P < 0.05 at all ages) but no significant benefit on solution for safe drinking water.In this paper, an weight and length increments. Methods to enhance the attempt is made to study the utility and effect of these impact of these interventions need to be identified. check dams in dilution of fluoride concentration in drinking water and its resultant impact on the health Bhandari N, Mazumder S, Bahl R, Martines J, Black RE, aspects of certain villagers of Anantapur District Bhan MK. Use of multiple opportunities for improving through the analysis of their blood serum and urine. feeding practices in under-twos within child health Ground water samples from three fluoride-affected programmes. Health Policy Plan 2005; 20(5):328-36. villages, blood and urine of males and females from the Notes: CORPORATE NAME: Infant Feeding Study same villages were collected and analyzed for fluoride Group using ion selective electrode method. The results Abstract: OBJECTIVES: In a community randomized indicated that the fluoride levels in blood serum and trial, we aimed to promote exclusive breastfeeding and urine of males in the age group of 5-11 years are found appropriate complementary feeding practices in under- to be the highest. The concentration of fluoride in twos to ascertain the feasibility of using available ground water is directly proportional to the channels for nutrition counselling, their relative concentration of fluoride in blood serum and urine. The performance and the relationship between intensity of concentration of fluoride in ground water with depth of counselling and behaviour change. We also assessed the aquifer is a function of lithology, amount and whether using multiple opportunities to impart duration of rainfall, rate of infiltration, level of ground nutrition education adversely affected routine water exploitation in the area etc. The construction of activities. METHODS: We conducted a community check dams upstream of the identified marginally high randomized, controlled effectiveness trial in rural fluoride waters will not only cause additional recharge Haryana, India, with four intervention and four control of ground water but also reduces the fluoride communities. We trained health and nutrition workers concentration eventually improving the health of the in the intervention communities to counsel mothers at villagers. multiple contacts on breastfeeding exclusively for 6 months and on appropriate complementary feeding Bhandari N, Bahl R, Nayyar B, Khokhar P, Rohde JE, Bhan practices thereafter. The intervention was not just MK. Food supplementation with encouragement to training health and nutrition workers in counselling but feed it to infants from 4 to 12 months of age has a included community and health worker mobilization. small impact on weight gain. J Nutr 2001; FINDINGS: In the intervention group, about 32% of 131(7):1946-51. caregivers were counselled by traditional birth Abstract: It is unclear whether a substantial decline in attendants at birth. The most frequent sources of malnutrition among infants in developing countries can counselling from birth to 3 months were immunization be achieved by increasing food availability and sessions (45.1%) and home visits (32.1%), followed nutrition counseling without concurrent morbidity- closely by weighing sessions (25.5%); from 7 to 12 reducing interventions. The study was designed to months, home visits (42.6%) became more important determine whether provision of generous amounts of a than the other two. An increase in the number of micronutrient-fortified food supplement supported by channels through which caregivers were counselled counseling or nutritional counseling alone would was positively associated with exclusive breastfeeding 356
- 365. prevalence at 3months (p = 0.002), consumption of electrocardiogram, etc.) suffer from poor sensitivity milk/cereal gruel or mix use at 9 months (p = 0.004) and specificity in detecting congenital heart disease. and 18 months (p = 0.003), undiluted milk at 9 months Thus, patients with heart murmurs today are frequently (p<0.0001) and 24 hour non-breast-milk energy intakes assessed by consultation as well with advanced at 18 months (p = 0.023), after controlling for potential imaging techniques. The most prominent among these confounding factors. Intervention areas, compared with is echocardiography. However, echocardiography is the control, had higher coverage for vitamin A (45% expensive and is usually only available in healthcare vs. 11.5%) and iron folic acid (45% vs. 0.4%) centers in major cities. Thus, for patients being supplementation. CONCLUSIONS: Using multiple evaluated with a heart murmur, developing a more available opportunities and workers for counselling accurate screening device is vital to efforts in reducing caregivers was feasible, resulted in high coverage and health care costs. METHODS AND MATERIAL: The impact, and instead of disrupting ongoing services, data set was collected from incoming pediatrics at the resulted in their improvement. cardiology clinic of The Children's Hospital (Denver, Colorado), on whom echocardiography had been Bhatia S, Dranyi T, Rowley D. Tuberculosis among Tibetan performed to identify congenital heart disease. refugees in India. Soc Sci Med 2002; 54(3):423-32. Recordings of approximately 10-15s duration were Abstract: Tuberculosis (TB) is a major public health made at 44,100Hz and the average record length was problem among Tibetan refugees in India. To approximately 60,000 points. The best three cycles determine the incidence of and risk factors for TB with respect to signal quality sounds were extracted among Tibetan refugees in India, data on TB were from the original recording. The resulting data included in the demographic and health surveillance comprised 241 examples, of which 88 were examples project carried out by the Tibetan government-in-exile of innocent murmurs and 153 were examples of in Dharamsala from 1994 to 1996. Risk factor and pathological murmurs. The selected phonocardiograms morbidity data were determined by baseline and were subject to the digital signal processing (DSP) monthly follow-up home visits, and reported TB was technique of fast Fourier transform (FFT) to extract the confirmed by clinic records. The surveillance covered energy spectrum in frequency domain. The spectral approximately 90% of the refugees in civilian range was 0-300Hz at a resolution of 1Hz. The settlements and approximately 70% of the monks in processed signals were used to develop statistical monasteries. In the settlement population, TB classifiers and a classifier based on our in-house incidence was extraordinarily high in the settlement artificial neural network (ANN) software. For the population, 10.9/ 1,000 in 1994. but decreased to latter, we also tried enhancements to the basic ANN 7.7/1,000 in 1996. Incidence rates varied between scheme. These included a method for setting the regions, age groups, and occupational groups, being decision-threshold and a scheme for consensus-based highest in the Doon Valley (14.8/1,000). in sweater decision by a committee of experts. RESULTS: Of the sellers (16.7/1,000), and in the unemployed (23/1,000). different classifiers tested, the ANN-based classifier Among monastery monks, incidence rates were even performed the best. With this classifier, we were able higher than in the settlements, averaging 17.2/1,000 to achieve classification accuracy of 83% sensitivity over the 3-year period. The proportion of patients and 90% specificity in discriminating between innocent without sputum results and variation in the proportion and pathological heart murmurs. For the problem of of smear positive cases indicated inadequate use and discrimination between innocent murmurs and poor quality of laboratory services. India's Revised murmurs of the ventricular septal defect (VSD), the National Tuberculosis Control Program, based on accuracy was higher, with sensitivity of 90% and WHO-recommendations, has been highly successful in specificity of 93%. CONCLUSIONS: An ANN-based pilot districts and is being extended to the whole approach for detection and identification of congenital country. This program should be adopted promptly by heart disease in pediatrics from heart murmurs can the health care system serving Tibetan refugees and result in an accurate screening device. Considering that vigorously implemented among the refugee population. only a simple feature set was used for classification, the results are very encouraging and point out the need Bhatikar SR, DeGroff C, Mahajan RL. A classifier based on for further development using improved feature set the artificial neural network approach for cardiologic with more potent diagnostic variables. auscultation in pediatrics. Artif Intell Med 2005; 33(3):251-60. Bhatikar SR, Mahajan RL, DeGroff C. A novel paradigm for Abstract: OBJECTIVE: This research work was aimed telemedicine using the personal bio-monitor. Biomed at developing a reliable screening device for diagnosis Sci Instrum 2002; 38:59-70. of heart murmurs in pediatrics. This is a significant Abstract: The foray of solid-state technology in the problem in pediatric cardiology because of the high medical field has yielded an arsenal of sophisticated rate of incidence of heart murmurs in this population healthcare tools. Personal, portable computing power (reportedly 77-95%), of which only a small fraction coupled with the information superhighway open up arises from congenital heart disease. The screening the possibility of sophisticated healthcare management devices currently available (e.g. chest X-ray, that will impact the medical field just as much. The full 357
- 366. synergistic potential ofthree interwoven technologies: solving this task. (1) compact electronics, (2) World Wide Web, and (3) Artificial Intelligence is yet to be realized. The system Bidiwala S, Pittman T. Neural network classification of presented in this paper integrates these technologies pediatric posterior fossa tumors using clinical and synergistically, providing a new paradigm for imaging data. Pediatr Neurosurg 2004; 40(1):8-15. healthcare. Our idea is to deploy internet-enabled, Abstract: A neural network was developed that utilizes intelligent, handheld personal computers for medical both clinical and imaging (CT and MRI) data to predict diagnosis. The salient features of the 'Personal Bio- posterior fossa tumor (PFT) type. Data from 33 Monitor' we envisage are: (1) Utilization of the children with PFTs were used to develop and test the peripheral signals of the body which may be acquired system. When all desired information was available, non-invasively and with ease, for diagnosis of medical the network was able to correctly classify 85.7% of the conditions; (2) An Artificial Neural Network (ANN) tumors. In cases with incomplete data, it was able to based approach for diagnosis; (3) Configuration of the correctly classify 72.7% of the tumors. In both diagnostic device as a handheld for personal use; (4) instances, the diagnoses made by the network were Internet connectivity, following the emerging bluetooth more likely to be correct than those made by the protocol, for prompt conveyance of information to a neuroradiologists. patient's health care provider via the World Wide Web. The proposal is substantiated with an intelligent Bierman KL, Coie JD, Dodge KA et al. Using the Fast handheld device developed by the investigators for Track randomized prevention trial to test the early- pediatric cardiac auscultation. This device performed starter model of the development of serious conduct accurate diagnoses of cardiac abnormalities in problems. Dev Psychopathol 2002; 14(4):925-43. pediatrics using an artificial neural network to process Notes: CORPORATE NAME: Conduct Problems heart sounds acquired by a low-frequency microphone Prevention Research Group and transmitted its diagnosis to a desktop PC via Abstract: The Fast Track prevention trial was used to infrared. The idea of the personal biomonitor presented test hypotheses from the Early-Starter Model of the here has the potential to streamline healthcare by development of chronic conduct problems. We optimizing two valuable resources: physicians' time randomly assigned 891 high-risk first-grade boys and and sophisticated equipment time. We show that the girls (51% African American) to receive the long-term elements of such a system are in place, with our Fast Track prevention or not. After 4 years, outcomes prototype. Our novel contribution is the synergistic were assessed through teacher ratings, parent ratings, integration of compact electronics' technology, peer nominations, and child self-report. Positive effects artificial neural network methodology and the wireless of assignment to intervention were evident in teacher web resulting in a revolutionary new paradigm for and parent ratings of conduct problems, peer social healthcare management. preference scores, and association with deviant peers. Assessments of proximal goals of intervention (e.g., Bialystok E, Martin MM. Attention and inhibition in hostile attributional bias, problem-solving skill, harsh bilingual children: evidence from the dimensional parental discipline, aggressive and prosocial behavior change card sort task. Dev Sci 2004; 7(3):325-39. at home and school) collected after grade 3 were found Abstract: In a previous study, a bilingual advantage for to partially mediate these effects. The findings are preschool children in solving the dimensional change interpreted as consistent with developmental theory. card sort task was attributed to superiority in inhibition of attention (Bialystok, 1999). However, the task Bigman Z, Pratt H. Time course and nature of stimulus includes difficult representational demands to encode evaluation in category induction as revealed by visual and interpret the task stimuli, and bilinguals may also event-related potentials. Biol Psychol 2004; 66(2):99- have profited from superior representational abilities. 128. This possibility is examined in three studies. In Study Abstract: Category induction involves abstraction of 1, bilinguals outperformed monolinguals on versions of features common to two or more stimuli. We predicted the problem containing moderate representational that category induction affects processing of each demands but not on a more demanding condition. stimulus, before completion of perceptual analysis. Studies 2 and 3 demonstrated that bilingual children Event-related potentials (ERPs) were recorded from ten were more skilled than monolinguals when the target 11-13-year olds while they were performing visual dimensions were perceptual features of the stimulus category-induction tasks. Subjects viewed a series of and that the two groups were equivalent when the two geometric shapes belonging to the same perceptual target dimensions were semantic features. The category (size, color, or shape), defined by one or two conclusions are that bilinguals have better inhibitory shared features, and decided if a probe stimulus shared control for ignoring perceptual information than membership in that category. Large frontal N120, monolinguals do but are not more skilled in frontal-central N300 and smallest P450 were elicited representation, confirming the results of the original by the first stimulus; number of shared features study. The results also identify the ability to ignore an affected P150, N170, and P450 amplitudes to the obsolete display feature as the critical difficulty in 358
- 367. second stimulus. PrincipalComponent Analysis (PCA) mediators of family resemblances in weight status, indicated networks of frontal, parietal and occipital such as parents' disinhibited or binge eating and activity, different to each stimulus. Results suggest that parenting practices are shaped largely by in young adolescents category induction affects early environmental factors, individual differences in these stages of stimulus processing. Processing is based on behaviors also have genetic bases. A primary public selective analysis of stimuli for shared features, not health goal should be the development of family-based exhaustive examination of all features of all stimuli. prevention programs for childhood overweight. The findings reviewed here suggest that effective Billick SB. Preserving balance in forensic psychiatry. J Am prevention programs must focus on providing Acad Psychiatry Law 2001; 29(4):372-3. anticipatory guidance on parenting to foster patterns of preference and food selection in children more Billings J. Management matters: strengthening the research consistent with healthy diets and promote children's base to help improve performance of safety net ability to self-regulate intake. Guidance for parents providers. Health Care Manage Rev 2003; 28(4):323- should include information on how children develop 34. patterns of food intake in the family context. Practical Abstract: It is becoming increasingly apparent that advice for parents includes how to foster children's some disparities in health outcomes for vulnerable preferences for healthy foods and how to promote populations relate to performance of providers. Based acceptance of new foods by children. Parents need to on analysis of Medicaid claims records, large understand the costs of coercive feeding practices and differences in performance among primary care be given alternatives to restricting food and pressuring providers are documented for New York City patients, children to eat. Providing parents with easy-to-use suggesting the need for better evidence in making information regarding appropriate portion sizes for management decisions. children is also essential as are suggestions on the timing and frequency of meals and snacks. Especially Bilukha O, Hahn RA, Crosby A et al. The effectiveness of during early and middle childhood, family early childhood home visitation in preventing violence: environments are the key contents for the development a systematic review. Am J Prev Med 2005; 28(2 Suppl of food preferences, patterns of food intake, eating 1):11-39. styles, and the development of activity preferences and Notes: CORPORATE NAME: Task Force on patterns that shape children's developing weight status. Community Preventive Services Designing effective prevention programs will, however, require more complete knowledge than Birch LL, Davison KK. Family environmental factors currently available regarding behavioral intermediaries influencing the developing behavioral controls of food that foster overweight, including the family factors that intake and childhood overweight. Pediatr Clin North shape activity patterns, meals taken away from home, Am 2001; 48(4):893-907. the impact of stress on family members' eating styles, Abstract: Although a large body of research has food intake, activity patterns, and weight gain. The assessed direct genetic links between parent and child research presented here provides an example of how weight status, relatively little research has assessed the ideas regarding the effects of environmental factors and extent to which parents (particularly parents who are behavioral mediators on childhood overweight can be overweight) select environments that promote investigated. Such research requires the development overweight among their children. Parents provide food of reliable and valid measures of environmental environments for their children's early experiences with variables and behaviors. Because childhood overweight food and eating. These family eating environments is a multifactorial problem, additional research is include parents' own eating behaviors and child- needed to develop and test theoretic models describing feeding practices. Results of the limited research on how a wide range of environmental factors and behavioral mediators of familial patterns of overweight behavioral intermediaries can work in concert with indicate that parents' own eating behaviors and their genetic predispositions to promote the development of parenting practices influence the development of childhood overweight. The crucial test of these children's eating behaviors, mediating familial patterns theoretic models will be in preventive interventions. of overweight. In particular, parents who are overweight, who have problems controlling their own Birchall M, Bailey D, King P. Effect of process standards on food intake, or who are concerned about their children's survival of patients with head and neck cancer in the risk for overweight may adopt controlling child- south and west of England. Br J Cancer 2004; feeding practices in an attempt to prevent overweight 91(8):1477-81. in their children. Unfortunately, research reveals that Notes: CORPORATE NAME: South West Cancer these parental control attempts may interact with Intelligence Service Head and Neck Tumour Panel genetic predispositions to promote the development of Abstract: The aim of the study was to compare problematic eating styles and childhood overweight. standards for the process of care and 2-year survival Although the authors have argued that behavioral between two cohorts of patients with head and neck cancer in the south and west of England. A total of 566 359
- 368. and 727 patientspresented in 1996-97 and 1999-2000, psychological harm) can be distinguished from respectively. The median number of cases treated per secondary victimization (devaluation and mistrust in surgeon was 4 (1997, range 1-26) and 4 (2000, 1-23) the social environment). The degree of negative health and per radiotherapist was 10 (1-51) and 19 (1-70). For outcomes depends on risk factors like previous abuse, all 'nontemporal' standards, the overall standard severity of the violent act, and lack of social support. increased, without reaching minimum high targets, Prevention must aim at changes of societal conditions while most 'waiting times' increased. Overall 2-year that enhance sexual aggression and the establishment survival was 64.1% in 1997 and 65.1% in 2000. There of programs for men and women at risk in which was no difference in survival between networks (range techniques of control of sexual aggression, attenuation 56-68, 1997, log-rank test 4.1, P=0.4; 62-69, 2000, log- and inhibition can be learnt. rank test 1.26, P=0.69). Patients assessed by a multidisciplinary clinic exhibited improved survival Black J, Zenel JA. Child abuse by intentional iron poisoning (1997: P=0.1; 2000: hazard ratio 0.7, P=0.02), as did presenting as shock and persistent acidosis. Pediatrics those with a pretreatment chest X-ray (hazard ratio 0.7, 2003; 111(1):197-9. P=0.03). Despite an increased incidence, standards for Abstract: A case of intentional iron poisoning the process of care for patients with head and neck presented to our hospital. The patient's persistent cancer improved between 1996 and 2000, while acidosis and the team's observation of maternal waiting times increased and 2-year survival rates indifference indicated the diagnosis. This case should remained unaltered. Two out of five networks alert physicians to a potential source for intentional demonstrated centralisation of services between audits. poisoning that is present in most homes with young Being seen in a multidisciplinary clinic correlated infants. strongly with patient survival. Black MM, Sazawal S, Black RE, Khosla S, Kumar J, Bish JP, Ferrante SM, McDonald-McGinn D, Zackai E, Menon V. Cognitive and motor development among Simon TJ. Maladaptive conflict monitoring as evidence small-for-gestational-age infants: impact of zinc for executive dysfunction in children with chromosome supplementation, birth weight, and caregiving 22q11.2 deletion syndrome. Dev Sci 2005; 8(1):36-43. practices. Pediatrics 2004; 113(5):1297-305. Abstract: Using an adaptation of the Attentional Abstract: OBJECTIVE: Infants who are born small for Networks Test, we investigated aspects of executive gestational age (SGA) are at risk for developmental control in children with chromosome 22q11.2 deletion delays, which may be related to deficiencies in zinc, an syndrome (DS22q11.2), a common but not well essential trace metal, or to deficiencies in their ability understood disorder that produces non-verbal cognitive to elicit caregiver responsiveness (functional isolation deficits and a marked incidence of psychopathology. hypothesis). The objective of this study was to evaluate The data revealed that children with DS22q11.2 at 6 and 10 months of age the impact of a 9-month demonstrated greater difficulty than controls in supplementation trial of 5 mg of zinc on the locating and processing target items in the presence of development and behavior of infants who were born distracters. Importantly, children with DS22q11.2 SGA and to evaluate infants' ability to elicit responsive showed a deficit in the ability to monitor and adapt to caregiver behavior. METHODS: A randomized, stimulus conflict. These data provide evidence of controlled trial of zinc supplementation was conducted inadequate conflict adaptation in children with among 200 infants in a low-income, urban community DS22q11.2, a problem that is also present in in Delhi, India. Infants were recruited when they were schizophrenia. The findings of specific executive full term (>36 weeks) and SGA (birth weight <10th dysfunction in this group may provide a linkage percentile weight-for-gestational age). Infants were between particular genetic abnormalities and the randomized to receive daily supplements of a development of psychopathology. micronutrient mix (folate, iron, calcium, phosphorus, and riboflavin) with or without 5 mg of zinc sulfate. Bitzer J. [Sexual aggression against girls and adult women-- The supplement was administered by field workers causes and consequences]. Ther Umsch 2005; daily from 30 days to 9 months of age. At 6 and 10 62(4):217-22. months, infant development and behavior were Abstract: The causes of sexual aggression are multiple. measured in a clinical setting using the Bayley Scales Bioevolutionary rooted behavioral dispositions (sexual of Infant Development II. Caregiver responsiveness, aggressiveness of men as a reproductive strategy) are observed on an Indian version of the Home enforced by specific male dominated structures of Observation for Measurement of the Environment society and socially determined stereotypes of female scale, was measured during a home visit at 10 months. roles which deter women from self determination of During both the clinic and home visits, caregivers their sexuality; these macrosocial factors combine with reported on their infant's temperament. RESULTS: individual conditions of socialization, in which There were no direct effects of zinc supplementation violence plays an important role. With respect to the on the infants' development or behavior at either 6 or consequences of sexual aggression primary 10 months. In a subgroup analysis among the zinc- victimization (the trauma itself with physical and supplemented infants, lower birth weight infants were 360
- 369. perceived to bemore temperamentally difficult than and sleep through the night. OBJECTIVE: This higher weight infants; in the control group, birth weight investigation evaluated the efficacy of an intervention was not associated with temperament. Heavier birth to delay the early introduction of complementary weight infants had better scores on all measures of feeding among first-time, black, adolescent mothers development and behavior at 6 months and on changes living in multigenerational households. The in mental and motor development from 6 to 10 months, intervention focused on reducing the cultural barriers to compared with lighter birth weight infants. Boys had the acceptance of the recommendations of the better weight gain and higher scores on mental American Academy of Pediatrics, WIC, and World development and emotional regulation than girls. Health Organization on complementary feeding by Infants who were from families of higher highlighting 3 topics: 1) recognition of infants' cues; 2) socioeconomic status (indexed by parental education, nonfood strategies for managing infant behavior; and house size, and home ownership) had higher scores on 3) mother-grandmother negotiation strategies. The mental development and orientation/engagement intervention was delivered through a mentorship model (exploratory behavior) than infants who were from in which a videotape made by an advisory group of families of lower socioeconomic status. In keeping black adolescent mothers was incorporated into a with the functional isolation hypothesis, caregiver home-visiting program and evaluated through a responsiveness was associated with infant irritability, randomized, controlled trial. METHODS: One hundred controlling for socioeconomic status, gender, birth eighty-one first-time, low-income, black mothers <18 weight, and weight gain. Responsive mothers were years old, living in multigenerational households were more likely to perceive their infants to be recruited from 3 urban hospitals. Infants were born at temperamentally easy than less responsive mothers. term, with birth weight appropriate for gestational age CONCLUSION: Possible explanations for the lack of and no congenital problems. Shortly after delivery, effects of zinc supplementation on infant development mothers and grandmothers completed a baseline and behavior include 1) subtle effects of zinc assessment and mothers were randomized into an supplementation that may not have been detected by intervention or control group. Intervention group the Bayley Scales, 2) interference with other nutritional mothers received home visitation every other week for deficiencies, or 3) no impact of zinc deficiency on 1 year. At 3 months, a subset of 121 adolescent infants' development and behavior. The link between mothers reported on their infant's intake through a food birth weight and irritability among infants in the zinc frequency questionnaire. Mothers who fed their infant supplementation group suggests that the response to only breast milk, formula, or water were classified as zinc supplementation may differ by birth weight, with optimal feeders. Mothers who provided complementary irritability occurring among the most vulnerable foods other than breast milk, formula, or water were infants. Longer term follow-up studies among zinc- classified as less optimal feeders. RESULTS: Sixty-one supplemented infants are needed to examine whether percent of the infants received complementary foods early supplementation leads to developmental or before 3 months old. Multivariate hierarchical logistic behavioral changes that have an impact on school-age regression was used to evaluate the determinants of performance. The relationship between infant being in the optimal versus less optimal feeders group. irritability and low maternal responsiveness lends After controlling for infant age and family income, support to the functional isolation hypothesis and the mothers of infants in the optimal feeders group were importance of asking caregivers about infant more likely to report accurate messages from WIC temperament. regarding the timing of complementary food and nearly 4 times more likely to be in the intervention group. The Black MM, Siegel EH, Abel Y, Bentley ME. Home and most common complementary food was cereal mixed videotape intervention delays early complementary with formula in the bottle. CONCLUSIONS: The feeding among adolescent mothers. Pediatrics 2001; success of this relatively brief intervention 107(5):E67. demonstrates the importance of using ecological theory Abstract: BACKGROUND: The American Academy and ethnographic research to design interventions that of Pediatrics, the Special Supplemental Nutrition enable participants to alter their behavior in the face of Program for Women, Infants, and Children (WIC), and contradictory cultural norms. The intervention focused the World Health Organization recommend that infants on interpreting infants' cues, nonfood methods of receive only breast milk or formula for the first 4 to 6 managing infant behavior, and mother-grandmother months of life, followed by the introduction of negotiations. It was delivered through methods that complementary foods. Despite these recommendations, were familiar and acceptable to adolescent mothers-a many infants, particularly those with adolescent mentorship model incorporating home visits and mothers, receive solid foods (often cereal mixed with videotape. The skill-oriented aspects of the intervention formula in a bottle) and liquids other than formula or delivered in a culturally sensitive context may have breast milk in the first few weeks of life. Decisions on enabled the young mothers to follow the guidelines that early feeding are often guided by grandmothers and they received from WIC and from their pediatricians. influenced by beliefs that infants need complementary Strategies, such as those used in this intervention, may food to counteract signals of hunger, reduce crying, be effective in promoting other caregiving 361
- 370. recommendations, thereby enablingproviders to meet the trimester after discharge, and highly related to both the increasing demands from parents for advice child symptoms and family factors measurable at regarding children's early growth and development. admission. Results suggest that efforts to improve postdischarge outcomes of children should target the Black S, Andersen K, Loane MA, Wootton R. The potential initial period following inpatient care, address of telemedicine for home nursing in Queensland. J vigorously the complex treatment needs of those with Telemed Telecare 2001; 7(4):199-205. severe conduct problems, and aim to improve parent- Abstract: The potential for telemedicine in home child relations. nursing was examined by retrospectively reviewing the case-notes relating to home visits made by nurses in Blair PS, Ball HL. The prevalence and characteristics Queensland. The case-notes of 166 clients were associated with parent-infant bed-sharing in England. randomly selected from 10 domiciliary nursing centres Arch Dis Child 2004; 89(12):1106-10. run by the Blue Care nursing organization in south-east Abstract: AIMS: To investigate the characteristics of Queensland. Two experienced community registered parent-infant bed-sharing prevalence in England. nurses independently undertook a retrospective review METHODS: Data on night-time sleeping practices of the case-notes. Each reviewer made an independent from a two year, local, longitudinal study and a three- judgement as to whether any of the home nursing visits year, national, cross-sectional study were obtained. A in the episode of care could have been conducted by total of 261 infants in North Tees were followed up at 1 telemedicine. Visits requiring hands-on care were and 3 months of age, as were 1095 infants aged 1 week deemed to be unsuitable for telemedicine. A total of to 1 year from five English health regions. RESULTS: 12,630 home visits were reviewed. The median number Data from both studies found that almost half of all of visits per client was 27 (range 1-722). The mean age neonates bed-shared at some time with their parents of the clients was 72 years (range 2-93 years). A total (local = 47%, 95% CI 41 to 54; national = 46%, 95% of 1521 home visits (12%) were judged suitable for CI 34 to 58), and on any one night in the first month telemedicine. There was no significant difference in over a quarter of parents slept with their baby (local = suitability between males (13%) and females (12%). 27%, 95% CI 22 to 33; national = 30%, 95% CI 20 to Care interventions suitable for telemedicine were more 42). Bed-sharing was not related to younger mothers, likely to be those of a supportive, educational or review single mothers, or larger families, and was not more nature. Forty per cent of clients lived up to 5 km from common in the colder months, at weekends, or among the home nursing centre, 33% lived 5-10 km from the the more socially deprived families; in fact bed-sharing centre and 27% lived over 10 km from the centre. The was more common among the least deprived in the first results of the present study confirm the potential for months of life. Breast feeding was strongly associated telemedicine in home nursing in Australia. with bed-sharing, both at birth and at 3 months. Bed- sharing prevalence was uniform with infant age from 3 Blader JC. Symptom, family, and service predictors of to 12 months; on any one night over a fifth of parents children's psychiatric rehospitalization within one year (national = 21%, 95% CI 18 to 24) slept with their of discharge. J Am Acad Child Adolesc Psychiatry infants. CONCLUSION: Bed-sharing is a relatively 2004; 43(4):440-51. common practice in England, not specific to class, but Abstract: OBJECTIVE: To investigate predictors of strongly related to breast feeding. readmission to inpatient psychiatric treatment for children aged 5 to 12 discharged from acute-care Blair RJ. Neurocognitive models of aggression, the hospitalization. METHOD: One hundred nine children antisocial personality disorders, and psychopathy. J were followed for 1 year after discharge from inpatient Neurol Neurosurg Psychiatry 2001; 71(6):727-31. care. Time to rehospitalization was the outcome of Abstract: This paper considers neurocognitive models interest. Predictors of readmission, examined via the of aggression and relates them to explanations of the Cox proportional hazards model, were symptom and antisocial personality disorders. Two forms of family factors assessed at admission, aspects of aggression are distinguished: reactive aggression psychiatric treatment, and demographic variables. elicited in response to frustration/threat and goal RESULTS: The Kaplan-Meier rehospitalization risk directed, instrumental aggression. It is argued that within 1 year of discharge, taking into account known different forms of neurocognitive model are necessary readmissions and censored observations, was 0.37. to explain the emergence of these different forms of Most readmissions (81%) occurred within 90 days of aggression. Impairments in executive emotional discharge. Four variables contributed simultaneously to systems (the somatic marker system or the social predicting readmission risk. More severe conduct response reversal system) are related to reactive problems, harsh parental discipline, and disengaged aggression shown by patients with "acquired parent-child relations conferred a higher risk for sociopathy" due to orbitofrontal cortex lesions. rehospitalization; these risks were attenuated when Impairment in the capacity to form associations parents disclosed higher stress in their parenting roles. between emotional unconditioned stimuli, particularly CONCLUSIONS: Findings showed that psychiatric distress cues, and conditioned stimuli (the violence rehospitalization of children is common, most likely in inhibition mechanism model) is related to the 362
- 371. instrumental aggression shownby persons with disturbances frequently found among IBS patients, and developmental psychopathy. of the possible role of early abuse in IBS. A review of the psychosocial treatments for IBS finds strong Blair Y, Macpherson LM, McCall DR, McMahon AD, evidence to support the efficacy of hypnotherapy, Stephen KW. Glasgow nursery-based caries cognitive therapy, and brief psychodynamic experience, before and after a community psychotherapy. The research relating RAP to IBS is development-based oral health programme's briefly reviewed, as is the research on its psychological implementation. Community Dent Health 2004; treatment. Cognitive-behavioral therapy that combines 21(4):291-8. operant elements and stress management has the Abstract: OBJECTIVE: To develop and evaluate NHS- strongest support as a treatment for RAP. based strategies likely to improve dental health and reduce inequalities in pre-5-year-old's oral health in Blandon-Gitlin I, Pezdek K, Rogers M, Brodie L. Detecting Greater Glasgow, Scotland, by ecological study of deception in children: an experimental study of the community-based oral health promotion programmes effect of event familiarity on CBCA ratings. Law Hum in two of the area's most socio-economically deprived Behav 2005; 29(2):187-97. communities. BASIC RESEARCH DESIGN: Abstract: The CBCA is the most commonly used Following an initial health service-based Oral Health deception detection. technique worldwide. Pezdek et al. Needs Assessment (OHNA) in a severely deprived (2004) used a quasi-experimental design to assess community, culturally relevant dental health promotion children's accounts of a traumatic medical procedure; interventions were initiated with multidisciplinary CBCA ratings were higher for descriptions of familiar collaborative networks. Ecological studies to monitor than unfamiliar events. This study tested this effect dental health involved cross-sectional caries using an experimental design and assessed the joint epidemiology of nursery children aged 36-59 months at effect of familiarity and veracity on CBCA ratings. baseline (1995/96), after two (1997/98) and four years Children described a true or a fabricated event. Half (1999/00), in the G22 (pilot) and G33 post code areas. described a familiar event; half described an unfamiliar These areas had similar socio-economic status (SES), event. Two CBCA-trained judges rated transcripts of i.e. severe social deprivation. RESULTS: At the outset, the descriptions. CBCA scores were more strongly mean dmft scores in the pilot area for the age groups influenced by the familiarity than the actual veracity of 36-47 months and 48-59 months were respectively 3.9 the event, and CBCA scores were significantly (95% CI 2.8 5.1) and 5.9 (95% CI 5.1-6.8), with the correlated with age. CBCA results were compared with proportions of caries-free children being 38% and 17%, results from other measures. Together with the results respectively. Reductions in mean dmft of 46% for the of K. Pezdek et al. (2004) these findings suggest that in 36-47 month-olds and 37% for the 48-59 month-olds its current form, CBCA is of limited utility as a occurred in the pilot public health programme area credibility assessment tool. over the four-year period; the proportions of caries-free children increased to 51% and 40%, respectively. Blank D. [Injury control from the perspective of contextual During the first two years of the programme, increases pediatrics]. J Pediatr (Rio J) 2005; 81(5 Suppl):S123- in the mean dmft of 36-47 month- and 48-59 month- 36. olds in the G33 (comparator) area were recorded. Abstract: OBJECTIVE: To describe the relationship However, this trend was reversed significantly two between injury control and contextual pediatrics. years later following the introduction of a similar SOURCES OF DATA: Quasi-systematic review of community development-based caries-prevention MEDLINE, SciELO and LILACS databases, using programme. CONCLUSION: While not being able to combinations of the words contextual, community, attribute causation, a programme of community injury, accident and violence; and non-systematic development to promote the dental health of pre-school review of book chapters and classic articles. children residing in two socio-economically SUMMARY OF THE FINDINGS: Safety depends on disadvantaged areas of Glasgow was associated with the interaction of family habits, cultural patterns and significant improvements in the dental health of these surroundings. Contextual pediatrics sees the child, the pre-school populations. family, and the community as a continuum; health diagnosis (sequential observation of problems and Blanchard EB, Scharff L. Psychosocial aspects of assets) is one of its cornerstones. Changing assessment and treatment of irritable bowel syndrome intrapersonal factors for injuries requires the use of in adults and recurrent abdominal pain in children. J both passive and active strategies. Family and cultural Consult Clin Psychol 2002; 70(3):725-38. risk factors for injury: home overcrowding, moving, Abstract: This article presents a selective review of poverty, and young, illiterate and unemployed parents. psychosocial research on irritable bowel syndrome The main neighborhood factors: material deprivation (IBS) in adults and on a possible developmental and traffic. Cultural factors: illiteracy, unsafe products, precursor, recurrent abdominal pain (RAP), in children. lack of mass transportation, handguns, workplaces For IBS the authors provide a summary of without safety rules, faulty community organization, epidemiology, of the psychological and psychiatric lack of communication between social sectors, 363
- 372. inadequate legislation, lowpriority for safety among diversity of experiences and views about parenting, and government actions, lack of economic resources, and included the parents of children up to the age of 6 low academic commitment with the field of safety. years, health visitors and family support centre CONCLUSIONS: The pediatrician's roles include workers. The mothers were those waiting to attend a strengthening of the longitudinal relationship with parenting programme, and included first-time mothers families, integrated interdisciplinary work, constructive and those with more than one child. The health visitors intervention, partnership with community, counseling and family support workers had a range of experience on injury risks pertaining to each developmental stage, in working with parents and children, and included by using lists with explicit processes and contents, and those who were facilitating parenting programmes and by handing out written materials. Active advocacy for those who were not. A number of themes emerged safety promotion in different environments, besides the surrounding the challenges and difficulties of parenting clinical setting. and effective parenting, including expectations of others, establishing routines, play, behavioural issues Blank M. Building the community school movement: vision, and discipline, empathy, and communication. Similar organization, and leadership. New Dir Youth Dev themes emerged from all groups; however, there were 2005; (107):99-104, table of contents. qualitative differences between parents and Abstract: On a local level, creating and sustaining professionals in the way in which these issues were community schools requires leadership from local expressed. Key statements from the parent focus government, schools, businesses, and nonprofit groups have been developed into self-efficacy organizations. These groups must provide the fuel and statements, which will be used as input to the direction to move the community school strategy development of a tool to measure the effectiveness of forward along a common vision and with strategic parenting programmes. methods for financing. At the federal level, it must continue to build constituency for community schools Bloss E, Wainaina F, Bailey RC. Prevalence and predictors if it is to succeed, although the community school of underweight, stunting, and wasting among children movement has made great strides in recent years. There aged 5 and under in western Kenya. J Trop Pediatr is not now a coherent federal framework to support the 2004; 50(5):260-70. community school vision. The proposed Full Services Abstract: The health and nutritional status of children Community Schools legislation would build a national aged 5 and under was assessed in three villages in constituency and legislate key principles advocated by Siaya District of western Kenya. A cross-sectional the Coalition for Community Schools: developing survey was conducted among 121 adults and 175 districtwide community school strategies, focusing on children during July 2002. Primary caretakers were results, and improving coordination of funding streams. interviewed during home visits to assess agricultural and sanitation resources, child feeding practices, and Block RW. Fillers. Pediatrics 2004; 113(2):432-3; author the nutritional status of their children aged 5 years and reply 432-3. under. Through anthropometry, the prevalence of underweight, stunting and wasting were determined: 30 Bloomfield L, Kendall S, Applin L et al. A qualitative study per cent were underweight, 47 per cent were stunted, exploring the experiences and views of mothers, health and 7 per cent were wasted. Predictors of visitors and family support centre workers on the undernutrition were analysed using logistic regression challenges and difficulties of parenting. Health Soc controlling for age, sex, and SES, and four major Care Community 2005; 13(1):46-55. findings emerged. First, children in their second year of Abstract: Successive policy documents have referred to life were more likely to be underweight and stunted. the need to support parents as an approach to reducing Second, children who were introduced to foods early social exclusion, behaviour problems among young had an increased risk of being underweight. Third, up- people and crime rates. Much of the rhetoric focuses on to-date vaccinations were protective against stunting, professional intervention, and there is less attention while reports of having upper respiratory infections or paid to the views and experiences of parents other illness in the past month predicted underweight. themselves. The present study explores the experiences Finally, living with non-biological parents significantly and views of mothers, health visitors and family increased risk of stunting. Emphasis should be placed support centre workers who work with parents on the on current immunization, prolonging exclusive challenges and difficulties of parenting children under breastfeeding, and improving access to nutrient-rich the age of 6 years. It provides an appreciation of their foods among adopted children and their families via views on effective parenting and how parents can be community-based nutrition interventions. helped to feel more effective in the parenting role. Focus groups, which were exploratory and interactive Blum JD, Talib N, Carstens P, Nasser M, Tomkin D, in form, were conducted across three primary care McAuley A. Rights of patients: comparative trusts in Hertfordshire, UK. Three samples were perspectives from five countries. Med Law 2003; purposively selected in order to examine the range and 22(3):451-71. Notes: GENERAL NOTE: KIE: 18 fn. 364
- 373. GENERAL NOTE: KIE:KIE Bib: health good results from psychiatric treatment. In Sweden care/economics; patients' rights there is a lack of consensus and conflicting political Abstract: Recognition and articulation of patient rights and medical perspectives prevail regarding the are core issues in the medical jurisprudence of most "apathetic" children. CONCLUSION: Children living nations. While the nature of rights in medical care may under unbearable life conditions can develop life- vary from country to country, reflecting the threatening depression-withdrawal stress reactions well idiosyncrasies of domestic law and health delivery, known as pervasive refusal syndrome (PRS). This is there are commonalities in this area of law that cut also true of children in traumatized asylum-seeking across borders. This paper presents five case studies in families. Excellent results are achieved when the the patient rights area from Malaysia, Ireland, South family's underlying fear and hopelessness can be erased Africa, Indonesia and the United States, respectively. and the treatment focuses on the traumatic experiences. The case discussions range from ongoing and fundamental concerns over broad patient rights issues, Bogard KL. Affluent adolescents, depression, and drug use: such as access to health care and informed consent, to the role of adults in their lives. Adolescence 2005; rights concerns of those suffering from HIV/AIDS, to a 40(158):281-306. novel consideration over ethical and legal issues Abstract: The present study examined the association concerning ownership of infant organs. It is the hope of between adult supports to whom affluent youth turn the authors that individually, and collectively, the cases when personally troubled or upset and their self- will provide helpful insights into this core area of reported depression and drug use. The sample medical law. consisted of 374 affluent seventh graders. Perceived parental closeness played a mediating role in reducing Blumberg D. Stage model of recovery for chemically depressive symptomology and drug use. Contrary to dependent adolescents: part 1--methods and model. J hypothesized predictions, other adult supports showed Psychoactive Drugs 2004; 36(3):323-45. neither mediating nor moderating effect on adjustment. Abstract: This qualitative study, presented in two parts, The data show that the presence of other adult supports refines the model of how chemically dependent in the context of low parental closeness actually adolescents initiate and engage in the recovery process. exacerbates, not moderates, maladjustment. Since this Part 1 describes the research process and results used to finding is contradictory to the support literature with derive the model. The model was derived from theory various populations, which shows the importance of grounded in verbatim reports of 30 chemically social supports for psychological well-being, the dependent participants who first attempted recovery particularity of this population and their potential from chemical dependence during adolescence. The challenges are highlighted. constant comparative method of grounded theory was used to analyze the data. This stage model of Bogels SM, van Oosten A, Muris P, Smulders D. Familial adolescent recovery includes the correlates of social anxiety in children and adolescents. using/precontemplation, transition, early recovery, and Behav Res Ther 2001; 39(3):273-87. ongoing recovery stages; the transition stage is divided Abstract: Retrospective studies suggest a relationship into contemplation and action phases. The stages, between parental rearing practices and social phobia. phases, and significant events are similar, but not The present study investigated whether socially identical to, those presented in adult-based models of anxious children perceive their current parental rearing recovery from chemical dependence. In Part 2, the as rejecting, overprotective, and lacking emotional resulting theory is compared with extant theories on warmth, and as emphasizing the importance of other's stages of recovery in chemically dependent adults, opinion, and de-emphasizing social initiatives and treatment implications for the adolescent population family sociability. Furthermore, we examined whether are reviewed, and topics for further research are parents of socially anxious children report to rely on suggested. such rearing practices, and suffer themselves from social fears. A regression analysis as well as extreme Bodegard G. Pervasive loss of function in asylum-seeking group comparisons were applied. Little support was children in Sweden. Acta Paediatr 2005; 94(12):1706- found for the presumed role of the assessed family 7. rearing aspects in the development of social anxiety in Abstract: Presently, a couple of hundred children from children. Solely family sociability (children's and traumatized asylum-seeking families in Sweden have mothers' report) and children's perception of developed severe loss of mental and physical functions overprotection of the mother predicted social anxiety in without evidence of underlying disease. Of the 23 the regression analysis. Given the influence of the treated children treated at this clinic, 15 have mentioned rearing practices, social anxiety of the recovered, three are improving and five are under mother still significantly predicted social anxiety of the initial care. Communication within the family is crucial child. In the extreme group comparisons, differences in from both pathogenic and salutogenic perspectives. A the expected direction were found between socially permanent residence permit, correcting the underlying anxious and normal children on parental rejection, situation of threat and insecurity, is a condition for emotional warmth, and family sociability. However, 365
- 374. the lack ofdifferences between socially anxious and these findings for the study of disclosure of traumatic clinical control children suggests that these variables events, facial expression, and the links between do not form a specific pathway to social fears. morality and emotion. Bohn DK, Tebben JG, Campbell JC. Influences of income, Bond C. Positive Touch and massage in the neonatal unit: a education, age, and ethnicity on physical abuse before British approach. Semin Neonatol 2002; 7(6):477-86. and during pregnancy. J Obstet Gynecol Neonatal Nurs Abstract: There is now a general trend towards a more 2004; 33(5):561-71. baby friendly, family centred approach in the Neonatal Abstract: OBJECTIVE: To examine the influence of Unit. Aspects of that approach-including positive touch socioeconomic status, education, ethnicity, and age on and massage- are gaining in popularity. This has the prevalence of intimate partner abuse before and caused much debate due to the ambiguity surrounding during pregnancy. DESIGN: Retrospective the implementation and validity of the interventions. correlational analysis. SETTING: Data were collected Here the impact of these complementary practices (not at six postpartum maternity settings. PARTICIPANTS: to be confused with complementary therapies) is 1,004 women from six ethnic groups. MAIN discussed. A review of the author's approach and OUTCOME MEASURE: Prevalence of intimate potential guidelines for implementation is provided. partner violence. RESULTS: 15.9% of study participants reported physical abuse by their current Bonnier C, Mesples B, Carpentier S, Henin D, Gressens P. partner and 5.2% reported abuse during pregnancy. Delayed white matter injury in a murine model of Decreased income, not having a high school education, shaken baby syndrome. Brain Pathol 2002; 12(3):320- and ethnicity were significantly related to current abuse 8. and abuse during pregnancy in bivariate analyses. Abstract: Shaken baby syndrome, a rotational Having less than a high school education emerged as acceleration injury, is most common between 3 and 6 the most significant predictor of both abuse variables in months of age and causes death in about 10 to 40% of multivariate analyses. African American and Puerto cases and permanent neurological abnormalities in Rican women had the highest incidence of abuse in survivors. We developed a mouse model of shaken their current relationship. No significant differences baby syndrome to investigate the pathophysiological were found in rates of abuse during pregnancy among mechanisms underlying the brain damage. Eight-day- women from different ethnic groups. CONCLUSIONS: old mouse pups were shaken for 15 seconds on a The results of this analysis support the notion that rotating shaker. Animals were sacrificed at different abuse is most prevalent among the most disadvantaged ages after shaking and brains were processed for women. However, it is not income per se, but rather the histology. In 31-day-old pups, mortality was 27%, and highly related variables of education and ethnicity that 75% of survivors had focal brain lesions consisting of have the largest effect. Abuse occurs frequently among hemorrhagic or cystic lesions of the periventricular all women, warranting universal screening during white matter, corpus callosum, and brainstem and health care encounters. Further research is needed to cerebellar white matter. Hemorrhagic lesions were evaluate relationships between education, ethnicity, evident from postnatal day 13, and cysts developed income, and abuse. gradually between days 15 and 31. All shaken animals, with or without focal lesions, had thinning of the Bonanno GA, Keltner D, Noll JG et al. When the face hemispheric white matter, which was significant on reveals what words do not: facial expressions of day 31 but not earlier. Fragmented DNA labeling emotion, smiling, and the willingness to disclose revealed a significant increase in cell death in the childhood sexual abuse. J Pers Soc Psychol 2002; periventricular white matter, on days 9 and 13. White 83(1):94-110. matter damage was reduced by pre-treatment with the Abstract: For survivors of childhood sexual abuse NMDA receptor antagonist MK-801. This study (CSA), verbal disclosure is often complex and painful. showed that shaking immature mice produced white The authors examined the voluntary disclosure- matter injury mimicking several aspects of human nondisclosure of CSA in relation to nonverbal shaken baby syndrome and provided evidence that expressions of emotion in the face. Consistent with excess release of glutamate plays a role in the hypotheses derived from recent theorizing about the pathophysiology of the lesions. moral nature of emotion, CSA survivors who did not voluntarily disclose CSA showed greater facial Bonnier C, Mesples B, Gressens P. Animal models of expressions of shame, whereas CSA survivors who shaken baby syndrome: revisiting the pathophysiology voluntarily disclosed CSA expressed greater disgust. of this devastating injury. Pediatr Rehabil 2004; Expressions of disgust also signaled sexual abuse 7(3):165-71. accompanied by violence. Consistent with recent Abstract: To better understand outcomes after early theorizing about smiling behavior, CSA nondisclosers brain injuries, studies must address multiple variables made more polite smiles, whereas nonabused including age at injury, the mechanisms and severity of participants expressed greater genuine positive injury, environmental factors (before and after injury) emotion. Discussion addressed the implications of 366
- 375. and developmental factors.Animal models are helpful matter. Presence of intraparenchymal brain lesions for elucidating these different aspects. First, this paper within the first 3 months was significantly associated describes a new model of shaken baby syndrome (SBS) with neurodevelopmental impairment. Severity of in mice, without impact or hypoxia. Mortality was motor and cognitive dysfunctions was related to the 27%; 75% of survivors had focal brain lesions extent of intraparenchymal lesions. CONCLUSIONS: consisting of haemorrhagic or cystic lesions of the Early clinical and radiologic findings in NAHI are of white matter, corpus callosum and cerebellum. All prognostic value for neurodevelopmental outcome. shaken animals, with and without focal lesions, showed delayed white matter atrophy. White matter damage Bonu S, Rani M, Razum O. Global public health mandates and atrophy were reduced by pre-treatment with an in a diverse world: the polio eradication initiative and NMDA receptor antagonist, indicating that excess the expanded programme on immunization in sub- glutamate release contributed to the pathophysiology of Saharan Africa and South Asia. Health Policy 2004; the lesions. Secondly, it discusses data on 70(3):327-45. neuroprotection after early brain injuries; drugs Abstract: BACKGROUND: The circulation of wild targeting the NMDA receptors cannot be used in poliovirus is expected to cease soon due to the success clinical practice but indirect neuroprotection strategies of the global polio eradication initiative. Thereafter, including anti-NO, anti-free radicals and trophic factors intensified polio eradication efforts such as National hold promise for limiting the excitotoxic white matter Immunisation Days (NIDs) will most likely be damage induced by early injury, in particular caused by discontinued. As a consequence, the expanded shaking, during brain development. Thirdly, it programme on immunization (EPI) will no longer describes two experimental models in which SBS enjoy extra inputs from the polio eradication initiative. outcomes are determined when the trauma is combined We investigated whether today's EPIs are ensuring with environmental influences, namely medications universal and equitable vaccine coverage; and whether during the acute phase, most notably anti-epileptic the removal of extra inputs associated with the drugs and rearing conditions. implementation of NIDs is likely to affect EPI coverage and equity. METHODS: Using data from Bonnier C, Nassogne MC, Saint-Martin C, Mesples B, Demographic and Health Surveys conducted in 15 Kadhim H, Sebire G. Neuroimaging of countries of South Asia and Africa during 1990-2001, intraparenchymal lesions predicts outcome in shaken we examined absolute levels of EPI coverage; changes baby syndrome. Pediatrics 2003; 112(4):808-14. in EPI coverage after the introduction of NIDs; and Abstract: OBJECTIVE: Studies of long-term outcome relative coverage according to urban versus rural on nonaccidental head injury (NAHI) in young children residence, higher versus lower education of mothers, have shown severe neurodevelopmental sequelae in and wealthiest vs. poorest population segment. most cases. For improving the knowledge of outcome RESULTS: Polio and non-polio antigen coverage and for identifying prognostic factors, additional increased in seven countries during the study period. clinical and cerebral imaging data are needed. The aim Substantial inequalities in coverage of non-polio of this study was to describe clinical and imaging antigens persist, however, translating into inequities in features over time and to consider their value for the risk of contracting vaccine preventable diseases. In predicting neurodevelopmental outcome. METHODS: some African countries, routine EPI coverage and/or A retrospective medical record review was conducted equity declined during the study period. In these of 23 children with confirmed NAHI, for whom an countries, any positive effect of NIDs on the EPI extended follow-up of 2.5 to 13 years (mean: 6 years) coverage must have been small, relative to the negative was contemplated. Glasgow Coma Scale scores, effects of declining economies or deteriorating health severity of retinal hemorrhages, presence of skull systems. In Nigeria, Zimbabwe, Kenya and Malawi, fractures, cranial growth deceleration, and sequential even polio coverage declined, in spite of the neuroimaging data (computed tomography and/or introduction of NIDs. CONCLUSION: As additional magnetic resonance imaging) were compared with inputs associated with polio eradication will cease, patterns of clinical evolution assessed by the Glasgow routine EPI services need to be strengthened Outcome Scale. RESULTS: Clinical outcome showed substantially in order to maintain levels of population that 14 (61%) children had severe disabilities, 8 (35%) immunity against polio and to improve social equity in had moderate disabilities, and 1 (4%) was normal. A the coverage of non-polio EPI antigens. Our findings low initial Glasgow Coma Scale score, severe retinal imply that this aim will require additional inputs, hemorrhages, presence of skull fracture, and cranial particularly in African countries. growth deceleration were significantly associated with poor developmental outcome. Eighteen of the 23 Bonuck KA, Trombley M, Freeman K, McKee D. patients had abnormal magnetic resonance imaging Randomized, controlled trial of a prenatal and postnatal scans. This examination disclosed atrophy when lactation consultant intervention on duration and performed beyond 15 days of injury. Atrophy intensity of breastfeeding up to 12 months. Pediatrics seemingly resulted from various brain lesions, namely, 2005; 116(6):1413-26. contusions, infarcts, and other lesions within the white Abstract: OBJECTIVE: To determine whether an 367
- 376. individualized, prenatal andpostnatal, lactation for further pathologic characterization (cellular and consultant intervention resulted in increased architectural). Three pathologic groups were identified: cumulative intensity of breastfeeding up to 52 weeks. type I; architectural disorganization with/without giant DESIGN: The randomized, nonblinded, controlled trial neurons, type IIA; architectural disorganization with recruited women from prenatal care. Baseline prenatal dysmorphic neurons, and type IIB; architectural interviews covered demographic data and breastfeeding disorganization, dysmorphic neurons, and balloon cells experience, intention, and knowledge. Interviews at 1, (BCs). The focal histopathologic subtypes of MCDs in 2, 3, 4, 6, 8, 10, and 12 months after birth collected cortical tissue resected were then retrospectively data on weekly feeding patterns, infant illness, and correlated with in situ extraoperative ECoG patterns. infant health care use. SETTING: Two community RESULTS: Cortical areas with histopathologic subtype health centers serving low-income, primarily Hispanic IIA showed significantly higher numbers of slow and/or black women. PARTICIPANTS: The analytic repetitive spike pattern in comparison with sample included 304 women (intervention: n = 145; histopathologic type I (p = 0.007) and normal control: n = 159) with > or = 1 postnatal interview. pathology (p = 0.002). The ictal onset came mainly INTERVENTION: Study lactation consultants from cortical areas with histopathologic type IIA (nine attempted 2 prenatal meetings, a postpartum hospital of 15 patients). None of the seizures originated from visit, and/or home visits and telephone calls. Control neocortical areas that showed BC-containing MCD subjects received the standard of care. OUTCOME (type IIB). CONCLUSIONS: This study shows that MEASURES: Cumulative breastfeeding intensity at 13 areas containing BCs are less epileptogenic than are and 52 weeks, based on self-reports of weekly feeding, closely located dysplastic regions. These results on a 7-level scale. RESULTS: The intervention group suggest a possible protective effect of BCs or a severe was more likely to breastfeed through week 20 (53.0% disruption in the neuronal networks in BCs containing vs 39.3%). Exclusive breastfeeding rates were low and dysplastic lesions. Further studies are needed to did not differ according to group. In multivariate elucidate the nature and the potential role(s) of balloon analyses, control subjects had lower breastfeeding cells in MCD-induced epileptogenicity. intensity at 13 weeks (odds ratio [OR]: 1.90; 95% confidence interval [CI]: 1.13-3.20) and 52 weeks (OR: Booth JR, Burman DD, Meyer JR, Gitelman DR, Parrish 2.50; 95% CI: 1.48-4.21). US-born control subjects had TB, Mesulam MM. Development of brain mechanisms lowest breastfeeding intensity at 13 weeks (OR: 5.22; for processing orthographic and phonologic 95% CI: 2.43-11.22) and 52 weeks (OR: 5.25; 95% CI: representations. J Cogn Neurosci 2004; 16(7):1234-49. 2.44-11.29). There were no significant differences in Abstract: Developmental differences in the breastfeeding intensity among the US-born neurocognitive networks for lexical processing were intervention, foreign-born intervention, and foreign- examined in 15 adults and 15 children (9- to 12-year- born control groups. CONCLUSIONS: This "best- olds) using functional magnetic resonance imaging practices" intervention was effective in increasing (fMRI). The lexical tasks involved spelling and breastfeeding duration and intensity. Breastfeeding rhyming judgments in either the visual or auditory promotion should focus on US-born women and modality. These lexical tasks were compared with exclusive breastfeeding. nonlinguistic control tasks involving judgments of line patterns or tone sequences. The first main finding was Boonyapisit K, Najm I, Klem G et al. Epileptogenicity of that adults showed greater activation than children focal malformations due to abnormal cortical during the cross-modal lexical tasks in a region development: direct electrocorticographic- proposed to be involved in mapping between histopathologic correlations. Epilepsia 2003; 44(1):69- orthographic and phonologic representations. The 76. visual rhyming task, which required conversion from Abstract: PURPOSE: Malformations due to abnormal orthography to phonology, produced greater activation cortical development (MCDs) are common pathologic for adults in the angular gyrus. The auditory spelling substrates of medically intractable epilepsy. The in situ task, which required the conversion from phonology to epileptogenicity of these lesions as well as its relation orthography, also produced greater activation for adults to histopathologic changes remains unknown. The in the angular gyrus. The greater activation for adults purpose of this study was to correlate the cellular suggests they may have a more elaborated posterior patterns of MCDs with the expression of focal cortical heteromodal system for mapping between epileptogenicity as assessed by direct extraoperative representational systems. The second main finding was electrocorticographic (ECoG) recordings by using that adults showed greater activation than children subdural grids. METHODS: Fifteen patients with drug- during the intra-modal lexical tasks in the angular resistant focal epilepsy due to pathologically confirmed gyrus. The visual spelling and auditory rhyming did not MCD who underwent subdural electrode placement for require conversion between orthography and extraoperative seizure localization and cortical phonology for correct performance but the adults mapping between 1997 and 2000 were included in the showed greater activation in a system implicated for study. Areas of interictal spiking and ictal-onset this mapping. The greater activation for adults suggests patterns were identified and separated during surgery that they have more interactive convergence between 368
- 377. representational systems duringlexical processing. highlights how important it is for expectant mothers and new mothers to be confirmed in their mothering Booth JR, Burman DD, Meyer JR et al. Larger deficits in role. Nurses in the maternity and child health services brain networks for response inhibition than for visual have an important task to support people in becoming selective attention in attention deficit hyperactivity and being parents, with regard to their emotional state. disorder (ADHD). J Child Psychol Psychiatry 2005; There is a need for more resources within these 46(1):94-111. services for establishing parent groups, including Abstract: BACKGROUND: Brain activation groups for fathers. This could improve parents' differences between 12 control and 12 attention deficit physical, psychological and emotional health, and hyperactivity disorder (ADHD) children (9- to 12-year- decrease their need for health and social services. olds) were examined on two cognitive tasks during functional magnetic resonance imaging (fMRI). Borowsky IW, Mozayeny S, Stuenkel K, Ireland M. Effects METHOD: Visual selective attention was measured of a primary care-based intervention on violent with the visual search of a conjunction target (red behavior and injury in children. Pediatrics 2004; triangle) in a field of distracters and response inhibition 114(4):e392-9. was measured with a go/no-go task. RESULTS: There Abstract: OBJECTIVE: Although many major health were limited group differences in the selective attention care organizations have made recommendations task, with control children showing significantly regarding physicians' roles in preventing youth greater intensity of activation in a small area of the violence, the efficacy of violence prevention strategies superior parietal lobule region of interest. There were in primary care settings remains to be empirically large group differences in the response inhibition task, tested. METHODS: We conducted a randomized, with control children showing significantly greater controlled trial to evaluate the effects of an office- intensity of activation in fronto-striatal regions of based intervention on children's violent behaviors and interest including the inferior, middle, superior and violence-related injuries. Children 7 to 15 years of age medial frontal gyri as well as the caudate nucleus and who presented at 8 pediatric practices and scored globus pallidus. CONCLUSION: The widespread positive on a brief psychosocial screening test (n = hypoactivity for the ADHD children on the go/no-go 224) were randomly assigned to an intervention group task is consistent with the hypothesis that response (clinicians saw the screening test results during the inhibition is a specific deficit in attention deficit visit and a telephone-based parenting education hyperactivity disorder. program was made available to clinicians as a referral resource for parents) or a control group (clinicians did Borg E. The legal status of the fetus. Can Nurse 2005; not see the screening test results). RESULTS: 101(8):19. Compared with control subjects, at 9 months after study enrollment, children in the intervention group Borjesson B, Paperin C, Lindell M. Maternal support during exhibited decreases in aggressive behavior (adjusted the first year of infancy. J Adv Nurs 2004; 45(6):588- mean difference: -1.71; 95% confidence interval [CI]: - 94. 2.89 to -0.53), delinquent behavior (adjusted mean Abstract: BACKGROUND: Mental health problems difference: -0.71; 95% CI: -1.28 to -0.13), and attention among children and adolescents are becoming more problems (adjusted mean difference: -1.02; 95% CI, - visible and some research indicates that they are 1.77 to -0.26) on the Child Behavior Checklist. increasing. Several studies suggest that social support Children in the intervention group had lower rates of counteracts the increasing risk of ill-health in families parent-reported bullying (adjusted odds ratio: 4.43; with children. However, there is a lack of studies which 95% CI: 1.87-10.52), physical fighting (adjusted odds focus on the support that expectant mothers and parents ratio: 1.79; 95% CI: 1.11-2.87), and fight-related might need. AIM: The aim of the study was to describe injuries requiring medical care (adjusted odds ratio: mothers' experiences of pregnancy, labour and 4.70; 95% CI: 1.33-16.59) and of child-reported homecoming, support needs, and sources of support in victimization by bullying (adjusted odds ratio: 3.23; their role as parents. METHODS: One hundred and 95% CI: 1.96-5.31). CONCLUSIONS: A primary care- twenty-two mothers participated in the study by based intervention that includes psychosocial screening answering a questionnaire consisting of 37 questions. and the availability of a parenting education resource Data were analysed using descriptive statistics, chi- can decrease violent behavior and injury among square tests and content analysis. FINDINGS: Mothers youths. of infants had a great need to talk about their experiences of labour soon afterwards and over the Bosch X. Spain makes plans to combat sex tourism. Lancet following months. Most of the mothers had generally 2004; 363(9408):542. received support from their partners. However, in some situations, other people in their networks, and Bosschaart AN, Bilo RA. [Child abuse--the approach in the maternity and child health services had been more hospital]. Ned Tijdschr Geneeskd 2005; 149(29):1605- supportive than partners. DISCUSSION: The study 7. 369
- 378. Abstract: It isestimated that at least 50,000 children Bostock L. Pathways of disadvantage? Walking as a mode are victims of child abuse each year in The of transport among low-income mothers. Health Soc Netherlands. Approximately 40 of these children die. Care Community 2001; 9(1):11-8. Doctors, in cooperation with other disciplines, have a Abstract: Research shows that lack of car ownership is role in signalling child abuse in hospitals. Education associated with poorer health. It is often assumed that must improve and enhance the knowledge and skills in the reason for this observed relationship is that access this field. Hospital directors should facilitate education to a car--or not--reflects access to household assets. to achieve and maintain this knowledge and enable it to Consequently, lack of car ownership is used as a be put into practice. Better signalling procedures will standard marker of low socio-economic status. result in quicker and more adequate treatment of these However, little attention has been paid to the children. The number of fatal cases will then decrease experience of carlessness in the context of as well. disadvantaged lives. This paper argues that "no access to a car" is not only an indicator of low socio-economic Bosshard G, Nilstun T, Bilsen J et al. Forgoing treatment at status but of walking as a mode of transport. These the end of life in 6 European countries. Arch Intern arguments are illustrated by data from a study of 30 Med 2005; 165(4):401-7. low-income mothers with young children. Although Notes: CORPORATE NAME: European End-of-Life walking is promoted as both an excellent and Consortium inexpensive form of exercise, these data suggest that GENERAL NOTE: KIE: 23 refs. reliance on walking can have negative effects on the GENERAL NOTE: KIE: KIE Bib: allowing to die welfare of families. The paper draws on qualitative Abstract: BACKGROUND: Modern medicine provides data to describe the ways in which carlessness restricts unprecedented opportunities in diagnostics and access to health and social care resources such as food treatment. However, in some situations at the end of a shops, health-care services and social networks. It also patient's life, many physicians refrain from using all explores the impact of walking on the well being of possible measures to prolong life. We studied the mothers and their day-to-day relationships with incidence of different types of treatment withheld or children. This is compounded by walking through areas withdrawn in 6 European countries and analyzed the that are neglected and depressed. The paper concludes main background characteristics. METHODS: Between that strategies to reduce social exclusion must June 2001 and February 2002, samples were obtained recognise the contradictory health effects of walking from deaths reported to registries in Belgium, and aim to regenerate the physical fabric of social Denmark, Italy, the Netherlands, Sweden, and housing estates as well as improve public transport Switzerland. The reporting physician was then sent a options. questionnaire about the medical decision-making process that preceded the patient's death. RESULTS: Bostrom BA. In re A (children): in the Royal Courts of The incidence of nontreatment decisions, whether or Justice (England). Issues Law Med 2001; 17(2):183- not combined with other end-of-life decisions, varied 93. widely from 6% of all deaths studied in Italy to 41% in Notes: GENERAL NOTE: KIE: KIE Bib: patient Switzerland. Most frequently forgone in every country care/minors; treatment refusal/minors were hydration or nutrition and medication, together Abstract: HELD: The proposed operation to separate representing between 62% (Belgium) and 71% (Italy) conjoined twins resulting in the death of one of the of all treatments withheld or withdrawn. Forgoing twins is lawful. Although Mary's death is foreseeable treatment estimated to prolong life for more than 1 as an inevitable consequence of the operation, the month was more common in the Netherlands (10%), invasive surgery is intended and necessary to save Belgium (9%), and Switzerland (8%) than in Denmark Jodie's life. Mary's death is not a purpose or intention (5%), Italy (3%), and Sweden (2%). Relevant of the surgery, and she will die only because her body, determinants of treatment being withheld rather than on its own, was never viable. withdrawn were older age (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.31-1.79), death outside the Bostrom BA. Miller v. HCA, Inc. Issues Law Med 2003; hospital (death in hospital: OR, 0.80; 95% CI, 0.68- 19(2):171-3. 0.93), and greater life-shortening effect (OR, 1.75; 95% Notes: GENERAL NOTE: KIE: KIE Bib: allowing to CI, 1.27-2.39). CONCLUSIONS: In all of the die/infants; informed consent/minors participating countries, life-prolonging treatment is withheld or withdrawn at the end of life. Frequencies Botash AS. From curriculum to practice: implementation of vary greatly among countries. Low-technology the child abuse curriculum. Child Maltreat 2003; interventions, such as medication or hydration or 8(4):239-41. nutrition, are most frequently forgone. In older patients and outside the hospital, physicians prefer not to Botkin JR. Preventing exploitation in pediatric research. Am initiate life-prolonging treatment at all rather than stop J Bioeth 2003; 3(4):31-2. it later. Notes: GENERAL NOTE: KIE: 8 refs. 370
- 379. GENERAL NOTE: KIE: KIE Bib: human and home visits by a midwife; women in the hospital- experimentation/informed consent; human based care group were hospitalised for four to five experimentation/minors days. MAIN OUTCOME MEASURES: Breastfeeding 28 days postpartum, women's views of their care and Boulard G. The meth menace: battling the fast-paced spread readmission to hospital. RESULTS: Women in the of methamphetamine may mean attacking it from home-based care group had shorter hospital stays (65 several fronts. State Legis 2005; 31(5):14-8. vs 106 hours, P < 0.001) and more midwife visits (4.8 vs 1.7, P < 0.001) than women in the hospital-based Boulet MC, Ethier LS, Couture G. [Life events and trauma care group. Prevalence of breastfeeding at 28 days was in chronic negligent mothers]. Sante Ment Que 2004; similar between the groups (90%vs 87%, P= 0.30), but 29(1):221-42. women in the home-based care group reported fewer Abstract: The present study examines more closely the problems with breastfeeding and greater satisfaction chronic behaviors of maltreating mothers. Events that with the help received. There were no differences in these mothers have experienced during childhood are satisfaction with care, women's hospital readmissions, examined, experiences including abuse, placement, postnatal depression scores and health status scores. A separation, bereavement, rejection, neglect, lack of higher percentage of neonates in the home-based care love and role reversal. Signs of unresolved trauma group were readmitted to hospital during the first six found in the discourse of mothers, such as dissociation, months (12%vs 4.8%, P= 0.004). CONCLUSIONS: In are also studied. It is proposed that negligent mothers low risk pregnancies, early discharge from hospital and from the chronic group will evoke more negative midwife visits at home after delivery is an acceptable experiences and/or more intense negative experiences alternative to a longer duration of care in hospital. which occurred during childhood than the mothers Mothers' preferences and economic considerations from the transitory group. The chronic group will also should be taken into account when choosing a policy of show more signs of dissociation. From a six years postnatal care. follow-up study, a sample of 20 mothers was recruited from the Child Protection Services, including the cases Boy A, Salihu HM. Intimate partner violence and birth of 10 chronic maltreating mothers and 10 transitory outcomes: a systematic review. Int J Fertil Womens maltreating mothers. Two main measures were used: Med 2004; 49(4):159-64. the Child Abuse Potential Inventory (CAPI) and the Abstract: OBJECTIVE: There is a lack of Adult Attachment Interview (AAI) (Main et Goldwyn, comprehensive information on the relationship between 1998). The experiences from childhood and complete domestic physical and emotional violence and discourse in AAI were analysed with the method used pregnancy outcomes. Accordingly, we undertook this by Main et Goldwyn (1998). Non parametric analysis systematic review of the literature to examine the indicate that mothers from the chronic group evoke evidence on the association between physical and more negative and very negative childhood experiences emotional abuse and pregnancy outcomes. STUDY than the mothers from the transitory group. Content DESIGN AND METHOD: A comprehensive literature analysis show that chronic maltreating mothers relate search was carried out using pertinent key words that having gone through more potentially traumatic events would retrieve any research article pertaining to the such as foster care placements, separations and abuse. topic. This was supplemented by cross-referencing of The analysis of the Adult Attachment Interview the articles. A total of 296 articles were found; case according to Main and Goldwyn's system demonstrate reports and articles that failed to satisfy the study that the majority of the chronic maltreating mothers inclusion criteria were removed and 30 articles were have two times more unresolved traumas. included in the review. RESULTS: Overall, adverse pregnancy outcomes, including low birth weight, Boulvain M, Perneger TV, Othenin-Girard V, Petrou S, maternal mortality and infant mortality are Berner M, Irion O. Home-based versus hospital-based significantly more likely among abused than postnatal care: a randomised trial. BJOG 2004; nonabused mothers. Abused pregnant mothers present 111(8):807-13. more often than nonabused mothers with kidney Abstract: OBJECTIVE: To compare a shortened infections, gain less weight during pregnancy, and are hospital stay with midwife visits at home to usual more likely to undergo operative delivery. Fetal hospital care after delivery. DESIGN: Randomised morbidity, such as low birth weight, preterm delivery, controlled trial. SETTING: Maternity unit of a Swiss and small size for gestational age are more frequent teaching hospital. POPULATION: Four hundred and among abused than nonabused gravidas. The risk for fifty-nine women with a single uncomplicated maternal mortality is three times as high for abused pregnancy at low risk of caesarean section. mothers. Black abused mothers are 3-4 times as likely METHODS: Women were randomised to either home- to die as their white counterparts. Unmarried victims based (n= 228) or hospital-based postnatal care (n= are also three times as likely to die as married abused 231). Home-based postnatal care consisted of early mothers. Intimate partner violence is also responsible discharge from hospital (24 to 48 hours after delivery) for increased fetal deaths in affected pregnancies (about 16.0 per 1000). CONCLUSION: Intimate 371
- 380. partner violence isoften a life-threatening event to both Health Insurance Program (SCHIP) was enacted in the mother and the fetus. This, in addition to the 1997 to provide health insurance coverage to uninsured heightened level of feto-maternal morbidity and low-income children from families who earned too mortality, represents clear-cut justification for routine much to be eligible for Medicaid. OBJECTIVES: To systematic screening for the presence of abuse during develop a "baseline" portrait of SCHIP enrollees in 5 pregnancy. states (Alabama, Florida, Kansas, Indiana, and New York) by examining: 1) SCHIP enrollees' demographic Boyes-Watson C. Seeds of change: using peacemaking characteristics and health care experiences before circles to build a village for every child. Child Welfare enrolling in SCHIP, particularly children with special 2005; 84(2):191-208. health care needs (CSHCN), racial and ethnic minority Abstract: Roca, Inc., a grassroots human development children, and adolescents; 2) the quality of the care and community organization, has adopted the adolescents received before enrollment; and 3) the peacemaking circle as a tool in its relationship building changes in enrollee characteristics as programs evolve with youth, communities, and formal systems. Circles and mature. METHODS: Each of 5 projects from the are a method of communication derived from Child Health Insurance Research Initiative (CHIRI) aboriginal and native traditions. In Massachusetts, the surveyed new SCHIP enrollees as identified by state Department of Social Services and the Department of enrollment data. CHIRI investigators developed the Youth Services are exploring the application of the CHIRI common core (a set of survey items from circle in programming with youth and families. By validated instruments), which were largely providing a consistent structure for open, democratic incorporated into each survey. Bivariate and communication, peacemaking circles enhance the multivariate analyses were conducted to ascertain formation of positive relationships in families, whether there were racial and ethnic disparities in communities, and systems. The outcome is a stronger access to health care and differences between CSHCN community with greater unity across truly diverse and those without. Current Population Survey data for participants. This article presents the theory and New York State were used to identify secular trends in practice of peacemaking circles, the lessons and enrollee characteristics. RESULTS: Most SCHIP challenges of implementing circles in formal enrollees (65% in Florida to 79% in New York) resided organizations, and the potential of the circle to support in families with incomes < or =150% of the federal a strengths-based and community-based approach to poverty level. Almost half of SCHIP enrollees lived in child welfare. single-parent households. A majority of SCHIP parents had not had education beyond high school, and in 2 Boyle RJ, Salter R, Arnander MW. Ethics of refusing states (Alabama and New York) approximately 25% parental requests to withhold or withdraw treatment had not completed high school. The vast majority of from their premature baby. J Med Ethics 2004; children lived in households with a working adult, and 30(4):402-5; discussion 406-9. in a substantial proportion of households both parents Notes: GENERAL NOTE: KIE: 52 refs. worked. Children tended to be either insured for the GENERAL NOTE: KIE: KIE Bib: allowing to entire 12 months or uninsured the entire 12 months die/infants before enrolling in SCHIP. Private insurance was the Abstract: In the United Kingdom women have access predominant form of insurance before enrollment in to termination of pregnancy for maternal reasons until SCHIP in most states, but 23.3% to 51.2% of insured 24 weeks' completed gestation, but it is accepted children had Medicaid as their most recent insurance. practice for children born at or beyond 25 weeks' HEALTH CARE USE AND UNMET NEEDS gestation to be treated according to the child's BEFORE SCHIP: The vast majority of all SCHIP perceived best interests even if this is not in accordance enrollees had a usual source of care (USC) during the with parental wishes. The authors present a case drawn year before SCHIP. The proportion of children who from clinical practice which highlights the discomfort changed their USC after enrolling in SCHIP ranged that parents may feel about such an abrupt change in from 29% to 41.3%. A large proportion of SCHIP their rights over their child, and argue that parents enrollees used health services during the year before should have greater autonomy over treatment decisions SCHIP, with some variability across states in the use of regarding their prematurely born children. health care. Nevertheless, 32% to almost 50% of children reported unmet needs. CSHCN: The Brach C, Lewit EM, VanLandeghem K et al. Who's enrolled prevalence of CSHCN in SCHIP (between 17% and in the State Children's Health Insurance Program 25%) in the study states was higher than the prevalence (SCHIP)? An overview of findings from the Child of CSHCN reported in the general population in those Health Insurance Research Initiative (CHIRI). states. In many respects, CSHCN were similar to Pediatrics 2003; 112(6 Pt 2):e499. children without special health care needs, but CSHCN Notes: CORPORATE NAME: Child Health Insurance had poorer health status, were more likely to have had Research Initiative unmet needs, and were more likely to use the Abstract: BACKGROUND: The State Children's emergency department, mental health care, specialty care, and acute care in the year before enrolling in 372
- 381. SCHIP than childrenwithout special health care needs. (eg, minority children, CSHCN, and adolescents) RACE AND ETHNICITY: A substantial proportion of should be monitored. 5) States and health plans should SCHIP enrollees were black non-Hispanic or Hispanic actively promote quality health care with the goal of children (Alabama: 34% and <1%; Florida: 6% and improving the care received by SCHIP enrollees before 26%; Kansas: 12% and 15%; and New York: 31% and enrollment. 6) States will have to craft policies that fit 45%, respectively). Minority children were poorer, in their local context. 7) Collecting baseline information poorer health, and less likely to have had a USC or on SCHIP enrollees on a continuous basis is important, private insurance before enrolling in SCHIP. The because enrollee characteristics and needs can change, prevalence and magnitude of the disparities varied and many vulnerable children are enrolling in SCHIP. among the states. QUALITY OF CARE FOR ADOLESCENTS: Seventy-three percent of adolescent Braden K, Swanson S, Di Scala C. Injuries to children who SCHIP enrollees engaged in one or more risk behaviors had preinjury cognitive impairment: a 10-year (ie, feeling sad or blue; alcohol, tobacco, and drug use; retrospective review. Arch Pediatr Adolesc Med 2003; having sexual intercourse; and not wearing seat belts). 157(4):336-40. Although almost 70% of adolescents reported having Abstract: OBJECTIVE: To determine differences had a preventive care visit the previous year, a majority between hospitalized injured children who had of them did not receive counseling in each of 4 preinjury cognitive impairments (IMPs) and children counseling areas. Controlling for other factors, having who had no preinjury cognitive conditions (NO). a private, confidential visit with the physician was DESIGN: Comparative analysis, excluding fatalities, of associated with an increased liked likelihood (2-3 times patients with IMP (n = 371) with patients with NO (n = more likely) that the adolescent received counseling for 58 745), aged from 0 to 19 years. MAIN OUTCOME 3 of 4 counseling areas. TRENDS OVER TIME: New MEASURES: Demographics, injury characteristics, York SCHIP enrollees in 2001, compared with 1994 injury nature and severity, use of resources, disability, enrollees in New York's SCHIP-precursor child health and disposition at discharge from acute care. DATA insurance program, were more likely to be black or SOURCE: Medical records of children injured between Hispanic, older, from New York City, and from January 1, 1989, and December 31, 1998, submitted to families with lower education, income, and the National Pediatric Trauma Registry, Boston, Mass. employment levels. A greater proportion of 2001 RESULTS: Compared with children with NO, children enrollees was uninsured for some time in the year with IMPs were more likely to be boys (72.5% vs before enrollment, was insured by Medicaid, and 64.3%), to be older (53.1% vs 40.0%, aged 10-19 lacked a USC. Secular trends in the low-income years), to be victims of child abuse (5.9% vs 1.6%), population in the state did not seem to be responsible and to be individuals with self-inflicted injuries (2.2% for these differences. Program modifications during vs 0.1%). They were more likely to be injured as this time period that may be related to the shift in pedestrians (19.9% vs 13.8%), less likely to be injured enrollee characteristics include changes to benefits, in sport activities (2.7% vs 6.9%), and less likely to outreach and marketing efforts, changes in the sustain a penetrating injury (3.8% vs 8.3%). They were premium structure, and the advent of a single more likely to sustain injuries to multiple body regions application form for multiple public programs. (57.4% vs 43.7%) and the head (62.0% vs 45.1%), and CONCLUSIONS: SCHIP enrollees are a diverse to be severely injured. They were more likely to be group, and there was considerable variation among the admitted to the intensive care unit (52.6% vs 25.2), and 5 study states. Overall, SCHIP enrollees had substantial their mean length of stay was twice as long (9.9 vs 4.8 and wide-ranging health care needs despite high levels days). They were also more likely to develop of prior contact with the health care system. A sizable impairments from the current injury (46.6% vs 41.0%) minority of SCHIP enrollees has special health care and more likely to be discharged to a rehabilitation needs. There is racial and ethnic diversity in the facility (11.1% vs 2.3%). The IMPs became worse in composition of enrollees as well, with racial and ethnic 75 children. CONCLUSIONS: Preinjury cognitive disparities present. The quality of care adolescents impairments in a pediatric population had a significant received before enrollment in SCHIP was suboptimal, effect on the causes, nature, severity of injury, and with many reporting unmet health care needs and not outcomes. Targeted prevention programs should receiving recommended counseling. The characteristics consider the characteristics of this population. of SCHIP enrollees can be expected to change as SCHIP programs evolve and mature. POLICY Bradley JE, Jackson JA. Immunity, immunoregulation and IMPLICATIONS: 1) Benefits should be structured to the ecology of trichuriasis and ascariasis. Parasite meet the needs of SCHIP enrollees, which are Immunol 2004; 26(11-12):429-41. comparable to Medicaid enrollees' needs in many Abstract: Immune responses to human roundworm respects. 2) Provider networks will have to be broad if (Ascaris lumbricoides) and whipworm (Trichuris continuity of care is to be achieved. 3) Multiple trichiura) and their role in controlling worm outreach strategies should be used, including using populations are reviewed. Recent providers to distribute information about SCHIP. 4) immunoepidemiological data implicate T(H)2- The quality of care delivered to vulnerable populations mediated responses in limiting A. lumbricoides and T. 373
- 382. trichiura populations. Reinfectionstudies further hazards models estimated the mortality hazard (RR) suggest that IL-5 cytokine responses are negatively associated with polygyny for children of HIV-negative associated with adult recruitment in T. trichiura but not and HIV-positive mothers. HIV prevalence in the full A. lumbricoides and may therefore be involved in cohort of mothers was 11.9%, and 23% of mothers negative intraspecific and interspecific interactions lived in polygynous households. Multivariate analysis mediated through the host immune system. The showed an increased hazard of child mortality if the importance of inducible immunoregulatory networks in mother was HIV-positive (RR = 1.75, p<0.001). the ecology of the host-parasite relationship is Maternal education reduced mortality, whereas low considered, with particular regard to possible birth weight increased mortality risk. Polygyny was manipulative strategies by the parasites. This aspect of associated with an increase in the hazard of child the worms' interaction with the host immune system is mortality in the full sample (RR = 1.36, p<0.001) and both poorly known and potentially central to an in mothers who were HIV-positive (RR = 2.17, understanding of parasite population dynamics and the p<0.001), but not in HIV-negative mothers. Being born evolutionary pressures that have shaped present-day to an HIV-positive mother increased mortality risk and host-parasite associations. Some possible implications polygyny accentuated a child's risk of death. Polygyny of worm-mediated immunomodulation for the had no significant effect on the survival of children occurrence of bystander infectious diseases in human with HIV-negative mothers. Polygynous households, populations and the management of de-worming where not all wives may have HIV, could be diverting programmes are also discussed. resources away from the children of the infected wives. Bradley R. The child with a chronic condition: parents teach Brajsa-Zganec A. The long-term effects of war experiences advanced practice nursing students. J Nurs Educ 2001; on children's depression in the Republic of Croatia. 40(4):180-2. Child Abuse Negl 2005; 29(1):31-43. Abstract: OBJECTIVE: The aim of the study was to Bradley RG, Follingstad DR. Group therapy for incarcerated investigate whether different levels of depressive women who experienced interpersonal violence: a pilot symptoms in early adolescent boys and girls could be study. J Trauma Stress 2003; 16(4):337-40. predicted on the basis of war experiences, perceived Abstract: This study evaluated effectiveness of group available social support (instrumental support, support therapy for incarcerated women with histories of to self-esteem, belonging and acceptance) and childhood sexual and/or physical abuse. The extraversion. METHODS: The sample consisted of 583 intervention was based on a two-stage model of trauma children ages 12 to 15 years; 283 children were treatment and included Dialectical Behavior Therapy displaced from different parts of Croatia for a period of skills and writing assignments. We randomly assigned approximately three and a half years. The following 24 participants to group treatment (13 completed) and instruments were administered: Questionnaire on 25 to a no-contact comparison condition (18 Children's Stressful and Traumatic War Experiences, completed). We evaluated treatment effects, using the Reynolds Adolescent Depression Scale, Junior Beck Depression Inventory, Inventory of Interpersonal Eysenck Personality Questionnaire, and Interpersonal Problems, and Trauma Symptom Inventory. The data Support Evaluation List. RESULTS: Regression demonstrate significant reductions in PTSD, mood, and analyses showed that more war experiences were interpersonal symptoms in the treatment group. related to more depressive symptoms for boys only. The greater extent of perceived available social support Brahmbhatt H, Bishai D, Wabwire-Mangen F, Kigozi G, for boys (instrumental support, support to self-esteem, Wawer M, Gray RH. Polygyny, maternal HIV status belonging and acceptance) related to fewer depressive and child survival: Rakai, Uganda. Soc Sci Med 2002; symptoms. For girls, perceived instrumental support 55(4):585-92. and self-esteem were related to fewer depressive Notes: CORPORATE NAME: Rakai Project Group symptoms. Predictors in the boys' sample accounted for Abstract: The objective of this research was to assess 35% of the variance in the results on the depression the association of child mortality with polygyny and scale, and 27% in the girls' sample. CONCLUSIONS: maternal HIV status through a prospective community- We conclude that boys suffer more from the long-term based study in Rakai district, Uganda. We sought to effects of war than girls. In situations where children test whether there was an indirect evidence that cannot be shielded from stressful events, such as war, a polygynous households in an HIV prevalent area may greater level of perceived social support is related to divert resources away from the children of HIV- fewer depressive symptoms both for boys and girls in infected mothers in favor of children with better early adolescence. survival prospects. We test this theory using data from a follow-up study which collected detailed behavioral Brambilla P, Hardan AY, di Nemi SU et al. The functional and medical information at 10-month intervals on a neuroanatomy of autism. Funct Neurol 2004; 19(1):9- cohort of over 4000 pregnant women and their infants 17. (5300 person years of observation). Cox proportional Abstract: Autism is a neurodevelopmental syndrome characterized by impaired social and executive 374
- 383. functions. Functional magneticresonance imaging children. METHODS: A cross-sectional survey of (fMRI) is a non-invasive technique that allows academic staff at the University of Otago. Random investigation of the neural networks underlying samples of academic medical practitioners and non- cognitive impairments in autism. In this article, brain Health Sciences academic staff completed written imaging studies investigating the functional brain questionnaires, including open and closed questions. anatomy of autism are reviewed. Face recognition, Questions focussed on the Liam Williams-Holloway theory of mind and executive functions have all been (W-H) and Tovia Laufau (TL) cases. RESULTS: The explored in functional neuroimaging studies involving response rate was 107/164 (65%) of eligible staff. autistic patients. The available literature suggests an Support for doctors seeking treatment orders was involvement of abnormal functional mechanisms in strong (77% in the W-H case, and in the TL case, 70% face recognition, mentalization and executive functions believed an order should have been sought). Women in adults with high-functioning autism or Asperger's were less likely than men to support a treatment order, syndrome, possibly due to brain maturation significantly in the W-H case. There were no abnormalities, and resulting in dysfunctional reciprocal significant differences between medical and non- cortico-subcortical connections. Future functional medical respondents. Court processes were viewed as neuroimaging research should investigate subgroups of confrontational and a last resort only after mediation autistic children and adolescents longitudinally and failed. Scientific evidence was rated as the most attempt to integrate genetic, cognitive and empirical important consideration in treatment decisions, approaches. Such studies will be instrumental in followed by likely outcome, establishment of trust furthering understanding of the pathophysiology of between parents and doctors, and the age of the child. autism and in exploring the importance of dimensional CONCLUSIONS: Among this highly educated group measures of the broader phenotype currently defined as there was strong support for seeking treatment orders autism. in the child's best interests. But various mediation options were preferred and should be explored further. Bramwell R, Weindling M. Families' views on ward rounds More evidence is needed on the success of treatment in neonatal units. Arch Dis Child Fetal Neonatal Ed orders and on the attitudes of a more representative 2005; 90(5):F429-31. sample of the population. Notes: CORPORATE NAME: FVWR Research Team Abstract: OBJECTIVE: To discover parental Brann LS, Skinner JD. More controlling child-feeding preferences about visiting during ward rounds. practices are found among parents of boys with an DESIGN: Survey using a short structured interview average body mass index compared with parents of SETTING AND PARTICIPANTS: Families of babies boys with a high body mass index. J Am Diet Assoc cared for in a regional neonatal intensive care unit. 2005; 105(9):1411-6. RESULTS: Eighty six respondents, no refusals. Sixty Abstract: OBJECTIVE: To determine if differences three had visited during a ward round, and 13 had come existed in mothers' and fathers' perceptions of their in especially for the round. About half had overheard sons' weight, controlling child-feeding practices (ie, conversations about other babies or thought discussions restriction, monitoring, and pressure to eat), and about their baby had been overheard. Concerns about parenting styles (ie, authoritarian, authoritative, and these experiences were only expressed by respondents permissive) by their sons' body mass index (BMI). who had actually experienced overhearing. Parents and DESIGN: One person (L.S.B.) interviewed mothers families had little information about the ward round, and boys using validated questionnaires and measured held diverse views, and expressed different priorities. boys' weight and height; fathers completed They described a mixture of concerns about questionnaires independently. SUBJECTS/SETTING: communication, practicalities, and issues of ethics and Subjects were white, preadolescent boys and their principle. Confidentiality was a matter of concern for parents. Boys were grouped by their BMI into an some, but many parents expected some sharing of average BMI group (n=25; BMI percentile between information between families on the unit. 33rd and 68th) and a high BMI group (n=24; BMI CONCLUSIONS: Units should consider: the percentile > or = 85th). STATISTICAL ANALYSES information they have for parents about ward rounds; PERFORMED: Multivariate analyses of variance and the possibility that consultations may be overheard; the analyses of variance. RESULTS: Mothers and fathers opportunities for parents to communicate with the of boys with a high BMI saw their sons as more clinical team. overweight (mothers P=.03, fathers P=.01), were more concerned about their sons' weight (P<.0001, P=.004), Brandon S, Clarke D, George A, Jensen J, Interns T, Paul C. and used pressure to eat with their sons less often than A survey of attitudes to parent-doctor conflicts over mothers and fathers of boys with an average BMI treatment for children. N Z Med J 2001; (P<.0001, P<.0001). In addition, fathers of boys with a 114(1145):549-52. high BMI monitored their sons' eating less often than Abstract: AIMS: To investigate professional and public fathers of boys with an average BMI (P=.006). No attitudes to the intervention of the law when parents differences were found in parenting by boys' BMI and doctors disagree about the medical treatment of groups for either mothers or fathers. CONCLUSIONS: 375
- 384. More controlling child-feedingpractices were found Abstract: The test-retest reliability of the Spanish among mothers (pressure to eat) and fathers (pressure Diagnostic Interview Schedule for Children (DISC-IV) to eat and monitoring) of boys with an average BMI is presented. This version was developed in Puerto compared with parents of boys with a high BMI. A Rico in consultation with an international bilingual better understanding of the relationships between committee, sponsored by NIMH. The sample (N = 146) feeding practices and boys' weight is necessary. consisted of children recruited from outpatient mental However, longitudinal research is needed to provide health clinics and a drug residential treatment facility. evidence of causal association. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Brannon RB, Strother EA. Child abuse & neglect. The Results indicated fair to moderate agreement for parent responsibility of the dental community. LDA J 2005; reports on most diagnoses. Relatively similar 64(3):6-9, 15. agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of Bratzke H. Research in forensic neurotraumatology. impairment as a criterion for diagnosis did not Forensic Sci Int 2004; 144(2-3):157-65. substantially change the pattern of results for specific Abstract: Over the past 100 years forensic research in disorders. Parents were more reliable when reporting neurotraumatology was focusing on the genesis, e.g. on diagnoses of younger (4-10) than older children. biomechanis, and the origin of epidural, subdural, Children 11-17 years old were reliable informants on subarachnoidal, intracerebral and brain stem disruptive and substance abuse/dependence disorders, haemorrhage, particularly under aspects to enable the but unreliable for anxiety and depressive disorders. differential diagnosis of bleeding due to non-traumatic Hence, parents were more reliable when reporting diseases. Moreover the estimation of the age of brain about anxiety and depressive disorders whereas injuries has important criminological implications children were more reliable than their parents when (survival time following traumatic forces to the head, reporting about disruptive and substance disorders. alibi etc.). Beside these main fields of research, aspects of expertise in special areas such as head trauma due to Bredemeyer SL. Implementation of the SIDS guidelines in child abuse, capability to act despite severe brain midwifery practice. Aust J Midwifery 2004; 17(4):17- injuries and research on cervical trauma are reviewed. 21. Abstract: The literature suggests that midwives Brave Heart MY. The historical trauma response among strongly influence parenting practices immediately natives and its relationship with substance abuse: a after birth and during early postnatal management of Lakota illustration. J Psychoactive Drugs 2003; the newborn. Midwives must therefore be aware of the 35(1):7-13. current evidence and public health recommendations Abstract: Historical trauma (HT) is cumulative for reducing the risk of Sudden Infant Death Syndrome emotional and psychological wounding over the (SIDS) and provide consistent information about use of lifespan and across generations, emanating from the supine position. Midwives must also include massive group trauma experiences; the historical information about environmental factors that are also trauma response (HTR) is the constellation of features known to increase the risk of SIDS such as exposure to in reaction to this trauma. The HTR often includes cigarette smoke, covering the infant's face during sleep depression, self-destructive behavior, suicidal thoughts and other potential unsafe sleeping practices such as and gestures, anxiety, low self-esteem, anger, and co-sleeping and bed sharing with their infant. The difficulty recognizing and expressing emotions. It may position midwives use to settle infants and place them include substance abuse, often an attempt to avoid for sleep is an important example for parents. The painful feelings through self-medication. Historical position favoured by midwives when placing a unresolved grief is the associated affect that newborn to sleep will have a significant impact on accompanies HTR; this grief may be considered parental practice after discharge home. A standardised fixated, impaired, delayed, and/or disenfranchised. This evidenced based approach to the SIDS Guidelines article will explain HT theory and the HTR, delineate immediately after birth will facilitate consistency in the features of the HTR and its grounding in the practice and uniformity in the message parents are literature, offer specific Native examples of HT and given about safe sleeping practices for their newborn HTR, and will suggest ways to incorporate HT theory infant. in treatment, research and evaluation. The article will conclude with implications for all massively Breiner SJ. RE: Response and an additional comment on traumatized populations. "the Legacy of the Clergy Abuse Scandal" (D. Finkelhor, 2003). Child Abuse Negl 2004; Bravo M, Ribera J, Rubio-Stipec M et al. Test-retest 28(12):1251-2. reliability of the Spanish version of the Diagnostic Interview Schedule for Children (DISC-IV). J Abnorm Bremner JD, Vythilingam M, Anderson G et al. Assessment Child Psychol 2001; 29(5):433-44. of the hypothalamic-pituitary-adrenal axis over a 24- 376
- 385. hour diurnal periodand in response to neuroendocrine in an extensive area, which included orbitofrontal challenges in women with and without childhood cortex, anterior cingulate, and medial prefrontal cortex sexual abuse and posttraumatic stress disorder. Biol (Brodmann's areas 25, 32, 9), left hippocampus, and Psychiatry 2003; 54(7):710-8. fusiform gyrus/inferior temporal gyrus, with increased Abstract: BACKGROUND: Preclinical studies showed activation in posterior cingulate, left inferior parietal that early stress results in long-term alterations in the cortex, left middle frontal gyrus, and visual association hypothalamic-pituitary-adrenal (HPA) axis. We and motor cortex. There were no differences in patterns performed a comprehensive assessment of the HPA of brain activation during retrieval of neutral word axis in women with and without a history of early pairs between patients and control subjects. childhood sexual abuse and posttraumatic stress CONCLUSIONS: These findings are consistent with disorder (PTSD). METHODS: Fifty-two women with dysfunction of specific brain areas involved in memory and without a history of early childhood sexual abuse and emotion in PTSD. Regions implicated in this study and PTSD underwent a comprehensive assessment of of emotionally valenced declarative memory are the HPA axis, including measurement of cortisol in similar to those from prior imaging studies in PTSD plasma every 15 min over a 24-hour period and cortisol using trauma-specific stimuli for symptom and corticotropin (ACTH) following corticotropin- provocation, adding further supportive evidence for a releasing factor (CRF) and ACTH challenge. dysfunctional network of brain areas involved in RESULTS: Abused women with PTSD had lower memory, including hippocampus, medial prefrontal levels of cortisol during the afternoon hours (12:00- cortex, and cingulate, in PTSD. 8:00 PM) of a 24-hour period compared with non- PTSD women. Their ACTH response to a CRF Brennan PO. Oliver Twist, textbook of child abuse. Arch challenge was blunted compared with nonabused non- Dis Child 2001; 85(6):504-5. PTSD (but not abused non-PTSD) women. There were no differences in cortisol response to CRF and ACTH Brennan RA. A nurse-managed universal newborn hearing challenges between the groups. Increased PTSD screen program. MCN Am J Matern Child Nurs 2004; symptom levels were associated with low afternoon 29(5):320-5. cortisol levels. CONCLUSIONS: These findings Abstract: Hearing loss is one of the most common suggest that early abuse is associated with increased major birth defects, yet the average age for identifying CRF drive as evidenced by decreased pituitary significant hearing loss in children in the United States sensitivity to CRF, whereas in abuse with PTSD there is 30 months.Hearing loss directly affects a child's is a specific hypocortisolemia that is most pronounced ability to develop normal language skills, impairs his or in the afternoon hours. her ability to communicate with others in the environment, and has been shown to correlate with Bremner JD, Vythilingam M, Vermetten E et al. Neural poor academic performance. However, if hearing loss correlates of declarative memory for emotionally is detected early and interventions are begun before 6 valenced words in women with posttraumatic stress months of age, children with hearing loss develop disorder related to early childhood sexual abuse. Biol language, cognitive, and speech skills comparable to Psychiatry 2003; 53(10):879-89. their non-hearing-impaired peers. Only 38 states Abstract: BACKGROUND: Animal studies have mandate universal newborn hearing screening before shown that early stressors result in lasting changes in discharge from the hospital.This article describes an structure and function of brain areas involved in institutional universal hearing screening program memory, including hippocampus and frontal cortex. developed by nursing, which collaborated with Patients with childhood abuse-related posttraumatic physicians, audiologists, and otolaryngologists. Careful stress disorder (PTSD) have alterations in both planning, including a thorough literature review, declarative and nondeclarative memory function, and networking with area hospitals, and dialoging with imaging studies in PTSD have demonstrated changes in experts in the field led to a successful program.The function during stimulation of trauma-specific outcomes from this program compare favorably to memories in hippocampus, medial prefrontal cortex, nationally published data. and cingulate. The purpose of this study was to assess neural correlates of emotionally valenced declarative Bretherton I, Lambert JD, Golby B. Involved fathers of memory in women with early childhood sexual abuse preschool children as seen by themselves and their and PTSD. METHODS: Women with early childhood wives: accounts of attachment, socialization, and sexual abuse-related PTSD (n = 10) and women companionship. Attach Hum Dev 2005; 7(3):229-51. without abuse or PTSD (n = 11) underwent positron Abstract: Studies of infant-father attachment and other emission tomographic (PET) measurement of cerebral aspects of father-child relationships burgeoned during blood flow during a control condition and during the 1980s and 90s, in step with new expectations for retrieval of neutral (e.g., "metal-iron") and emotionally greater father participation in childrearing, but less is valenced (e.g., "rape-mutilate") word pairs. RESULTS: known about how involved fathers experience During retrieval of emotionally valenced word pairs, themselves as attachment figures, socialization agents, PTSD patients showed greater decreases in blood flow 377
- 386. and playmates/companions oftheir young children. In 2003:90. an attempt to investigate these topics from a Abstract: El reclutamiento de niños por parte de la relationship perspective, we administered the Parent guerrilla y las fuerzas paramilitares ha aumentado Attachment Interview (PAI) to 49 married fathers from significativamente en los últimos años. Ninguna de las dual career families who, based on current literature, partes ha hecho un esfuerzo serio por detener esta were expected to be active participants in caring for práctica. En ocasiones, tanto la guerrilla como los and interacting with their preschool children. The 22 paramilitares han ofrecido la desmovilización de niños open-ended PAI questions were designed to probe para obtener condiciones favorables en las fathers' thoughts and feelings about parent-child negociaciones con el gobierno. No sólo se trata de un attachment, but also elicited extensive descriptions of intento flagrante de negociar una ventaja política con other aspects of fathering, including socialization and cuestiones innegociables, sino que ninguna de estas companionship. In addition, fathers reflected on promesas se ha cumplido hasta ahora. Cada una de las similarities and differences between the father- and fuerzas irregulares en conflicto continúa violando mother-child relationships, and these accounts were claramente sus propios reglamentos sobre la edad compared with corresponding discussions by their mínima para el reclutamiento. Es más, el Estado no ha wives. Among new issues raised by the study were the protegido a los niños mediante la aplicación de la role of affection in attachment relationships, evidence legislación colombiana, que prohíbe el reclutamiento for the attachment hierarchy construct, issues of de menores de 18 años, y las autoridades judiciales no parental self-control in relation to discipline, han procesado penalmente a los responsables de esta conceptual overlaps between attachment and other aborrecible práctica. aspects of parenting, and the diverse meanings of father-mother differences and disagreements in the Brewer VR, Fletcher JM, Hiscock M, Davidson KC. three domains of parenting addressed in this study. Attention processes in children with shunted hydrocephalus versus attention deficit-hyperactivity Bretherton I, Page TF. Shared or conflicting working disorder. Neuropsychology 2001; 15(2):185-98. models? Relationships in postdivorce families seen Abstract: Children with congenital hydrocephalus, through the eyes of mothers and their preschool children with attention deficit-hyperactivity disorder, children. Dev Psychopathol 2004; 16(3):551-75. and normal controls were evaluated with measures of Abstract: Marvin and Stewart and Byng-Hall proposed focused attention (Visual Orienting and Detection that effective family collaboration requires family Task), sustained attention (continuous performance members to construct "shared family working models," test), and attention shifting (Wisconsin Card Sorting and that the renegotiation of these working models Test). Components from these tasks have been linked during family transitions is facilitated by family to attention systems mediated by anterior or posterior members' "interactional awareness" (ability to be brain networks. Children with congenital perceptive observers of family relationships). We apply hydrocephalus showed an inability to focus and shift these constructs to data collected from 71 mothers and attention, which specifically implicated impairment of their 4.5- to 5.0-year-old preschool children, 2 years the disengage and move components of the posterior after parental divorce. Maternal representations of the brain attention system. Children with attention deficit- father as coparent and ex-spouse, and of father- and hyperactivity disorder displayed the expected mother-child relationships were assessed via two performance patterns on measures of focused attention interviews. A family story completion task captured once their difficulties with sustained attention were child representations of mother-child and father-child, taken into account. However, they showed problems coparental and ex-spousal interactions. Maternal with shifting and sustaining attention, which are accounts of mother-child conversations illustrated the commonly associated with the anterior brain attention negotiation of shared working models. Primarily system. qualitative analyses contrasting maternal and child perspectives are presented in the first section. Then we Briffa T. Intersex surgery disregards children's human rights. use regression analyses to predict children's story Nature 2004; 428(6984):695. themes from maternal representations of flexible, Notes: GENERAL NOTE: KIE: KIE Bib: patient sensitive, and effective discipline-related interactions; care/minors maternal depressive symptoms; and perception of the child's father. Finally, we identify gender differences in Brill C, Fiorentino N, Grant J. Covictimization and inner children's enactments of divorce-related and child- city youth: a review. Int J Emerg Ment Health 2001; empathy themes. We conclude by considering how our 3(4):229-39. findings could be used to assist post-divorce families in Abstract: Covictimization represents a real and present constructing shared rather than conflicting working danger to inner city youth. This paper reviews the models of family relations. scope of this problem and a potential emergency mental health response. Brett S. Aprenderás a no llorar: niños combatientes en Colombia. Bogotá, CO: Human Rights Watch, 378
- 387. Brinton B, FujikiM. Social competence in children with 2002; 14(2):209-24. language impairment: making connections. Semin Abstract: Frith has argued that people with autism Speech Lang 2005; 26(3):151-9. show "weak central coherence," an unusual bias toward Abstract: Children with language problems frequently piecemeal rather than configurational processing and a experience social difficulty. This is the case not only reduction in the normal tendency to process for children diagnosed as having impairments such as information in context. However, the precise cognitive autism spectrum disorder, Asperger syndrome (AS), or and neurological mechanisms underlying weak central mental retardation but also for children falling into coherence are still unknown. We propose the diagnostic categories traditionally considered to be hypothesis that the features of autism associated with primarily language based (e.g., language impairment, weak central coherence result from a reduction in the learning disability). In considering what interventions integration of specialized local neural networks in the might be most effective, it is important to consider how brain caused by a deficit in temporal binding. The various aspects of development are connected. This visuoperceptual anomalies associated with weak article describes causal networks in which various central coherence may be attributed to a reduction in factors influence the relationship between language synchronization of high-frequency gamma activity deficits and social difficulties. Case descriptions of between local networks processing local features. The Joseph, an adolescent with language impairment, and failure to utilize context in language processing in Cari, a 6-year-old diagnosed with AS, illustrate the autism can be explained in similar terms. Temporal complexity of this relationship and demonstrate how binding deficits could also contribute to executive intervention might be designed to facilitate positive dysfunction in autism and to some of the deficits in social communication outcomes. socialization and communication. Brisch KH, Bechinger D, Betzler S, Heinemann H. Early Brockington I. Diagnosis and management of post-partum preventive attachment-oriented psychotherapeutic disorders: a review. World Psychiatry 2004; 3(2):89- intervention program with parents of a very low 95. birthweight premature infant: results of attachment and Abstract: This paper reviews the psychiatry of the neurological development. Attach Hum Dev 2003; puerperium, in the light of work published during the 5(2):120-35. last eight years. Many distinct disorders are seen. In Abstract: The birth of a very small preterm infant (< or addition to various psychoses and a heterogeneous = 1500 grams) can be a traumatizing experience for group of depressions, there are specific anxiety, many parents. A developmental risk model is presented obsessional and stress-related disorders. It is important that is the background to an early attachment-oriented to identify severe disorders of the mother-infant preventive psychotherapeutic intervention. This relationship, which usually respond to treatment, but comprehensive parent-centered intervention program is have pernicious effects if untreated. The complexity of composed of supportive group psychotherapy, post-partum psychiatry requires the deployment of attachment-oriented focal individual psychotherapy, a multidisciplinary specialist teams, which can handle home visit and video-based sensitivity training. The the challenges of therapy, prevention, training, research intervention aims at improving parental coping, the and service development. process of attachment and parent-infant interaction. In a prospective longitudinal design mothers were Brocklehurst P, McGuire W. Evidence based care. BMJ randomly assigned to a control (N = 44) and an 2005; 330(7481):36-8. intervention group (N = 43) after preterm delivery. Results show that the percentage of secure (control vs. Brodlie M, Laing IA, Keeling JW, McKenzie KJ. Ten years intervention group: 77.8% vs. 59.4%) and insecure of neonatal autopsies in tertiary referral centre: (control vs. intervention group: 8.3% vs. 31.3% retrospective study. BMJ 2002; 324(7340):761-3. avoidant, 13.9% vs. 9.4% ambivalent) attachment Abstract: OBJECTIVES: To measure the neonatal quality in high-risk preterm infants is comparable to autopsy rate at a tertiary referral centre and identify results from studies with term infants. There was no trends over the past decade. To identify factors that significant statistical difference in terms of quality of may influence the likelihood of consent being given for attachment of the preterm infants between the control autopsy. To examine any discordance between group and the intervention group. However, only in the diagnoses before death and at autopsy. DESIGN: control group, impaired neurological development Retrospective review of patients' records. Setting: corresponded significantly with an insecure quality of Tertiary neonatal referral centre affiliated to university. attachment, but not in the intervention group, although OUTCOME MEASURES: Sex, gestational age, birth there were significantly more neurologically impaired weight, type of delivery, and length of stay in neonatal infants in the intervention group. This result is unit for baby. Maternal age, marital status, history of discussed as an effect of the intervention program. previous pregnancies, and details of who requested permission for autopsy. Concordance between Brock J, Brown CC, Boucher J, Rippon G. The temporal diagnoses before death and at autopsy. RESULTS: An binding deficit hypothesis of autism. Dev Psychopathol 379
- 388. autopsy was performedin 209/314 (67%) cases. New Notes: GENERAL NOTE: KIE: 17 refs. information was obtained in 50 (26%) autopsies. In six GENERAL NOTE: KIE: KIE Bib: AIDS/human (3%) cases this information was crucial for future experimentation; human experimentation/foreign counselling. In 145 (74%) there was complete countries; human experimentation/research design concordance between the clinical cause of death and Abstract: The vertical transmission trials conducted in the findings at autopsy. From 1994 onwards the a variety of developing countries by researchers from autopsy rate in the neonatal unit fell. The only more developed countries illustrate a variety of crucial significant factor associated with consent for autopsy ethical issues. Three crucial issues are the injustice of was increased gestational age. CONCLUSIONS: the use of placebo control groups, the coerciveness of Important extra information can be gained at neonatal the offer to participate, and the exploitation of Third autopsies. This should help parents to make an World countries. This paper examines each of these informed decision when they are asked to give issues separately. It develops a new standard for when permission for their baby to have an autopsy. These such control groups are acceptable. It concludes that findings are of particular relevance in view of the the issue of coercive offers is not well founded. It also recent negative publicity surrounding neonatal concludes that concerns about exploitation are better autopsies and the general decline in the neonatal addressed by assurances about the future care of the autopsy rate over the decade studied. subjects in the trial than by assurances of availability of the drugs in the country in general. Brodsky BS, Oquendo M, Ellis SP, Haas GL, Malone KM, Mann JJ. The relationship of childhood abuse to Brody GH, Ge X. Linking parenting processes and self- impulsivity and suicidal behavior in adults with major regulation to psychological functioning and alcohol use depression. Am J Psychiatry 2001; 158(11):1871-7. during early adolescence. J Fam Psychol 2001; Abstract: OBJECTIVE: This study investigated 15(1):82-94. whether a higher frequency of reported childhood Abstract: A longitudinal transactional model was tested trauma would be found in depressed adults with higher linking parenting and youth self-regulation to youths' levels of trait impulsivity, aggression, and suicidal psychological functioning and alcohol-use behavior. behavior. METHOD: In 136 depressed adult inpatients, Participants included one hundred twenty 12-year-olds, the authors assessed trait impulsivity, aggression their mothers, and their fathers from whom three waves history, and number of lifetime suicide attempts as well of data were collected at 1-year intervals. Teachers as the medical lethality and the intent to die associated provided assessments of self-regulation, and parenting with the most lethal attempt. These variables were then was assessed from multiple perspectives, including compared between those with and those without a youth reports, parent reports, and observer ratings. reported history of childhood physical or sexual abuse. Youths reported their psychological functioning and RESULTS: Subjects who reported an abuse history alcohol-use behavior. The data supported the model. were more likely to have made a suicide attempt and Parenting and youth self-regulation were stable across had significantly higher impulsivity and aggression time, and self-regulation was linked with changes in scores than those who did not report an abuse history. harsh-conflicted parenting from Wave 1 to Wave 2. Impulsivity and aggression scores were significantly Parenting at Wave 2 was associated with youth self- higher in subjects with a history of at least one suicide regulation. Youth self-regulation at Wave 2 mediated attempt. A logistic regression analysis revealed that the paths from parenting practices at Wave 2 to youth abuse history remained significantly associated with psychological functioning and alcohol use at Wave 3. suicide attempt status after adjustment for impulsivity, aggression history, and presence of borderline Brody GH, Kim S, Murry VM, Brown AC. Longitudinal personality disorder. Among those who attempted direct and indirect pathways linking older sibling suicide, there were no significant differences in competence to the development of younger sibling severity of suicidal behavior between those with and competence. Dev Psychol 2003; 39(3):618-28. without a childhood history of abuse. Abstract: A 4-wave longitudinal model tested direct CONCLUSIONS: Abuse in childhood may constitute and indirect links between older sibling (OS; M = 11.7 an environmental risk factor for the development of years) and younger sibling (YS; M = 9.2 years) trait impulsivity and aggression as well as suicide competence in 152 rural African American families. attempts in depressed adults. Alternatively, impulsivity Data were collected at 1-year intervals. At each wave, and aggression may be inherited traits underlying both different teachers assessed OS competence, YS childhood abuse and suicidal behavior in adulthood competence, and YS self-regulation. Mothers reported disorders. Additional research is needed to estimate the their own psychological functioning; mothers and YSs relative contributions of heredity and environmental reported parenting practices toward the YS. OS experience to the development of impulsivity, competence was stable across time and was linked with aggression, and suicidal behavior. positive changes in mothers' psychological functioning from Wave 1 to Wave 2. Mothers' Wave 2 Brody BA. Ethical issues in clinical trials in developing psychological functioning was associated with countries. Stat Med 2002; 21(19):2853-8. involved-supportive parenting of the YS at Wave 3. OS 380
- 389. Wave 2 competenceand Wave 3 parenting were Child Psychol 2002; 30(1):65-76. indirectly linked with Wave 4 YS competence, through Abstract: The intergenerational transmission of risk Wave 3 YS self-regulation. Structural equation factors for problem behaviors was examined across modeling controlled for Wave 1 YS competence; thus, three generations. Two hundred fifty-four 2-year-old the model accounted for change in YS competence toddlers, one or two of their parents, and one across 3 years. grandmother of each toddler were studied. Grandmothers and parents were individually Brody GH, Kim S, Murry VM, Brown AC. Protective interviewed. Data were analyzed for the male and longitudinal paths linking child competence to female toddlers combined. Correlations and behavioral problems among African American siblings. hierarchical multiple regression analyses were Child Dev 2004; 75(2):455-67. performed. Findings indicate that the grandmother- Abstract: A 4-wave longitudinal design was used to parent relationship, parental personality attributes, examine protective links from child competence to marital harmony, and drug use and the parent-toddler behavioral problems in first- (M=10.97 years) and relationship, predict the toddlers' behavior. The second- (M=8.27 years) born rural African American investigation provides evidence for a longitudinal, children. At 1-year intervals, teachers assessed child intergenerational process whereby the grandmother- behavioral problems, mothers reported their parent relationship and the parents' personality and psychological functioning, and both mothers and behavioral attributes are transmitted across generations children reported parenting practices. Structural through their association with the parent-child equation modeling indicated that child competence was relationship. linked with residualized positive changes in mothers' psychological functioning from Wave 1 to Wave 2. Brook JS, Zheng L, Whiteman M, Brook DW. Aggression in Mothers' psychological functioning and child toddlers: associations with parenting and marital competence at Wave 2 forecast involved-supportive relations. J Genet Psychol 2001; 162(2):228-41. parenting at Wave 3, which was associated negatively Abstract: This study examined the relation among with externalizing and internalizing problems at Wave parenting factors, marital relations, and toddler 4. The importance of replicating processes leading to aggression. A structured questionnaire was outcomes among children in the same study is administered to both parents of 254 2-year-olds. The discussed. authors used correlation and hierarchical multiple regression analyses to assess the extent to which Brook JS, Brook DW, Whiteman M. Maternal correlates of certain personality traits, drug use, parenting style, and toddler insecure and dependent behavior. J Genet marital conflicts were related to the toddlers' aggressive Psychol 2003; 164(1):72-87. behavior. Results showed that the maternal child- Abstract: The present study was designed to examine rearing and parental aggression domains had a direct the relationship between characteristics of mothers and effect on toddler aggression. The domain of maternal their toddler's insecure and dependent behavior. The child rearing also served as a mediator for the domains authors studied 254 2-year-old toddlers and their of marital relations, paternal child rearing, parental mothers via a structured questionnaire administered to aggression, and parental drug use. The findings the mothers in their homes. The extent to which indicated that maternal child-rearing practices, insecure and dependent behavior is related to the personality attributes, and drug use were more domains of maternal child rearing, maternal personality important than paternal attributes in relation to toddler traits, parental marital relations, and maternal drug use aggression. Implications for prevention among families was assessed. Using Pearson correlations and at risk are discussed. hierarchical multiple regression analyses, the authors found that the maternal child-rearing and maternal Brook WC. Wireless-case history. Monitoring med mobile. personality domains have a direct effect on the Health Manag Technol 2005; 26(6):26, 28. toddlers' insecure and dependent behavior. The Abstract: A pediatric trauma center leverages its maternal child-rearing domain also served as a wireless infrastructure to help improve patient mediator for the domains of the maternal personality outcomes with innovations including a point-of-care attributes, parents' marital relations, and maternal drug medication administration system. use. There also was evidence suggesting an indirect effect of maternal personality attributes on the toddlers' Brooke PS. Legal questions. Sexual discrimination: no good insecure and dependent behavior, which is mediated by knight. Nursing (Lond) 2002; 32(10):90. the domain of maternal child-rearing practices. Implications for the prevention of insecure and Brooke PS. Legal questions. Suspected child abuse: dependent behavior in toddlers are discussed. disturbing disclosures. Nursing (Lond) 2002; 32(10):92. Brook JS, Whiteman M, Zheng L. Intergenerational transmission of risks for problem behavior. J Abnorm Brophy M, Dunn J. What did mummy say? Dyadic 381
- 390. interactions between young"hard to manage" children of an 8-month center- and home-based prevention and their mothers. J Abnorm Child Psychol 2002; program for preschoolers at high risk for conduct 30(2):103-12. problems. We report immediate program effects on Abstract: Thirty preschoolers rated as "hard to manage" observed and self-rated parenting practices and on Goodman's (R. Goodman, 1997) Strengths and observed child behavior with peers. Ninety-nine Difficulties Questionnaire (SDQ), and a group of preschool-age siblings of adjudicated youths and their matched control children were observed and recorded families were randomly assigned to an enhanced on audiotape at home, interacting with their mothers version of the Incredible Years Series (Webster- (Time 1). At the 18-month follow-up home visits Stratton, 1989; n = 50) or to a no-intervention control (Time 2), the children and mothers were filmed across condition (n = 49). In an intent-to-treat design, the 4 observation settings. Mother-child interactions were intervention yielded significant effects on negative rated on affect, control, responsiveness and parenting, parental stimulation for learning, and child "connectedness" of communication. At Time 1, social competence with peers. Improvements in mothers of the "hard to manage" group used more negative parenting, stimulation for learning, and child negative control and engaged in fewer connected social competence support the potential of the conversations than did mothers in the control group. At intervention to prevent later conduct problems in high- Time 2, mothers of the "hard to manage" group risk children. displayed higher levels of negative control and lower levels of positive control. These results are discussed in Brotman LM, Klein RG, Kamboukos D, Brown EJ, Coard terms of the importance of examining connected SI, Sosinsky LS. Preventive intervention for urban, communication and different observation contexts low-income preschoolers at familial risk for conduct when examining dyadic mother-child interactions. problems: a randomized pilot study. J Clin Child Adolesc Psychol 2003; 32(2):246-57. Brosnan CA, Upchurch SL, Meininger JC, Hester LE, Abstract: Conducted a pilot study to test the feasibility Johnson G, Eissa MA. Student nurses participate in of a prevention program for promoting parenting in public health research and practice through a school- families of preschoolers at high risk for behavior based screening program. Public Health Nurs 2005; problems. Risk status was based on a family history of 22(3):260-6. antisocial behavior and residence in a low-income, Abstract: Obesity has reached epidemic proportions urban community. Thirty preschoolers (ages 21/2 to 5) among children in minority populations, placing them and their parents were randomly assigned to a 1-year, at risk for diabetes and hypertension. The importance home- and clinic-based intervention or to a no- of educating a generation of nurses who have the intervention control condition. Despite families' knowledge, skills, and passion to address this public multiple risk factors, high rates of attendance and health need is crucial to the profession and to satisfaction were achieved. Relative to controls, America's health. This article describes the use of a intervention parents were observed to be significantly Community Partnership Model to frame baccalaureate more responsive and use more positive parenting nursing students' (B.S.N.) service learning within the practices. Results support the feasibility of engaging context of a research study to screen middle- and high- high-risk families in an intensive prevention program. school students for health risks. The missions of The meaningful changes achieved in parenting suggest education, research, and practice are linked together in that a preventive approach is promising for families the model by three processes: evidence-based practice, with multiple risk factors. service learning, and scholarly teaching. The aim of the project was early identification of obesity, Brouh Y, Paut O, Lena G, Paz-Paredes A, Camboulives J. hypertension, and type 2 diabetes and their predictors [Shaken baby syndrome: improvement of cerebral in a high-risk student population, between 12 and 19 blood flow velocity after a subdural external derivation years of age. Early evidence indicates that the model is in a six-month old infant]. Ann Fr Anesth Reanim feasible and effective for directing student learning and 2002; 21(8):676-80. addressing public health problems in the community. Abstract: The shaken baby syndrome is a severe form of child abuse. The intracranial injuries are associated Bross DC. Protecting children from maltreatment in a with a high morbidity and mortality rates. A 6 month- hospital setting. Child Abuse Negl 2001; 25(12):1551- old healthy infant presented at home a 3. cardiorespiratory arrest. After a cardiopulmonary resuscitation, radiological survey showed sub-dural Brotman LM, Gouley KK, Chesir-Teran D, Dennis T, Klein haematomas and retinal haemorrhages, without a RG, Shrout P. Prevention for preschoolers at high risk history of trauma. The diagnosis of shaken baby for conduct problems: immediate outcomes on syndrome was made. Despite medical management and parenting practices and child social competence. J Clin a fontanelle tap, clinical signs of intracranial Child Adolesc Psychol 2005; 34(4):724-34. hypertension worsened. Transcranial Doppler Abstract: This study investigated the immediate impact examination found the cerebral blood flow velocities to be decreased while the pulsatility index was increased. 382
- 391. A sub-dural-external drainageallowed the cerebral the lower C-spine (C4 to C7); 4 of these were motor blood flow to increase and the pulsatility index to vehicle related, and all 4 patients died. Isolated C-spine decrease. We conclude that transcranial Doppler injuries occurred in 43%, whereas 38% had associated examination can be helpful for the clinician caring closed head injuries (CHI). The overall mortality rate children presenting a shaken baby syndrome. was 18.5%, most commonly motor vehicle related (95%), occurring in younger children (mean and Brown C. Fractures and child abuse. Nursing (Lond) 2004; median age 5 years) and associated with upper C-spine 34(12):8. injuries (74%) and CHI (89%). C1 dislocations occurred in younger children (mean age, 6.6 years), Brown JV, Demi AS, Celano MP, Bakeman R, Kobrynski L, most often as a result of motor vehicle-related trauma Wilson SR. A home visiting asthma education (especially pedestrians) and were associated with the program: challenges to program implementation. highest injury severity score (ISS), longest length of Health Educ Behav 2005; 32(1):42-56. stay (LOS), most CHIs, and the highest mortality rate Abstract: This study describes the implementation of a (50%). C-spine fractures with or without SCI occurred nurse home visiting asthma education program for low- most commonly as a result of falls and dives. Sporting income African American families of young children injuries occurred almost exclusively in adolescent boys with asthma. Of 55 families, 71% completed the (mean age, 13.8 years) and were isolated injuries program consisting of eight lessons. The achievement associated with a relatively low ISS and shorter LOS. of learning objectives was predicted by caregiver Interestingly, 75% of sporting injuries showed factors, such as education, presence of father or SCIWORA, and all infants suffering from child abuse surrogate father in the household, and safety of the had SCIWORA. CONCLUSIONS: Mechanisms of neighborhood, but not by child factors, such as age or injury are age related, with younger children sustaining severity of asthma as implied by the prescribed asthma C-spine injuries as a result of motor vehicle-related medication regimen. Incompatibility between the trauma and older adolescents commonly injured during scheduling needs of the families and the nurse home sporting activities. C-spine injuries in children most visitors was a major obstacle in delivering the program commonly involve the upper C-spine, but complete on time, despite the flexibility of the nurse home lesions of the cord are associated more frequently with visitors. The authors suggest that future home-based lower C-spine injuries. The type of C-spine injury is asthma education programs contain a more limited related to the mechanism of injury: SCIWORA is number of home visits but add telephone follow-ups associated with sporting activities and child abuse, C- and address the broader needs of low-income families spine dislocations most commonly result from motor that most likely function as barriers to program vehicle-related trauma (especially among pedestrians), success. and C-spine fractures occur most commonly as a result of falls and dives. Predictors of mortality include Brown RL, Brunn MA, Garcia VF. Cervical spine injuries in younger age, motor vehicle-related mechanism, C1 children: a review of 103 patients treated consecutively dislocations, high ISS greater than 25, and associated at a level 1 pediatric trauma center. J Pediatr Surg CHI. A high index of suspicion for SCIWORA is 2001; 36(8):1107-14. essential when evaluating adolescents with neck Abstract: PURPOSE: Cervical spine (C-spine) injuries trauma associated with sporting injuries or victims of occur infrequently in children but may be associated child abuse. with significant disability and mortality. The purpose of this study was to review the experience of a level 1 Brown TE. Atomoxetine and stimulants in combination for pediatric trauma center to determine the epidemiology, treatment of attention deficit hyperactivity disorder: risk factors, mechanisms, levels, types of injury, four case reports. J Child Adolesc Psychopharmacol comorbid factors, and outcomes associated with these 2004; 14(1):129-36. potentially devastating injuries. METHODS: A Abstract: Atomoxetine and stimulants have both been retrospective analysis of 103 consecutive C-spine demonstrated effective as single agents for treatment of injuries treated at a level 1 pediatric trauma center over attention deficit hyperactivity disorder in children, a 9(1/2)-year period (January 1991 through August adolescents, and adults. However, attention deficit 2000) was performed. RESULTS: The mean age was hyperactivity disorder symptoms in some patients do 10.3 +/- 5.2 years, and the male-to-female ratio was not respond adequately to single-agent treatment with 1.6:1. The most common mechanism of injury was these medications, each of which is presumed to impact motor vehicle related (52%), followed by sporting dopaminergic and noradrenergic networks by injuries (27%). Football injuries accounted for 29% of alternative mechanisms in different ratios. Four cases all sports-related injuries. Sixty-eight percent of all are presented to illustrate how atomoxetine and children sustained injuries to C1 to C4; 25% to C5 to stimulants can be utilized effectively in combination to C7; and 7% to both. Spinal cord injury without extend duration of symptom relief without intolerable radiographic abnormality (SCIWORA) occurred in side effects or to alleviate a wider range of impairing 38%. Five patients had complete cord lesions involving symptoms than either agent alone. This combined pharmacotherapy appears effective for some patients 383
- 392. who do notrespond adequately to monotherapy, but identification of communities with disparate oral health because there is virtually no research to establish safety needs, problems, and resources; and (3) effective and effectiveness of such strategies, careful monitoring presentation of community-specific oral health survey is needed. data to community leaders, stakeholders, and decision makers. Brugge D, Carranza L, Steinbach S, Wendel A, Hyde J. Environmental management of asthma at Brummer S. Streamlined support. Centralized desktop Massachusetts managed care organizations. J Public management improves IT service at an Atlanta-based Health Manag Pract 2001; 7(5):36-45. children's healthcare system. Health Manag Technol Abstract: Asthma management staff at eight 2004; 25(4):22-4. Massachusetts managed care organizations (MCOs) were interviewed to learn the extent of inclusion of Brunod R, Cazenave B, Angele C. [Outcome of small girls, environmental prevention strategies in their asthma victims of incest]. Rev Med Suisse Romande 2001; disease management policies. Six of the plans had 121(7):513-6. formal asthma disease management programs, all reported to be based on the National Heart Lung and Bryan E. The impact of multiple preterm births on the Blood Institute guidelines, but none followed these family. BJOG 2003; 110 Suppl 20:24-8. guidelines in their entirety. Three MCOs provided for Abstract: Multiple births are important contributors to home visits that included addressing environmental the preterm and low birthweight population and the factors for severe asthmatics. Despite the limited role numbers of twin births have been steadily rising since that MCOs appear to play in environmental prevention the early 1980s in all developed countries. This is of asthma, the authors identify opportunities and largely due to the increased use of ovulation induction encourage efforts to expand these programs. and multi-embryo transfer in the treatment of subfertility. Parents of preterm twins have been shown Bruguera M, Sanchez Tapias JM. [Viral hepatitis in to be less responsive to their infants than those with immigrants and in adopted children. A problem of singletons. Parental stress with twins has also been unknown magnitude in Spain]. Med Clin (Barc) 2001; demonstrated by the higher incidence of maternal 117(15):595-6. depression and of child abuse in multiple birth families. Furthermore, siblings of twins are more likely to have Brumley DE, Hawks RW, Gillcrist JA, Blackford JU, Wells behaviour problems. Mortality and long-term WW. Successful implementation of community water morbidity rates are greatly increased amongst multiple fluoridation via the community diagnosis process. J birth children. The problems of the single surviving Public Health Dent 2001; 61(1):28-33. twin and the unaffected co-twin of a disabled child are Abstract: OBJECTIVES: This paper describes the often underestimated as is the complexity of the community diagnosis process and how it was used to bereavement of parents who still have surviving implement community water fluoridation in Tennessee. multiples. Addressing the cause of the epidemic of METHODS: Public health dental staff developed a iatrogenic multiple births is likely to be the single most survey instrument to collect community-specific data effective way to reduce the number of preterm infants on the oral health status of schoolchildren. Key survey and the long-term problems to which they are prone. findings were presented to county health councils who were determining and prioritizing the health needs of Brzozowska A. [Child maltreatment as a risk factor for their communities. RESULTS: Community-specific suicidal behavior--a literature review]. Psychiatr Pol data showed higher caries levels in children without 2004; 38(1):29-36. access to an optimally fluoridated community water Abstract: Based on a review of studies done in the last supply. Presentation of local survey findings to county 20 years the author presents recent knowledge on the health councils resulted in fluoridation being a high- possible relationship between child maltreatment and priority health issue in several counties. With health suicidal behaviour in childhood, adolescence and council support, opposition to fluoridation by utility adulthood. district officials was overcome when decision makers were challenged with local survey findings. The Buchanan GR, Journeycake JM, Adix L. Severe chronic community diagnosis process resulted in the successful idiopathic thrombocytopenic purpura during childhood: fluoridation of six community water systems serving a definition, management, and prognosis. Semin Thromb total of 33,000 residents. CONCLUSIONS: The Hemost 2003; 29(6):595-603. community diagnosis approach was successful in Abstract: Chronic idiopathic thrombocytopenic purpura implementing community water fluoridation in (ITP) can be categorized as mild, moderately severe, or geographic areas historically opposed to this public severe. Severe chronic ITP during childhood is a rare health measure. The success of these fluoridation disorder characterized by clinically significant initiatives was attributed to: (1) current, community- mucocutaneous hemorrhage, usually in the setting of specific assessments of children's oral health; (2) marked thrombocytopenia. It can cause substantial 384
- 393. morbidity and rarelymortality. Many patients improve child development. with time or even fully recover, but for those whose quality of life is negatively influenced by hemorrhage Bulgan T, Gilbert CE. Prevalence and causes of severe or side effects of conventional therapy (corticosteroids, visual impairment and blindness in children in intravenous immunoglobulin G, or anti-D), Mongolia. Ophthalmic Epidemiol 2002; 9(4):271-81. splenectomy is recommended. If splenectomy is Abstract: BACKGROUND: Reliable epidemiological unsuccessful or not feasible, other drug treatments are data on the prevalence and causes of visual loss in available, but few efficacy data exist, and the toxicity children are difficult to obtain, but are essential for and cost of these treatments can be appreciable. Their planning. No such data are available from Mongolia. use is best avoided outside of clinical trials conducted AIM: To determine the prevalence and causes of in specialty centers or in multi-institutional networks. severe visual impairment and blindness (SVI/BL) in children from a defined area of Mongolia, using several Buchko B. Should newborn nursery viewing windows be methods of identification. METHODS: Children with eliminated? Writing for the PRO position. MCN Am J presenting visual acuities of <6/60 in the better eye Matern Child Nurs 2002; 27(5):262. who lived in 10 of the 18 provinces (Aimaks) were identified 1) by family doctors 2) in the school for the Buckley ME, Klein DN, Durbin CE, Hayden EP, Moerk KC. blind 3) by visiting eye departments in the capital. All Development and validation of a Q-sort procedure to eligible children were examined (or data extracted from assess temperament and behavior in preschool-age hospital records) and the cause of visual loss children. J Clin Child Adolesc Psychol 2002; determined using the WHO classification system. 31(4):525-39. RESULTS: Sixty-four children with SVI/BL before Abstract: Few broad observational measures of refraction were identified who lived in the 10 study preschool-age children's temperament and behavior Aimaks. They were recruited by family doctors (52); currently exist. Studied the Child Temperament and by home visits (3); from hospital records (4); or from Behavior Q-Set (CTBQ-Set) as a naturalistic the school for the blind (5). The prevalence of SVI/BL observation measure to tap the major domains of before refraction was 0.19/1,000 children (95% CI temperament and behavior in preschoolers. Pairs of 0.16-0.22), decreasing to 0.16/1,000 after refraction observers rated the behavior of a community sample of (95% CI 0.13-0.19) but there was considerable preschoolers during 2 independent home visits using q- variation from Aimak to Aimak. The major causes of sort methodology. The CTBQ-Set scales displayed SVI/BL were lesions of the lens (34%), central nervous good levels of internal consistency and convergent and system disorders (19%), lesions of the whole globe discriminant content saturation. The scales displayed (e.g. microphthalmos) (14%), and retinal conditions good interrater reliability at each observation and (12.5%). Hereditary factors were responsible for 27% moderate test-retest stability between observations. The of causes, and 17% of children were blind following construct validity of the CTBQ-Set scales was acquired conditions of childhood. The underlying cause supported by correlations with mothers' ratings of their could not be determined in 48%. The causes of SVI/BL children's behavior using the Child Behavior Checklist was analysed in a further 16 children who lived outside for 2- and 3-year-olds (CBCL/2-3) and the Children's the study Aimaks to compare the causes in children in Behavior Questionnaire. The CTBQ-Set shows special education with those not in schooling, and by promise as an observer-reated measure of preschoolers' age. CONCLUSION: The prevalence estimate obtained behavior and temperament in their natural home was lower than anticipated, and possible reasons are environment. discussed. The pattern of causes of SVI/BL is similar to that in children in schools for the blind in China, but Buijs R, Olson J. Parish nurses influencing determinants of is very different from other Asian countries. health. J Community Health Nurs 2001; 18(1):13-23. Meningococcal meningitis was the most common Abstract: How are the concepts health, health preventable cause of SVI/BL, and immunisation is promotion, faith community, and health determinants being considered. Other preventable causes were rare, connected? How can a nurse draw on the unique and the majority of children needing surgical features of a faith community to promote health? In intervention had already been identified and referred this article, we explore the relations among these for treatment. The control of blindness in children concepts and consider the answers to these questions. could possibly be improved by better management of Parish nurses provide a concrete example of the conditions requiring surgery, and by the provision of interactions among these concepts. They are often low vision devices. hired by faith communities to intentionally promote health within and beyond the faith community. Bullough VL. Children and adolescents as sexual beings: a Increasingly, faith communities are being used as historical overview. Child Adolesc Psychiatr Clin N settings for health promotion interventions. We Am 2004; 13(3):447-59, v. describe examples of how a parish nurse can influence Abstract: This article provides a historical overview of 2 determinants of health: social support and healthy attitudes toward the sexual and erotic behavior of children and adolescents. It includes an examination of 385
- 394. the conflicting attitudesof historians toward childhood discussed. These findings suggest that although state- and the living conditions and attitudes that influenced sanctioned racism may help to explain the greater childhood sexual development. Attitudes have varied racial inequality in stunting in South Africa than in from an emphasis on childhood innocence to fears of Brazil, the eradication of a disadvantage for nonwhites childhood sinfulness, from children being regarded as will depend on changes in the same fundamental asexual creatures to being extremely sexual, and from socioeconomic inequalities that characterize both being little adults to regarding childhood as unique and nations. different. Although there have always been observers of childhood sexuality, and much adult interest in it, Burgess IF, Brown CM, Lee PN. Treatment of head louse research into the topic mainly is a twentieth century infestation with 4% dimeticone lotion: randomised development. Sigmund Freud was a pioneer in controlled equivalence trial. BMJ 2005; recognizing children as sexual beings; however, 330(7505):1423. research since his time has challenged and modified his Abstract: OBJECTIVE: To evaluate the efficacy and assumptions. Whatever their discipline, however, there safety of 4% dimeticone lotion for treatment of head is general agreement that sexuality is part of childhood louse infestation. DESIGN: Randomised controlled development. equivalence trial. SETTING: Community, with home visits. PARTICIPANTS: 214 young people aged 4 to Bundy AL. Aligning systems to create full-service schools: 18 years and 39 adults with active head louse the Boston experience, so far. New Dir Youth Dev infestation. INTERVENTIONS: Two applications 2005; (107):73-80, table of contents. seven days apart of either 4.0% dimeticone lotion, Abstract: Leaders of full-service schools in Boston applied for eight hours or overnight, or 0.5% seek to expand the number and increase the impact of phenothrin liquid, applied for 12 hours or overnight. Boston's full-service schools, catalyzing a realignment OUTCOME MEASURES: Cure of infestation (no of public resources and an expansion of private evidence of head lice after second treatment) or investment. The Full-Service Schools Roundtable, led reinfestation after cure. RESULTS: Cure or by a dynamic staff and supported by the mayor and the reinfestation after cure occurred in 89 of 127 (70%) superintendent of schools, is a steadily growing participants treated with dimeticone and 94 of 125 coalition of educators, public agencies, human service (75%) treated with phenothrin (difference -5%, 95% providers, and community leaders. Challenges for the confidence interval -16% to 6%). Per protocol analysis Roundtable are to build the public will to invest in full- showed that 84 of 121 (69%) participants were cured service schools; secure leadership from stakeholders; with dimeticone and 90 of 116 (78%) were cured with share accountability across sectors so that schools phenothrin. Irritant reactions occurred significantly less prioritize youth development and health, and service with dimeticone (3/127, 2%) than with phenothrin providers share responsibility for school success; and (11/125, 9%; difference -6%, -12% to -1%). Per become a political force, championing the strategic protocol this was 3 of 121 (3%) participants treated realignment of public investments based on child with dimeticone and 10 of 116 (9%) treated with outcomes. phenothrin (difference -6%, -12% to -0.3%). CONCLUSION: Dimeticone lotion cures head louse Burchfield DJ. Postnatal steroids to treat or prevent chronic infestation. Dimeticone seems less irritant than existing lung disease in preterm infants. Pediatrics 2003; treatments and has a physical action on lice that should 111(1):221-2; author reply 221-2. not be affected by resistance to neurotoxic insecticides. Burgard S. Does race matter? Children's height in Brazil and Burgio GR, Gluckman E, Locatelli F. Ethical reappraisal of South Africa. Demography 2002; 39(4):763-90. 15 years of cord-blood transplantation. Lancet 2003; Abstract: I examine racial differences in child stunting 361(9353):250-2. in mid-1990s South Africa and Brazil, two multiracial Notes: GENERAL NOTE: KIE: 22 refs. societies with different histories of legal support for GENERAL NOTE: KIE: KIE Bib: blood donation racial discrimination. Using data from nationally Abstract: Since the first successful use of cord blood as representative household samples linked to source of haemopoietic stem cells for transplantation in community-level measures, the analysis shows that 1988, more than 2000 patients with malignant or non- racial inequality in the distribution of socioeconomic malignant disorders have been treated with this resources across households and communities explains procedure. Collection and storage of cord blood has much of the racial difference in stunting in both prompted ethical considerations, mainly dealing with countries. Even after these factors are controlled, the issues of autonomy in making decisions about however, the results indicate that in South Africa, donation of cord blood, and of privacy and nonwhite children are still at greater risk of growth confidentiality in the tests required before use of faltering than are white children. The nature of placental cells for transplantation. The ethical socioeconomic and racial differences in children's implications of possible storage of cord-blood cells for growth is examined, and major determinants are autologous use has also been discussed. Preimplantation selection of HLA-matched embryos to 386
- 395. obtain a donorof cells for cord-blood transplantation of Burrow AL, Finley GE. Transracial, same-race adoptions, a sibling with a life-threatening disease has raised the and the need for multiple measures of adolescent issue of the extent to which this approach complies adjustment. Am J Orthopsychiatry 2004; 74(4):577-83. with the principles of bioethics. Abstract: Using a multimeasure approach, the current study investigated 12 indices of academic, familial, Burmahl B. The picture of health. Health Facil Manage psychological, and health outcomes for 4 groups of 2003; 16(1):12-7. transracial and same-race adopted adolescents. A secondary analysis of the National Longitudinal Study Burnand G. Integrative aspects of problem theory: a review of Adolescent Health data showed that Asian of applications. Genet Soc Gen Psychol Monogr 2002; adolescents adopted by White parents had both the 128(2):101-38. highest grades and the highest levels of psychosomatic Abstract: It is argued that people work on 6 interrelated symptoms, whereas Black adolescents adopted by general problems, called key problems, which are Black parents reported the highest levels of depression. necessarily simply conceived and therefore open to a Intriguingly, and by contrast, Black adoptees reported priori identification. Key problems demand separate higher levels of self-worth than non-Black adoptees. attention, and, with children below 9 years of age and The implications of the findings for future again between 10 and 17 years of age, and with adults investigations of transracial adoption are discussed. in long-term groups, they receive attention 1 by 1, as focal problems, with intervening transitional phases, in Busari JO, Weggelaar NM. How to investigate and manage a fixed sequence. Isolated societies stress 1 focal the child who is slow to speak. BMJ 2004; problem, and families and individuals tend to do the 328(7434):272-6. same. Humor and elated play worsen the problem. Brain lateralization helps in separating work on the 1st Bush T, Curry SJ, Hollis J et al. Preteen attitudes about key problem from work on other problems, and failure smoking and parental factors associated with favorable to accomplish this contributes to mental disorder. The attitudes. Am J Health Promot 2005; 19(6):410-7. theory can be fitted to aspects of brain activity (as Abstract: PURPOSE: To describe youth smoking- shown in the electroencephalograph), such as the related attitudes and evaluate the effects of parental change with age in theta coherence growth rate. factors on child adoption of positive attitudes about smoking. DESIGN: This study used baseline and 20- Burnside E, Startup M, Byatt M, Rollinson L, Hill J. The month data from a family-based smoking-prevention role of overgeneral autobiographical memory in the study (82.9% completed both surveys). SETTING: development of adult depression following childhood Telephone recruitment from two health maintenance trauma. Br J Clin Psychol 2004; 43(Pt 4):365-76. organizations. SUBJECTS: Children aged 10 to 12 Abstract: OBJECTIVE: Overgeneral autobiographical years and one parent of each child (n=418 families) memory (AM) has been associated with episodes of were randomly assigned to a frequent assessment clinical depression in adults and also with reported cohort (12.5% of participants). Intervention. Families experience of childhood sexual abuse (CSA). This received a mailed smoking-prevention packet (parent study investigated whether AM has a role in the handbook, videotape about youth smoking, comic development of adult depression in survivors of CSA book, pen, and stickers), outreach telephone counselor and whether it is related to circumstances of CSA. calls to the parent, a newsletter, and medical record METHOD: A community sample of women who prompts for providers to deliver smoking-prevention reported a history of CSA (N = 41) completed the messages to parents and children. MEASURES: autobiographical memory test and were interviewed Demographics, tobacco status, attitudes about smoking about any adult episodes of depression using the (Teenage Attitudes and Practices Survey), family Schedule for Affective Disorders and Schizophrenia- discussions about tobacco, family cohesiveness (family Lifetime. RESULTS: Women who reported episodes of support and togetherness), parent involvement, parent depression recalled fewer categoric memories in monitoring, and parenting confidence. Results. One- response to cue words than those who reported no third of the children endorsed beliefs that they could episodes of depression. Correlations indicated that the smoke without becoming addicted, and 8% to 10% number of categoric memories recalled for all cue endorsed beliefs on the benefits of smoking. Children's words was associated with early abuse and greater positive attitudes about smoking were associated with duration of abuse. CONCLUSIONS: Relationships lower family cohesiveness (p = .01). Parental use of between AM and the age, and duration of abuse are tobacco was the only significant predictor of children's consistent with previous findings of a relationship positive attitudes about tobacco at 20 months (p = .03). between CSA and AM. Categoric AM appears to serve CONCLUSIONS: Children as young as 10 years as a defence against distressing memories. However, underestimate addictive properties of smoking, which this suggestion needs to be tested with prospective may place them at risk for future smoking. Parental use studies showing whether AM recall style becomes of tobacco and family cohesiveness are important more specific as a result of an episode of depression. factors in the formulation of preteen attitudes about smoking. 387
- 396. Bushman BJ, BonacciAM. Violence and sex impair used to identify 266 children at high risk for ADHD. memory for television ads. J Appl Psychol 2002; Parents completed standardized instruments assessing 87(3):557-64. network structure and function, DSM-IV diagnoses of Abstract: Participants watched a violent, sexually disruptive disorders, caregiver strain, and treatment explicit, or neutral TV program that contained 9 ads. receipt, and children self-reported internalizing Participants recalled the advertised brands. They also symptoms. Relationships were examined with analysis identified the advertised brands from slides of of variance and multivariate prediction, adjusting for supermarket shelves. The next day, participants were sociodemographic characteristics, psychopathology, telephoned and asked to recall again the advertised and parental strain. RESULTS: Network characteristics brands. Results showed better memory for people who varied by race and socioeconomic status (SES), but not saw the ads during a neutral program than for people by child gender. African-American and disadvantaged who saw the ads during a violent or sexual program parents reported smaller network sizes, but more both immediately after exposure and 24 hr later. frequent contact and higher levels of support than their Violence and sex impaired memory for males and white and high-SES counterparts. High levels of females of all ages, regardless of whether they liked instrumental support lowered the odds of ADHD programs containing violence and sex. These results treatment during the 12 months before (OR =.7, p suggest that sponsoring violent and sexually explicit <.001) and after (OR =.7, p <.001) the network TV programs might not be a profitable venture for assessment interview. In contrast, parental strain advertisers. increased the likelihood of ADHD treatment during both periods. CONCLUSIONS: Clinicians should Bussen S, Rehn M, Haller A, Weichert K, Dietl J. [Genital anticipate high levels of caregiver strain and low levels findings in sexually abused prepubertal girls]. Zentralbl of instrumental support among their patients' parents Gynakol 2001; 123(10):562-7. and address the potential high need for respite care in Abstract: Genital findings in sexually abused treatment plans. prepubertal girls.Childhood sexual abuse is defined as the involvement of dependent, developmentally Busza J, Castle S, Diarra A. Trafficking and health. BMJ immature children and adolescents in sexual activities 2004; 328(7452):1369-71. that they do not fully comprehend, to which they are unable to give informed consent or that violate the Butchart A, Engstrom K. Sex- and age- specific relations social taboos of family roles. Essential to the diagnosis between economic development, economic inequality of sexual abuse is an awareness of the problem and and homicide rates in people aged 0-24 years: a cross- acknowledgement of its manifestations. The evaluation sectional analysis. Bull World Health Organ 2002; of the sexually abused girl usually is performed in a 80(10):797-805. pediatric and adolescent gynecology outpatient Abstract: OBJECTIVE: To test whether relations department. Thus, the gynecologist will be part of a between economic development, economic inequality, multidisciplinary approach to the problem and will and child and youth homicide rates are sex- and age- need to be competent in the basic skills of history specific, and whether a country's wealth modifies the taking, physical examination, selection of laboratory impact of economic inequality on homicide rates. tests und differential diagnosis. Findings secondary to METHODS: Outcome variables were homicide rates sexual abuse are often subtle. Acute tears or bruisings around 1994 in males and females in the age ranges 0- are rare, because force is seldom part of sexual acts 4, 5-9, 10-14, 15-19 and 20-24 years from 61 countries. committed against a child. A vaginal opening of greater Predictor variables were per capita gross domestic than 5 mm is not common and may indicate vaginal product (GDP), GINI coefficient, percentage change in penetration. An intact hymen not necessarily exclude per capita gross national product (GNP) and female vaginal intercourse. Lack of physical evidence never economic activity as a percentage of male economic rules out abuse because sexual acts may leave no activity. Relations were analysed by ordinary least physical findings. squares regression. FINDINGS: All predictors explained significant variances in homicide rates in Bussing R, Zima BT, Gary FA et al. Social networks, those aged 15-24. Associations were stronger for males caregiver strain, and utilization of mental health than females and weak for children aged 0-9. Models services among elementary school students at high risk that included female economic inequality and for ADHD. J Am Acad Child Adolesc Psychiatry 2003; percentage change in GNP increased the effect in 42(7):842-50. children aged 0-9 and the explained variance in Abstract: OBJECTIVE: This study explores whether females aged 20-24. For children aged 0-4, country parental support networks vary by sociodemographic clustering by income increased the explained variance factors among children at high risk for attention- for both sexes. For males aged 15-24, the association deficit/hyperactivity disorder (ADHD) and whether with economic inequality was strong in countries with network characteristics influence the receipt of mental low incomes and weak in those with high incomes. health treatment for the child. METHOD: A school CONCLUSION: Relations between economic factors district-wide, two-phase screening study design was and child and youth homicide rates varied with age and 388
- 397. sex. Interventions totarget economic factors would based INT reported a trend toward lower total have the strongest impact on rates of homicide in parenting distress compared with caregivers of children young adults and late adolescent males. In societies who received SC with no home visits. with high economic inequality, redistributing wealth without increasing per capita GDP would reduce Byard RW, Donald TG. Initial neurologic presentation in homicide rates less than redistributions linked with young children sustaining inflicted and unintentional overall economic development. fatal head injuries. Pediatrics 2005; 116(6):1608; author reply 1608-9. Bute M. Congenital heart disease and treatment options. Case Manager 2004; 15(2):56-8; quiz 59. Byock I. The ethics of loving care. Health Prog 2004; 85(4):12-9, 57. Butler-Sloss DE. The role of the law in the care of sick Notes: GENERAL NOTE: KIE: 31 refs. children. Med Sci Law 2003; 43(2):93-7. GENERAL NOTE: KIE: KIE Bib: terminal care Butler-Sloss E, Hall A. Expert witnesses, courts and the law. Byrne MW. Conducting research as a visiting scientist in a J R Soc Med 2002; 95(9):431-4. women's prison. J Prof Nurs 2005; 21(4):223-30. Abstract: Incarcerated populations have disparities in Butz AM, Pulsifer M, Marano N, Belcher H, Lears MK, health risks and illness conditions meriting study, but Royall R. Effectiveness of a home intervention for the history of prison research is marred by unethical perceived child behavioral problems and parenting conduct. Ethical participation strategies are discussed stress in children with in utero drug exposure. Arch in the context of studies implemented by the author in a Pediatr Adolesc Med 2001; 155(9):1029-37. state prison system. This study used ethnographic Abstract: OBJECTIVE: To determine if a home-based approaches, observed adherence to federal and nurse intervention (INT), focusing on parenting institutional review board regulations and corrections education/skills and caregiver emotional support, department directives, and maintained continuous reduces child behavioral problems and parenting stress communication with vested interests to provide entry in caregivers of in utero drug-exposed children. and long-term access for studies on female prisoners DESIGN: Randomized clinical trial of a home-based and their civilian infants. A culture clash between the INT. SETTINGS: Two urban hospital newborn punitive restrictive environment that serves the nurseries; homes of infants (the term infant is used custody-control-care mission of corrections systems interchangeably in this study with the term child to and the open inquiry environment needed for conduct denote those from birth to the age of 36 months); and a of health research exists. Federal regulations protect research clinic in Baltimore, Md. PARTICIPANTS: In prisoners as human subjects but additional vigilance utero drug-exposed children and their caregivers (N = and communication by researchers are required. 100) were examined when the child was between the Gaining and maintaining access to prison inmates for ages of 2 and 3 years. Two groups were studied: nursing research are leadership challenges that can be standard care (SC) (n = 51) and INT (n = 49). met within the caring and collaborative paradigm of INTERVENTION: A home nurse INT consisting of 16 nursing. home visits from birth to the age of 18 months to provide caregivers with emotional support and Caan W. GP involvement in child protection. Br J Gen Pract parenting education and to provide health monitoring 2002; 52(481):678. for the infant. MAIN OUTCOME MEASURES: Scores on the Child Behavior Checklist and the Cackett P, Fleck B, Mulhivill A. Bilateral fourth-nerve palsy Parenting Stress Index. RESULTS: Significantly more occurring after shaking injury in infancy. J AAPOS drug-exposed children in the SC group earned t scores 2004; 8(3):280-1. indicative of significant emotional or behavioral Abstract: The shaken baby syndrome is a serious form problems than did children in the INT group on the of child abuse that typically results in serious short- Child Behavior Checklist Total (16 [31%] vs 7 [14%]; and long-term neurological sequelae. Isolated cranial P =.04), Externalizing (19 [37%] vs 8 [16%]; P =.02), nerve palsies have been reported after shaking injuries and Internalizing (14 [27%] vs. 6 [12%]; P =.05) scales in infants. We report a child with bilateral fourth and on the anxiety-depression subscale (16 [31%] vs. 5 cranial nerve palsy that developed after a shaking [10%]; P =.009). There was a trend (P =.06) in more injury. caregivers of children in the SC group reporting higher parenting distress than caregivers of children in the Cadoret RJ, Langbehn D, Caspers K et al. Associations of INT group. CONCLUSIONS: In utero drug-exposed the serotonin transporter promoter polymorphism with children receiving a home-based nurse INT had aggressivity, attention deficit, and conduct disorder in significantly fewer behavioral problems than did in an adoptee population. Compr Psychiatry 2003; utero drug-exposed children receiving SC (P =.04). 44(2):88-101. Furthermore, those caregivers receiving the home- Abstract: Prior studies of the Iowa Adoption cohorts 389
- 398. have demonstrated thatthe degree of adoptee range of early traumatic events that may be directly or aggressiveness and conduct disorder has a significant indirectly experienced by youth. These studies raise genetic component. Other studies have implicated the many fundamental questions such as validity of current neurotransmitter serotonin or polymorphisms in the diagnostic criteria for post-traumatic stress disorder, serotonin transporter gene (5HTT) as an important comorbidity with anxiety, depressive disorders and source of variability in "externalizing" behaviors such childhood traumatic grief symptoms. Vulnerability and as aggressivity, conduct disorder, and attention deficit- protective factors, mainly gender, age and social hyperactivity disorders (ADHD). Following this lead, support are considered. A common problem in research we genotyped a subgroup of adoptees (n = 87) at high into the impact of trauma on children is the presence of risk for these kinds of disorders with respect to the many limitations: studies are often retrospective, use serotonin-transporter-linked promoter region self-report questionnaires and the results may not be (5HTTLPR) polymorphism, and used ordinal logistic generalizable (i.e. they are trauma or population regression to conduct an association study. Primary specific). There is a lack of well designed studies, analysis failed to detect a main effect between addressing in particular treatments for post-traumatic 5HTTLPR status and subscales of aggressivity, symptoms in children and adolescents. conduct disorder, or attention deficit. However, when biologic parent status and sex of proband were Cahn ES, Gray C. Using the coproduction principle: no more considered, certain interactions between 5HTTLPR and throwaway kids. New Dir Youth Dev 2005; (106):27- other genetic risk factors were evident. One type of 37, 4. interaction with the LL variant of 5HTTLPR increased Abstract: Youth development does not take place only externalizing behavior in individuals with antisocial in institutions or even primarily in institutions. It takes biologic parentage; a second interaction with one or place in the core economy-the economy of family, more 5HTTLPR short variants (SS or SL) appeared to neighborhood, and community. Major challenges increase externalizing behaviors in conjunction with a include rebuilding the kind of village it takes to raise a genetic diathesis for alcoholism. Gender of adoptee child and enabling a child to be part of that rebuilding. also appeared to interact with 5HTTLPR. Male Another challenge is to make sure that any external individuals with the short variant were more likely to incentives that are provided to youth are linked to have higher symptom counts for conduct disorder, activities that build self-esteem and convey a definition aggressivity, and ADHD. In contrast, among females, of value that is different from that established by the short variant (SS, SL) was associated with lower money and market price. This chapter provides an levels of such behavior. The results support the introduction to time banking and to coproduction, hypothesis that gene-biological family history approaches to youth development that enable youth to interactions are involved in the externalizing behaviors participate as major players, as opposed to recipients, studied and constitute interesting findings for future in the reshaping of their lives and communities. replication. Cairncross S, Shordt K, Zacharia S, Govindan BK. What Caffo E, Forresi B, Lievers LS. Impact, psychological causes sustainable changes in hygiene behaviour? A sequelae and management of trauma affecting children cross-sectional study from Kerala, India. Soc Sci Med and adolescents. Curr Opin Psychiatry 2005; 2005; 61(10):2212-20. 18(4):422-8. Abstract: This study was designed and the field work Abstract: PURPOSE OF REVIEW: In this review we carried out by a non-governmental organisation (NGO) examine the most recent literature on the impact, responsible for implementing hygiene promotion. The psychological sequelae and management of trauma sustainability of changed hygiene behaviour was affecting children and adolescents. We focus on studied at various periods up to nine years after the consequences of early traumatic events in childhood, conclusion of a multifaceted hygiene promotion adolescence and adulthood; mediating variables (risk intervention in Kerala, India. Various methods and protective factors) intervention strategies and including a questionnaire to assess knowledge, spot available treatments. RECENT FINDINGS: observation, demonstration of skills on request, and Increasingly often, mental health professionals are household pocket voting were used and compared for being asked to address the needs of children and the measurement of the hygiene outcome. Pocket adolescents who have been exposed to traumatic voting gave the lowest prevalence of good practice, events, either as individuals or in groups. Studies on a which we infer to be the more accurate. Good wide range of age groups, populations and types of handwashing practice was reported by more than half trauma revealed that traumatized children and the adults in intervention areas, but < 10% in a control adolescents are at high risk for developing a range of area. Handwashing prevalence showed no association different behavioural, psychological and with the elapsed time since the interventions, indicating neurobiological problems. Social support may have a that behaviour change had occurred and persisted. protective effect on the relationship between exposure Recall of participation in health education classes was to traumatic events and psychosocial symptoms. significantly associated with good hygiene as indicated SUMMARY: Several recent studies analyze a wide by women's handwashing practice (OR 2.04, CI 1.05- 390
- 399. 3.96) and byseveral other outcomes, suggesting that out has caused the AMA grave concern, with many the classes were an effective component of the experts decrying the rise of so-called "exemptions of intervention. The evidence for a specific impact on convenience." In some areas, nearly one out of five behaviour from home visits and an awareness children have not received their recommended campaign is less strong, although the home visits had vaccines. The consequences are serious not only for influenced knowledge. The finding of an association those unprotected children, but for the rest of society as between interventions and male handwashing, in well. "Herd immunity" is threatened as more and more ecological analysis (comparing administrative areas i.e. parents free ride off of the community's dwindling panchayats) but not at individual level, suggests that immunity, and outbreaks of diseases thought to have the effect of the interventions on men may have been been conquered have already occurred. Lawsuits indirect, via women or neighbours, underlining the against vaccine manufacturers threaten them with need to direct interventions at men as well as women. bankruptcy, costs are being externalized onto the The finding that hygiene behaviour persisted for years healthcare and legal systems, and vulnerable implies that hygiene promotion is a more cost-effective populations are suffering harm or even death. In the health intervention than previously supposed. interests of social welfare, state legislatures and health departments should consider methods to ensure that the Calandrillo SP. Vanishing vaccinations: why are so many exemption process is carefully tailored to prevent Americans opting out of vaccinating their children? check-the-box opt-outs of convenience, while still Univ Mich J Law Reform 2004; 37(2):353-440. allowing exemptions for those with earnest and Notes: GENERAL NOTE: KIE: 526 fn. informed convictions or medical reasons. GENERAL NOTE: KIE: KIE Bib: immunization Abstract: Vaccinations against life-threatening diseases Caldas AF Jr, Burgos ME. A retrospective study of are one of the greatest public health achievements in traumatic dental injuries in a Brazilian dental trauma history. Literally millions of premature deaths have clinic. Dent Traumatol 2001; 17(6):250-3. been prevented, and countless more children have been Abstract: The purpose of this retrospective study was saved from disfiguring illness. While vaccinations to analyse data from the records of patients seen in the carry unavoidable risks, the medical, social and dental trauma emergency clinic in a general hospital in economic benefits they confer have led all fifty states the city of Recife, Brazil, during the years 1997-1999, to enact compulsory childhood vaccination laws to stop according to sex, age, cause, number of injured teeth, the spread of preventable diseases. Today, however, type of tooth and type of trauma. The records of all vaccines are becoming a victim of their success--many patients seen by dentists were collected. Altogether, individuals have never witnessed the debilitating 250 patients from 1 to 59 years of age presenting 403 diseases that vaccines protect against, allowing dental injuries were examined and/or treated. The complacency toward immunization requirements to causes of dento-alveolar trauma were classified in five build. Antivaccination sentiment is growing fast in the categories: home injuries, street injuries, school United States, in large part due to the controversial and injuries, sports activities, violence. The type of trauma hotly disputed link between immunizations and autism. was classified by dentists working at the dental trauma The internet worsens fears regarding vaccination clinic on the basis of Andreasen's classification. The safety, as at least a dozen websites publish alarming gender difference in the number of cases of trauma was information about the risks of vaccines. Increasing statistically significant (males 63.2% vs females 36.8) numbers of parents are refusing immunizations for (P<0.0001). Fracture in enamel only (51.6%) and their children and seeking legally sanctioned fractures in dentine (40.8%) were the most commonly exemptions instead, apparently fearing vaccines more occurring types of injury. Injuries were most frequently than the underlying diseases that they protect against. diagnosed as serious among the youngest patients (up A variety of factors are at play: religious and to 15 years of age); 82.4% of intrusive luxation cases philosophical beliefs, freedom and individualism, were diagnosed in the 1-5 years age group. The main misinformation about risk, and overperception of risk. causes of tooth injury were falls (72.4%), collisions State legislatures and health departments now face a with objects (9.2%), violence (8.0%), traffic accidents difficult challenge: respecting individual rights and (6.8%) and sports (3.6%). Trauma caused by violence freedoms while also safeguarding the public welfare. was found to be statistically significant in the 6-15 Nearly all states allow vaccination exemptions for years age group (P<0.0005). religious reasons and a growing number provide "philosophical" opt-outs as well. However, in all but a Caldwell BA, Redeker N. Sleep and trauma: an overview. handful of jurisdictions, neither objection is seriously Issues Ment Health Nurs 2005; 26(7):721-38. documented or verified. Often, the law requires a Abstract: Sleep disturbance is common after traumatic parent to do no more than simply check a box events of various types, such as combat, physical indicating she does not wish her child to receive trauma, and sexual abuse, and closely intertwined with immunizations. The problem is exacerbated by Posttraumatic Stress Disorder (PTSD), a common financial incentives schools have to encourage students outcome of severe and prolonged trauma. This paper to opt out of vaccinations. The rise in parents opting reviews the current literature on the significance and 391
- 400. characteristics of sleepdisturbance occurring in the translation into public health practice. Am J Prev Med context of trauma, examines the relationship between 2005; 28(2 Suppl 1):4-5. sleep disturbance and PTSD, identifies gaps in knowledge relative to the role of sleep disturbance in Calzada EJ, Eyberg SM. Self-reported parenting practices in trauma and PTSD, and discusses the implications of Dominican and Puerto Rican mothers of young this body of knowledge for clinical practice. children. J Clin Child Adolesc Psychol 2002; 31(3):354-63. Callaghan P, Greenberg L, Brasseux C, Ottolini M. Abstract: Explored self-reported parenting in a Postpartum counseling perceptions and practices: Hispanic sample of mothers living in the mainland what's new? Ambul Pediatr 2003; 3(6):284-7. United States using a cultural framework. Participants Abstract: BACKGROUND: The in-hospital were 130 immigrant or first-generation Dominican and postpartum period is a critical opportunity for health Puerto Rican mothers with a child between the ages of care providers to enhance maternal understanding of 2 and 6 years. Mothers completed questionnaires newborn care, yet few studies have determined whether related to their parenting behavior and also filled out a health care providers' educational priorities match detailed demographic form and a measure of those of new mothers. OBJECTIVE: To document how acculturation. Results suggested that both Dominican well pediatricians' perceptions of educational priorities and Puerto Rican mothers engage in high levels of for counseling about care of the newborn match those praise and physical affection and low levels of harsh, of new mothers during the postpartum hospitalization, inconsistent, and punitive parenting behaviors. and to determine whether pediatricians' actual Dominican and Puerto Rican parenting was similar on counseling practices reflected maternal priorities. measures of authoritarian and permissive parenting, but DESIGN: Cross-sectional study of perceived differences emerged on a measure of authoritative educational needs with direct observation of parenting and when parenting was considered at the pediatrician counseling practices. SETTING: A more detailed level of individual behaviors. Parenting suburban Washington, DC, community hospital. was related to several demographic characteristics, PARTICIPANTS AND INTERVENTION: All including father's education level and child age; more pediatricians on staff and a convenience sample of specifically, higher paternal education and younger age postpartum mothers were asked to rate the importance of the child were related to higher levels of of newborn counseling issues using lists generated authoritative parenting by mothers. Parenting and from focus groups and interviews. Pediatricians were acculturation were generally not related. Discussion observed while counseling mothers, and their focused on a culturally sensitive interpretation of postpartum counseling practices were scored using a normative parenting among Dominican and Puerto template derived from the rating procedure. MAIN Rican mothers. OUTCOME MEASURES: Comparison of pediatricians' and mothers' perceptions of educational Calzada JI, Kerr NC. Traumatic hyphemas in children priorities and the description of pediatricians' actual secondary to corporal punishment with a belt. Am J counseling practice. RESULTS: Mothers listed 9 issues Ophthalmol 2003; 135(5):719-20. as "very important" and expected the pediatrician to Abstract: PURPOSE: To report the severity of ocular address health problems, especially jaundice, feeding, injury in seven children with traumatic hyphemas testing, pain medications for circumcision, behavior, resulting from the accidental striking of the child in the and when to call the pediatrician for concerns or to face with a belt during the administration of corporal schedule well-child care. Pediatricians and mothers punishment. DESIGN: Observational case series. agreed on 6 out of 11 very important issues. METHODS: We retrospectively reviewed the records Pediatricians were observed to discuss an average of 8 of all patients (n = 7, aged 4 to 14 years) with traumatic issues per session, especially those they rated as very hyphemas secondary to belt injuries evaluated by the important, but they frequently failed to mention safety, senior author between 1989 to 2002 at Le Bonheur sleep position, when to call for advice, testing, infant Children's Medical Center, a regional pediatric referral behavior, or circumcision issues. CONCLUSION: hospital in Memphis, Tennessee. RESULTS: Anterior Mothers desire to learn a significant amount of segment injuries ranged from small hyphemas with information regarding the care of their newborn before normal intraocular pressure and no vision loss to hospital discharge. Although pediatricians discussed injuries with severe elevations of intraocular pressure more issues than in a previously reported study of and permanent, significant loss of vision. postpartum counseling, they still fell short of maternal CONCLUSIONS: Ocular injury to a child can result expectations. Pediatricians must ensure that other from trauma inflicted with a belt by a parent or sources of information, such as nurses, media, and caretaker during corporal punishment and may result in reinforcement at postpartum well-child visits, permanent loss of vision. supplement the information they provide in their in- hospital counseling sessions. Cameron P. Do homosexual teachers account for about half of news stories of molestations of pupils? A Boston Calonge N. Community interventions to prevent violence: 392
- 401. Globe replication. PsycholRep 2002; 90(1):173-4. immature parental decision-makers. Parents do, Abstract: Homosexual interaction was involved in 11 however, want more information. Citing a variety of (48%) of 23 and 10 (45%) of 22, that is, about half of psychosocial concerns, respondents believe that parents two nationwide databases of newspaper stories about should have access to predictive genetic testing for teachers sexual involvement with pupils reported by childhood onset conditions, even when there are no Cameron and Cameron in 1998. Whether this proven treatments. Respondents want this information relationship holds at a local level was examined by to make reproductive and non-reproductive plans and searching all indexed 'sex crimes' in the Boston Globe decisions. Although respondents varied in their from 1991 through 1998 for local stories about sex personal interest in testing, overwhelmingly they between pupil and teacher. Of the 21 teachers in 20 believed that the decisions belong to the parents. stories, 11 (52%) interacted homosexually with pupils. Professional guidelines that proscribe predictive testing Thus it appears that nationally and locally, as reported for untreatable childhood onset conditions should be in newspapers, about half of the molestations by re-examined in light of consumer attitudes. teachers are homosexual. Campbell H. Informed consent in neonatal randomised trials. Cameron P, Landess T, Cameron K. Homosexual sex as Lancet 2001; 357(9266):1445. harmful as drug abuse, prostitution, or smoking. Notes: GENERAL NOTE: KIE: Campbell, Harry Psychol Rep 2005; 96(3 Pt 2):915-61. GENERAL NOTE: KIE: 2 refs. Abstract: In 2003, the U.S. Supreme Court said same- GENERAL NOTE: KIE: KIE Bib: human sex sexual activity could not be prohibited by law. experimentation/informed consent; human Analyzing data from the 1996 National Household experimentation/minors Survey of Drug Abuse (N= 12,381) and comparing those who engaged in four recreational activities- Campbell JC. Abuse during pregnancy: a quintessential homosexual sex, illegal drug use, participation in threat to maternal and child health--so when do we start prostitution, and smoking --against those who to act? CMAJ 2001; 164(11):1578-9. abstained, participants (1) were more frequently disruptive (e.g., more frequently criminal, drove under Campbell MA, Porter S, Santor D. Psychopathic traits in the influence of drugs or alcohol, used illegal drugs, adolescent offenders: an evaluation of criminal history, took sexual risks), (2) were less frequently productive clinical, and psychosocial correlates. Behav Sci Law (e.g., less frequently had children in marriage, more 2004; 22(1):23-47. frequently missed work), and (3) generated excessive Abstract: Although a large body of research has costs (e.g., more promiscuous, higher consumers of established the relevance of psychopathy to adult medical services). Major sexuality surveys have offenders, its relevance to adolescent offenders is far reported similar findings for homosexuals. Societal less clear. The current study evaluated the clinical, discrimination inadequately accounts for these psychosocial and criminal correlates of psychopathic differences since parallel comparisons of black and traits in a sample of 226 male and female incarcerated white subsamples produced a pattern unlike the adolescent offenders. According to an 18-item version differences found between homosexuals and of the Psychopathy Checklist-Youth Version (PCL- nonhomosexuals. YV; Forth, Kosson, & Hare, 2003), only 9.4% exhibited a high level of psychopathic traits (PCL- Campbell E, Ross LF. Parental attitudes regarding newborn YV>/=25). Consistent with past research, higher PCL- screening of PKU and DMD. Am J Med Genet A 2003; YV scores were positively associated with self- 120(2):209-14. reported delinquency and aggressive behavior and were Notes: GENERAL NOTE: KIE: 28 refs. unrelated to emotional difficulties. Although higher GENERAL NOTE: KIE: KIE Bib: genetic screening; PCL-YV scores were associated with the experience of mass screening physical abuse, the only psychosocial factor to predict Abstract: The ability to perform predictive genetic PCL-YV scores was a history of non-parental living testing of children raises ethical concerns. Current arrangements (e.g. foster care). In terms of criminality, guidelines support the screening of newborns for a violent/versatile criminal history was positively conditions in which early treatment reduces morbidity associated with psychopathic traits. However, PCL-YV and mortality, and oppose most other predictive genetic scores were unrelated to participants' official criminal screening and testing in childhood. Little is known, records for total, non-violent, violent, and technical however, about parental attitudes. We conducted focus violation convictions. In conclusion, the data partially groups to gain information on the attitudes, beliefs, and support the construct validity of psychopathy with concerns of parents about newborn screening and adolescent offenders, but some inconsistencies with testing for both treatable and untreatable conditions prior adult and adolescent psychopathy research were that present in childhood. Respondents across racial evident. These issues are discussed. groups support mandatory newborn screening for treatable conditions like phenylketonuria (PKU), citing Campbell N. In that case: a Lead Maternity Carer (LMC) is lack of parental knowledge, and concerns about 393
- 402. discussing newborn healthchecks with a pregnant our country's medical system. Opportunities to teach woman and her partner. Response. N Z Bioeth J 2003; students to recognize and address these disparities 4(1):36-8. abound within medical education. Participatory Notes: GENERAL NOTE: KIE: KIE Bib: informed training and educational action projects can prepare consent/minors; mass screening learners to lead us toward a more just and egalitarian medical system with the potential to change the context Campos-Outcalt D. How does HIPAA affect public health of family and community in which we care for patients. reporting? J Fam Pract 2004; 53(9):701-4. However, systematic commitment from educational programs is necessary to produce activated clinicians, Canabarro ST, Eidt OR, Aerts DR. [Pediatric injuries at teachers, and researchers to achieve these changes. home]. Rev Gaucha Enferm 2004; 25(2):257-65. Abstract: Physical trauma occurred at home with Caniano DA. Ethical issues in the management of neonatal children from zero to six years of age is a descriptive surgical anomalies. Semin Perinatol 2004; 28(3):240-5. study outlining an epidemiologic case series that aims Abstract: This article provides a framework for at characterising trauma and the situations in which it thinking about three areas in neonatal surgery that occurs. Subjects were 120 individuals legally contain potential moral and ethical concerns for responsible for hospitalized children of the mentioned pediatric surgeons and the parents of a newborn and/or age in the second semester of 2002. The study detected fetus with a surgical anomaly. The utilization of life- the necessity of implanting an information system in sustaining therapy for neonates has made survival ambulatory care units and hospitals in order to get possible for many infants with serious birth defects. knowledge about several relevant variables, as sorts, Sometimes the use of these treatments is problematic in frequency, circumstances and causes for the traumas. terms of their actual benefit to the infant and the The necessity of an educational approach to prevention potential for enhancing their future quality of life. was also strongly evidenced. Second, the prenatal diagnosis of congential anomalies has made counseling of the prospective parents a Canahuati J, Joya de Suarez MJ. Supporting breastfeeding: routine part of pediatric surgical practice and raises the current status and future challenges. Child Welfare issue of how best to advise and support a couple whose 2001; 80(5):551-62. fetus has a significant birth defect. Finally, pediatric Abstract: Although breastfeeding is an optimal source surgeons have a responsibility to their patients and of nutrition that promotes the health and development society to provide the highest quality of care. This may of infants, rates of breastfeeding have been declining. involve participation in multi-institutional clinical International conventions and strategies, such as the trials, so that the optimal care of a surgical neonate Innocenti Declaration and the 10 Steps to Successful with a congenital or acquired condition is ascertained Breastfeeding, are helping to educate society about the by rigorous prospective research evaluation. benefits of breastfeeding and to create supports for mothers and their children, but advocacy and education Canino IA, Inclan JE. Culture and family therapy. Child are still needed Adolesc Psychiatr Clin N Am 2001; 10(3):601-12. Abstract: Children and families constitute an ever- Candib LM, Gelberg L. How will family physicians care for increasing culturally diverse group in this country. the patient in the context of family and community? Together with incentives in multicultural education and Fam Med 2001; 33(4):298-310. the evidence of the impact of different cultural values Abstract: Difficulties caring for patients in the context in the media, these groups have become more visible, of family and community stem from problems of more complex, and harder to study. Culture is defined power and vulnerability. Patients are disempowered in as dynamic and expressive of shared values and relation to physicians and to the medical care system. behaviors. Cultural patterns may be situation specific Physicians are disempowered in their ability to provide and change according to contextual demands (rural comprehensive relationship-centered care to versus urban youth) or may be population specific (the individuals and families because of economic culture of gay youth versus heterosexual youth). Some constraints on medical care and limits on continuity of people also ascribe to cultural beliefs, but these do not care. Individual patients are also vulnerable to abuses necessarily translate to behaviors. Families and their of power within their families because of physical and children vary in their level of acculturation and sexual abuse; the recognition of such abuses and developmentally vary in their level of ethnic appropriate interventions for them requires awareness identification. Child-rearing patterns and parenting of the gender ideology that underlies interpersonal approaches are constantly in flux, as are gender roles abuses of power. Families and communities can be and, increasingly, religious affiliations. Clinicians are disempowered because of vulnerabilities related to challenged to treat these families and often find the race, ethnicity, poverty, and homelessness. The cultural dissonance with their own native culture and additive effects of these vulnerabilities have created theoretical approaches as obstacles for the appropriate health disparities that are a hallmark of inequities in assessment and treatment interventions. As the field of family therapy has developed, so have culturally 394
- 403. sensitive and competentapproaches in the field of Cannon A. Rome: can we talk? US News World Rep 2002; mental health. These approaches must be integrated 132(14):23-4. into the multiplicity of other factors that define normality and psychopathology and be studied further Capaldi DM, Conger RD, Hops H, Thornberry TP. in the context of their relevance and efficacy for special Introduction to special section on three-generation groups of children and families who suffer with studies. J Abnorm Child Psychol 2003; 31(2):123-5. specific disorders. In the meantime, cultural awareness Abstract: Interest in lifespan research and cross- and competence will continue to help clinicians generational associations in parenting practices and understand better the impact of values and patterns in child behaviors has grown rapidly in recent years. The family cycles, family organization, child-rearing four papers presented in this journal test three key practices, and the expression of symptoms in family intergenerational research questions regarding systems. intergenerational continuities for externalizing behaviors, using different 3-generational samples. Canivet C. [Infant crying--a safety risk?]. Lakartidningen 2005; 102(23):1805-7. Capaldi DM, Pears KC, Patterson GR, Owen LD. Continuity Abstract: A Dutch study is described, in which the of parenting practices across generations in an at-risk occurrence of potentially detrimental parental actions sample: a prospective comparison of direct and induced by infant crying were assessed and thereafter mediated associations. J Abnorm Child Psychol 2003; related to various factors, including the parents' 31(2):127-42. judgment that the crying was "excessive". commentary Abstract: A prospective model of parenting and in the same Lancet issue questions whether this might externalizing behavior spanning 3 generations (G1, G2, be interpreted as a "blaming of the victim" process. and G3) was examined for young men from an at-risk Official Swedish and international statistics on child sample of young adult men (G2) who were in abuse, especially a recent UNICEF report, are approximately the youngest one third of their cohort to summarized. The co-occurrence of spouse and child become fathers. It was first predicted that the young abuse is briefly discussed. Southall and co-workers' men in G2 who had children the earliest would show report on covert video recordings of life threatening high levels of antisocial behavior. Second, it was child abuse is related, as well as some of the public predicted that G1 poor parenting practices would show reactions following it, and a proposed new both a direct association with the G2 son's subsequent categorization of child abuse. parenting and a mediated effect via his development of antisocial and delinquent behavior by adolescence. The Cannell J, Hudson JI, Pope HG Jr. Standards for informed young fathers had more arrests and were less likely to consent in recovered memory therapy. J Am Acad have graduated from high school than the other young Psychiatry Law 2001; 29(2):138-47. men in the sample. Findings were most consistent with Notes: GENERAL NOTE: KIE: KIE Bib: fraud and the interpretation that there was some direct effect of misconduct; informed consent; mental health parenting from G1 to G2 and some mediated effect via Abstract: Malpractice suits against therapists for either antisocial behavior in G2. instilling or recovering false memories of sexual abuse have increased in the last few years and some of the Capone A Jr. Lens-sparing vitreous surgery for infantile awards have been large. Failure to give informed amblyogenic vitreous hemorrhage. Retina 2003; consent, that is, failing to inform patients concerning 23(6):792-5. the risk of recovering false memories, is one of the Abstract: PURPOSE: To report on a series of infants main allegations increasingly made against therapists with amblyogenic vitreous and/or subinternal limiting in recovered memory cases. In the landmark case on membrane hemorrhage managed by lens-sparing informed consent, Canterbury v. Spence fashioned a vitrectomy. DESIGN: Retrospective case series standard of disclosure that focused on how material the studying retinal attachment status and visual acuity. potential warnings were to the patient's decision and RESULTS: Eleven eyes sustained vitreous hemorrhage specifically stated the standard would be set by the law, as a consequence of shaken baby syndrome, 1 due to not by the profession. The court ruled that the "risk or hyaloidal canal hemorrhage extending into the vitreous, cluster of risks" must be disclosed to the patient in a 1 due to Terson syndrome, 1 due to birth trauma, and 2 manner that meets the patient's "informational needs." due to a presumed coagulation disorder. Age of the A review of relevant literature shows that a substantial patients at the time of surgery ranged from 2 to 23 body of information existed by the early 1990s that months (age adjusted for prematurity). Follow-up warned psychotherapists about the risk of false reports ranged from 7 to 81 months (mean, 28 months). Ten of sexual and physical abuse. This article concludes eyes had visual improvement. Two infants with shaken that the "risk or cluster of risks" that must be disclosed baby syndrome had bilateral nonrecordable flash visual to a patient recovering repressed memories in evoked potential before surgery; one eye of one infant psychotherapy should have included warnings about had a better than expected visual outcome after recovering false memories. surgery. One eye sustained a retinal tear without 395
- 404. detachment. One eyein an infant with severe shaken sufficient support system is discussed. baby syndrome and traumatic retinopathy developed a total rhegmatogenous retinal detachment with Carlson GA, Mick E. Drug-induced disinhibition in proliferative vitreoretinopathy. CONCLUSIONS: psychiatrically hospitalized children. J Child Adolesc Infantile amblyogenic vitreous hemorrhage may be Psychopharmacol 2003; 13(2):153-63. effectively managed by lens-sparing vitreous surgery. Abstract: OBJECTIVE: To examine rates and Visual outcome of shaken baby syndrome may be predictors of drug-induced behavioral disinhibition limited as a consequence of structural damage to the (DIBD) in psychiatrically hospitalized children. retina, optic nerve, or posterior visual pathways. METHODS: DIBD was examined in 267 children psychiatrically hospitalized for at least 4 weeks. Age, Carbaugh SF. Family teaching toolbox. Preventing shaken gender, diagnosis, and medication were covariates. baby syndrome. Adv Neonatal Care 2004; 4(2):118-9. DIBD was defined as dramatic increase in aggression identified by increased time-outs while on medicaton. Cardona M, Garcia HI, Giraldo CA et al. [Homicides in RESULTS: Twenty (7.5%) children met our criteria. Medellin, Colombia, from 1990 to 2002: victims, Attention deficit hyperactivity disorder, pervasive motives and circumstances]. Cad Saude Publica 2005; developmental disorder, and selective serotonin 21(3):840-51. reuptake inhibitor use appeared to increase the risk, and Abstract: In Medellin, Colombia, homicide has been older age and stimulant use decreased the risk of the first cause of morbidity and mortality for 20 years. DIBD. However, it was often difficult to distinguish Medellin has the highest homicide rates of all major true DIBD from the behavioral fluctuations of these cities in Latin America. This study describes the disturbed children. Fifteen percent of children victims, motives, and circumstances in homicides in subsequently improved on the same regimen, 40% Medellin from 1990 to 2002. The period included improved when the offending drug was stopped and 55,365 homicides, of which 1,394 were randomly another treatment was started, and the remainder had studied. Of this sample, 93.6% (95%CI: 92.2%-94.8%) adverse response to many medications. were males, 77.0% (95%CI: 75.0%-79.5%) less than CONCLUSIONS: DIBD is a complex phenomenon 35 years of age, one-fourth had consumed alcohol, and that does not lend itself to simple conclusions and nine out of ten were killed with firearms. The main requires further study. motives were revenge and armed robbery. 37.0% (95%CI: 34.0%-41.0%) of the victims lived in the Carlson M. What the nuns didn't know. Could they have lowest socioeconomic stratum of the city. uncovered abuse? Not in a culture that kept them in the Characteristics of homicides in Medellin have dark. Time 2002; 159(15):84. remained unchanged since the 1980s, when the most violent period in the city's history began. The most Caroli M, Argentieri L, Cardone M, Masi A. Role of heavily affected groups are young males who live and television in childhood obesity prevention. Int J Obes die in poor neighborhoods, and the murders are Relat Metab Disord 2004; 28 Suppl 3:S104-8. individual acts that leave no wounded behind. Abstract: OBJECTIVE: To assess the role of television as tool for childhood obesity prevention. METHOD: Carey LK, Nicholson BC, Fox RA. Maternal factors related Review of the available literature about the relationship to parenting young children with congenital heart between television and childhood obesity, eating habits disease. J Pediatr Nurs 2002; 17(3):174-83. and body shape perception. RESULTS: The reviewed Abstract: The purpose of this study was to compare the studies showed the following: television watching early child-rearing practices between mothers of young replaces more vigorous activities; there is a positive children with congenital heart disease (CHD) and correlation between time spent watching television and mothers of healthy children. In addition, maternal being overweight or obese on populations of different stress, parental developmental expectations, and the age; obesity prevalence has increased as well as the early behavioral and emotional development of their number of hours that TV networks dedicate to children; children were explored. Maccoby's (1992) socialization during the last 30 y, the rate of children watching theory emphasizing the reciprocal nature of mother- television for more than 4 h per day seems to have child interactions provided the framework for this increased; children are exposed to a large number of study. Findings from quantitative self-report measures important unhealthy stimulations in terms of food and videotaped parent-child interactions showed a intake when watching television; over the last few remarkable similarity between mothers of children with years, the number of television food commercials CHD and mothers of healthy children. In contrast, targeting children have increased especially when it qualitative data revealed important differences with comes to junk food in all of its forms; the present use mothers of CHD children reporting high levels of of food in movies, shows and cartoons may lead to a vigilance with their children. The important role of misconception of the notion of healthy nutrition and promoting the principle of normalization among stimulate an excessive intake of poor nutritional food; mothers of children with CHD and ensuring a and obese subjects shown in television programmes are 396
- 405. in a muchlower percentage than in real life and are Carter MC, Perzanowski MS, Raymond A, Platts-Mills TA. depicted as being unattractive, unsuccessful and Home intervention in the treatment of asthma among ridiculous or with other negative traits and this is likely inner-city children. J Allergy Clin Immunol 2001; to result in a worsening of the isolation in which obese 108(5):732-7. subjects are often forced. The different European Abstract: BACKGROUND: In Atlanta, as in other countries have different TV legislations. major urban areas of the United States, asthma is a CONCLUSION: The usual depiction of food and leading cause of school absenteeism, emergency obesity in television has many documented negative department use, and hospitalization. Recent guidelines consequences on food habits and patterns. The for asthma management recommend reducing exposure different national regulations on programs and to relevant allergens, but neither the feasibility nor the advertising directed to children could have a role in the efficacy of this form of treatment has been established different prevalence of childhood obesity in different for children living in poverty. OBJECTIVE: We sought European countries. Television could be a convenient to investigate allergen avoidance as a treatment for tool to spread correct information on good nutrition asthma among inner-city children. METHODS: One and obesity prevention. hundred four children with asthma living in the city of Atlanta were enrolled into a controlled trial of Carrera JM, Di Renzo GC. Mother-infant health promotion avoidance without being skin tested. The children were in developing countries: how can the developed world randomized to an active avoidance group, a placebo help developing countries? J Matern Fetal Neonatal avoidance group, and a second control group for which Med 2004; 15(3):145-6. no house visits occurred until the end of the first year. Avoidance included bed and pillow covers, hot Carroll JL. Developmental plasticity in respiratory control. J washing of bedding, and cockroach bait. Eighty-five Appl Physiol 2003; 94(1):375-89. children completed the study, and the outcome was Abstract: Development of the mammalian respiratory measured as unscheduled clinic visits, emergency control system begins early in gestation and does not department visits, and hospitalization for asthma, as achieve mature form until weeks or months after birth. well as changes in mite and cockroach allergen levels. A relatively long gestation and period of postnatal RESULTS: There was a significant decrease in acute maturation allows for prolonged pre- and postnatal visits for asthma among children whose homes were interactions with the environment, including visited (P < .001). However, there was no significant experiences such as episodic or chronic hypoxia, difference between the active and placebo homes either hyperoxia, and drug or toxin exposures. Developmental in the effect on asthma visits or in allergen plasticity occurs when such experiences, during critical concentrations. When the children with mite allergy periods of maturation, result in long-term alterations in were considered separately, there was a significant the structure or function of the respiratory control correlation between decreased mite allergen and neural network. A critical period is a time window change in acute visits (P < .01). The avoidance during development devoted to structural and/or measures for cockroach allergen appeared to be functional shaping of the neural systems subserving ineffective, and the changes observed did not correlate respiratory control. Experience during the critical with changes in visits. CONCLUSIONS: Applying period can disrupt and alter developmental trajectory, allergen avoidance as a treatment for asthma among whereas the same experience before or after has little children living in poverty is difficult because of or no effect. One of the clearest examples to date is multiple sensitivities and problems applying the blunting of the adult ventilatory response to acute protocols in this environment. The current results hypoxia challenge by early postnatal hyperoxia demonstrate that home visiting positively influences exposure in the newborn. Developmental plasticity in the management of asthma among families living in neural respiratory control development can occur at poverty. Furthermore, the results for children with mite multiple sites during formation of brain stem neuronal allergy strongly suggest that decreasing relevant networks and chemoafferent pathways, at multiple allergen exposure should be an objective of treatment times during development, by multiple mechanisms. in this population. Past concepts of respiratory control system maturation as rigidly predetermined by a genetic blueprint have Carty H. Commentary on: A survey of non-accidental injury now yielded to a different view in which extremely imaging in England, Scotland and Wales and complex interactions between genes, transcriptional Observational study of skeletal surveys in suspected factors, growth factors, and other gene products shape non-accidental injury. Clin Radiol 2003; 58(9):694-5. the respiratory control system, and experience plays a key role in guiding normal respiratory control Casagrande KM. Children not meant to be: protecting the development. Early-life experiences may also lead to interests of the child when abortion results in live birth. maladaptive changes in respiratory control. Quinnipiac Health Law J 2002; 6(1):19-55. Pathological conditions as well as normal phenotypic Notes: GENERAL NOTE: KIE: 164 fn. diversity in mature respiratory control may have their GENERAL NOTE: KIE: KIE Bib: abortion/legal roots, at least in part, in developmental plasticity. aspects; allowing to die/infants; allowing to die/legal 397
- 406. aspects Castledine G. Interim suspension and a nurse who videoed children at play. Br J Nurs 2002; 11(16):1055. Casamassimo PS. Dental disease prevalence, preventon, and health promotion: the implications on pediatric oral Castledine G. The repercussions of the organ retention health of a more diverse population. Pediatr Dent 2003; scandal. Br J Nurs 2001; 10(4):275. 25(1):16-8. Notes: GENERAL NOTE: KIE: KIE Bib: fraud and misconduct; organ and tissue donation Caspi A, Sugden K, Moffitt TE et al. Influence of life stress on depression: moderation by a polymorphism in the 5- Castro MX, Soares AM, Fonseca W, Rey LC, Guerrant RL, HTT gene. Science 2003; 301(5631):386-9. Lima AA. Common infectious diseases and skin test Abstract: In a prospective-longitudinal study of a anergy in children from an urban slum in northeast representative birth cohort, we tested why stressful Brazil. Braz J Infect Dis 2003; 7(6):387-94. experiences lead to depression in some people but not Abstract: BACKGROUND: Acute respiratory infection in others. A functional polymorphism in the promoter (ARI), diarrheal disease (DD) and infective dermatitis region of the serotonin transporter (5-HT T) gene was (ID) are important causes of morbidity in children found to moderate the influence of stressful life events under five, in Northeast Brazil. Objectives: (a) to on depression. Individuals with one or two copies of evaluate the morbidity of ARI, DD and ID; and (b) to the short allele of the 5-HT T promoter polymorphism determine their association with cellular immunity in exhibited more depressive symptoms, diagnosable poor urban children from Fortaleza, Brazil. depression, and suicidality in relation to stressful life MATERIALS AND METHODS: A prospective cohort events than individuals homozygous for the long allele. study. At enrollment, multipuncture skin-tests This epidemiological study thus provides evidence of a (Multitest CMI) were performed and interpreted gene-by-environment interaction, in which an according to standard procedures. Children were individual's response to environmental insults is followed for infectious diseases by weekly home visits. moderated by his or her genetic makeup. RESULTS: Seventy-one children aged 6 to 21 months were recruited in an ongoing cohort of newborns. A Casseron W, Genton P. DOPA-sensitive dystonia-plus mean of 39 (6 to 63) home visits per child were made, syndrome. Dev Med Child Neurol 2005; 47(3):200-3. which detected 184.5 symptomatic days per child-year Abstract: We report on two sisters with a childhood- of observation. ARI was present in 62% of the days of onset form of predominantly axial dystonia with illness (6,378 out of 10,221), DD in 23% (2,296 days), marked diurnal fluctuations. Onset of clinical features ID in 6% (597) and other infections in 4% (373). was at approximately 6 years of age. Associated Episodes per child-year were: 10 for ARI, 7 for DD features included marked fatigue, slight facial and 1 for ID. Twelve (17%) out of 71 children were dysmorphism, short stature, obesity, and learning anergic. The incidences of ARI, DD and ID were disability*. Dystonia and fatigue responded to 3,4- similar in responsive versus anergic children. The dihydroxyphenylalanine (DOPA) therapy, with mean duration of ID in anergy was 8.5 days, while it recurrence of symptoms upon withdrawal; the efficacy was 4.3 in the responsive group (P=0.007). Anergy was has been maintained over 7 years. Other symptoms independent of age, sex and nutritional status. were not influenced. There was no other case in the CONCLUSIONS: A high incidence of ARI and DD family (which included an older, healthy brother), was found in these poor urban children. Skin-test except for non-specific fatigue without dystonia in the responsiveness was not related to malnutrition, nor to mother, and there was no significant family history morbidity due to ARI and DD, however anergic except for obesity on the father's side. These children had a longer duration of infective dermatitis. observations are discussed in relation to the classical descriptions of Segawa syndrome, and to more recent Catalano R, Lind S, Rosenblatt A, Novaco R. Economic reports of childhood onset, age-related, and transient antecedents of foster care. Am J Community Psychol benign paroxysmal tonic upgaze and ataxia. The 2003; 32(1-2):47-56. combination of symptoms, their sensitivity to DOPA, Abstract: Individual and ecological research suggests and their persistence throughout childhood constitute, that rising unemployment may affect the incidence of to our knowledge, a new clinical entity, which we violence through two countervailing mechanisms propose to categorize as a DOPA-sensitive dystonia- suggested by frustration-aggression theory. The first, or plus syndrome. provocation effect, assumes increased violence among persons who feel anger because they believe their job Castellano E, Bodner G. From the theory of seduction to loss was arbitrary. The second, or inhibition effect, traumatic seduction: incest. Int J Psychoanal 2002; posits less violence among employed persons who 83(Pt 2):504-7. attempt to reduce their chances of job loss by curtailing behavior objectionable to employers. The literature Castiglia PT. Shaken baby syndrome. J Pediatr Health Care also reports that these mechanisms affect victimization 2001; 15(2):78-80. measured as foster care sought by the state for abused 398
- 407. children. The fostercare finding, although consistent impact of home-based teaching on reducing asthma with theory and important for basic as well as applied admissions and emergency department (ED) visits for reasons, arises from methods that cannot rule out Medicaid-managed care patients utilizing two different several rival hypotheses. We revisit this research and study design methods. This was an historical- apply improved methods to test the reported prospective study utilizing health plan administrative association in Los Angeles and San Francisco counties. data, including membership files and medical claims. We find that, as implied by the provocation and We identified 381 patients aged 2-56 with inhibition mechanisms, differences in monthly hospitalizations or ED visits for asthma. These high prevalence of foster care placements increase with risk asthma members were recruited for a home-based modest increases in unemployment but decline when teaching program to prevent future hospitalizations or unemployment becomes much higher than usual levels. ED visits. We evaluated program effectiveness using two quasi-experimental research designs: a "one-group Catalano RF, Haggerty KP, Oesterle S, Fleming CB, pre/post-test design," where enrolled members served Hawkins JD. The importance of bonding to school for as their own control, and a more rigorous "untreated healthy development: findings from the Social control group design with pre/post test," where results Development Research Group. J Sch Health 2004; for enrolled members and a similar control group were 74(7):252-61. compared pre/post test. Poisson regression models were used to investigate the dependence of member Cather JC, Cather JC. A child with nonscarring alopecia. rates for asthma-related events on program enrollment, Proc (Bayl Univ Med Cent) 2005; 18(3):269-72. age, sex, race, and geographic region. Using the pre/post test design, members enrolled in the home- Catlin A. Thinking outside the box: prenatal care and the call based teaching program demonstrated statistically for a prenatal advance directive. J Perinat Neonatal significant reductions in hospital admissions and ED Nurs 2005; 19(2):169-76. visits (p < 0.001). The untreated control group design, Abstract: The concept of advance directives is well- however, found no association between utilization and known in the care of adults as a mechanism for enrollment in the home-based teaching program (p = choosing in advance the extent of medical interventions 0.510). Small differences were detected for subgroups. desired in clinical situations, particularly life-extending A marginally statistically significant impact of the interventions such as ventilation support and drugs to program was found for Whites, but not for Blacks. The maintain cardiopulmonary status. Infants born quasi-experimental design that utilized an external extremely prematurely often require life-supporting control group provided an approach that more measures for which their parents or guardians report accurately explained true disease management program feeling unprepared to make decisions about. Current impact. In addition, this approach allowed for subgroup prenatal care does not include an educational analyses to detect opportunities for program component that teaches women about the length of improvement. gestation needed for a healthy viability, survivorship, and outcome without major impairment. Women who Caughy MO, O'Campo PJ, Randolph SM, Nickerson K. The go into preterm labor are asked to make immediate influence of racial socialization practices on the decisions during times of crisis without any formal cognitive and behavioral competence of African education base for this decision making. Feminist American preschoolers. Child Dev 2002; 73(5):1611- ethics (the philosophical stance that articulates that 25. women's moral experience is worthy of respect and Abstract: The association between parent racial disallows women's subordination) (Becker LB, Becker socialization and child competence was examined in a CB, eds. Feminist ethics. In: Encyclopedia of Ethics. socioeconomically diverse sample of African American New York: Routledge Press; 2001) requires that preschoolers living in an urban setting. Interviews were healthcare decisions be based on education, context, conducted in the homes of 200 families. Racial and particular situations. The purpose of this article is socialization was assessed by parent report as well as to examine the current content of typical prenatal care by observation of the sociocultural context of the and education and to suggest an additional educational home, and child outcomes were assessed using the component to prenatal care-education of women about Kaufman Assessment Battery for Children and the infant viability and the planning of future decisions if a Child Behavior Checklist. Results indicated that nonviable or critically ill newborn is delivered. A African American parents who provided homes that prenatal discussion and parental/family directive is were rich in African American culture had preschool suggested. children who had greater amounts of factual knowledge and better developed problem-solving skills. African Catov JM, Marsh GM, Youk AO, Huffman VY. Asthma American parents who socialized their preschool home teaching: two evaluation approaches. Dis Manag children to be proud of their heritage reported fewer 2005; 8(3):178-87. problem behaviors. Abstract: The aim of this research was to measure the Caulfield H. Right to life. Nurs Stand 2001; 15(18):26. 399
- 408. Cavet J, SloperP. The participation of children and young Cerasoli G, Zondini M, Pocecco M. Home care for diabetic people in decisions about UK service development. children: keeping children out of hospital. Acta Child Care Health Dev 2004; 30(6):613-21. Biomed Ateneo Parmense 2003; 74 Suppl 1:41-4. Abstract: BACKGROUND: The involvement of Abstract: This article examines how home care for children and young people in decisions regarding diabetic children resident in the Azienda Sanitaria service development is well supported in government Locale (Local Health Centre) of Cesena is organised. It policy and underpinned by the UN Convention on the outlines the tasks the Diabetes Health Visitor Nurse Rights of the Child. Information on the extent, nature carries out, the times and ways of execution, and the and outcomes of children and young people's methods for analysing the effectiveness of the service. participation can inform further development in this Finally, some of the results achieved through the area. METHODS: Systematic literature searches, plus activation of this new service have been included, contact with professional networks, were used to gather among which the fact that the average number of days and review evidence on children and young people's a child is kept in hospital at the clinical onset of participation. RESULTS: There is a rapidly developing diabetes has dropped from 10 to 5. body of information describing and analysing innovative practices in this field. However, there is also Cespedes-Londono JE, Jaramillo-Perez I, Castano-Yepes a smaller, but substantial, amount of evidence RA. [The impact of social security system reform on demonstrating the limited extent of current health services equity in Colombia]. Cad Saude Publica involvement. A good deal of guidance is now available 2002; 18(4):1003-24. about how to promote the involvement of children and Abstract: To evaluate the impact on access to, and use young people. However, the basis of this advice is not of, health services in Colombia's new national health always clear, and more evidence about children's views insurance system, the authors compared two cross and their experience of participation in public decision- sections of the population: before (1993) and after making is required. Issues identified as barriers to (1997), with the approval of Act 100, creating the change included adult attitudes and intransigence, lack General System for Social Security in Health (SGSSS). of training for key adults, lack of clarity leading to Two equity indicators were assessed: concentration tokenism, the nature of organizations (i.e. their curves (CC) and concentration indices (CI), formality, complexity, bureaucracy and internal summarizing the distribution of access to health care politics) and the short-term nature of much funding. and utilization of health care services provided by the The evidence suggests that good practice includes a SGSSS according to income deciles. Between 1993 listening culture among staff, clarity, flexibility, and 1997, the CI for access to insurance halved from adequate resources, skills development and training for 0.34 to 0.17; simultaneously, coverage increased from staff and participating children and young people, 23% to 57%, especially among the poorest segments of inclusion of marginalized groups, feedback and the population, where it increased from 3.7% to 43.7% evaluation. There is only limited evidence that children as a result of subsidies provided by local governments. and young people's involvement in public decision- The CI for utilization of health care services did not making leads to more appropriate services, although vary significantly. Increased disease prevalence and there is evidence that participating children and young utilization of services among the insured, due to biased people benefit in terms of personal development and selection of risks and moral hazards, were also that staff and organizations learn more about their documented. These findings suggest a positive impact views. CONCLUSIONS: The value of the participation by the Reform on inequalities in access to health care of children and young people in public decision- insurance; however, a similar effect on inequities in making is now well accepted, and is recognized in the utilization of health services is not clear. standards set in the Children's National Service Framework. However, there is an urgent need for Ceylan A, Ertem M, Korukluoglu G et al. An epidemic internal and external evaluations of children's caused by measles virus type D6 in Turkey. Turk J involvement. Pediatr 2005; 47(4):309-15. Abstract: In this study, the extent of measles outbreak Celia F. Cutaneous anthrax: an overview. Dermatol Nurs was investigated in the Idil and Cizre counties of 2002; 14(2):89-92. Sirnak Province. New cases determined in patients who Abstract: The recent acts of bioterrorism have raised applied to primary care clinics and those detected new questions about this uncommon disease. Clinicians during home visits were evaluated. In 2001, a total of are puzzled as to why some of the victims exposed to 2,143 cases reported in Sirnak Province were signified Bacillus anthracis spores developed the cutaneous form as a probable outbreak. Three hundred and thirty-three of the disease and others the inhalational form. Despite patients in Cizre and 219 patients in Idil applied to the these questions, cutaneous anthrax remains relatively primary care clinics. Of the cases, in Cizre 8.4% simple to treat effectively. The real clinical challenge (n=28) and in Idil 6.4% (n=14) were infants aged nine lies in the diagnosis, especially being able to months and younger who had not yet been vaccinated. distinguish it from a spider bite. Totally, 17 new cases (8 in Cizre and 9 in Idil) in the exanthema phase were determined during home visits 400
- 409. and these wereconsidered as outbreak cases. Virus behavior. At a median follow-up of 850 days, 19% of isolation was achieved in 12 cases. All isolates were parents assigned to PCIT had a re-report for physical sent to the Centers for Disease Control (CDC) for abuse compared with 49% of parents assigned to the genotyping and classified as D6 group. In conclusion, standard community group. Additional enhanced measles epidemics are still seen in our country. services did not improve the efficacy of PCIT. The Therefore, measles outbreaks necessitate intensive relative superiority of PCIT was mediated by greater intervention by physicians who are employed in reduction in negative parent-child interactions, primary health care services. consistent with the PCIT change model. Chabrol H, Teissedre F, Saint-Jean M, Teisseyre N, Roge B, Chahine Z, van Straaten J, Williams-Isom A. The New York Mullet E. Prevention and treatment of post-partum City neighborhood-based services strategy. Child depression: a controlled randomized study on women Welfare 2005; 84(2):141-52. at risk. Psychol Med 2002; 32(6):1039-47. Abstract: The New York City Administration for Abstract: BACKGROUND: Research is needed to Children's Services (ACS) instituted a neighborhood- evaluate the efficacy of prevention and treatment for based services system through the realignment of all post-partum depression. METHOD: Subjects were foster care, preventive, and protective services along screened with the Edinburgh Post-natal Depression community district lines. ACS, with its community Scale (EPDS) at the obstetric clinic. Mothers at risk (N partners, also formed neighborhood-based networks to = 258) (EPDS scores > or = 9) were randomly assigned improve service coordination and collaboration among to a prevention/treatment group or a control group. The key community stakeholders and to shape a prevention group received one cognitive-behavioural multisystem strategy tailored to each district informed prevention session during hospitalization. At 4 to 6 by child welfare data. Based on analysis of weeks post-partum, subjects were screened again with neighborhood-specific census tract child welfare data, the EPDS, after drop-out rates (refusals plus no return ACS initiated the Community Partnership to of the second EPDS) of 25.4% (33/130) in the Strengthen Families project to address the intervention group and 10.9% (14/128) in the control disproportionate number of foster care placements group. Mothers with probable depression (EPDS scores originating from a small group of high-need > or = 11) were assessed using the Hamilton communities, including Manhattan's Central Harlem. Depression Rating Scale (HDRS) and the Beck This article describes examples of specific strategies Depression Inventory (BDI). Mothers with major based on the Central Harlem experience. depression continued in the treatment group (N = 18) or in the control group (N = 30). Treated subjects Chamberlin RW. Developing a statewide network of family received a cognitive-behavioural programme of resource centers in New Hampshire: lessons learned. between five and eight weekly home-visits. RESULTS: Pediatr Rev 2003; 24(8):285-8. Compared with the control group, women in the prevention group had significant reductions in the Chambers TL. An open letter to Doctors Mather and frequency of probable depression (30.2 % v. 48.2%). Bannon. Arch Dis Child 2005; 90(3):236-7. Recovery rates based on HDRS scores of < 7 and BDI scores of < 4 were also significantly greater in the Chan YL, Chu WC, Wong GW, Yeung DK. Diffusion- treated group than in the control group. weighted MRI in shaken baby syndrome. Pediatr CONCLUSIONS: The study suggests that this Radiol 2003; 33(8):574-7. programme for prevention and treatment of post- Abstract: We present the characteristic CT and MRI partum depression is reasonably well-accepted and findings of a 2-month-old girl with shaken baby efficacious. syndrome. Diffusion-weighted MR imaging performed 8 days after the insult established the presence of injury Chaffin M, Silovsky JF, Funderburk B et al. Parent-child to the white matter in the corpus callosum and interaction therapy with physically abusive parents: subcortical white matter in the temporo-occipito- efficacy for reducing future abuse reports. J Consult parietal region. Diffusion-weighted MR imaging is Clin Psychol 2004; 72(3):500-10. valuable in the diagnostic work-up of suspected shaken Abstract: A randomized trial was conducted to test the baby syndrome, as injury to the white matter can be efficacy and sufficiency of parent-child interaction demonstrated days after the injury. therapy (PCIT) in preventing re-reports of physical abuse among abusive parents. Physically abusive Chandler S, Christie P, Newson E, Prevezer W. Developing parents (N=110) were randomly assigned to one of a diagnostic and intervention package for 2- to 3-year- three intervention conditions: (a) PCIT, (b) PCIT plus olds with autism: outcomes of the frameworks for individualized enhanced services, or (c) a standard communication approach. Autism 2002; 6(1):47-69. community-based parenting group. Participants had Abstract: The aim of the research was to develop and multiple past child welfare reports, severe parent-to- evaluate a model of good practice which would make child violence, low household income, and significant an explicit link between diagnosis and intervention, levels of depression, substance abuse, and antisocial 401
- 410. and so giveparents a very clear rationale for the 40(1):114-9. autism-specific yet individualized programme that they Abstract: BACKGROUND/PURPOSE: There is were carrying out. It employed an action research currently no evidence-based screening instrument to design, which essentially is responsive to participants, assist in the detection of physical child abuse patients. thus developing a user-friendly model of service. The The screening index for physical child abuse (SIPCA) programme was based on the developmental was previously developed as a potentially new tool for perspective that the pragmatics of language are the this need. It is a scale that assigns point values, on the precursors of speech itself and enable both basis of variable weights from logistic regression communication and relationship between child and models, to age and patterns of injuries (including parents. Since these are impaired in autism they should fracture of base or vault of skull, contusion of eye, rib therefore be prioritized in early intervention. Ten fracture, intracranial bleeding, multiple burns), with children aged 1:10 to 2:9 at assessment, and with a higher scores indicating greater suspicion for abuse. diagnosis of autism, underwent an intervention based The purpose of this study is to validate this new tool in on home visits, modelling, workshops and written another independent data set. METHODS: A cross- information, with parents as 'therapists' in naturally sectional hospital discharge database from 1961 occurring situations. Within 18 months all children hospitals in 17 states is used (n = 58558). Children made substantial progress in social interaction and aged 14 years or younger with International expressive communication, including gestural and Classification of Diseases, Ninth Revision, Clinical verbal communication. Modification codes 800 to 959 are included for analysis. Child abuse cases are identified by E codes Chang DC, Cornwell EE 3rd, Sutton ER, Yonas MA, Allen and certain International Classification of Diseases, F. A multidisciplinary youth violence-prevention Ninth Revision, Clinical Modification codes in the initiative: impact on attitudes. J Am Coll Surg 2005; 995.5x range. Screening index for physical child abuse 201(5):721-3. performance is evaluated by discrimination (receiver Abstract: BACKGROUND: In a previous report, operating characteristic) and goodness of fit (pseudo enhanced resource commitment at a Level I trauma r2). RESULTS: A total of 447 abused patients (0.76%) center was associated with improved outcomes for was identified. The receiver operating characteristic of most major categories of injured patients, except those SIPCA in this data set is 0.89 as compared with 0.86 in with gunshot wounds, which disproportionately the development data set. The pseudo r 2 of SIPCA in affected the young (ages 15 to 24 years). We this data set is 0.26 as compared with 0.28 in the hypothesized that a primary violence-prevention development data set. A SIPCA score of 3 has a initiative geared toward changing attitudes about sensitivity of 86.6% and a specificity of 80.5% for interpersonal conflict among at-risk youths can be detecting physical abuse; raising the threshold to a effective. STUDY DESIGN: Between May 2002 and score of 4 improves the specificity to 93.1% but at a November 2003, 97 youths (mean age 12.6 years) were loss of sensitivity to 71.8%. CONCLUSIONS: The recruited from one of two Police Athletic League validity of the new SIPCA instrument is supported by centers in the catchment area of our Level I trauma its performance in an independently derived data set. A center. Participant attitudes about interpersonal score of 3 on SIPCA represents a balanced trade off in conflicts were surveyed with six previously validated the sensitivity and specificity of the instrument in scales before and after a hospital tour with a video and detecting physical abuse and is an optimal threshold slide presentation graphically depicting the results of above which to begin considering abuse in differential gun violence. Mean differences in scores between pre- diagnosis. Application of the instrument could assist and postintervention surveys were assessed. clinicians in detecting physical child abuse cases RESULTS: Of the 97 participants, 48 (49.4%) among pediatric trauma patients. completed the intervention program with both the pre- and postintervention tests, with a mean of 25.8 days Chapman AL, Specht MW, Cellucci T. Factors associated between tests. There was a statistically significant with suicide attempts in female inmates: the hegemony reduction in the Beliefs Supporting Aggression scale of hopelessness. Suicide Life Threat Behav 2005; (mean -0.38 U; 95% CI, -0.23 to -0.54; p < 0.01), and a 35(5):558-69. trend toward reduced Likelihood of Violence (mean - Abstract: In this study factors associated with past 0.17 U; 95% CI, 0.01 to -0.34; p = 0.06). suicide attempts in female inmates were examined. CONCLUSIONS: A multidisciplinary violence- Female inmate participants (N = 105) were given prevention outreach program can produce short-term structured diagnostic assessments of antisocial and improvement in beliefs supporting aggression among borderline personality disorders and substance at-risk youth. Longterm impact of this attitude change dependence, as well as measures of depression, needs to be examined in future studies. hopelessness, problem-focused coping styles, and reasons for living. There was a high lifetime prevalence Chang DC, Knight VM, Ziegfeld S, Haider A, Paidas C. The of past suicide attempts (38.1%). Suicide attempts were multi-institutional validation of the new screening positively associated with personality disorders, index for physical child abuse. J Pediatr Surg 2005; hopelessness, depression, childhood physical/emotional 402
- 411. abuse, and familyhistory of suicide and mood brain is of particular interest since it is the most disorders, and negatively associated with income, understood part with respect to the cellular and reasons for living, and problem-focused coping. molecular mechanisms that underlie its development. Controlling for hopelessness, borderline personality Hox paralogs and Hox-regulating genes kreisler/mafB disorder and family history of suicide attempts were and Krox20 are required for the normal formation of the only variables that remained uniquely associated rhombomeres in vertebrate embryos. From studies of with suicide attempts. rhombomeres r3 and r4, the authors review mechanisms whereby these developmental genes may Chapman MV, Wall A, Barth RP. Children's voices: the govern the early embryonic development of para-facial perceptions of children in foster care. Am J neuronal networks and specify patterns of motor Orthopsychiatry 2004; 74(3):293-304. activities operating throughout life. A model whereby Abstract: Scant research exists on how abused and the regional identity of progenitor cells can be neglected children view the foster care experience and abnormally specified in r3 and r4 after a mutation of how these perceptions vary by demographic these genes is proposed. Novel neuronal circuits may characteristics and placement type. Data come from a develop from some of these misspecified progenitors national probability sample of children placed in child while others are eliminated, eventually affecting welfare supervised foster care for at least 1 year. These respiration and survival after birth. findings indicate that children generally feel positively toward their out-of-home care providers and maintain Chatterji P, Markowitz S. The impact of maternal alcohol hope for reunification with their biological family. and illicit drug use on children's behavior problems: Differences are present between children in family evidence from the children of the national longitudinal foster care, group care, and kinship care placements. survey of youth. J Health Econ 2001; 20(5):703-31. Abstract: This study uses Children of the National Chassin L, Presson CC, Rose J, Sherman SJ, Davis MJ, Longitudinal Survey of Youth to test for evidence of a Gonzalez JL. Parenting style and smoking-specific causal relationship between maternal alcohol, parenting practices as predictors of adolescent smoking marijuana, and cocaine use, and children's behavior onset. J Pediatr Psychol 2005; 30(4):333-44. problems. Ordinary least squares (OLS) results provide Abstract: OBJECTIVE: To test whether parenting style strong evidence that substance use is associated with and smoking-specific parenting practices prospectively behavior problems. However, OLS estimation fails to predicted adolescent smoking. METHODS: Three account for unobserved factors that may be correlated hundred eighty-two adolescents (age 10-17 years, with substance use and child behavior. To account for initial nonsmokers, 98% non-Hispanic whites) and this problem, mother-child and family fixed-effects their parents were interviewed, with smoking also models are tested. The results suggest that maternal assessed 1-2 years later. RESULTS: Adolescents from illicit drug use is positively associated with children's disengaged families (low acceptance and low behavior problems, while alcohol use has a less behavioral control) were most likely to initiate consistent impact. smoking. Adolescents' reports of parents' smoking- related discussion was related to lowered smoking risk Chattopadhyay A, McKaig RG. Social development of for adolescents with nonsmoking parents, but unrelated commercial sex workers in India: an essential step in to smoking onset for adolescents with smoking parents. HIV/AIDS prevention. AIDS Patient Care STDS 2004; Smoking-specific parenting practices did not account 18(3):159-68. for the effects of general parenting styles. Abstract: India has the highest number of HIV/AIDS CONCLUSIONS: Both parenting style and smoking- cases in the world. Current HIV/AIDS prevention specific parenting practices have unique effects on strategies are based on regular and appropriate condom adolescent smoking, although effects were largely use. However, most commercial sex workers (CSWs), confined to adolescents' reports; and for smoking- who form the core/high-risk groups toward whom the specific parenting practices, effects were confined to prevention strategy is directed, are disempowered and families with nonsmoking parents. Interventions that socioeconomically marginalized. This does not allow focus only on smoking-specific parenting practices them to insist on condom use by the client, especially may be insufficient to deter adolescent smoking. in absence of governmental structural support. This paper discusses HIV/AIDS prevention issues that relate Chatonnet F, Dominguez del Toro E, Thoby-Brisson M et to CSWs in India; issues that play a vital role in al. From hindbrain segmentation to breathing after initiation, perpetuation, and expansion of economic birth: developmental patterning in rhombomeres 3 and activity of CSWs; and those factors that influence the 4. Mol Neurobiol 2003; 28(3):277-94. HIV/AIDS preventive practices of CSWs. This paper Abstract: Respiration is a rhythmic motor behavior that argues that CSWs can be empowered and emancipated; appears in the fetus and acquires a vital importance at that HIV/AIDS control and prevention efforts in India birth. It is generated within central pattern-generating must recognize that ad hoc promotion of condom use neuronal networks of the hindbrain. This region of the or similar such programs will not be effective to control HIV/AIDS; and that more extensive 403
- 412. developmental work aimedat betterment of living Chege MN, Kabiru EW, Mbithi JN, Bwayo JJ. Childcare conditions of CSWs is required for effective practices of commercial sex workers. East Afr Med J HIV/AIDS prevention. 2002; 79(7):382-9. Abstract: OBJECTIVE: To determine the childcare Chaudhuri N. Interventions to improve children's health by practices of commercial sex workers (CSWs). improving the housing environment. Rev Environ DESIGN: A descriptive cross-sectional survey was Health 2004; 19(3-4):197-222. conducted between July and December 2000 during Abstract: Young children spend more than 90% of their which a structured questionnaire was administered. time in the household environment--a likely place of SETTING: Kibera slum, Nairobi, Kenya. SUBJECTS: exposure to hazardous substances. In the developing Three hundred eighty five CSWs and four focus group world, childhood diarrheal disease and acute lower discussions (FGDs) held. Health cards from 126 under respiratory infections represent a large portion of the five years old children belonging to the respondents global burden of disease and are strongly related to were reviewed for immunization status and regularity housing conditions. In the developed world, allergies of growth monitoring. RESULTS: The mean age of the and asthma are also strongly linked to housing 385 CSWs surveyed was 32 +/- 7 years and mean conditions. Therefore, intervention to improve housing duration of sex work was 6 +/- 4 years. The mean is essential to improve and maintain children's health. number of living children was 3.4 +/- 2 and 81.2% of This paper will review several factors that have been the mothers lived with their children. Three quarters of shown to mediate housing and health relations, the CSWs practised prostitution at home. The most including psychosocial, environmental, socioeconomic, common daily childcare activities by the mothers were behavior-cultural, and physiological factors, and will food preparation (96.2%) and washing children's provide examples of intervention to improve child clothes (91.3%). Overall 96.8% of their under-five health, with housing as a focus. Environmental years old children were fully immunized and 80% of contaminants found in the household include biological their under one year old children had their growth (for example, vector-borne diseases, dustmites, mold, monitored monthly. About three quarters of the water- and sanitation-related), chemical (for example, mothers with adolescent children educated them on lead, volatile organic compounds, asbestos) or physical HIV/STDs. Health seeking behaviour for the children (for example, radon, electric and magnetic fields). was hampered by health care cost (71.4%) and Socioeconomic factors include household income, the consumption of alcohol by the mothers. Like other ability to obtain adequate and appropriate housing, and mothers, the CSWs encouraged their adolescent the ability to implement ongoing preventative children to take up some adult roles such as maintenance. Housing tenure has been used as a proxy maintaining a clean house (93.3%). However only for socioeconomic status and shown some relation with 2.0% took time to converse or counsel the children. health outcome. Socioeconomic factors can be relevant Focus group discussions (FGDs) with the CSWs to the ability of households to create social networks showed that children were left unattended at night that affect health. Psychosocial factors, including stress while the mothers went out in search of clients. Efforts and depression, can also be related to housing type or to provide better education for the children were design. Behavioral-cultural factors include practices undermined by lack of funds (52.2%) and truancy that might influence exposure to chemical, biological, (46.6%). One third of the study population had or radiation hazards like time-activity patterns, invested for the future maintenance of their children. including gender relations and household decision- CONCLUSION: There was more emphasis on making patterns. Physiological factors include genetics physical, rather than psychological aspect of childcare. or the nutritional and immune status of household The practice of living with the children ensured that members, which can influence the extent to which earnings from the sex trade were used for the other housing factors like biological or chemical immediate needs of the children such as food. However contaminants adversely affect children. Examples of this practice had a negative influence on the children as intersectoral interventions and strategies to improve the majority of the respondents conducted their sexual child health globally, with housing and health as a business at home with little or no privacy. Health focus, include integrated pest-management programs to seeking behaviour for the children was hampered by control vector-borne diseases like malaria and Chagas lack of funds and to some extent alcohol consumption disease and energy-efficiency programs to improve by the mothers. Efforts to invest in the education of thermal comfort and to reduce the presence of allergens their children were undermined by lack of funds and like mold and dustmites. Other interventions include truancy. housing and health policy, regulation and standard setting, education, training, and participation. Chemtob CM, Nakashima JP, Hamada RS. Psychosocial intervention for postdisaster trauma symptoms in Chauvel PY. From epilepsy genes to epileptogenic elementary school children: a controlled community networks: the missing links. Curr Opin Neurol 2004; field study. Arch Pediatr Adolesc Med 2002; 17(2):139-40. 156(3):211-6. Abstract: CONTEXT: Natural disasters negatively 404
- 413. affect children's emotionaland behavioral adjustment. polio vaccine, OPV, is administered as a drop often on Although treatments to reduce psychological morbidity a lump of sugar placed in the child's mouth. Given following disasters are needed, it has been difficult to multiple times, the vaccine may protect a child for life!. conduct treatment research in postdisaster In this essay, the Nigerian scenario serves as a case environments because of the sensitivity of victims to study of community involvement and trust in perceived intrusiveness and exploitation. OBJECTIVE: international humanitarian policy. The underlying To evaluate the efficacy of a public health--inspired causes of the rebellion and its long term impact on intervention combining school-based screening and immunization programs in the region as well around psychosocial treatment to identify and treat children the world are of interest and relevance to students, with persistent disaster-related trauma symptoms. teachers and practitioners of public health. DESIGN: To identify children with continued high levels of trauma-related symptoms 2 years after a Chen JQ, Han P, Dunne MP. [Child sexual abuse: a study major disaster, we conducted a community-wide among 892 female students of a medical school]. school-based screening of disaster-exposed public Zhonghua Er Ke Za Zhi 2004; 42(1):39-43. elementary school children. Children with the highest Abstract: OBJECTIVE: This study was designed to levels of trauma-related symptoms were randomly ascertain the prevalence of child sexual abuse (CSA) assigned to 1 of 3 consecutively treated cohorts. among female students of a medical school and to Children in the cohorts awaiting treatment served as explore the impact of CSA on the mental health and wait-list controls. Within each cohort, children were health related risk behaviors of the victims being randomly assigned to either individual or group sexually abused and to provide useful reference for treatment to allow comparison of the efficacy of the 2 CSA prevention. METHODS: A cross-sectional survey treatment modalities. SETTING: All 10 public was carried out among 892 female students from a elementary schools on the island of Kauai (one of the medical school by anonymous self-administered Hawaiian Islands) 2 years after Hurricane Iniki. questionnaire during Oct. 2002. The questionnaire used PARTICIPANTS: All 4258 children in second through for this study mainly included (1) general demographic sixth grade were screened. The 248 children with the information; (2) sexual experiences; (3) 12 forms of highest levels of psychological trauma symptoms were CSA. In this study, cases of CSA were defined as those selected for treatment. INTERVENTION: Children who answered positively to one or more of the 12 were randomly assigned to either individual or group questions relating to childhood sexual experiences treatment provided by specially trained school-based (including non-physical contact CSA and physical counselors. Treatment comprised 4 sessions. MAIN contact CSA) occurring before age 16 with a person OUTCOME MEASURES: The Kauai Reaction when a child did not want to. (4) Center for Inventory, a self-report measure of trauma symptoms, Epidemiologic Studies (CES)-Depression Scale; (5) and the Child Reaction Inventory, a semistructured Self Esteem Scale; (6) Risk Behaviors; (7) Health clinical interview for posttraumatic stress disorder status' self-evaluation. Survey procedures were symptoms. RESULTS: After treatment, children designed to protect students' privacy by allowing reported significant reductions in self-reported trauma- anonymous and voluntary participation. Students were related symptoms. This symptom reduction was seated separately, completed the self-administered maintained at the 1-year follow-up. Clinical interviews questionnaire in their classrooms during a regular class also indicated that treated children had fewer trauma period. Respondents were encouraged to participate in symptoms compared with untreated children. this survey, but given the sensitive nature of the CONCLUSIONS: School-based community-wide subject, they could skip portion of the questionnaire if screening followed by psychosocial intervention seems they were not comfortable with the questions. The to effectively identify and reduce children's disaster- completed questionnaires were sealed in envelopes by related trauma symptoms and may facilitate students themselves (the envelope was distributed with psychological recovery. While group and individual questionnaire at the same time), and then collected treatments did not differ in efficacy, fewer children together. Data were analysed by using the Statistical dropped out of the group treatment. This approach may Package for the Social Sciences software. Frequency, be applicable to screening and treating children percentage, Chi-square test and t-test of statistics were exposed to a variety of large-scale disasters. used to analyze the CSA prevalence and explore the influence of CSA on mental health of students. Chen C. Rebellion against the polio vaccine in Nigeria: RESULTS: Among 892 female students, 25.6% implications for humanitarian policy. Afr Health Sci reported having experienced CSA (any one of 12 forms 2004; 4(3):205-7. non-physical contact and physical contact CSA) before Abstract: Polio eradication has been top on the agenda the age of 16 years. The median age at first episode of various international humanitarian organizations was 12 years. Comparing the rates of CSA of female since 1988. Caused by a virus that enters through the students in different parents' education level, between mouth, poliomyelitis attacks the nervous system, and one-child in a family and more than one-child in a can lead to irreversible paralysis or death. Children family, among rural area, county and city, there were under five years of age are most at risk, and the oral no significant differences. Compared to the students 405
- 414. who had notexperienced CSA, the students who had aggressive children. experienced CSA reported higher levels of depression (CES-D score 18.78 vs. 16.68, t = 2.81, P = 0.005), Cheung R, Nelson W, Advincula L, Young Cureton V, lower levels of health status self-evaluation (score 3.53 Canham DL. Understanding the culture of Chinese vs. 3.78, t = 2.94, P = 0.003); higher proportion of children and families. J Sch Nurs 2005; 21(1):3-9. subjects who reported drinking alcohol and having ever Abstract: Providing appropriate health care to a client smoked during the past 30 days (drinking 32.7% vs. can be accomplished only in an environment that is 22.9%, chi(2) = 8.51, P = 0.004; smoking 8.8% vs. sensitive to the cultural values and beliefs of the client. 4.4%, chi(2) = 6.17, P = 0.013); a higher percentage As the population of first- and second-generation engaged in sexual intercourse (19.3% vs. 5.9%, chi(2) Chinese immigrants increases in the United States, the = 33.48, P = 0.000); ever seriously considered need to develop culturally sensitive health care attempting suicide (23.7% vs. 15.4%, chi(2) = 8.09, P = becomes significant. Chinese immigrants and their 0.004), making a plan about how would attempt suicide families have become an important part of American (17.9% vs. 9.7%, chi(2) = 10.62, P = 0.001), being society, including the school setting. The school nurse, threatened or injured by someone with a weapon such who regularly works with students and families, should as a knife, or club on school property (3.5% vs. 1.1%, work in a manner that allows Chinese immigrants to chi(2) = 6.17, P = 0.013), being involved in physical maintain their cultural values and beliefs, while fight (16.7% vs. 5.6%, chi(2) = 27.05, P = 0.000) providing appropriate care for the student. The Chinese during the 12 months preceding the survey. culture is unique and holds values and beliefs that CONCLUSIONS: The results further showed that the contrast with those of the Western culture. A school CSA of girls in our country is not uncommon, as nurse who understands and incorporates the Chinese reported before in our country and in the other culture will be better able to develop a positive countries and is associated with poor mental health and interaction with the family and make arrangements for risky behaviors. The findings highlight the urgent need culturally appropriate care. for the further research into CSA epidemiological characteristics, health services for the victims abused Chi TC, Hinshaw SP. Mother-child relationships of children sexually, sexual abuse prevention programs in schools with ADHD: the role of maternal depressive symptoms and the general community in China. and depression-related distortions. J Abnorm Child Psychol 2002; 30(4):387-400. Chervin RD, Dillon JE, Archbold KH, Ruzicka DL. Conduct Abstract: We investigated the Depression-->Distortion problems and symptoms of sleep disorders in children. hypothesis by examining the effects of maternal J Am Acad Child Adolesc Psychiatry 2003; 42(2):201- depressive symptoms on cross-informant discrepancies 8. in reports of child behavior problems and several Abstract: OBJECTIVE: Conduct problems and measures of parent-child relationship. The sample hyperactivity are frequent among children referred for included ninety-six 6 to 10-year-old children diagnosed sleep-disordered breathing (SDB), restless legs with ADHD-Combined Type, and their mothers, who syndrome, or periodic leg movements during sleep provided baseline data before participating in a (PLMS), but children not referred to sleep centers have randomized clinical trial. Measures incorporated child received little study. METHOD: Parents of children characteristics, self-reports of maternal depressive aged 2 to 14 years were surveyed at two general clinics symptoms, parenting practices, and laboratory mother- between 1998 and 2000. A Pediatric Sleep child interactions. Elevations in maternal depressive Questionnaire generated validated scores for SDB and symptoms were associated with maternal reports of PLMS. The Conners Parent Rating Scale (CPRS-48) negative parenting style but not with observed produced an age- and sex-adjusted Conduct Problem laboratory interactions. Mothers' levels of depressive Index (CPI) and Hyperactivity Index. RESULTS: symptoms predicted negative biases in their reports of Parents of about 1,400 children were approached; those their child's ADHD symptoms, general behavior of 872 (62%) completed the surveys. Bullying and problems, and their own negative parenting style. other specific aggressive behaviors were generally two Whereas levels of depressive symptoms did not predict to three times more frequent among 114 children at observed parenting behaviors, maternal distortions did high risk for SDB than among the remaining children. predict problemaTic parent-child interactions. An association between high CPI and SDB scores (p Exploratory analyses showed a marginally significant <.0001) retained significance after adjustment for mediation effect of the relationship between maternal sleepiness, high Hyperactivity Index, stimulant use, or depressive symptomatology and reports of negative PLMS scores. Analogous results were obtained for the parenting by depressive distortions. We discuss association between high CPI and PLMS scores. implications of linkages between depressive symptoms CONCLUSIONS: Conduct problems were associated in mothers, depression-related distortions, and mother- with symptoms of SDB, restless legs syndrome, and child relationships for research and intervention in PLMS. Although these results cannot prove a cause- developmental psychopathology. and-effect relationship, assessment for sleep disorders may provide a new treatment opportunity for some 406
- 415. Chiarello LA, O'NeilM, Dichter CG et al. Exploring only minimal epidemiological information. The study physical therapy clinical decision making for children is designed to provide additional data on the with spastic diplegia: survey of pediatric practice. epidemiology of hospitalized burns patients in Taiwan. Pediatr Phys Ther 2005; 17(1):46-54. Data were obtained from the Burn Injury Information Abstract: PURPOSE: The purpose of this special System (BIIS), which brings together information interest report is to describe the outcomes of a research supplied by 34 contracted hospitals. The study time round table discussion regarding the physical therapy course spanned a 2-year period from July 1997 to June management of mobility for children with spastic 1999. Patient characteristics (age, sex, education level, diplegia. DESCRIPTION: Sixty-two pediatric physical etc.), causes and severity of injuries, and medical care therapists and physical therapists assistants participated measures were explored. A total of 4741 patients were in focus groups during the Research Round Table at the registered with BIIS over the study period. The American Physical Therapy Association (APTA) 1999 majority of hospitalized patients (67%) were male. The Combined Sections Meeting. A case description of a age distribution of burns patients showed peaks child with spastic diplegia and guiding questions were occurring at the age groups of 0-5 and 35-44 years. used to facilitate discussion. SUMMARY OF Over the time course of a day, burn injuries occurred EXPERIENCE: Common practices in patient more frequently from 10:00 to 12:00 h and 16:00 to management across the child's life-span emerged from 18:00 h. Injuries suspected as the result of suicide, the discussion. Practices in examination, evaluation homicide or child abuse accounted for 4.8% of and prognosis, and intervention differed depending on hospitalized cases. More than 48% of the burns the age and function of the child and the family's needs. occurred in the home. The leading type of burn injury In general, therapists reported that younger children was scalding, followed by naked flame, explosion, receive examinations that include standardized tests of electrical burns, and chemical burns due to caustic or development and ongoing intervention with a corrosive substances. The mean percent total body frequency of one to five times per week. In contrast, surface area (%TBSA) for adults was 19%, and for older children receive therapy services on an episodic young children was 12%. The average length of basis that address their specific needs. The elements of hospital stay was 18 days. In conclusion, children patient management served as a useful framework for under 5 years and adults between 35 and 44 years of exploring decision making. IMPORTANCE TO age are two high-risk groups for burn injuries. PEDIATRIC PHYSICAL THERAPY: The information Corresponding to meal preparation time, hot substances compiled from this project needs to be validated such as boiling water, hot soup, etc. are the most through systematic inquiry. Therapists may, however, common agents responsible for scalds. Prevention use the practices reported here to reflect on their programs for reducing the risk of burn injuries during clinical decision making and to identify questions for cooking and eating are required, especially for parents further exploration. This descriptive document is the with young children. first step in the development of a guideline for evidence-based practice. The development of such a Chilcoat HD, Breslau N. Low birth weight as a vulnerability clinical guideline could serve as an education tool for marker for early drug use. Exp Clin Psychopharmacol novice therapists, a program evaluation tool to ensure 2002; 10(2):104-12. quality care, and a foundation for future research to Abstract: Using prospective data from a community- promote evidence-based practice. based sample, the authors tested (a) whether low birth weight (LBW) was a vulnerability marker for children's Chiczewski D, Kelly M. Munchausen syndrome by proxy. early drug use and (b) whether the antecedents and The importance of behavioral characteristics in sequelae of LBW may act as mediators or confounders recognition and investigation. Emerg Med Serv 2002; in the pathway to early drug use. A total of 823 31(10):117-9. children and their mothers--473 LBW (<2,500 g) and Abstract: Munchausen Syndrome by Proxy is a serious 350 normal birth weight (NBW)--were assessed when form of child abuse/maltreatment that often leads to the children were 6 years old and again when they were death. Unfortunately, it is sometimes recognized only 11 years old. The incidence of drug use was higher in after a child dies. Police and EMS personnel are LBW versus NBW boys (relative odds = 2.0, 95% mandated reporters of child abuse; however, it is confidence interval = 1.2-2.6), but there was no important to understand the differences in behaviors difference in incidence for girls. The increased risk for and characteristics found in Munchausen syndrome, as LBW boys remained after adjustment for IQ, opposed to other forms of abuse. externalizing problems, attention-deficit/hyperactivity disorder, and maternal smoking. These findings Chien WC, Pai L, Lin CC, Chen HC. Epidemiology of suggest that LBW is a useful vulnerability marker for hospitalized burns patients in Taiwan. Burns 2003; early drug use among boys, independent of the 29(6):582-8. antecedents and sequelae of LBW. Abstract: Previous studies based on either single hospital data or sampling of specific groups of Chiu YN. Exploring the issue of abused hyperactive children hospitalized burns victims in Taiwan have provided in Taiwan. Acta Paediatr Taiwan 2005; 46(1):1-2. 407
- 416. Cho S, ShinMS. Neural network based automatic diagnosis Abstract: OBJECTIVES: To document and of children with brain dysfunction. Int J Neural Syst characterize fracture and embolization of peripherally 2001; 11(4):361-9. inserted central catheters (PICCs) in the pediatric Abstract: This paper proposes the use of multilayer population and define predisposing features for these perceptron for brain dysfunction diagnosis. The complications. STUDY DESIGN: A case series was performance of MLP was better than that of assembled by examining the records of PICC insertions Discriminant Analysis and Decision Tree classifiers, in a single tertiary care pediatric hospital over a 6-year with an 85% accuracy rate in an experimental test period. A control group was selected by simple random involving 332 subjects. In addition, the neural network sampling of eligible PICC insertions. RESULTS: employing Bayesian learning was able to identify the Among approximately 1650 PICCs, 11 children were most important input variable. These two results identified with a fractured line, requiring invasive demonstrate that the neural network can be effectively retrieval. Patient characteristics did not reveal any used in the diagnosis of children with brain specific risk factors compared with the control group. dysfunction. Likewise, catheter size, site, and medications infused through the line were not significant predisposing Chomchai C, Na Manorom N, Watanarungsan P, Yossuck P, factors for fracture. However, duration of placement Chomchai S. Methamphetamine abuse during and a line complication (blockage of the line or leaking pregnancy and its health impact on neonates born at at the insertion site) were significantly associated with Siriraj Hospital, Bangkok, Thailand. Southeast Asian J catheter fractures. In all cases, the embolized line Trop Med Public Health 2004; 35(1):228-31. fragment was successfully retrieved by percutaneously Abstract: To ascertain the impact of intrauterine inserted catheters and snares. No major complications methamphetamine exposure on the overall health of arose from these fractured catheters. CONCLUSIONS: newborn infants at Siriraj Hospital, Bangkok, Thailand, Fracture and embolization of PICCs occur and may birth records of somatic growth parameters and pose a potential risk of serious consequences. It is neonatal withdrawal symptoms of 47 infants born to prudent to list PICC fracture as a rare but potentially methamphetamine-abusing women during January serious complication of this device when obtaining 2001 to December 2001 were compared to 49 informed consent for its insertion. newborns whose mothers did not use methamphetamines during pregnancy. The data on Christensen CL, Bowen DJ, Hart A Jr, Kuniyuki A, Saleeba somatic growth was analyzed using linear regression AE, Campbell MK. Recruitment of religious and multiple linear regression. The association between organisations into a community-based health methamphetamine use and withdrawal symptoms was promotion programme. Health Soc Care Community analyzed using the chi-square. Home visitation and 2005; 13(4):313-22. maternal interview records were reviewed in order to Abstract: Programmes concerned with health assess for child-rearing attitude, and psychosocial promotion activities frequently rely on community parameters. Infants of methamphetamine-abusing organisations to deliver health behaviour change mothers were found to have a significantly smaller interventions. This paper presents data on the gestational age-adjusted head circumference recruitment of religious organisations (ROs) into a (regression coefficient = -1.458, p < 0.001) and birth research project focused on dietary change. The weight (regression coefficient = -217.9, p < or = 0.001) authors contacted the membership list of a local multi- measurements. Methamphetamine exposure was also denominational religious umbrella organisation by associated with symptoms of agitation (5/47), vomiting mail. The recruitment process consisted of a screening (11/47) and tachypnea (12/47) when compared to the survey followed by an informational meeting with RO non-exposed group (p < 0r =0.001). Maternal representatives, with additional meetings as necessary. interviews were conducted in 23 cases and showed The ROs were surveyed by telephone, and the initial that: 96% of the cases had inadequate prenatal care (<5 and follow-up meetings were held at a location visits), 48% had at least one parent involved in convenient to the RO representatives, often the RO's prostitution, 39% of the mothers were unwilling to take building. For this paper, the unit of analysis is the RO. their children home, and government or non- The ROs approached during the recruitment process government support were provided in only 30% of the were of a variety of faiths and denominations. All were cases. In-utero methamphetamine exposure has been located within the metropolitan area of Seattle, WA, shown to adversely effect somatic growth of newborns USA. The screening survey was used to determine RO and cause a variety of withdrawal-like symptoms. eligibility, and collect further information on the RO These infants are also psychosocially disadvantaged and its membership. The survey included questions and are at greater risk for abuse and neglect. adapted from previous RO surveys and questions developed by the project team. The recruitment Chow LM, Friedman JN, Macarthur C et al. Peripherally strategy yielded a 26% enrollment rate of eligible ROs. inserted central catheter (PICC) fracture and In comparison to eligible ROs, those that did not meet embolization in the pediatric population. J Pediatr the eligibility criteria were less stable, smaller and had 2003; 142(2):141-4. a membership that was less white, less college- 408
- 417. educated and moreworking class. The size of the RO Chu SY, Barker LE, Smith PJ. Racial/ethnic disparities in and the number of years that the religious leader had preschool immunizations: United States, 1996-2001. been with the RO were the strongest predictors of the Am J Public Health 2004; 94(6):973-7. RO's interest in participating in the project. These data Abstract: OBJECTIVES: We examined current will be helpful in recruiting community organisations racial/ethnic differences in immunization coverage into health promotion programmes. rates among US preschool children. METHODS: Using National Immunization Survey data from 1996 through Christianson A, Modell B. Medical genetics in developing 2001, we compared vaccination coverage rates between countries. Annu Rev Genomics Hum Genet 2004; non-Hispanic White, non-Hispanic Black, Hispanic, 5:219-65. and Asian preschool children. RESULTS: During the Abstract: Since Watson & Crick's 1953 description of 6-year study period, the immunization coverage gap the structure of DNA, significant progress has been between White and Black children widened by an achieved in the control of congenital disorders, most of average of 1.1% each year, and the gap between White which has benefited industrialized countries. Little and Hispanic children widened by an average of 0.5% advantage accrued to developing nations, most of each year. The gap between White and Asian children which in the same time frame achieved a significant narrowed by an average of 0.8% each year. epidemiological transition, resulting in congenital CONCLUSIONS: Racial/ethnic disparities in disorders attaining public health significance. The preschool immunization coverage rates have increased burden of congenital disorders in these lower-resource significantly among some groups; critical countries is high and they need to develop medical improvements in identifying, understanding, and genetic services. We present a new pragmatic approach addressing race/ethnicity-specific health care for the care and prevention of congenital disorders in differences are needed to achieve the Healthy People these countries, pioneered initially by the World Health 2010 goal of eliminating disparities. Organization. Chung S, Shannon M. Hospital planning for acts of terrorism Chronis AM, Lahey BB, Pelham WE Jr, Kipp HL, Baumann and other public health emergencies involving children. BL, Lee SS. Psychopathology and substance abuse in Arch Dis Child 2005; 90(12):1300-7. parents of young children with attention- Abstract: In today's world the increased potential of deficit/hyperactivity disorder. J Am Acad Child terrorist attacks places unique burdens and Adolesc Psychiatry 2003; 42(12):1424-32. consequences on health care workers. Hospitals and Abstract: OBJECTIVE: To compare the prevalence of hospital personnel must now be prepared to react psychological disorders in parents of young children immediately to such events. They must also implement, with and without attention-deficit/hyperactivity in advance, policies to protect their own health care disorder (ADHD) and comorbid disruptive behavior personnel while providing care to victims. In this disorders (DBD). METHOD: Subjects included 98 review, we discuss the four major forms of mass three- to seven-year-old children with DSM-IV ADHD casualty terrorism (biological, chemical, nuclear, and (68 with ADHD and comorbid oppositional defiant or thermomechanical) including clinical signs and conduct disorder [ADHD+ODD/CD]) and 116 non- symptoms for each, the impact on health care ADHD comparison children recruited in 1995-96 personnel, and special considerations for children. We during the first wave of a longitudinal study. Biological will then outline key principles of hospital preparation mothers were administered interviews to assess ADHD with regard to paediatrics in anticipation of such and DBD in their children and mood, anxiety, and emergencies. substance use disorders in themselves. In addition, they were queried about symptoms of childhood ADHD and Chvetzoff G, Garnier M, Perol D et al. Factors predicting DBD, and antisocial personality disorder in themselves home death for terminally ill cancer patients receiving and their children's biological fathers. RESULTS: hospital-based home care: the Lyon comprehensive Child ADHD was associated with increased rates of cancer center experience. J Pain Symptom Manage maternal and paternal childhood ADHD relative to 2005; 30(6):528-35. comparison children. Child ADHD+ODD/CD was Abstract: This study aimed to determine factors associated with maternal mood disorders, anxiety favoring home death for cancer patients in a context of disorders, and stimulant/cocaine dependence, and coordinated home care. A retrospective study was paternal childhood DBD. Mothers of children with conducted among patients followed up by the home ADHD+ODD/CD also reported increased drinking care coordinating unit of the cancer center of Lyon. problems in their children's fathers. CONCLUSIONS: The main endpoint was place of death. Univariate These findings indicate that many young children with analysis included general characteristics (age, gender, ADHD, particularly those with comorbid ODD/CD, rural or urban residence, disease), Karnofsky Index require comprehensive services to address both their (KI), type of care at referral (chemotherapy, palliative ADHD and the mental health needs of their parents. care, or other supportive care), and coordinating medical oncologist (MCO) home visits. Significant factors were used in a logistic regression analysis. Of 409
- 418. 250 patients, 90(36%) had home death. Low KI and of theory of mind. Findings are discussed in terms of MCO home visit were correlated with home death the influence of harsh caregiving on the development (odds ratio, respectively, 2.1 and 3.1). These results of theory of mind. Implications for the understanding indicate that health care support favors home death. A of normal developmental processes are highlighted. hospital-based home care unit is effective for bridging the gap between community and hospital. MCO home Cignacco E. Between professional duty and ethical visits offer concrete support to health care confusion: midwives and selective termination of professionals, patients, and relatives. pregnancy. Nurs Ethics 2002; 9(2):179-91; discussion 191-3. Cicchetti D, Rogosch FA. The impact of child maltreatment Notes: GENERAL NOTE: KIE: 12 refs. and psychopathology on neuroendocrine functioning. GENERAL NOTE: KIE: KIE Bib: abortion/attitudes; Dev Psychopathol 2001; 13(4):783-804. nursing ethics Abstract: Cortisol regulation was investigated in a Abstract: This qualitative study describes midwives' sample of school-aged maltreated (n = 167) and experiences in relation to termination of pregnancy for demographically comparable low-income fetal abnormalities, and their corresponding nonmaltreated (n = 204) boys and girls in the context professional and ethical position. Thirteen midwives of a day camp research program. The presence of working in a university clinic were interviewed about clinical-level internalizing and clinical-level their problems in this respect. The information externalizing symptomatology was determined through gathered was evaluated by using qualitative content adult report and child self report. Children who analysis. The study focused on the emotional exhibited clinical-level internalizing problems only, experience of the midwives, their professional position, clinical-level externalizing problems only, and and ethical conflict. In this situation, midwives are comorbid clinical-level internalizing and extemalizing faced with a conflict between the woman's right to self- problems were identified. Clinical-level cases were determination on one hand and the right to life of the more prevalent among the maltreated children. child on the other. This conflict causes a high level of Maltreated children with clinical-level internalizing emotional stress and, subsequently, professional problems were distinguished by higher morning, identity problems. Although questions concerning the afternoon, and average daily cortisol levels across the child's right to life are generally suppressed, the ethical week of camp attendance. In contrast, nonmaltreated principle of the woman's right to self-determination is boys with clinical-level externalizing problems rationalized. Although this process of rationalization emerged as distinct in terms of low levels of morning seems to present a false ethical decision, it enables and average daily levels of cortisol. Maltreated midwives to continue with their daily professional children with comorbid clinical-level internalizing and duties. As far as orientating midwives to the value of externalizing problems were more likely not to show these women's right to self-determination is concerned, the expected diumal decrease in cortisol. The findings it must be assumed that they have made an ethical are discussed in terms of the joint impact of decision to which they have given insufficient thought. maltreatment and different forms of psychopathology This problem is exacerbated by the fact that midwives on neuroendocrine regulation. are largely excluded from the decision-making process of the parents in question. They cannot therefore help Cicchetti D, Rogosch FA, Maughan A, Toth SL, Bruce J. in this process in a valuable and responsible way by False belief understanding in maltreated children. Dev providing clear information and proposing objective Psychopathol 2003; 15(4):1067-91. criteria. In relation to the tasks they are expected to Abstract: False belief understanding was investigated fulfill, these midwives revealed that they were in a in maltreated (N = 203), low socioeconomic status state of professional confusion. (SES) nonmaltreated (N = 143), and middle SES nonmaltreated (N = 172) 3- to 8-year-old children. Cinq-Mars C, Wright J, Cyr M, McDuff P. Sexual at-risk Contrasts among the three groups provided an behaviors of sexually abused adolescent girls. J Child opportunity to examine the impact of family contextual Sex Abus 2003; 12(2):1-18. influences on theory of mind development. Abstract: The present study investigated sexual at-risk Specifically, child maltreatment served as an behaviors of sexually abused adolescent girls. "experiment of nature" in order to elucidate theory of Variables of interest were presence of consensual mind abilities. Two false belief tasks and language sexual activity, age at first consensual intercourse, assessments were administered. Among children with a number of sexual partners, condom use, and verbal mental age of 49 months or greater, pregnancies. Participants were 125 sexually abused maltreatment was related to delays in the development adolescent girls aged 12 to 17 years. Results showed of theory of mind, beyond the influence of that severity of sexual abuse (e.g., penetration, multiple chronological age and SES. The occurrence of perpetrators, physical coercion, multiple incidents of maltreatment during the toddler period, onset during abuse) was related to a greater number of sexual at-risk the toddler years, and physical abuse were features of behaviors. For instance, adolescents with a history of maltreatment associated with delay in the development sexual abuse involving penetration were 13 times as 410
- 419. likely to havebeen pregnant. Although family analysis defined five risk categories based on baseline characteristics were significantly associated with being characteristics as follows: (1) High (n = 31; 100% had sexually active, their effect proved non-significant in both parents with SUDs, 100% had early substance the final hierarchical regression. Regression analyses use, and the mean ND score = 58.9); (2) Intermediate- clearly showed that the likelihood of engaging in High (n = 76; 45% had one parent with SUD, 100% sexual at-risk behaviors increased as a function of the early substance use and ND = 51.9); (3) Intermediate number of severity factors. (n = 76; 100% both parents with SUDs, 0% early substance use and ND = 51.4); (4) Intermediate-Low (n Clark C. An argument for considering parental smoking in = 161; 100% with one SUD parent; 0% early substance child abuse and neglect proceedings. J Contemp Health use and ND = 49.9) and; (5) Low (n = 216; no parental Law Policy 2002; 19(1):225-46. SUD, no early substance use and ND = 47.5). Compared with all other groups, children in the High Clark DB, Cornelius J. Childhood psychopathology and risk group had significantly accelerated substance adolescent cigarette smoking: a prospective survival involvement across all substance types and stages. The analysis in children at high risk for substance use ordering of risk categories from low to high was also disorders. Addict Behav 2004; 29(4):837-41. consistent for all substance involvement outcomes. The Abstract: Children of parents with substance use findings indicate that these five risk categories disorders (SUDs) have been shown to demonstrate an constitute general liability classes for adolescent increased risk for cigarette smoking in adolescence. In substance involvement, and may identify homogeneous this prospective study, we hypothesized that adolescent groups of children requiring distinct preventive cigarette smoking risk would be accounted for by interventions. childhood disruptive behavior disorders and parent cigarette smoking. Preadolescent children (ages 10-12 Clark DB, Winters KC. Measuring risks and outcomes in years) of fathers with SUD considered at high average substance use disorders prevention research. J Consult risk (HAR; n=274) and children of fathers without Clin Psychol 2002; 70(6):1207-23. SUD or major psychopathology considered at low Abstract: Assessment planning in substance use average risk (LAR; n=298) participated in structured disorder prevention research entails the identification interviews to determine mental disorder diagnoses and of measurement domains and the selection of substance use history. Both parents were assessed. The corresponding instruments needed to fulfill specific age of onset of daily tobacco use was determined in project goals. The study design, developmental periods three follow-up assessments conducted through late examined, feasibility constraints, and anticipated adolescence. Conduct disorder (CD) and parental statistical analyses are important considerations in smoking predicted earlier daily cigarette smoking, and optimally designing the assessment protocol. As a mediated the relationship between risk status and conceptual framework to organize the domains offspring daily cigarette smoking. Through the considered here as examples, the multifactorial model identification of childhood characteristics predicting of complex disorders with elaborations emphasized by daily cigarette smoking in adolescence, these results the discipline of developmental psychopathology is may facilitate targeting of early childhood preventive applied. Risks reviewed include family history, interventions. childhood maltreatment, peer relationships, and psychopathology. The substance involvement Clark DB, Cornelius JR, Kirisci L, Tarter RE. Childhood dimensions germane as outcomes include substance risk categories for adolescent substance involvement: a type, consumption quantity and frequency, and general liability typology. Drug Alcohol Depend 2005; substance-related problems. Comprehensive diachronic 77(1):13-21. evaluation over critical developmental periods provides Abstract: Childhood risks for adolescent substance the technical foundation for etiology and intervention involvement include parental substance use disorders research. (SUDs), psychological dysregulation and early tobacco and alcohol experimentation. This study was designed Clark DB, Wood DS, Martin CS, Cornelius JR, Lynch KG, to identify childhood risk categories predicting Shiffman S. Multidimensional assessment of nicotine accelerated adolescent substance involvement across dependence in adolescents. Drug Alcohol Depend drug types and stages. The index subjects were 560 2005; 77(3):235-42. children recruited from high risk (n = 266) or low risk Abstract: Despite the critical importance of adolescent (n = 294) families based on fathers' SUDs. smoking, the assessment of nicotine dependence during Assessments were conducted at approximately ages 11 this developmental period has been the subject of (baseline), 13, 16, and 19 years. Childhood predictors relatively little research. In this study, 301 adolescents included parent SUDs, early tobacco or alcohol use (ages 12 through 18 years) reporting daily smoking (i.e., substance use), and neurobehavior disinhibition were recruited for a project on alcohol use disorders (ND) as determined by indicators of cognitive, (AUDs). The sample included 140 females and 161 affective and behavioral disinhibition. A cluster males, 251 subjects from clinical and 50 from community sources, and 176 subjects with AUDs at the 411
- 420. baseline assessment. Subjectswere evaluated with the allocation of scarce medical resources; and is securely Nicotine Dependence Syndrome Scale (NDSS), the rooted in the ethical tradition of promoting and Fagerstrom Test for Nicotine Dependence (FTND) and defending human dignity. a determination of average number of cigarettes per day (cigarettes/day). A varimax factor analysis of 27 Clark PA. What residents are not learning: observations in NDSS items revealed four factors: (1) Drive/Tolerance an NICU. Acad Med 2001; 76(5):419-24. (13 items; Cronbach alpha = 0.91); (2) Continuity (five Notes: GENERAL NOTE: KIE: 5 refs. items; Cronbach alpha = 0.67); (3) Priority (three GENERAL NOTE: KIE: KIE Bib: patient care/minors items; Cronbach alpha = 0.64); (4) Stereotypy (five Abstract: In light of the November 1999 report of the items; Cronbach alpha = 0.66). The NDSS total score, Institute of Medicine on medical errors as a leading refined by the removal of four items, was also cause of death and injury, and the July 2000 report of examined (23 items; Cronbach alpha = 0.90). the Accreditation Council for Graduate Medical Predicting cigarettes/day at follow-up, initial smoking Education citing violations of work-hour standards for rate was the best predictor, with the FTND and NDSS residents and interns, there is a clear need for Total score showing significant and similar predictive substantial changes in residency training. The author, a validity. The NDSS Total showed incremental validity clinical bioethicist, uses his extended observations at a in the prediction of smoking progression in a model neonatal intensive care unit (NICU) of a major U.S. including demographic characteristics, initial smoking teaching hospital to outline specific concerns about rate and FTND. The findings suggest that the NDSS residents' and interns' training, medical and otherwise, has acceptable psychometric properties when applied that create unnecessary hazards and other difficulties in to adolescents, complementing smoking rate and the medical care of children. These concerns-which FTND in a multidimensional smoking assessment. arise from constructive criticisms he makes of specific NICU procedures, methods, approaches, and policies- Clark PA. The ethics of mandatory HIV testing of all apply directly to training residents in several areas of pregnant women. Linacre Q 2003; 70(1):2-17. medicine and more generally to all residents' training, Notes: GENERAL NOTE: KIE: 38 refs. and echo many of the issues stated in the reports GENERAL NOTE: KIE: KIE Bib: AIDS/testing and mentioned above. The author maintains that a well- screening rounded medical education, fostering not only clinical skills but others (e.g., skills in teaching; in Clark PA. Medical futility in pediatrics: is it time for a communication; in collaborating with nurses, social public policy? J Public Health Policy 2002; 23(1):66- workers, and others; in working with families; in 89. showing compassion; in dealing with confidentiality Notes: GENERAL NOTE: KIE: 49 refs. issues; in using common sense; in being the patient's GENERAL NOTE: KIE: KIE Bib: allowing to die; advocate), is crucial for producing well-rounded allowing to die/infants physicians. He emphasizes that in order for such a Abstract: For the past decade, there has been a debate well-rounded education to occur, the residency raging within the medical, ethical, and legal program-which in many cases means the attending communities focusing on the issue of medical futility. physicians-must teach and model these varied skills What has fueled the fires of this multi-faceted debate is and attitudes to their trainees. the patient rights movement and the perception that the right to self-determination extends not only to the Clark S. Roy Meadow. Lancet 2005; 366(9484):449-50. refusal of medical treatments but to demands for overtreatment. The medical specialities of Pediatrics Clark SJ, Wilkinson DR. Decision making by the child and Neonatology further complicate this issue because protection team of a medical center. Health Soc Work despite the dramatic technological advances in these 2003; 28(4):322-3. areas, diagnostic and prognostic certainty for many medical conditions remains illusive. As a result, Clarke D, Howells J, Wellingham J, Gribben B. Integrating surrogates have to decide whether children with healthcare: the Counties Manukau experience. N Z various congenital anomalies, diseases, and genetic Med J 2003; 116(1169):U325. defects should be treated aggressively if at all. This Abstract: In 1998, Counties Manukau District Health uncertainty has led to conflicts between physicians and Board (CMDHB) was experiencing rapidly increasing families about whether certain medical treatments are demands on its secondary services. It was finding it futile and thus not in the best interest of the child. From increasingly difficult to meet the health needs of its a legal and ethical perspective, one way to resolve relatively deprived population. There was widespread these conflicts would be a specific process-based evidence of "systems failure", with poor coordination public policy approach to futility determinations on a of primary and secondary services. A strategic plan case-by-case basis. The medical futility policy was devised to meet identified priorities and this was proposed as a public policy protects the patient's right subsequently implemented with extensive community to self-determination; the physician's right of involvement. A "disruptive change" model was professional integrity; society's concern for the just 412
- 421. utilised. Thirty separateprojects were undertaken to Claudon M, Upton J, Burrows PE. Diffuse venous improve coordination and integration of health malformations of the upper limb: morphologic services. Brief summaries of all projects are presented, characterization by MRI and venography. Pediatr and full evaluations were performed of major projects. Radiol 2001; 31(7):507-14. Factors critical to project success were: dedicated and Abstract: OBJECTIVES: To define the morphologic effective leadership; involvement of clinical staff; early abnormalities in patients presenting with diffuse pure engagement of the Maori and Pacific community; venous malformations (VM) of the upper extremity. careful selection of stakeholders; reassurance for SUBJECTS AND METHODS: A retrospective review providers about privacy issues; close monitoring of of MRI and venography was performed on five project progress; realistic timeframes; and adequate patients, aged 6 months to 20 years, with extensive VM initial funding. CMDHB believes that the critical factor of the upper limbs. Abnormalities of major conducting to success in improving the performance of the health veins were categorized as varicosities, stenoses, and sector will be the ability of our key leaders in primary asymmetrical pouches; anomalous venous spaces were and secondary care, in both management and clinical classified into confluent lakes, interconnecting roles, to adopt a systems view to problem analysis and channels and spongelike plexiform networks. MRI and solution building venographic data were reviewed separately and then simultaneously in order to establish correlation Clarke EE. The experience of starting a poison control between types, location, and extent of lesions. centre in Africa--the Ghana experience. Toxicology RESULTS: In all patients, the percentage of 2004; 198(1-3):267-72. replacement of normal tissues by VM was shown by Abstract: The need for a poison centre in Ghana has MRI to be significantly higher in the distal limb than in been well demonstrated over the years as evidenced by the proximal limb. Involvement of multiple tissue the occurrence of a variety of cases of poisoning. layers was seen in all cases, including, with a Important causes are accidental poisoning from decreasing rate, muscles, tendons, interosseous mishandling of pesticides, accidental poisoning among membrane of the forearm, and bone. Venography children from kerosene and pesticide' ingestion due to showed superficial varicosities, frequently associated unsafe storage methods in the home, use of herbal with stenoses and assymetric pouches in all patients. potions of unknown composition, overdoses of certain Interconnecting channels and venous lakes were noted pharmaceuticals for illegal abortion, and accidental in half of the segments, typically in muscle and other food poisonings. Bites from venomous animals deep locations, and subcutaneous spongelike lesions particularly snakes are also common. Though were seen in two patients. MRI provided a more preparations toward the establishment of a poison accurate evaluation of tissue extent. Venograms better control centre started in mid 1999, it was not until early demonstrated morphological details and provided more 2002 that the operations of a modest information centre information about the venous drainage. Direct commenced. Major roles the centre are currently comparison of MR images with venograms helped to performing include providing: an information service identify and characterize venous lesions on cross- for health professionals on management advice in cases sectional MR data. CONCLUSION: Diffuse VM of the of poisoning; training for primary health personnel in upper extremity are most extensive distally, and all the management of common poisonings; training for tissues layers can be involved, each with a agricultural personnel in prevention and first aid characteristic morphologic appearance. The management of pesticide poisoning; public awareness morphology of different components of the VM is education and information programmes for prevention related to the nature of the surrounding tissue. of poisoning. Some of the important challenges being faced include ensuring adequate sensitization on the Claus C, Lidberg L. Ego-boundary disturbances in need for centers particularly among health sadomasochism. Int J Law Psychiatry 2003; 26(2):151- professionals, difficulties in acquiring adequate 63. numbers of and appropriate training for staff of the centre, dedicated phone lines, literature and timely Clayton EW. Ethical, legal, and social implications of acquisition of toxicological data-bases. Others are poor genomic medicine. N Engl J Med 2003; 349(6):562-9. networking among centers in the region and the Notes: GENERAL NOTE: KIE: KIE Bib: absence of clinical and laboratory toxicology services confidentiality/legal aspects; genetic screening dedicated to managing poisonings. The key lessons learned include the need for multi-sectoral involvement Cleaver JE. Cancer in xeroderma pigmentosum and related and support from the onset, the need to learn from disorders of DNA repair. Nat Rev Cancer 2005; experiences of established centers and the need to 5(7):564-73. model requirements to suit local conditions without Abstract: Nucleotide-excision repair diseases exhibit compromising the effectiveness of services. cancer, complex developmental disorders and neurodegeneration. Cancer is the hallmark of Clarke P. Why do you want this job? Interview by Renate xeroderma pigmentosum (XP), and neurodegeneration Thome. Nurs Stand 2001; 15(41):18-9. 413
- 422. and developmental disordersare the hallmarks of Cloutier A, Finley J. Telepediatric cardiology practice in Cockayne syndrome and trichothiodystrophy. A Canada. Telemed J E Health 2004; 10(1):33-7. distinguishing feature is that the DNA-repair or DNA- Abstract: Telemedicine was introduced in Canadian replication deficiencies of XP involve most of the pediatric cardiology practice in 1987 in the Maritime genome, whereas the defects in CS are confined to provinces with real-time echocardiography actively transcribed genes. Many of the proteins transmissions. This early experience was adopted involved in repair are also components of dynamic progressively by other provinces, and, with multiprotein complexes, transcription factors, technological progress, many different applications are ubiquitylation cofactors and signal-transduction now available. Telemedicine has now become an networks. Complex clinical phenotypes might therefore essential tool in providing access to one of the 15 result from unanticipated effects on other genes and pediatric cardiology centers for the entire Canadian proteins. population from coast to coast. This includes teleconsultations and surgical discussions. Clements PT, Averill JB. Patterns of knowing as a method Additionally, a teleeducation program links all 15 of assessment and intervention for children exposed to centers for professional education. Indeed, 16 years family-member homicide. Arch Psychiatr Nurs 2004; after its introduction, telemedicine has become as 18(4):143-50. essential component in the delivery of pediatric Abstract: The patterns of knowing identified by Carper cardiology. We will likely see further development in in 1978, specifically empirics, aesthetics, ethics, and this field consistent with technological advances and personal knowing, continue to be applied to the patient demand as well as expanded networks and expanding role of nursing. Sociopolitical knowing and newer applications. unknowing add important dimensions, as well. Knowing is an individual process and a metamorphosis Clubb PA, Browne DC, Humphrey AD, Schoenbach V, of interplay among theory, research, and practice. Meyer B, Jackson M. Violent behaviors in early These patterns of knowing are inherently applicable to adolescent minority youth: results from a "middle any specialty within the profession of nursing. As school youth risk behavior survey". Matern Child nursing specialties such as forensic nursing emerge, the Health J 2001; 5(4):225-35. patterns of knowing can provide a foundational Notes: CORPORATE NAME: RSVPP Steering approach to comprehensive assessment and Committee intervention for victims of interpersonal violence. As Abstract: OBJECTIVES: To describe the prevalence an example, forensic nurses confronted with children and characteristics of violence and violence-related who have witnessed family-member homicide can use behaviors among six populations of U.S. minority all of the patterns of knowing for comprehensive adolescents in grades 6-8. METHODS: Six thousand nursing assessment and intervention. four hundred non-White adolescents were recruited from six sites that were part of a collaborative project. Cloitre M, Koenen KC, Cohen LR, Han H. Skills training in Surveys were administered either during the school day affective and interpersonal regulation followed by or at community facilities. All students at each site exposure: a phase-based treatment for PTSD related to were asked 10 questions about recent violence-related childhood abuse. J Consult Clin Psychol 2002; behaviors (including use of threats, fighting, weapon 70(5):1067-74. carrying, and weapon use). Prevalence of each Abstract: Fifty-eight women with posttraumatic stress violence-related behavior was reported within and disorder (PTSD) related to childhood abuse were across sites, and stratified by race/ethnicity, gender, randomly assigned to a 2-phase cognitive-behavioral age, and other characteristics expected to influence the treatment or a minimal attention wait list. Phase 1 of behaviors. RESULTS: Sixty-six percent (66%) of the treatment included 8 weekly sessions of skills training middle school students sampled reported being in affect and interpersonal regulation; Phase 2 included involved in some type of recent fighting and/or 8 sessions of modified prolonged exposure. Compared weapon-related behaviors. Sixty-one percent (61%) with those on wait list, participants in active treatment indicated some form of fighting behavior in the past 3 showed significant improvement in affect regulation months (threatening to beat someone up, physical problems, interpersonal skills deficits, and PTSD fighting, and/or being hurt in a fight). Thirty percent symptoms. Gains were maintained at 3- and 9-month (30%) of participating youth reported one or more follow-up. Phase 1 therapeutic alliance and negative weapon-related behaviors (threatening to use a weapon, mood regulation skills predicted Phase 2 exposure carrying a weapon, using a weapon, and/or being cut, success in reducing PTSD, suggesting the value of stabbed or shot at). Reported gun carrying among establishing a strong therapeutic relationship and males varied depending upon site, but was as high as emotion regulation skills before exposure work among 20%. Grade in school was positively associated with chronic PTSD populations. reported violent behaviors. Adolescents who reported living full-time with a parent or parent figure, and Cloud J. Pedophilia. Time 2002; 159(17):42-6, 48. those who reported religious observance or beliefs, were less likely to report violence involvement. All 414
- 423. violence-related behaviors weremore common among policies accompanying these trends led to increased male than female adolescents. CONCLUSIONS: income inequality but also poverty and unequal access Violence prevention efforts should begin in elementary to many other health-relevant resources. But school and continue throughout adolescence. Programs international pressures towards neo-liberal doctrines should be prepared to provide services or referrals to and policies are differentially resisted by various victims of violence, implement programs tailored nations because of historically embedded variation in toward females as well as males, and build partnerships class and institutional structures. Data presented with churches and other community organizations in indicates that neo-liberalism is associated with greater which youth are involved. poverty and income inequalities, and greater health inequalities within nations. Furthermore, countries with Coates J. Recommending particular treatment options: the Social Democratic forms of welfare regimes (i.e., those vitamin K experience. N Z Med J 2001; that are less neo-liberal) have better health than do 114(1131):215. those that are more neo-liberal. The paper concludes with discussion of what further steps are needed to "go Coates J, Findlay B, Hill J. Obtaining consent for epidural beyond" the income inequality hypothesis towards analgesia for women in labour. N Z Med J 2001; consideration of a broader set of the social 114(1126):72-3. determinants of health. Notes: GENERAL NOTE: KIE: 12 refs. GENERAL NOTE: KIE: KIE Bib: informed consent Coch D, Sanders LD, Neville HJ. An event-related potential study of selective auditory attention in children and Coatsworth JD, Santisteban DA, McBride CK, Szapocznik J. adults. J Cogn Neurosci 2005; 17(4):605-22. Brief Strategic Family Therapy versus community Abstract: In a dichotic listening paradigm, event- control: engagement, retention, and an exploration of related potentials (ERPs) were recorded to linguistic the moderating role of adolescent symptom severity. and nonlinguistic probe stimuli embedded in 2 different Fam Process 2001; 40(3):313-32. narrative contexts as they were either attended or Abstract: This study extends a program of research unattended. In adults, the typical N1 attention effect investigating the effectiveness of Brief Strategic was observed for both types of probes: Probes Family Therapy to engage and retain families and/or superimposed on the attended narrative elicited an youth in treatment. The study contrasted Brief Strategic enhanced negativity compared to the same probes Family Therapy (BSFT) with a Community when unattended. Overall, this sustained attention Comparison (CC) condition selected to represent the effect was greater over medial and left lateral sites, but common engagement and treatment practices of the was more posteriorly distributed and of longer duration community; 104 families were randomly assigned to for linguistic as compared to nonlinguistic probes. In BSFT or CC. Results indicate that families assigned to contrast, in 6- to 8-year-old children the ERPs were BSFT had significantly higher rates of engagement morphologically dissimilar to those elicited in adults (81% vs. 61%), and retention (71% vs. 42%). BSFT and children displayed a greater positivity to both types was also more effective than CC in retaining more of probe stimuli when embedded in the attended as severe cases. Post hoc analyses of treatment compared to the unattended narrative. Although both effectiveness suggest that BSFT was able to achieve adults and children showed attention effects beginning comparable treatment effects despite retaining more at about 100 msec, only adults displayed left- difficult cases. We discuss these results from a public lateralized attention effects and a distinct, posterior health perspective, and highlight the study's distribution for linguistic probes. These results suggest contribution to a small but growing body of literature that the attentional networks indexed by this task that suggests the benefits of a family-systems paradigm continue to develop beyond the age of 8 years. for engagement and retention in treatment. Cochran C, Skillman GD, Rathge RW, Moore K, Johnston J, Coburn D. Beyond the income inequality hypothesis: class, Lochner A. A rural road: exploring opportunities, neo-liberalism, and health inequalities. Soc Sci Med networks, services, and supports that affect rural 2004; 58(1):41-56. families. Child Welfare 2002; 81(5):837-48. Abstract: This paper describes and critiques the income Abstract: The Great Plains Rural Collaborative project inequality approach to health inequalities. It then explored rural poverty through the experiences of presents an alternative class-based model through a people living at or below 185% of poverty. Researchers focus on the causes and not only the consequences of collected information through qualitative and income inequalities. In this model, the relationship quantitative research methods. They designed focus between income inequality and health appears as a group questions to identify obstacles rural families face special case within a broader causal chain. It is argued when trying to access economic opportunities, social that global and national socio-political-economic trends networks, and services and supports. The article have increased the power of business classes and highlights the salient findings. lowered that of working classes. The neo-liberal 415
- 424. Cocu M, ThorneC, Matusa R et al. Mother-to-child Abstract: INTRODUCTION: Nonattendance for transmission of HIV infection in Romania: results from otolaryngology appointments disrupts the management an education and prevention programme. AIDS Care of medical care and leads to ineffective use of 2005; 17(1):76-84. resources. The determinants of nonattendance in Abstract: A pilot prevention of mother-to-child pediatric otolaryngology patients have not been well transmission (PMTCT) programme was implemented documented. OBJECTIVES: To investigate health in Constanta County, Romania, between 2000 and provider determinants of nonattendance in pediatric 2002. The programme consisted of clinician training, otolaryngology patients. STUDY DESIGN: We routine antenatal HIV counselling and testing and the assessed the effects of waiting time for an appointment care of HIV-infected pregnant women and their infants. and the timing of the appointment (during the day, A total of 11,423 pregnant women (10,192 (89%) week, and year) on nonattendance proportions during a white Europeans, 862 (7.5%) Rroma, 369 (3.2%) 1 year period. Chi square tests were used to analyze Central Asians) were tested during the pilot, at a statistically significant differences of categorical median of 24 weeks' gestation. Rapid HIV testing at variables. Logistic regression was used for multivariate delivery was introduced during the pilot, to supplement analyses. RESULTS: A total of 2,628 pediatric visits the antenatal testing, both of which required informed were included in the study. The overall proportion of consent. Overall seroprevalence was 1.75 per 1,000 nonattendance at the pediatric otolaryngology clinic (95% confidence interval (CI) 1.07-2.70 per 1,000). was 33.0%. Nonattendance proportions were 32.7% HIV infection was associated with having a high-risk between 7 AM and 9 AM; 28.3% between 9 AM and 2 partner, prostitution and non-Caucasian ethnicity. PM, and 36.5% between 2 PM and 8 PM (P < .001). Twelve infected women completed their pregnancies, The proportion of nonattendance was 24.1% when of whom seven received antenatal antiretroviral there was a short waiting time for an appointment (0-7 therapy (ART); all neonates received prophylactic days), and 36.3% when there was an intermediate ART and five were delivered by elective caesarean waiting time (7-15 days), and 36.6% when there was a section. Three infants were HIV-infected, giving a long waiting time (15 days and above)(P < .001, P < vertical transmission rate of 25% (95% CI 5.49- .012, respectively). CONCLUSIVE: Health provider 57.2%); all three were born to mothers not identified as determinants of nonattendance in pediatric infected until delivery, and who therefore received no otolaryngology clinic appointments include the waiting antenatal ART. A key challenge for PMTCT in time for an appointment and the hour of the Romania will be the prompt identification of pregnant appointment within the day. HIV-infected women, to allow the optimum application of interventions. Cohen-Almagor R. Euthanasia and law in the Netherlands: reflections on Dutch perspectives. Synth Philos 2002; Coggan C, Hooper R, Adams B. Self-reported injury rates in 17(1):135-55. New Zealand. N Z Med J 2002; 115(1161):U167. Notes: GENERAL NOTE: KIE: 49 fn. Abstract: AIM: The study aimed to obtain baseline GENERAL NOTE: KIE: KIE Bib: information on the incidence and nature of self- euthanasia/attitudes; euthanasia/legal aspects; suicide reported injuries in New Zealand. METHODS: A Abstract: During the summer of 1999, twenty-eight cross-sectional survey was conducted of approximately interviews with some of the leading authorities on the 400 randomly-selected households from each of 13 euthanasia policy were conducted in the Netherlands. Territorial Local Authorities across New Zealand, The discussion begins with providing some giving a total sample size of 5282. Respondents were background information on the guidelines for asked if anyone in their household had been treated by conducting euthanasia. Next, I explain the research a medical doctor in the previous twelve months for any methodology and move on to discuss the interviewees' injuries and, if so, details of the injury event were responses to the question whether it is preferable to recorded. RESULTS: Forty one per cent of households legislate euthanasia. The interviewees exhibited split reported that someone in the household had sustained views on the issue. Some were in favor of legislation an injury. The most common types of injuries were for instrumental and symbolic reasons. Others utilized falls (33%), sports-related injuries (28%) and injuries different instrumental and symbolic reasons to argue caused by lifting an object (16%). Only eight per cent against legislation. Three interviewees preferred to wait of the injuries required overnight hospitalisation. for some years before changing the law. CONCLUSION: The findings from this study indicate that the total burden of injury in New Zealand is much Cohen JA, Mannarino AP. Addressing attributions in larger than estimated by routinely-collected injury treating abused children. Child Maltreat 2002; 7(1):82- hospitalisation data. 6. Cohen AD, Kaplan DM, Shapiro J, Levi I, Vardy DA. Cohen JA, Perel JM. Adolescent weight loss during Health provider determinants of nonattendance in treatment with olanzapine. J Child Adolesc pediatric otolaryngology patients. Laryngoscope 2005; Psychopharmacol 2004; 14(4):617-20. 115(10):1804-8. 416
- 425. Abstract: Antipsychotic medicationsare increasingly suggests ways pediatricians can enhance fathers' used in adolescents for a variety of psychiatric caregiving involvement by offering specific, culturally difficulties, including psychosis, bipolar disorder, and sensitive advice and how pediatricians might change aggression. Weight gain is a significant side effect of their office practices to support and increase fathers' neuroleptics, which may limit adolescents' compliance active involvement in their children's care and with these medications. This report presents a case of development. significant weight loss while on olanzapine, with a body mass index (BMI) falling from 25 to 19.5 during Coles J. Doing retrospective child sexual abuse research 8 months of treatment. Possible mechanisms for this safely and ethically with women: is it possible? Two effect are discussed. perspectives. Monash Bioeth Rev 2004; 23(2):S50-9. Notes: GENERAL NOTE: KIE: 26 fn. Cohen MH, Kemper KJ, Stevens L, Hashimoto D, Gilmour GENERAL NOTE: KIE: KIE Bib: behavioral J. Pediatric use of complementary therapies: ethical research/special populations and policy choices. Pediatrics 2005; 116(4):e568-75. Abstract: OBJECTIVE: Many pediatricians and parents Colgrove J, Bayer R. Could it happen here? Vaccine risk are beginning to integrate use of complementary and controversies and the specter of derailment. Health Aff alternative medical (CAM) therapies with conventional (Millwood) 2005; 24(3):729-39. care. This article addresses ethical and policy issues Abstract: Controversy over vaccine safety has achieved involving parental choices of CAM therapies for their high visibility over the past decade. At the same time, children. METHODS: We conducted a literature search however, levels of coverage for routinely to assess existing law involving parental choice of recommended childhood vaccines in the United States CAM therapies for their children. We also selected a are at their highest ever. We examine this apparent convenience sample of 18 states of varying sizes and paradox. We consider the ways in which concerns over geographic locations. In each state, we inquired within vaccine safety have emerged and diffused through the the Department of Health and Human Services whether popular media, legislative hearings, and Internet-based staff were aware of (1) any internal policies concerning activism. As a case study, we review the controversy these issues or (2) any cases in the previous 5 years in over the alleged connection between autism and the which either (a) the state initiated proceedings against measles-mumps-rubella (MMR) vaccine and consider parents for using CAM therapies for their children or why it had a dramatic effect on the vaccine's (b) the department received telephone calls or other acceptance in Great Britain but virtually none in the information reporting abuse and neglect in this domain. United States. We asked the American Academy of Pediatrics and the leading CAM professional organizations concerning Collin-Vezina D, Cyr M. [Current understanding about any relevant, reported cases. RESULTS: Of the 18 intergenerational transmission of child sexual abuse]. state Departments of Health and Human Services Child Abuse Negl 2003; 27(5):489-507. departments surveyed, 6 reported being aware of cases Abstract: OBJECTIVE: The aim of this article is to in the previous 5 years. Of 9 reported cases in these 6 review what is currently understood about states, 3 involved restrictive dietary practices (eg, intergenerational transmission of child sexual abuse limiting children variously to a watermelon or raw (CSA). METHOD: CSA transmission is discussed first foods diet), 1 involved dietary supplements, 3 involved from the point of view of men CSA survivors who children with terminal cancer, and 2 involved religious become sexually abusive, and then from the practices rather than CAM per se. None of the perspective of mothers who survived CSA whose professional organizations surveyed had initiated children have been sexually abused. Mechanisms that proceedings or received telephone calls regarding may help us understand how CSA is transmitted from abuse or neglect concerning parental use of CAM one generation to another are described. More therapies. CONCLUSIONS: Pediatric use of CAM specifically, focus is given to those mechanisms that therapies raises complex issues. Clinicians, hospitals, might differentiate CSA survivors who break the cycle state agencies, courts, and professional organizations of abuse from those who perpetuate it. RESULTS: In may benefit from a policy framework to help guide light of the research reviewed, it seems that the decision making. transmission of CSA is far from inevitable, since one- third of sexually abusive men and half of sexually Coleman WL, Garfield C. Fathers and pediatricians: abused children's mothers mentioned having been enhancing men's roles in the care and development of sexually abused in their childhood. Because of the their children. Pediatrics 2004; 113(5):1406-11. retrospective method used in many studies, causal links Notes: CORPORATE NAME: American Academy of could not be established. However, some mechanisms Pediatrics Committee on Psychosocial Aspects of have been proposed in order to better understand the Child and Family Health phenomenon of CSA. Severity of abuse, attachment Abstract: Research substantiates that fathers' relationships with parental figures, as well as interactions with their children can exert a positive dissociative symptoms that follow the abuse were influence on their children's development. This report 417
- 426. identified. Dissociative symptomatologyappeared to controlled trial. SETTING: Two large tertiary be a determining factor in understanding the cycle of hospitals, 54 peripheral hospitals. PARTICIPANTS: CSA. CONCLUSIONS: More studies on CSA 319 preterm infants (born at 23-33 weeks' gestation) transmission are needed to understand the mechanisms randomly assigned to one of four groups: cup/no that are involved in that cycle, as well as to develop dummy (n = 89), cup/dummy (n = 72), bottle/no effective strategies to treat and prevent CSA. dummy (n = 73), bottle/dummy (n = 85). Women with singleton or twin infants < 34 weeks' gestation who Collings SJ. Lexical redescription of child sexual abuse in wanted to breastfeed were eligible to participate. the South African English-language press. Psychol Rep INTERVENTIONS: Cup or bottle feeding occurred 2002; 91(1):28. when the mother was unable to be present to breast Abstract: Content analysis of 1,044 child sexual abuse feed. Infants randomised to the dummy groups reports over an 8-yr. period in the South African received a dummy on entry into the trial. MAIN English-language press indicated that 8.5% (n=89) of OUTCOME MEASURES: Full breast feeding reports use the language of consensual sexual activity (compared with partial and none) and any breast to describe the abuse, with this percentage remaining feeding (compared with none) on discharge home. constant over the 8-yr. period reviewed. Secondary outcomes: prevalence of breast feeding at three and six months after discharge and length of Collins CC, Grella CE, Hser YI. Effects of gender and level hospital stay. RESULTS: 303 infants (and 278 of parental involvement among parents in drug mothers) were included in the intention to treat treatment. Am J Drug Alcohol Abuse 2003; 29(2):237- analysis. There were no significant differences for any 61. of the study outcomes according to use of a dummy. Abstract: Most studies of parents in drug treatment Infants randomised to cup feeds were more likely to be have focused exclusively on mothers, and few studies fully breast fed on discharge home (odds ratio 1.73, have examined the effects of parents' level of 95% confidence interval 1.04 to 2.88, P = 0.03), but involvement with their children on the parents' drug had a longer length of stay (hazard ratio 0.71, 0.55 to use and psychological functioning, either before or 0.92, P = 0.01). CONCLUSIONS: Dummies do not after treatment. This study examined mothers and affect breast feeding in preterm infants. Cup feeding fathers (n = 331) who were parents of children under significantly increases the likelihood that the baby will the age of 18; participants were sampled from 19 drug be fully breast fed at discharge home, but has no effect treatment programs across four types of treatment on any breast feeding and increases the length of modalities in Los Angeles County. A majority of each hospital stay. group (57% of 214 mothers and 51% of 117 fathers) were classified as being highly involved with their Colombo L, Laudanna A, De Martino M, Brivio C. children. At the baseline assessment, higher parental Regularity and/or consistency in the production of the involvement was related to lower levels of addiction past participle? Brain Lang 2004; 90(1-3):128-42. severity, psychological severity, and symptoms of Abstract: In the present study we have investigated the psychological distress, and to higher levels of self- acquisition of the past participle of Italian verbs of the esteem and perception of parenting skills. In general, second (including mostly irregular verbs) and third fathers had higher levels of alcohol and drug-use (including mostly regular verbs) conjugations in school severity than did mothers, but fathers who were more age children, and with simulations with an artificial involved with their children showed lower levels of neural network. We aimed to verify the extent to which addiction severity than fathers who were less involved. children are sensitive to regularity, as opposed to the Parental involvement at baseline was unrelated to drug consistency in the mapping from the infinitive to the use at the 12-month follow-up, although parents who past participle. In particular, we predicted that children were less involved with their children reported would learn at some point that verbs of the second experiencing more stressors. Given the association of conjugation tend to be irregular, and therefore they parental involvement with lower levels of addiction would be more likely to produce irregularizations for severity and psychological distress at baseline, verbs of this class, compared to the verbs of the third treatment protocols should build upon the positive conjugation. However, they should also show relationships of parents with their children, and seek to sensitivity to the phonological mapping consistency improve those of less-involved parents. within each subclass, learning to produce correct forms on the basis of phonological similarity. In contrast, Collins CT, Ryan P, Crowther CA, McPhee AJ, Paterson S, children should be more likely to produce regular Hiller JE. Effect of bottles, cups, and dummies on forms for verbs of the third conjugation. Thus, a larger breast feeding in preterm infants: a randomised regularity effect would be expected for verbs of the controlled trial. BMJ 2004; 329(7459):193-8. third than of the second conjugation, leading to the Abstract: OBJECTIVE: To determine the effect of prediction of a regularity by conjugation interaction. artificial teats (bottle and dummy) and cups on breast feeding in preterm infants. DESIGN: Randomised Colon de Marti L. Youth violence: understanding and prevention: strategies of intervention. Part II. P R 418
- 427. Health Sci J 2001; 20(1):51-6. are organized and how words refer to them can be Abstract: Youth violence is a complex problem. The explained as learned generalizations over specific recent youth related violent incidents are of great experiences of words referring to categories; and impact taking in consideration the emotional costs to second, that the path of concepts from concrete to more victims, their families and to the health and safety of abstract can be observed throughout development and citizens; as well as the economic cost to society. It is a that even in their more abstract form, concepts retain major public health concern that requires participation, some of their original sensory basis. We illustrate these collaboration and integration of efforts from parents, two facts by examining, in two kinds of learners-- citizens and professionals from different disciplines. networks and young children--the development of three abstract ideas: (i) the idea of word; (ii) the idea of Colson ER, McCabe LK, Fox K et al. Barriers to following object; and (iii) the idea of substance. the back-to-sleep recommendations: insights from focus groups with inner-city caregivers. Ambul Pediatr Colunga E, Smith LB. From the lexicon to expectations 2005; 5(6):349-54. about kinds: a role for associative learning. Psychol Abstract: BACKGROUND: African American infants Rev 2005; 112(2):347-82. have a higher incidence of SIDS and increased risk of Abstract: In the novel noun generalization task, 2 1/2- being placed in the prone position for sleep. year-old children display generalized expectations OBJECTIVE: To determine new barriers and more about how solid and nonsolid things are named, information about previously identified barriers that extending names for never-before-encountered solids interfere with adherence to the Back-to-Sleep by shape and for never-before-encountered nonsolids recommendations among inner-city, primarily African by material. This distinction between solids and Americans. DESIGN/METHODS: We conducted 9 nonsolids has been interpreted in terms of an focus groups with caregivers of infants and young ontological distinction between objects and substances. children from women, infants, and children centers and Nine simulations and behavioral experiments tested the clinics in New Haven and Boston. Themes were hypothesis that these expectations arise from the identified using standard qualitative techniques. correlations characterizing early learned noun RESULTS: Forty-nine caregivers participated, of categories. In the simulation studies, connectionist whom 86% were African American, 6% were networks were trained on noun vocabularies modeled Hispanic, 4% were white, and 4% were other. Four after those of children. These networks formed themes were identified: 1) Safety: Participants chose generalized expectations about solids and nonsolids the position for their infants based on which position that match children's performances in the novel noun they believed to be the safest. Some participants did generalization task in the very different languages of not choose to put their infants in the supine position for English and Japanese. The simulations also generate sleep because they feared their infants would choke; 2) new predictions supported by new experiments with Advice: Participants relied on the advice of more children. Implications are discussed in terms of experienced female family members. Health care children's development of distinctions between kinds of providers were not uniformly a trusted source of categories and in terms of the nature of this knowledge. advice; 3) Comfort: Participants made choices about their infants sleeping positions based on their Comeau AM, Eaton RB. Successes of newborn screening perceptions of whether the infants appeared programs. Science 2002; 295(5552):44-5. comfortable. Participants thought that their infants appeared more comfortable in the prone position; 4) Compton SN, Burns BJ, Helen LE, Robertson E. Review of Knowledge: Some participants had either limited or the evidence base for treatment of childhood erroneous knowledge about the Back-to-Sleep psychopathology: internalizing disorders. J Consult recommendations. CONCLUSIONS: We identified Clin Psychol 2002; 70(6):1240-66. multiple barriers to adherence to recommendations Abstract: This article reviews the empirical literature regarding infant sleep position. Data obtained from on psychosocial, psychopharmacological, and these focus groups could be used to design educational adjunctive treatments for children between the ages of interventions aimed at improving communication about 6 and 12 with internalizing disorders. The aim of this and adherence to the Back-to-Sleep recommendations. review was to identify interventions that have potential to prevent substance use disorders in adolescence by Colunga E, Smith LB. The emergence of abstract ideas: treating internalizing disorders in childhood. Results evidence from networks and babies. Philos Trans R suggest that a variety of behavioral, cognitive- Soc Lond B Biol Sci 2003; 358(1435):1205-14. behavioral, and pharmacological interventions are Abstract: What is abstraction? In our view, abstraction effective in reducing symptoms of childhood is generalization. Specifically, we propose that abstract depression, phobias, and anxiety disorders. None of the concepts emerge as the natural product of associative studies reviewed included substance abuse outcomes. learning and generalization by similarity. We support Thus, little can be said about the relationship between this proposal by presenting evidence for two ideas: early treatment and the prevention of later substance first, that children's knowledge about how categories 419
- 428. use. The importanceof evaluating the generalizability Concha-Eastman A, Espitia VE, Espinosa R, Guerrero R. of research-supported interventions to community [Epidemiology of homicides in Cali, Colombia, 1993- settings is highlighted and recommendations for future 1998: six years of a population-based model]. Rev research are offered. Panam Salud Publica 2002; 12(4):230-9. Abstract: OBJECTIVES: To demonstrate the Comtois KA, Tisdall WA, Holdcraft LC, Simpson T. Dual usefulness of an effective and timely information diagnosis: impact of family history. Am J Addict 2005; model, underscore the seriousness of the problem of 14(3):291-9. homicides, and point out the need to apply this type of Abstract: Psychiatric outpatients with severe and model as well as comprehensive prevention projects, persistent mental illness and a current or past substance such as Desarrollo, Seguridad y Paz (DESESPAZ). use disorder (N = 89) were interviewed. Information From 1993 to 1998, 11 457 homicides were registered from the Family Informant Schedule and Criteria was in Cali, Colombia, through an epidemiological configured in three ways to capture the degree of surveillance model established under DESESPAZ by familial substance abuse: biological parents only, all the mayor's office in Cali. METHODS: Beginning in first-degree biological relatives, and all caregivers. All January 1993, a work group organized by DESESPAZ three configurations predicted the severity of lifetime reviewed and standardized the variables that different drug abuse on the Inventory of Drug Use institutions gathered about the victims, their assailants, Consequences, controlling for any gender and non- and the facts surrounding each case, and issued a substance-related Axis I diagnosis. Differences in weekly summary bulletin for the mayor and other local means represent low to very low substance abuse authorities. RESULTS: Between 1983 and 1994, the severity for those without family history and low to homicide rate increased from 23 to 124 per 100 000 medium severity for those with family history. The inhabitants. Subsequently, rates went down in 1995, clinical implications are discussed. 1996, and 1997 to 112, 102, and 86,1 per 100 000, respectively, and again rose slightly in 1998 to 88 per Conaglen HM. Sexual content induced delay: a 100 000. Even though people of all ages, including reexamination investigating relation to sexual desire. children under 5, have been victims of violence, the Arch Sex Behav 2004; 33(4):359-67. most affected group is that of men between the ages of Abstract: This article reports the utility of an 20 and 34. The ratio of men to women has varied from information processing approach to examine whether 14.3:1 to 9.2:1. In terms of numbers, percentages, and there is a relationship between sexual content induced rates, low-income groups are the most seriously delay and levels of sexual desire as determined by self- affected, although the highest-income groups have had report questionnaires. We tested this idea using a rates as high as 160 per 100 000. A firearm was used in partial replication of the J. H. Geer and H. S. Bellard over 80% of homicides, and the crime was most often (1996) protocol demonstrating sexual content induced committed at night and on a weekend. A suspect was delay (SCID) in responding to sexual versus neutral identified in only a few cases (8% to 21%). The words. In addition, the experiment examined whether bivariate analysis revealed a positive association with SCID was different in people with varying levels of alcohol consumption by the victim, as well as with the sexual desire. It was hypothesized that persons with use of firearms by the assailant (OR: 3.1; 95% CI: 2.6 low levels of sexual desire might respond more slowly to 3.6). Cases that occurred during a fight between to sexual word cues than others. Words with equal individuals or during group fighting showed an frequency of usage and similar word length were association with the use of a sharp weapon and with chosen from among those used in the Geer and Bellard alcohol consumption by the victim (OR: 1.9; 95% CI: study. The experiment was conducted with 171 1.4 to 2.6). CONCLUSIONS: A map shows the volunteers who completed sexual desire questionnaires, homicide distribution by neighborhood, and the lexical decision making tasks, and word ratings. The benefits of a population-based surveillance model are SCID effect was demonstrated by both men and discussed, particularly their usefulness for identifying women in the study with no significant variation risk factors and the measures that can be applied to between the sexes. In accordance with prediction, it prevent and control this form of violence. was found that persons with lower levels of sexual desire responded more slowly to sexual stimuli than Conger RD, Wallace LE, Sun Y, Simons RL, McLoyd VC, other participants, and rated sexual words as less Brody GH. Economic pressure in African American familiar, less acceptable, and less positive emotionally families: a replication and extension of the family to them. These findings have implications for stress model. Dev Psychol 2002; 38(2):179-93. understanding how emotional content contributes to Abstract: This study of 422 two-caregiver African SCID. They also suggest that further exploration of American families, each with a 10-11-year-old focal these ideas, perhaps using other stimulus modalities, child (54% girls), evaluated the applicability of the may be helpful in advancing understanding of family stress model of economic hardship for responses to sexual cues, and the potential implications understanding economic influences on child that may have in better understanding sexual desire. development in this population. The findings generally replicated earlier research with European American 420
- 429. families. The resultsshowed that economic hardship address the characteristics of their caregivers, the positively relates to economic pressure in families. multiple risk factors faced by these children, their Economic pressure was related to the emotional health and development, and their school performance. distress of caregivers, which in turn was associated Data were collected from mothers at intake into 50 with problems in the caregiver relationship. These publicly funded residential substance abuse treatment problems were related to disrupted parenting practices, programs for pregnant and parenting women. Findings which predicted lower positive child adjustment and from this study suggest that children whose mothers higher internalizing and externalizing symptoms. The abuse alcohol or other drugs confront a high level of results provide significant support for the family stress risk and are at increased vulnerability for physical, model of economic hardship and its generalizability to academic, and socioemotional problems. Children diverse populations. affected by maternal addiction are in need of long-term supportive services. Conkis W. A place to go where someone cares. CDS Rev 2003; 96(7):12. Connor DF, Glatt SJ, Lopez ID, Jackson D, Melloni RH Jr. Psychopharmacology and aggression. I: A meta- Connell CL, Lofton KL, Yadrick K, Rehner TA. Children's analysis of stimulant effects on overt/covert experiences of food insecurity can assist in aggression-related behaviors in ADHD. J Am Acad understanding its effect on their well-being. J Nutr Child Adolesc Psychiatry 2002; 41(3):253-61. 2005; 135(7):1683-90. Abstract: OBJECTIVE: To determine by meta-analysis Abstract: An understanding of the experience of food the effect size for stimulants on overt and covert insecurity by children is essential for better aggression-related behaviors in children with attention- measurement and assessment of its effect on children's deficit/hyperactivity disorder (ADHD), separately from nutritional, physical, and mental health. Our qualitative stimulant effects on the core symptoms of ADHD. study explored children's perceptions of household METHOD: A review of the literature from 1970 to food insecurity to identify these perceptions and to use 2001 revealed 28 studies meeting inclusion/exclusion them to establish components of children's food criteria for meta-analysis. These studies yielded 28 insecurity experience. Children (n = 32; 11-16 y old) independent effects of overt aggression and 7 from after school programs and a middle school in low- independent effects of covert aggression. RESULTS: income areas participated in individual semistructured The overall weighted mean effect size was 0.84 for in-depth interviews. Children as young as 11 y could overt and 0.69 for covert aggression related behaviors describe behaviors associated with food insecurity if in ADHD. Comorbid conduct disorder is associated they had experienced it directly or indirectly. Using the with diminishing stimulant effect size for overt constant comparative method of qualitative data aggression. CONCLUSION: Stimulant effects for analysis, children's descriptions of behaviors associated aggression-related behaviors in ADHD have effect with food insecurity were categorized into components sizes similar to those for the core symptoms of ADHD. of quantity of food, quality of food, psychological aspects, and social aspects described in the household Conroy S, McIntyre J. The use of unlicensed and off-label food insecurity literature. Aspects of quantity included medicines in the neonate. Semin Fetal Neonatal Med eating less than usual and eating more or eating fast 2005; 10(2):115-22. when food was available. Aspects of quality included Abstract: The use of unlicensed and off-label use of a few kinds of low-cost foods. Psychological medicines in neonates in intensive care is common and aspects included worry/anxiety/sadness about the widespread. Up to 93% of babies receive at least one family food supply, feelings of having no choice in the unlicensed or off-label medicine during their stay in foods eaten, shame/fear of being labeled as poor, and intensive care. Such practice is an essential part of their attempts to shield children. Social aspects of food care and should be done based on the best evidence insecurity centered on using social networks to acquire available. However, problems arise - on an every-day food or money and social exclusion. These results basis - because of the lack of appropriate information provide valuable information in understanding the and licensed medicine formulations for neonates. These effect of food insecurity on children's well-being problems include the selection of appropriate medicine especially relative to the social and emotional aspects and dose, administration and the increased risk of of well-being. medication errors. Initiatives to improve the situation are underway in the US and are proposed in Europe. Conners NA, Bradley RH, Mansell LW et al. Children of However, more urgent action is required to stop these mothers with serious substance abuse problems: an babies continuing to be deprived of their basic human accumulation of risks. Am J Drug Alcohol Abuse rights to safe, effective and high-quality therapy. 2003; 29(4):743-58. Abstract: This study examines the life circumstances Coohey C. Battered mothers who physically abuse their and experiences of 4084 children affected by maternal children. J Interpers Violence 2004; 19(8):943-52. addiction to alcohol or other drugs. The paper will Abstract: The purpose of this study is to understand 421
- 430. why some batteredmothers physically abuse their and caregiver demographic and clinical factors, children. Mothers who were battered and physically enrollment in a managed care behavioral health plan abused their children (the co-occurrence group) were was associated with lower inpatient/residential, compared with mothers who were neither battered nor psychiatric medication, and nontraditional services physically abused, who were only battered, and who utilization. No difference was found in outpatient only abused (N = 184). The mothers in the co- services utilization. Medicaid-funded managed care occurrence group were more likely than the mothers behavioral health plans appear to reduce use of some who did not physically abuse their children to have types of mental health services, but it is important to been severely assaulted by their own mothers as address the question of whether low-income children's children, have had poorer quality relationships with enrollment in such programs deprives them of needed and receive less support from their mothers, have more services. stressors, and have known their partners for less time. These differences were not found between the mothers Cooksey EC, Mott FL, Neubauer SA. Friendships and early in the co-occurrence and abuse-only groups. In the relationships: links to sexual initiation among multivariate analysis, having been assaulted by one's American adolescents born to young mothers. Perspect own mother as a child--not being battered by one's Sex Reprod Health 2002; 34(3):118-26. partner--was the most potent predictor for whether a Abstract: CONTEXT: Preadolescent friendships and mother physically abused her child. early teenage dating relationships have implications for adolescent sexual initiation that may differ by race and Coohey C. The relationship between familism and child gender. METHODS: Data on participants in the maltreatment in Latino and Anglo families. Child National Longitudinal Survey of Youth and their Maltreat 2001; 6(2):130-42. children are used to profile friendship and dating Abstract: Familism, or familismo, refers to attitudes, patterns among a sample of youth born to relatively behaviors, and family structures operating within an young mothers. Logistic regression analyses examine extended family system and is believed to be the most whether these patterns predict early sexual initiation, important factor influencing the lives of Latinos. and whether there are differences associated with Because of the complexity of the construct, this article gender and race. RESULTS: As youth moved from late begins by separating out and defining each dimension childhood to mid-adolescence, they shifted from of familism, and then clarifies its relationship to the having almost exclusively same-sex, same-grade broader literature on social networks, social support, friends to having more relationships with persons who and child maltreatment. The analysis tests whether are of the opposite sex and older. By ages 15-16,34% each dimension of familism is related to child had had sexual intercourse; the proportion was maltreatment within and between 35 abusive Latino, 35 significantly higher among blacks (45%) than among nonabusive Latino, 51 abusive Anglo, and 51 others (31%). Most adolescents reported neither nonabusive Anglo families. Nonabusing Latinas appear frequent dating nor a steady partner by ages 15-16, to have a higher level of familism than the other three although the prevalence of such reports was related to groups of mothers. However; when intraethnic friendship patterns in late childhood. Twelve percent of comparisons were made, nonabusive Anglos, compared youth who initiated sex in early adolescence did so with abusive Anglos, had higher levels of familism on outside of a dating relationship. For most subgroups several variables. Hence, familism seems to examined, the odds of initiating intercourse during characterize families--Latino and Anglo--who do not early adolescence were associated with going steady, maltreat their children. but not with frequency of dating. CONCLUSIONS: Prior social networking is an important element in Cook JA, Heflinger CA, Hoven CW et al. A multi-site study predicting early sexual activity. Overall, youth whose of Medicaid-funded managed care versus fee-for- mothers gave birth at young ages remain sexually service plans' effects on mental health service inexperienced into middle adolescence, but certain utilization of children with severe emotional subgroups are more likely than others to initiate early disturbance. J Behav Health Serv Res 2004; 31(4):384- sexual activity. 402. Abstract: Although Medicaid-funded managed care Coombes R. Past failures prompt drive for innovation to arrangements are commonly used in the delivery of tackle child abuse. Nurs Times 2002; 98(39):11. mental health and substance abuse services to low- income children and youth, little is known about the Cooper MC. A 6-month-old with bilateral swollen, painful, effectiveness of such efforts. This article examines and deformed hands. J Emerg Nurs 2004; 30(4):384-7. differences in mental health services utilization between children and youth with severe emotional Copping C. Reawakened trauma. Nurs Stand 2005; disturbance covered by Medicaid-funded managed care 20(13):32-3. behavioral health plans and those covered by fee-for- service plans. Data are from a federally funded multi- Cornelius MD, Leech SL, Goldschmidt L, Day NL. Is site study. In multivariate analyses controlling for child 422
- 431. prenatal tobacco exposurea risk factor for early employment at the time of follow-up were associated adolescent smoking? A follow-up study. Neurotoxicol with higher life satisfaction both 1 and 2 years after Teratol 2005; 27(4):667-76. injury. Motor independence at rehabilitation discharge Abstract: Recent reports indicate a relation between was also associated at 1 year. Current social integration prenatal tobacco exposure (PTE) and offspring and the absence of depressed mood were associated at smoking. Many of these reports have been 2 years. Life satisfaction was relatively stable between retrospective or have not included important variables years. Change that did occur was associated with such as other prenatal substance exposures, maternal marital status and depressed mood 2 years after injury. and child psycho-social characteristics, mother's CONCLUSIONS: Life satisfaction after TBI seems to current smoking, and friends' smoking. No prior study be related to attaining healthy and productive lifestyles. has examined the timing of PTE. In this prospective Future research should investigate other factors that study of a birth cohort of 567 14-year-olds, we affect life satisfaction to increase prediction and examined the relation between trimester-specific PTE, appreciate all influences on subjective well being after offspring smoking, and other correlates of adolescent TBI. smoking. Average age of the adolescents was 14.8 years (range: 13.9-16.6 years), 51% were female, 54% Cortese MM, Diaz PS, Samala U et al. Underimmunization were African-American. Data on maternal tobacco and in Chicago children who dropped out of WIC. Am J other substance use were collected both prenatally and Prev Med 2004; 26(1):29-33. postnatally, 51% of the mothers were prenatal smokers Abstract: BACKGROUND: The Special Supplemental and 53% smoked when their children were 14 years. Nutrition Program for Women, Infants, and Children PTE in the third trimester significantly predicted (WIC) serves a large proportion of Chicago infants, but offspring smoking (ever/never, smoking level, age of some discontinue participation before age 1 year. To onset) when demographic and other prenatal determine if children who remained active at WIC substances were included in the analyses. PTE immunization-linked sites after their first birthday were remained a significant predictor of the level of more likely to be immunized by ages 19 and 25 months adolescent smoking when maternal and child than those who dropped out, a retrospective cohort psychological characteristics were added to the model. study was conducted. METHODS: Four Chicago WIC When more proximal measures of the child's smoking sites that used monthly voucher pick-up were chosen. were included in the model, including mother's current Children born from July 1, 1997 to September 30, 1997 smoking and friends' smoking, PTE was no longer who attended these sites were eligible (N=1142). The significant. Significant predictors of adolescent cohort was divided into two groups: (1) active group smoking at age 14 were female gender, Caucasian race, (46%), who had a WIC visit on or after their first child externalizing behavior, maternal anxiety, and birthday; and (2) inactive group (54%), who had their child depressive symptoms. Although direct effects of last WIC visit before their first birthday. Children were PTE on offspring smoking behavior have previously enrolled through home visits. RESULTS: The records been reported from this study and by others, by early- for 200 children were analyzed. By age 19 months, 65 adolescence, this association is not significant after (84%) of 77 active children had received one dose of controlling for the more proximal covariates of measles-mumps-rubella vaccine (MMR), compared to adolescent smoking such as mother's current smoking 82 (67%) of 123 inactive children (risk ratio [RR]=1.3; and peer smoking. 95% confidence interval [CI], 1.1- 1.5). By age 25 months, 64 (83%) active children had received four Corrigan JD, Bogner JA, Mysiw WJ, Clinchot D, Fugate L. doses of diphtheria-tetanus-pertussis vaccine (DTP), Life satisfaction after traumatic brain injury. J Head one MMR, and three doses of Haemophilus influenzae Trauma Rehabil 2001; 16(6):543-55. type b vaccine (Hib), compared with 64 (52%) inactive Abstract: OBJECTIVE: To investigate correlates of life children (RR=1.6; 95% CI, 1.3-2.0). CONCLUSIONS: satisfaction after traumatic brain injury (TBI). In this cohort, children active in WIC after their first DESIGN: Prospective, longitudinal study of patients birthday were more likely to be immunized by ages 19 with TBI studied 1 and 2 years after injury. SETTING: and 25 months, compared with those who were no A specialized inpatient TBI rehabilitation unit in a longer active. Chicago children who drop out of WIC midwestern academic medical center. SUBJECTS: may represent those at highest risk for Two hundred eighteen consecutive patients admitted underimmunization and may require special strategies for rehabilitation, at least 14 years of age, with a to improve coverage. primary diagnosis of TBI, consented to participate, and interviewed 1 and/or 2 years after injury (112 Cory CZ, Jones BM. Can shaking alone cause fatal brain interviewed both years, 58 at year 1 only, 48 at year 2 injury? A biomechanical assessment of the Duhaime only). MAIN OUTCOME MEASURES: Satisfaction shaken baby syndrome model. Med Sci Law 2003; With Life Scale. RESULTS: Stepwise multiple 43(4):317-33. regressions accounted for statistically significant, but Abstract: A biomechanical model of a one-month old small, proportions of variance. Not having a preinjury baby was designed and tested by Duhaime and co- history of substance abuse and having gainful workers in 1987 in an attempt to assess the 423
- 432. biomechanics of theshaken baby syndrome (SBS). The understanding the onset, course, and recurrence of study implied that pure shaking alone cannot cause early-onset unipolar and bipolar disorder. fatal head injuries, a factor which has been applied in Recommendations included the need for a criminal courts. In an attempt to test the validity of the multidisciplinary research initiative on the model a preliminary study was undertaken in which a pathogenesis of unipolar depression encompassing replica was constructed and tested. The broad genetic and environmental risk and protective factors. description of the design and construction of the Specifically, we encourage the NIMH to convene a Duhaime model allowed for variations and therefore panel of experts and advocates to review the findings uncertainties in its reproduction. It was postulated concerning children at high risk for unipolar therefore that differences in certain parameters may depression. Joint analyses of existing data sets should increase angular head accelerations. To further examine specific risk factors to refine models of investigate this observation, an adjustable replica pathogenesis in preparation for the next era of model was developed and tested. The results indicated multidisciplinary research. Other priority areas include that certain parameter changes in the model did in fact the need to assess the long-term impact of successful lead to an increase in angular head acceleration. When treatment of juvenile depression and known precursors these parameter changes were combined and an of depression, in particular, childhood anxiety injurious shake pattern was employed, using maximum disorders. Expanded knowledge of pediatric-onset physical effort, the angular head acceleration results bipolar disorder was identified as a particularly exceeded the original Duhaime et al. (1987) results and pressing issue because of the severity of the disorder, spanned two scaled tolerance limits for concussion. the controversies surrounding its diagnosis and Additionally, literature suggests that the tolerance treatment, and the possibility that widespread use of limits used to assess the shaking simulation results in psychotropic medications in vulnerable children may the original study may not be reliable. Results from our precipitate the condition. The Workgroup recommends study were closer to the internal head injury, subdural that the NIMH establish a collaborative multisite haematoma, tolerance limits. A series of end point multidisciplinary Network of Research Programs on impacts were identified in the shake cycles, therefore, Pediatric-Onset Bipolar Disorder to achieve a better an impact-based head injury measure (Head Injury understanding of its causes, course, treatment, and Criterion - HIC) was utilized to assess their severity. prevention. The NIMH should develop a capacity- Seven out of ten tests conducted resulted in HIC values building plan to ensure the availability of trained exceeding the tolerance limits (critical load value, investigators in the child and adolescent field.Mood Sturtz, 1980) suggested for children. At this present disorders are among the most prevalent, recurrent, and stage the authors conclude that it cannot be disabling of all illnesses. They are often disorders of categorically stated, from a biomechanical perspective, early onset. Although the NIMH has made important that pure shaking cannot cause fatal head injuries in an strides in mood disorders research, more data, infant. Parameters identified in this study require beginning with at-risk infants, children, and further investigation to assess the accuracy of adolescents, are needed concerning the etiology and simulation and increase the biofidelity of the models developmental course of these disorders. A diverse before further conclusions can be drawn. There must program of multidisciplinary research is recommended now be sufficient doubt in the reliability of the to reduce the burden on children and families affected Duhaime et al. (1987) biomechanical study to warrant with these conditions. the exclusion of such testimony in cases of suspected shaken baby syndrome. Cotton JL, Gallaher KJ, Henry GW. Accuracy of interpretation of full-length pediatric echocardiograms Costello EJ, Pine DS, Hammen C et al. Development and transmitted over an integrated services digital network natural history of mood disorders. Biol Psychiatry telemedicine link. South Med J 2002; 95(9):1012-6. 2002; 52(6):529-42. Abstract: BACKGROUND: Transmission of Abstract: To expand and accelerate research on mood echocardiograms via telemedicine links has allowed disorders, the National Institute of Mental Health remote hospitals direct access to pediatric cardiology (NIMH) developed a project to formulate a strategic subspecialty care. This study assessed the accuracy of research plan for mood disorder research. One of the echocardiogram interpretation across an integrated areas selected for review concerns the development and services digital network (ISDN) telemedicine link. natural history of these disorders.The NIMH convened METHODS: Telemedicine systems were installed a multidisciplinary Workgroup of scientists to review between Cape Fear Valley Medical Center neonatal the field and the NIMH portfolio and to generate intensive care unit and University of North Carolina specific recommendations. To encourage a balanced Hospitals. One board-certified pediatric cardiologist and creative set of proposals, experts were included interpreted 105 full-length echocardiograms that were within and outside this area of research, as well as videotaped and then transmitted over the system. Six public stakeholders.The Workgroup identified the need months later, the same cardiologist reinterpreted the for expanded knowledge of mood disorders in children 105 original videotape studies from the off-site hospital and adolescents, noting important gaps in and results were compared with the interpretations of 424
- 433. the transmitted data.RESULTS: Interpretation of Cross War Memorial Children's Hospital from 1989 to transmitted echocardiograms did not differ 2002 were reviewed retrospectively. The circumstances significantly from the original studies for diagnosis, of the injury, clinical status, CT findings, evaluation of left ventricular function, valve function complications, and outcome were assessed. RESULTS: evaluation, and the presence of a ductus arteriosus. The median age was 7 years. Seventy-seven percent of Minor differences in qualitative parameters were seen. the victims were boys. The majority of the children CONCLUSION: Transmission of full-length were injured in the crossfire of civilian violence. The echocardiograms over the ISDN telemedicine link is initial management consisted of debridement under comparable to videotape review. There was no loss of local anesthesia in 16 children and neurosurgical significant clinical information, and the minor procedures under general anesthesia were performed in discrepancies noted did not impact management 14. Sixteen children sustained transhemispheric decisions. injuries, 5 bihemispheric injuries, 5 tangential injuries, and 4 transventricular injuries. All 3 children with a Cottrell D, Boston P. Practitioner review: The effectiveness GCS <4 died within 72 h of admission. Three of the 7 of systemic family therapy for children and children with GCS 4-7 died but there were no deaths in adolescents. J Child Psychol Psychiatry 2002; those children whose GCS was >7 post-resuscitation. 43(5):573-86. Motor deficits, cranial nerve palsies, and visual field Abstract: BACKGROUND: Systemic family therapy defects were very common. Early post-traumatic has become a widely used intervention in child and seizures were the commonest complication (18%). adolescent mental health services over the last twenty CONCLUSION: Children with higher post- years. METHODS: This paper reviews the resuscitation GCSs fared better than adults in terms of development of systemic family therapy, briefly mortality but not necessarily morbidity. As in the case describes the theory and techniques associated with the with adults, the GCS after resuscitation is a very good most prominent contemporary strands of systemic prognostic indicator of mortality. practice, and examines the empirical justification for using systemic family therapies with children and Coulter A. After Bristol: putting patients at the centre. BMJ adolescents. RESULTS: There is a paucity of well- 2002; 324(7338):648-51. designed randomised controlled trials of systemic therapies with children and adolescents and those trials Coulton CJ, Korbin J, Chan T, Su M. Mapping residents' that do exist evaluate older structural and strategic perceptions of neighborhood boundaries: a therapies. Methodological limitations of existing methodological note. Am J Community Psychol 2001; research include the use of unrepresentative 29(2):371-83. participants, small sample sizes and wide age ranges. Abstract: Neighborhood influences on children and There is a lack of credible no-treatment or alternative youth are the subjects of increasing numbers of studies, treatment controls, tests of clinical as opposed to but there is concern that these investigations may be statistical significance, and conceptually relevant biased, because they typically rely on census-based outcome measures that examine underlying units as proxies for neighborhoods. This pilot study interactional mechanisms. The term 'family therapy' tested several methods of defining neighborhood units encompasses a wide range of interventions and it is not based on maps drawn by residents, and compared the always clear what treatment intervention has been results with census definitions of neighborhoods. When delivered. Nevertheless, there is good evidence for the residents' maps were used to create neighborhood effectiveness of systemic family therapies in the boundary definitions, the resulting units covered treatment of conduct disorders, substance misuse and different space and produced different social indicator eating disorders, and some support for their use as values than did census-defined units. Residents' second-line treatments in depression and chronic agreement about their neighborhoods' boundaries illness. CONCLUSIONS: Systemic family therapy is differed among the neighborhoods studied. This pilot an effective intervention for children and adolescents study suggests that discrepancies between researcher but further well-designed outcome studies are needed and resident-defined neighborhoods are a possible using clearly specified, manualised forms of treatment source of bias in studies of neighborhood effects. and conceptually relevant outcome measures. Coupland NJ. Social phobia: etiology, neurobiology, and Coughlan MD, Fieggen AG, Semple PL, Peter JC. treatment. J Clin Psychiatry 2001; 62 Suppl 1:25-35. Craniocerebral gunshot injuries in children. Childs Abstract: Social phobia is a common and often Nerv Syst 2003; 19(5-6):348-52. disabling condition, with an etiology that is not Abstract: INTRODUCTION: Despite the worldwide established. There is evidence at several levels for an increase in the incidence of gunshot injuries, there are interplay of biological and psychological processes in few large published series on craniocerebral gunshot social phobia. Genetic studies show that both genetic injuries in children. MATERIALS AND METHODS: and environmental factors are important, with evidence The records of 30 consecutive children who were pointing to associations with 2 genetic conditions, treated for craniocerebral gunshot injuries at the Red 425
- 434. autism and fragileX syndrome. Behavioral inhibition Coutinho SB, de Lira PI, de Carvalho Lima M, Ashworth A. has emerged as an important precursor to social phobia Comparison of the effect of two systems for the and possibly to other anxiety disorders. Epidemiologic promotion of exclusive breastfeeding. Lancet 2005; and clinical studies have suggested that factors within 366(9491):1094-100. the family environment, such as overprotection, Abstract: BACKGROUND: Promotion of overcontrol, modeling of anxiety, criticism, and in breastfeeding is an important child-survival some cases abuse, can play a role in the development intervention, yet little is known about which of social phobia. During childhood, complex promotional strategies are the most effective. We interactions between brain system disturbances that aimed to compare the effects on rates of breastfeeding mediate responses to negative social cues and factors in of two systems for promotion of breastfeeding in the social setting may lead to the development of a Brazil--a hospital-based system and the same system distorted set of internal "blueprints" for social behavior. combined with a programme of home visits. The impact of severe social anxiety on brain systems METHODS: In February, 2001, maternity staff from that mediate behavioral change may prevent patients two hospitals in Pernambuco, Brazil, were trained from learning better "blueprints." These can be taught according to the Baby-Friendly Hospital Initiative through cognitive-behavioral therapies. The effective (BFHI). In a randomised trial between March and control of social anxiety with medications enables August, 2001, 350 mothers giving birth at these patients to recover; whether recovery can last after hospitals were assigned ten postnatal home visits to discontinuation of medications may depend on whether promote and support breastfeeding (n=175) or no home a new "blueprint" has been developed and whether visits (n=175). Breastfeeding practices were studied on stable changes in affected brain systems have occurred. days 1, 10, 30, 60, 90, 120, 150, and 180 by researchers Neuroimaging techniques are at the early stage of unaware of group allocation. The primary outcome identifying abnormalities at the neurotransmitter and measure was the rate of exclusive breastfeeding from systems levels. birth to 6 months. Analyses were by intention to treat. FINDINGS: The hospital-training intervention Cournos F. The trauma of profound childhood loss: a achieved a high rate (70%) of exclusive breastfeeding personal and professional perspective. Psychiatr Q in the hospitals, but this rate was not sustained at home 2002; 73(2):145-56. and at 10 days of age only 30% of infants were Abstract: Profound loss in childhood as a precipitant exclusively breastfed The patterns of exclusive for symptoms of posttraumatic stress disorder has been breastfeeding in the two trial groups for days 10-180 a largely neglected subject. There is now some differed significantly (p<0.0001), with a mean literature to suggest that severe loss and the absence of aggregated prevalence of 45% among the group care may be as predictive of psychological distress in assigned home visits compared with 13% for the group children as events that are more frequently studied, assigned none. INTERPRETATION: The BFHI such as exposure to natural disasters and physical or achieves high rates of exclusive breastfeeding in sexual abuse. This paper combines the author's hospital; however, in Brazil at least, the rates fall personal experience as an orphaned child who was rapidly thereafter. Reliance on the BFHI as a strategy placed in foster care with a discussion of this emerging for breastfeeding promotion should be reassessed. A literature to examine the relationship between combination of promotional systems (hospital-based childhood loss and trauma symptoms. An awareness of and in the community) is needed. the traumatic nature of severe losses in childhood could help caregivers and mental health professionals deal Covington CY. A review of "The National Breastfeeding more effectively with such children. Policy in Nigeria: the working mother and the law". Health Care Women Int 2005; 26(7):555-60. Cousins DA, Barrett I, Kaplan CA. Medicolegal issues in paediatric practice: proceedings of the 4th Northern Cowal K, Shinn M, Weitzman BC, Stojanovic D, Labay L. Regional Paediatric Colloquium. Med Sci Law 2004; Mother-child separations among homeless and housed 44(1):75-9. families receiving public assistance in New York City. Abstract: Ethical dilemmas frequently arise in Am J Community Psychol 2002; 30(5):711-30. paediatric practice. Given the nature of the speciality, Abstract: We examined the incidence, characteristics, these issues are pertinent to both the medical and legal and predictors of separations of children from mothers professions. It is of potential benefit for the professions in 543 poor families receiving public assistance, 251 of to meet and discuss such cases outwith the immediate whom had experienced homelessness during the clinical setting. A series of such meetings have been previous 5 years. Forty-four percent of the homeless held in the Northern region. We report the proceedings mothers and 8% of housed mothers were separated of the fourth meeting. Four cases were presented and from one or more children. A total of 249 children the issues arising were debated. The key points from were separated from 110 homeless families and 34 each discussion are described. children from 23 housed families. Children were placed with relatives and in foster care but were rarely returned to their mothers. Maternal drug dependence, 426
- 435. domestic violence, andinstitutionalization predicted The case was submitted to English law by the hospital, separations, but homelessness was the most important and the operation permitted against the parents' wishes. predictor, equivalent in size to 1.9 other risk factors. I consider the relationship between the legal decision We infer that policies regarding child welfare and and the moral reasons adduced in its support, reasons substance abuse treatment should be changed to reduce gaining their force against the framework of much unnecessary placements. Studies of homeless children mainstream normative ethical theory. I argue that in a who remain with families may be biased if separated few morally dilemmatic situations, such a legalistic- children are excluded. theoretical approach cannot plausibly accommodate certain irreducible and ineliminable features of the Cowan FM, Langhaug LF, Mashungupa GP et al. School ethical experience of any concrete individual based HIV prevention in Zimbabwe: feasibility and implicated in the situation, and that this failure partly acceptability of evaluation trials using biological undermines its self-appointed role of guiding such an outcomes. AIDS 2002; 16(12):1673-8. individual's conduct. For example, the problem as Notes: CORPORATE NAME: Regai Dzive Shiri experienced by the judge and by the parents might not Project be the same problem at all, and some of their respective Abstract: OBJECTIVE: To determine the feasibility reasons may be mutually unintelligible or impotent. I and acceptability of conducting a community certainly do not argue for a rejection of law or of moral randomized trial (CRT) of an adolescent reproductive theory; I merely challenge their implicit claim to health intervention (ARHI) using biological measures comprehensiveness and their fixation with an idealised of effectiveness. SETTING: Four secondary schools and putatively universal rationality modelled on and surrounding communities in rural Zimbabwe. converging scientific enquiry. Finally, I claim that at METHODS: Discussions were held with pupils, least in the twins' case there may be insufficient parents, teachers and community leaders to determine normative robustness to the conclusions reached, or acceptability. A questionnaire and urine sampling indeed reachable, by the court in a situation where survey was undertaken among Form 1 and 2 pupils. intuitions and moral reasons pull in fundamentally Studies were undertaken to inform likely participation incommensurable directions; as such, there may be and follow up in a future CRT. A community survey of room for an acknowledgement of the spiritual, through 16-19-year-olds was conducted to determine levels of a humble abstention from making a decision--which is secondary school attendance and likely HIV prevalence not to be confused with deciding to do nothing. at final follow up in the event of a trial. RESULTS: Form 1 and 2 pupils aged 12-18 years (n = 723; median Coyer SM. Mothers recovering from cocaine addiction: age, 15 years) participated in the research. Prevalences factors affecting parenting skills. J Obstet Gynecol of HIV, Chlamydia and gonorrhoea were 3.6% [95% Neonatal Nurs 2001; 30(1):71-9. confidence interval (CI), 2.3-5.3%], 0.4% (95% CI, Abstract: OBJECTIVE: To identify factors that may 0.1-1.3%) and 1.9% (95% CI, 1.0-3.3%) respectively. influence parenting by mothers who are recovering There was poor correlation between biological from cocaine addiction. DESIGN: Exploratory evidence of sexual experience and questionnaire descriptive, with in-depth unstructured interviews. responses, due to concerns about confidentiality. Only SETTING: Interviews were conducted in the woman's 13% (95% CI, 4-27%) of those infected with HIV home or in a treatment center. PARTICIPANTS: A and/or a sexually transmitted disease admitted to convenience sample of 11 women recovering from having had sex. In the community survey of 573 cocaine addiction who were mothers of children 3 adolescents aged 16-19 years, 6.6% (95% CI, 3.9- years of age and younger. RESULTS: A content 10.3%) of females and 5.1% (95% CI, 2.9-8.2%) of analysis was used to analyze the interview data. Two males were HIV positive. High participation and themes, personal/psychologic factors and retention rates are achievable within a trial in this environmental/contextual factors, and four subthemes setting. CONCLUSIONS: It is acceptable and feasible emerged. They identify issues that may affect parenting to conduct randomized trials to establish the by mothers being treated for cocaine addiction. effectiveness of ARHIs. However, self-reported Subthemes included low self-esteem, difficulty behavioural outcomes will probably be biased, developing a maternal identity, isolation from friends emphasizing the importance of using externally and family, and chronic life stress. CONCLUSION: validated biological outcome measures to determine This study provides a better understanding of the effectiveness. sources contributing to vulnerability in the parenting role for mothers recovering from cocaine addiction and Cowley C. The conjoined twins and the limits of rationality will assist nurses in providing care for these mothers in applied ethics. Bioethics 2003; 17(1):69-88. and their children. Notes: GENERAL NOTE: KIE: 24 fn. GENERAL NOTE: KIE: KIE Bib: patient care/minors Craig M. Perinatal risk factors for neonaticide and infant Abstract: In this article I consider the case of the homicide: can we identify those at risk? J R Soc Med surgical separation of conjoined twins resulting in the 2004; 97(2):57-61. immediate and predictable death of the weaker one. 427
- 436. Craissati J, McClurgG, Browne K. The parental bonding 18 years who have lost a sibling to cancer. At the experiences of sex offenders: a comparison between camp, the children are divided into age-appropriate child molesters and rapists. Child Abuse Negl 2002; groups and spend time, through various activities, 26(9):909-21. learning about the grief process to reduce their feelings Abstract: OBJECTIVE: It has often been hypothesized of isolation, to express grief appropriately, and to move that because of a lack of early satisfactory attachments, forward in the grief process. Similar programs, as well sex offenders grow up unable to form relationships as the uniqueness of this program, are discussed. with adults, which makes them susceptible to pursue CLINICAL IMPLICATIONS: Camp New Horizons intimacy in maladaptive ways. This research aims to has met many of the educational and support needs of empirically examine the parental bonding patterns for a bereaved siblings. Networks of support and friendship group of sex offenders, comparing child molesters and have formed that allow the children to reach out to one rapists. METHOD: Seventy-six men convicted of a another when needed. Parents and children have sexual offense (57 child molesters and 19 rapists) increased their communication about the death in their completed the parental bonding instrument (PBI), and family, thus accepting their feelings and increasing were assessed by means of a semi-structured clinical support in the family system. Continued collaboration interview. RESULTS: Affectionless control style of between centers will create ongoing support for the parental bonding was highly prevalent amongst the sex healthcare professionals and the programs they offenders. There was some suggestion that low parental provide. care was associated with childhood abuse and disturbances, particularly for child molesters. High Crisp BR, Lister PG. Child protection and public health: overprotection in mothers was linked with parental nurses' responsibilities. J Adv Nurs 2004; 47(6):656- separation and sex play with male peers in childhood. 63. CONCLUSIONS: There is a need to replicate the study Abstract: BACKGROUND: Health care workers have with non-sexual offenders as a comparison group, and been recognized as having a key role in the protection to establish whether the PBI provides a useful adjunct and care of Scotland's children, particularly in respect to studies of adult romantic attachment in sex of identification and detection of child abuse. Nurses, offenders. especially health visitors, are often the first professionals to suspect that child abuse has taken Crandon IW, Bruce CA, Harding HE. Civilian cranial place. While previous research has found that health gunshot wounds: a Jamaican experience. West Indian visitors have primarily perceived their role as that of Med J 2004; 53(4):248-51. providing support and advice to vulnerable families, Abstract: Gunshot injuries are an escalating social and there are pressures on them to fulfil a more narrow medical dilemma in many Western and some surveillance role. Concurrent with a lack of clarity developing countries. Of 40 patients arriving at the about the role of health visitors in child protection, University Hospital of the West Indies (UHWI), there has been increasing recognition that other nurses Jamaica, from 1993 to 1998, with gunshot wounds of can also make an important contribution, including the head, 30 were admitted. Six of those admitted died those who do not work directly with children. AIMS: within 24 hours, five with poor Glasgow Coma scores. The aim of the study was to explore nurses' Ten patients had surgery, two of whom died. Six understanding of their professional responsibilities in complications occurred: two patients each developed relation to child protection, and the potential for nurses an infection, cerebrospinal fluid fistula or seizures. All to be involved in the protection of children from abuse. patients were victims of an assault and all had METHODS: A qualitative interview-based design was intracranial penetration, the most common sites of used, and 99 nurses working in an National Health which were facial and frontal. Median hospital stay Service trust in a Scottish city were interviewed, either was eleven days. The Glasgow Coma Score on individually or in groups, about their professional admission was a good prognostic indicator. Fourteen involvements in child protection issues. Interview data patients had associated injuries, four of which were in were subjected to thematic analysis. FINDINGS: There the neck. Surgery was considered inappropriate for was lack of consensus among interviewees about the moribund patients and those with inaccessible bone and nursing remit in child protection issues, particularly bullet fragments. Young males were the most common with respect to the extent to which nurses should victims of this devastating form of assault. actively seek to detect cases of child abuse. An emphasis on identification and detection was not easily Creed J, Ruffin JE, Ward M. A weekend camp for bereaved accepted by many nurses, and was perceived by some siblings. Cancer Pract 2001; 9(4):176-82. to be a change from their more traditional role of Abstract: PURPOSE: The purpose of this article is to supporting families, as well as being potentially in describe a weekend bereavement camp for children age conflict with some public health responsibilities. 6 to 18 years who have lost a brother or sister to CONCLUSION: In spite of the perception of some cancer. A description of the planning for the camp and nurses that there is a sharp divide between child the weekend program is included. OVERVIEW: Camp protection work and public health interventions, many New Horizons is a weekend camp for children age 6 to of the child protection roles identified by nurses, such 428
- 437. as supporting families,parenting education and service Although a common source was suspected, only development, are clearly within the ambit of Iceland implicated imported lettuce as a vehicle, with contemporary notions of public health. Furthermore, it an analytic epidemiologic study (OR = 40.8; P = 0.005; is clear that there is a role in child protection for a 95% CI 2.7-3175). CONCLUSION: The identification much wider group of nurses than health visitors. of international outbreaks, necessary for investigation and control, can be facilitated by standardized phage- Crockenberg SC, Leerkes EM. Parental acceptance, typing techniques, the electronic transfer of molecular postpartum depression, and maternal sensitivity: typing patterns, formal and informal links established mediating and moderating processes. J Fam Psychol through international surveillance networks, and the 2003; 17(1):80-93. early reporting of national outbreaks to such networks. Abstract: Mothers (n = 92), fathers (n = 84), and their infants (60% male) participated in a longitudinal study Cropper S, Hopper A, Spencer SA. Managed clinical of postpartum depression and maternal sensitivity. networks. Arch Dis Child 2002; 87(1):1-4; discusssion Mothers completed questionnaire measures of 1-4. remembered parental acceptance, depressive symptoms, and infant distress to novelty and limits. Cross R, Gregory S. Giving children a 'voice'. Emerg Nurse Mothers and partners reported on marital aggression 2002; 10(6):11-5. and avoidance. Maternal sensitivity was observed in the laboratory at 6 months. Characteristics of mothers, Cross TP, Leavey J, Mosley PR, White AW, Andreas JB. partners, and infants combined to predict postpartum Outcomes of specialized foster care in a managed child depression and maternal sensitivity. Remembered welfare services network. Child Welfare 2004; parental rejection predicted postpartum depressive 83(6):533-64. symptoms with prenatal depression controlled; self- Abstract: This study (N = 384) presents results from esteem mediated this effect. Paternal acceptance outcome measurement in a services network providing buffered against postpartum depression when infants specialized foster care (SFC) to children in child were highly reactive and when partners were protective service custody. A majority of participants aggressive. Paternal acceptance reduced the impact of improved on most outcomes. Global improvement was postpartum depression on maternal sensitivity; having associated with increased length of stay up to two an aggressive marital partner exacerbated the effect. years, five months, and with younger age, fewer problems, and, paradoxically, the presence of a trauma Crook PD, Aguilera JF, Threlfall EJ et al. A European history. Results suggest the value of SFC within outbreak of Salmonella enterica serotype Typhimurium managed services and of research using outcome definitive phage type 204b in 2000. Clin Microbiol measurement systems. Infect 2003; 9(8):839-45. Abstract: OBJECTIVE: To describe the clinical, Crown L. Intimate partner violence. Tenn Med 2005; epidemiologic and microbiological features of a large 98(10):462-3. outbreak of infection with a multiresistant Salmonella enterica serotype Typhimurium definitive type DT204b Crunelli V, Leresche N. Childhood absence epilepsy: genes, infection involving at least 392 people in five European channels, neurons and networks. Nat Rev Neurosci countries. METHODS: Icelandic public-health doctors 2002; 3(5):371-82. responded to a report on an Internet news site of an Abstract: Childhood absence epilepsy is an idiopathic, outbreak of infection with a multiresistant strain of generalized non-convulsive epilepsy with a Typhimurium DT104 in England by contacting the multifactorial genetic aetiology. Molecular-genetic Public Health Laboratory Service (PHLS) analyses of affected human families and experimental Communicable Disease Surveillance Centre (CDSC). models, together with neurobiological investigations, An international alert was sent out through Enter-net. have led to important breakthroughs in the All strains from England & Wales, The Netherlands, identification of candidate genes and loci, and potential Scotland and Germany, and 17 of the outbreak isolates pathophysiological mechanisms for this type of from Iceland, were phage-typed, screened for epilepsy. Here, we review these results, and compare antimicrobial resistance, and subjected to molecular the human and experimental phenotypes that have been typing. Hypothesis-generating interviews were investigated. Continuing efforts and comparisons of conducted, followed by case-control studies performed this type will help us to elucidate the multigenetic traits in Iceland and England. RESULTS: Isolates from cases and pathophysiology of this form of generalized in Iceland, England and Wales, The Netherlands, epilepsy. Scotland and Germany were identified as Typhimurium DT204b. The antimicrobial resistance Cruz R, Travis JW, Glick LB. Circumcision as human-rights pattern was ACGNeKSSuTTmNxCpL. All strains violation: assessing Benatar and Benatar. Am J Bioeth tested displayed an identical plasmid profile. Strains 2003; 3(2):W7. from five cases in England & Wales and five cases in Notes: GENERAL NOTE: KIE: 25 refs. Iceland possessed identical pulsed-field profiles. 429
- 438. GENERAL NOTE: KIE:KIE Bib: patient care/minors CONCLUSIONS: This study shows the Healthy School and Drugs project as implemented in Holland Crystal DS, Ostrander R, Chen RS, August GJ. Multimethod may have some effect on drug use in the children assessment of psychopathology among DSM-IV exposed to it. subtypes of children with attention- deficit/hyperactivity disorder: self-, parent, and teacher Culbert A, Davis DJ. Parental preferences for neonatal reports. J Abnorm Child Psychol 2001; 29(3):189-205. resuscitation research consent: a pilot study. J Med Abstract: Using data based on self-, parent, and teacher Ethics 2005; 31(12):721-6. reports, we assessed various aspects of Abstract: OBJECTIVE: Obtaining informed consent psychopathology in a large sample of control children for resuscitation research, especially in the newborn, is and those with ADHD. Confirmatory factor analysis problematic. This study aimed to evaluate parental was employed to extract response bias from latent preferences for hypothetical consent procedures in constructs of aggression, anxiety, attention problems, neonatal resuscitation research. DESIGN: Mail-out depression, conduct disorder, and hyperactivity. These survey questionnaire.Setting/ PARTICIPANTS: latent constructs were then entered into logistic Randomly selected parents who had received regression equations to predict membership in control obstetrical or neonatal care at a tertiary perinatal centre. versus ADHD groups, and to discriminate between MAIN OUTCOME MEASURES: Parental levels of ADHD subtypes. Results of the regression equations comfort (Likert-type scale 1-6) regarding different showed that higher levels of attention problems and methods of obtaining consent in hypothetical aggression were the best predictors of membership in resuscitation research scenarios. RESULTS: The the ADHD group relative to controls. Logistic response rate was 34%. The respondents were a group regression also indicated that a higher degree of of highly educated women with a higher family income aggression was the only significant predictor of than would be expected in the general population. In membership in the ADHD-Combined group compared terms of results, parents valued the impact the research to the ADHD-Inattentive group. However, when would have on their baby and the importance of a comorbid diagnoses of Oppositional Defiant Disorder positive interaction with the physicians conducting the and Conduct Disorder were controlled for in the research study. Parents felt most comfortable with logistic regression, greater hyperactivity rather than prospective consent in the setting of prenatal classes or aggression was the sole variable with which to prenatal visits with a physician, but they were distinguish the ADHD-Combined from the ADHD- somewhat uncomfortable with prospective consent Inattentive subtype. Results are discussed in the upon admission to hospital after labour had begun. context of the DSM-IV ADHD nosology and the role Parents were uncomfortable with waived consent, of instrument and source bias in the diagnosis of deferred consent, and opting out, no matter when ADHD. during the pregnancy consent was requested. CONCLUSION: This pilot study reports parental Cuijpers P, Jonkers R, de WI, de JA. The effects of drug preferences for prenatal information and consent for abuse prevention at school: the 'Healthy School and such research trials of neonatal resuscitation. A low Drugs' project. Addiction 2002; 97(1):67-73. response rate and potentially skewed demographics of Abstract: AIMS: To examine the effects of the 'Healthy the respondents prevent generalisability of this result. School and Drugs' project, a Dutch school-based drug Interview studies should be performed to better prevention project that was developed in the late 1980s determine parental preferences for informed consent in and disseminated during the 1990s. This programme is a more representative population. currently being used by 64-73% of Dutch secondary schools and it is estimated that at least 350000 high Cullen KW, Baranowski T, Rittenberry L, Cosart C, Hebert school students receive this intervention each year. D, de Moor C. Child-reported family and peer DESIGN, SETTING AND PARTICIPANTS: A quasi- influences on fruit, juice and vegetable consumption: experimental study in which students of nine reliability and validity of measures. Health Educ Res experimental (N = 1156) schools were compared with 2001; 16(2):187-200. students of three control schools (N = 774). The groups Abstract: Family, peers and other environmental were compared before the intervention, 1 year later, 2 factors are likely to influence children's dietary years later and 3 years later. MEASUREMENTS: Self- behavior but few measures of these phenomena exist. report measures of tobacco, alcohol and marijuana use, Questionnaires to measure family and peer influences attitudes towards substance use, knowledge about on children's fruit, juice and vegetable (FJV) substances and self-efficacy. FINDINGS: Some effects consumption were developed and pilot tested with an on the use of tobacco, alcohol and cannabis were ethnically diverse group of Grade 4-6 children. found. Two years after the intervention, significant Principal components analyses revealed subscales with effects could still be shown on alcohol use. Effects of acceptable internal consistencies that measured parent the intervention were also found on knowledge, but and peer FJV modeling, normative beliefs, normative there was no clear evidence for any effects on attitude expectations, perceived peer FJV norms, supportive towards substance use and on self-efficacy. and permissive parenting practices, food rules, 430
- 439. permissive eating, andchild food preparation. Internal Cunha AJ, dos Santos SR, Martines J. Integrated care of consistencies were adequate to high, but test-re-test childhood disease in Brazil: mothers' response to the correlations often were low. Children also completed recommendations of health workers. Acta Paediatr questionnaires on FJV availability and accessibility in 2005; 94(8):1116-21. the home, and food records for 2 days in the classroom. Abstract: AIM: To describe the process of follow-up in Parental modeling, peer normative beliefs and FV primary care facilities where the Integrated availability were significantly correlated with FJV Management of Childhood Illness (IMCI) strategy was consumption. Further research with these scales is implemented. IMCI was developed by WHO and warranted. UNICEF as an integrated approach to manage sick children under 5 y of age and aims to reduce mortality Culverwell T. The parent's perspective. Proc Nutr Soc 2005; and morbidity. METHODS: From August 2001 to 64(3):339-43. February 2002, 229 sick children who had a health Abstract: The present paper gives an insight from a condition included in the IMCI case management parent's perspective into the roles of health guidelines were seen in six family healthcare facilities professionals and service providers in the daily in Brazil. We analysed the care provided to 153 management of a child with complex needs that children who were recommended for a 2- or 5-d include enteral feeding. It focuses on the case of a 9- follow-up visit. Children who did not return were year-old boy and discusses some aspects of his visited and assessed at home. RESULTS: Only 87 diagnosis and treatment, and the support received. It children (56.9%) timely returned for follow-up: 70 had highlights the need for a multi-agency approach based improved, eight presented the same health conditions, around the child, in which parents are consulted, the five were worse and four had a new problem. The main opinions of professionals from the different disciplines reasons given for not returning for follow-up were: the are valued by other professionals and professionals do child had improved (35.1%) and other family priorities not issue conflicting advice but share knowledge before (47.4%). Home visits showed that, although most giving advice. There should be national accessibility to children had improved (n=49), some had a new health support services and a standardised training problem and one child was sick enough to be referred. programme for carers. Better communication between Prescription of antibiotics was associated with parents, carers, health professionals and service increased probability of returning for a follow-up visit providers and working together can reduce the stress (RR =1.64 [1.22-2.20], p=0.001). CONCLUSION: for the patient and carer, and put less strain on much- Adherence to follow-up was just over 50%, mostly needed resources. because the condition had already resolved, but some children were still sick and needed intervention. Cummings EM, Goeke-Morey MC, Papp LM. Everyday Training on counselling on the recognition of danger marital conflict and child aggression. J Abnorm Child signs and when to return for a follow-up visit must be Psychol 2004; 32(2):191-202. reinforced. Abstract: Children's immediate aggressive responding to exposure to marital conflict was examined. Cunningham CE, McHolm A, Boyle MH, Patel S. Participants were 108 families with 8- to 16-year-old Behavioral and emotional adjustment, family children (53 boys, 55 girls), with diary records of functioning, academic performance, and social children's reactions to marital conflict in the home relationships in children with selective mutism. J Child completed by 103 mothers (n = 578 records) and 95 Psychol Psychiatry 2004; 45(8):1363-72. fathers (n = 377 records) during a 15-day period. Child Abstract: This study addressed four questions which responses to analog presentations of marital conflict parents of children with selective mutism (SM) tactics were also obtained. Exposure to destructive frequently ask: (1) Is SM associated with anxiety or conflict tactics and negative parental emotionality oppositional behavior? (2) Is SM associated with increased the likelihood of aggressive behavior in parenting and family dysfunction? (3) Will my child children when they witnessed marital conflict, whereas fail at school? and (4) Will my child make friends or be constructive conflict tactics and positive parental teased and bullied? In comparison to a sample of 52 emotionality decreased the probability of aggression. community controls, 52 children with SM were more Conflict topics presumed to be threatening to the child anxious, obsessive, and prone to somatic complaints. In (child- or marital-related) also heightened the contrast, children with SM were less oppositional and likelihood of aggression. Aggressive responding to evidenced fewer attentional difficulties at school. We conflict in both home and laboratory predicted found no group differences in family structure, externalizing behavior problems. Fathers' and mothers' economic resources, family functioning, maternal separate diary reports, and child responses to analog mood difficulties, recreational activities, or social presentation of conflict, provided generally consistent networks. While parents reported no differences in findings. An exposure hypothesis for marital conflict as parenting strategies, children with SM were described an influence on child aggression is discussed. as less cooperative in disciplinary situations. The academic (e.g., reading and math) and classroom cooperative skills of children with SM did not differ 431
- 440. from controls. Parentsand teachers reported that Cunningham RM, Vaidya RS, Walton M, Maio RF. Training children with SM had significant deficits in social emergency medicine nurses and physicians in youth skills. Though teachers and parents rated children with violence prevention. Am J Prev Med 2005; 29(5 Suppl SM as less socially assertive, neither teachers nor 2):220-5. parents reported that children with SM were victimized Abstract: Adolescents seen in an urban Emergency more frequently by peers. Department (ED) are more likely to die from violence than from any other illness or condition for which they Cunningham G. Ethics and genetics. N Engl J Med 2003; seek care in the ED. Most injured patients presenting to 349(19):1870-2; author reply 1870-2. our nation's EDs are treated and released, even after a Notes: GENERAL NOTE: KIE: 1 ref. firearm-related injury. These youth who are discharged GENERAL NOTE: KIE: KIE Bib: confidentiality/legal from the ED will not interface with resources on the aspects; genetic screening inpatient trauma unit. The current standard of care in the ED involves no referral for violence-related Cunningham M, Zayas LH. Reducing depression in prevention services. Despite the fact that ED pregnancy: designing multimodal interventions. Soc physicians and nurses frequently medically manage Work 2002; 47(2):114-23. victims of violent assault, there are few courses on Abstract: Research indicates that high levels of stress, youth violence prevention (YVP) framed from the low social support networks, and depression during viewpoint of emergency healthcare providers, and ED pregnancy have a powerful negative effect on maternal staff remain relatively uneducated as a specialty on the functioning and infant developmental outcomes. Low- identification, assessment, and referral resources income, inner-city women from ethnic minority available for early intervention and prevention. This groups, whose levels of depression have been article focuses on the development and in-depth documented as higher than their white counterparts, are description of a case-based, 1-hour continuing medical at increased risk, as are their infants. This article education presentation for ED physicians, residents, reviews the relevant research literature and proposes and nursing staff on YVP. This presentation is aimed to that "bundling" several social work treatments intended increase awareness of the role of ED personnel in YVP to reduce or prevent depression, expand social and to provide basic knowledge and skills needed to networks, and enhance mothers' knowledge of child begin to incorporate YVP into routine clinical practice development is more effective than any single in an Emergency Department setting. approach. Joining treatments into one intervention approach offers multiple treatments for multiple Cunningham SM. The joint contribution of experiencing and problems and can be designed to be evaluated. witnessing violence during childhood on child abuse in the parent role. Violence Vict 2003; 18(6):619-39. Cunningham PB, Henggeler SW. Implementation of an Abstract: This article examines adult respondents' empirically based drug and violence prevention and abuse of children as a consequence of their own intervention program in public school settings. J Clin childhood experiences of abuse, both direct Child Psychol 2001; 30(2):221-32. experiences of childhood violence (hitting) and Abstract: Describes the implementation of a exposure to interparental violence (witnessing). In collaborative preventive intervention project (Healthy particular, the study examines the extent to which these Schools) designed to reduce levels of bullying and factors function interactively: Are both experience and related antisocial behaviors in children attending two exposure necessary or is either sufficient to increase urban middle schools serving primarily African disproportionately the probability of child abuse? American students. These schools have high rates of Using data from the Second National Family Violence juvenile violence, as reflected by suspensions and Survey, results of a logistic regression analysis show expulsions for behavioral problems. Using a quasi- that either or both factors produced higher than average experimental design, empirically based drug and and relatively similar rates of child abuse. Only violence prevention programs, Bullying Prevention and respondents with neither form of family violence Project ALERT, are being implemented at each middle reported lower than average rates of abuse of their own school. In addition, an intensive evidence-based children. The analysis controlled for gender, race, intervention, multisystemic therapy, is being used to family income, and family structure; race was the only target students at high risk of expulsion and court control variable to be significantly associated with referral. Hence, the proposed project integrates both child abuse. Finally, no control variable modified the universal approaches to prevention and a model that interaction between the family violence variables. focuses on indicated cases. Targeted outcomes, by which the effectiveness of this comprehensive school- Curry M, Bristol J. The effects of childhood sexual abuse on based program will be measured, are reduced youth adherence and health. Focus 2003; 18(5):5-6. violence, reduced drug use, and improved psychosocial functioning of participating youth. Curzon M. Non-accidental injury (NAI). Editorial. Eur J Paediatr Dent 2003; 4(2):58. 432
- 441. Cuttini M. Intrapartumprevention of meconium aspiration what extent are postnatal services accessible to mothers syndrome. Lancet 2004; 364(9434):560-1. and neonates? Are postnatal services in the community in continuity with those of the hospital? Are the Czeizel AE, Puho E. Maternal use of nutritional supplements services provided by the appropriate source of care? during the first month of pregnancy and decreased risk The authors conducted a telephone survey among 1158 of Down's syndrome: case-control study. Nutrition mothers in a large urban area in the province of 2005; 21(6):698-704; discussion 774. Quebec, Canada. The results were compared to clinical Abstract: OBJECTIVE: We studied the association guidelines widely recognised by professionals. The between the use of nutritional supplements during the results show serious discrepancies with these first gestational month and the origin of Down's guidelines. The authors found a low accessibility to syndrome. METHODS: We compared 781 subjects services: less than half of the mothers received a home with Down's syndrome caused by pure trisomy 21 with visit by a nurse. In terms of continuity of care, less than their matched controls who had no defect. We also 10% of the mothers received a follow-up telephone call compared subjects who had Down's syndrome with within the recommended time frame and only 18% groups of 22 843 patient controls (i.e., subjects with benefited from a home visit within the recommended other congenital abnormalities) and 38 151 population period. Finally, despite guidelines to the contrary, controls (without defects). Subjects with Down's hospitals continue to intervene after discharge. This syndrome and other congenital abnormalities were results in a duplication of services for 44.7% of the identified in the large population-based dataset of the new-borns. On the other hand, 40.7% are not seen in Hungarian Congenital Abnormality Registry between the recommended period after hospital discharge at all. 1980 and 1996, and matched population controls were These results raise concerns about the integration of selected from the National Birth Registry. There were services between agencies. Following earlier work, the three sources of exposure data: 1) prospective and present authors have grouped explanatory factors under medically recorded data based on prenatal logbooks, 2) four dimensions: the strategic dimension, particularly retrospective maternal information based on leadership; the structural dimension, including the size questionnaires, and 3) home visits in non-respondent of the network; the technological dimension, with cases of Down's syndrome and congenital respect to information transmission system; and the abnormalities. A possible association between the use cultural dimension, which concerns the collaboration of nutritional supplements, mainly folic acid and process and the development of relationships based on antioxidant vitamins C and E, during the first month of trust. pregnancy and the incidence of Down's syndrome was studied. RESULTS: A significant protective effect was D'Angelo SL. Child testimony in sexual abuse cases. When seen with large doses of folic acid ( approximately 6 children testify in court. J Pediatr Adolesc Gynecol mg/d) and iron (150-300 mg/d of ferrous sulfate) 2002; 15(3):170-4. during the first gestational month against Down's syndrome (adjusted odds ratio 0.4, 95% confidence D'Antuono M, Louvel J, Kohling R et al. GABAA receptor- interval 0.2 to 0.7 for both). In general, folic acid and dependent synchronization leads to ictogenesis in the iron were used together, so it was difficult to separate human dysplastic cortex. Brain 2004; 127(Pt 7):1626- these effects due to the limited number of subjects and 40. controls. Only iron alone showed a protective effect Abstract: Patients with Taylor's type focal cortical against Down's syndrome (odds ratio 0.4, 95% dysplasia (FCD) present with seizures that are often confidence interval 0.1 to 0.9). The use of antioxidant medically intractable. Here, we attempted to identify vitamins was a rare event in the first month of the cellular and pharmacological mechanisms pregnancy. CONCLUSION: Pharmacologic doses of responsible for this epileptogenic state by using field folic acid and iron appear to have a preventive effect potential and K+-selective recordings in neocortical against Down's syndrome. slices obtained from epileptic patients with FCD and, for purposes of comparison, with mesial temporal lobe D'Amour D, Goulet L, Labadie JF, Bernier L, Pineault R. epilepsy (MTLE), an epileptic disorder that, at least in Accessibility, continuity and appropriateness: key the neocortex, is not characterized by any obvious elements in assessing integration of perinatal services. structural aberration of neuronal networks. Health Soc Care Community 2003; 11(5):397-404. Spontaneous epileptiform activity was induced in vitro Abstract: A trend toward the reduction in the length of by applying 4-aminopyridine (4AP)-containing hospital stays has been widely observed. This medium. Under these conditions, we could identify in increasing shift is particularly evident in perinatal care. FCD slices a close temporal relationship between ictal A stay of less than 48 hours after delivery has been activity onset and the occurrence of slow interictal-like shown to have no negative effects on the health of events that were mainly contributed by GABAA either the mother or the baby as long as they receive an receptor activation. We also found that in FCD slices, adequate follow-up. This implies a close integration pharmacological procedures capable of decreasing or between hospital and community health services. The increasing GABAA receptor function abolished or present article addresses the following questions: To potentiated ictal discharges, respectively. In addition, 433
- 442. the initiation ofictal events in FCD tissue coincided sounds were repeated, giving 100 cases that were with the occurrence of GABAA receptor-dependent randomly distributed on a compact disc. Four interictal events leading to [K+]o elevations that were cardiologists assessed and categorised the cases as larger than those seen during the interictal period. having "no murmur", "innocent murmur", or Finally, by testing the effects induced by baclofen on "pathological murmur", recorded the assessment time epileptiform events generated by FCD and MTLE per case, their degree of certainty, and whether they slices, we discovered that the function of GABAB recommended referral. RESULTS: On average, 2.1 receptors (presumably located at presynaptic inhibitory minutes were spent on each case. The mean sensitivity terminals) was markedly decreased in FCD tissue. and specificity were 89.7% and 98.2% respectively, Thus, epileptiform synchronization leading to in vitro and the inter-observer and intra-observer variabilities ictal activity in the human FCD tissue is initiated by a were low (kappa 0.81 and 0.87), respectively. A total synchronizing mechanism that paradoxically relies on of 93.4% of cases with a pathological murmur and GABAA receptor activation causing sizeable increases 12.6% of cases with an innocent murmur were in [K+]o. This mechanism may be facilitated by the recommended for referral. CONCLUSION: decreased ability of GABAB receptors to control Telemedical referral of patients with heart murmurs for GABA release from interneuron terminals. remote assessment by a cardiologist is safe and saves time. Skilled auscultation is adequate to detect patients Daane DM. Child and adolescent violence. Orthop Nurs with innocent murmurs. 2003; 22(1):23-9; quiz 30-1. Abstract: Although the juvenile violent crime rate has Dahl S, Hauff E. [Treatment of psychologically traumatised decreased steadily during the past 5 years, the problem patients]. Tidsskr Nor Laegeforen 2003; 123(23):3437; of violence and violence-related behaviors in the lives author reply 3437-8. of our children and adolescents remains. The incidence of violent victimization against children and violence Dake JA, Price JH, Telljohann SK. The nature and extent of and violence-related behavior by today's youth is bullying at school. J Sch Health 2003; 73(5):173-80. related to a variety of factors. Exposure to violence in Abstract: In elementary schools, the prevalence of the home, school, community, or video games and bullying ranges from 11.3% in Finland to 49.8% in other entertainment significantly influences aggressive Ireland. The only United States study of elementary behaviors among children and adolescents. Other students found that 19% were bullied. Bullying childhood violence predictors include alcohol and drug behavior declines as students progress through the use, gender, and low self-esteem. The childhood grades. School bullying is associated with numerous violence risk indicators have implications for child and physical, mental, and social detriments. A relationship adolescent violence prevention and intervention also exists between student bullying behavior and programs. Nurses who recognize dangerous and school issues such as academic achievement, school potentially dangerous behavior in children and bonding, and absenteeism. Prevention of school adolescents are better able to provide violence bullying should become a priority issue for schools. prevention and intervention services and referrals to The most effective methods of bullying reduction children at risk or in danger. Because orthopaedic involve a whole school approach. This method includes nurses often see adolescents who have already assessing the problem, planning school conference sustained injury from violence, identification of those days, providing better supervision at recess, forming a at risk is particularly important. bullying prevention coordinating group, encouraging parent-teacher meetings, establishing classroom rules Dahl LB, Hasvold P, Arild E, Hasvold T. Heart murmurs against bullying, holding classroom meetings about recorded by a sensor based electronic stethoscope and bullying, requiring talks with the bullies and victims, e-mailed for remote assessment. Arch Dis Child 2002; and scheduling talks with the parents of involved 87(4):297-301; discussion 297-301. students. Finally, this review suggests further studies Abstract: BACKGROUND: Heart murmurs are needed to help ameliorate the bullying problem in US common in children, and they are often referred to a schools. specialist for examination. A clinically innocent murmur does not need further investigation. The Dalton R. Journal will publish accused scientist's work. referral area of the University Hospital is large and Nature 2001; 409(6820):548. sparsely populated. A new service for remote auscultation (telemedicine) of heart murmurs in Daniell C. Veterinarians and SPCAs: an essential children was established where heart sounds and short partnership. Can Vet J 2002; 43(3):188-90. texts were sent as an attachment to e-mails. AIM: To assess the clinical quality of this method. METHODS: Dannetun E, Tegnell A, Hermansson G, Giesecke J. Parents' Heart sounds from 47 patients with no murmur (n = 7), reported reasons for avoiding MMR vaccination. A with innocent murmurs (n = 20), or with pathological telephone survey. Scand J Prim Health Care 2005; murmurs (n = 20) were recorded using a sensor based 23(3):149-53. stethoscope and e-mailed to a remote computer. The 434
- 443. Abstract: OBJECTIVE: Duringthe second half of the therapist, a physiotherapist, a play specialist and a team 1990s and the first years of the 2000s a declining of trained counsellors, working in partnership to coverage for MMR vaccination in two-year-olds was provide a quality service for families. * The evaluation, observed in Sweden. The aim was to assess reasons for which used a longitudinal multimethod process postponement or non-vaccination. DESIGN: A analysis based on an action research framework, telephone survey using a structured questionnaire on suggests that children with complex and life-limiting parents' attitudes regarding their choice to postpone or illnesses and their families benefit greatly from an abstain from vaccinating their child. SETTING: The effective seamless service. This paper recommends a County of Ostergotland in Sweden. SUBJECTS: A framework of care that may be relevant to other teams total of 203 parents of children who had no registered of children's community services across the country. date for MMR vaccination at a Child Health Centre. This service has been judged by the impact it has had MAIN OUTCOME MEASURES: Parental reasons for on the families who use it and the professionals non-vaccination. RESULTS: In all, 26 of the 203 employed within it. children had received MMR vaccination but this had not been registered. Of those not vaccinated, 40% of Dapretto M, Lee SS, Caplan R. A functional magnetic the parents had decided to abstain and 60% to postpone resonance imaging study of discourse coherence in vaccination. Fear of side effects was the most common typically developing children. Neuroreport 2005; reason for non-vaccination in both groups. The main 16(15):1661-5. source of information was the media followed by the Abstract: Using functional magnetic resonance imaging Child Health Centre. Parents with a single child more and a previously validated activation paradigm, we often postponed vaccination and those who abstained investigated the neural networks involved in detecting were more likely to have had a discussion with a doctor discourse coherence in a sample of typically or nurse about MMR vaccine. CONCLUSION: developing children. Study participants listened to Postponers and abstainers may have different reasons short question-answer dialogues and determined for their decision. The role of well-trained healthcare whether the answers made sense. Consistent with prior staff in giving advice and an opportunity to discuss adult findings, when this decision involved an implicit MMR vaccination with concerned parents is very appraisal of the conversation logic, frontotemporal important. activity was strongly left lateralized. In contrast, when this determination involved detecting a change in the Danvers L, Freshwater D, Cheater F, Wilson A. Providing a conversation topic, activity in frontotemporal regions seamless service for children with life-limiting illness: was bilateral, with a right hemisphere bias. Despite experiences and recommendations of professional staff behavioral performance differences, children and at the Diana Princess of Wales Children's Community adults showed remarkably similar activation profiles Service. J Clin Nurs 2003; 12(3):351-9. when making sense of conversation, indicating that the Abstract: The Diana Children's Community Teams neural architecture subserving this fundamental (DCCTs), a new nurse-led service funded by the communicative function is established relatively early Department of Health, were established to provide care during normal development. in the community as an alternative to hospital for children with life-threatening/life-limiting illnesses and Darbyshire P, Oster C, Carrig H. Children of parent(s) who their families. This paper presents selected findings have a gambling problem: a review of the literature and highlighting the professionals' experiences which commentary on research approaches. Health Soc Care formed part of the evaluation of the Diana, Princess of Community 2001; 9(4):185-93. Wales Children's Community Service in Leicester, Abstract: Problem gambling is becoming an Leicestershire and Rutland. The Diana Service in increasingly widespread and damaging social and Leicestershire attempts to encompass both parental health problem. As opportunities for gambling become empowerment and interagency collaboration. By more accessible, especially through lotteries and working in partnership with the children and their electronic gaming machines, it is likely that more families, the team provides an integrated and people will develop serious gambling problems. Given multiprofessional community-based service. This paper the worldwide increasing spending on gambling particularly concentrates on the perceptions and activities and the increasing number of problem recommendations from the Diana team itself. Three gamblers, it is unfortunate but likely that the children independently managed Community Nursing Services who grow up in problem gambling families will existed in Leicestershire prior to the Diana teams; a become an important area of concern for child health Paediatric Macmillan Service, a Children's Community and social workers. Considerable research has been Nursing Service and a Respite Service. The undertaken into problem gambling and the adult Leicestershire DCCT integrated the three nursing problem gambler, but within the gambling and child services into a single team. This team has moved away health literature there is almost no recognition of the from a traditional uniprofessional service structure by experiences of children who live in problem-gambling encompassing a wider team of multiprofessionals, families. Drawing on the findings of the landmark including a cultural link worker, an occupational Productivity Commission Report, this review explores 435
- 444. the marked increasein gambling and its social effects, without being well accepted by the majority of especially from the Australian perspective. The professionals. The objectives of this study were then to damaging social effects of problem gambling on identify professionals'expectations and objections to families and children are reviewed and the comparative perinatal regionalisation and to compare them from a invisibility of children and young people in such professional group to another one. METHODS: research is discussed. The pervasive influence of Professionals of 3 French perinatal networks were developmentalism is critiqued and highlighted in under consideration: the Rhone, the Auvergne and the relation to the exclusion of children's perspectives from Gard-Lozere networks. The study included two stages: our research understandings. The review concludes by 1) a psychosociological qualitative study, based on proposing that adoption of some of the emerging 'new professionals'interviews, aimed at identifying main paradigm' approaches to childhood and children's concerns of professionals and developing a experiences could markedly enhance our questionnaire; then 2) an epidemiological quantitative understandings of the lives and experiences of this study, using this questionnaire within French networks. significant group of children and young people. In the questionnaire, 8 dimensions explored the professionals'views: constraints related to regulation Das Eiden R, Leonard KE, Morrisey S. Paternal alcoholism aspects and to the setting up of maternity units care and toddler noncompliance. Alcohol Clin Exp Res levels, risk of loss of professionals' competence and 2001; 25(11):1621-33. prestige, consequences on medical practices, on inter- Abstract: BACKGROUND: This study examined the professional relationship, on work organization and effect of fathers' alcoholism and associated risk factors financial aspects, and related to the new role of 'private on toddler compliance with parental directives at 18 practice'professionals, legal consequences. RESULTS: and 24 months of age. METHODS: Participants were The response rate of the epidemiological study was 215 families with 12-month-old children, recruited 80%. The results permitted to construct 8 dimension through birth records, who completed assessments of scores describing the reasons of poor acceptability of parental substance use, family functioning, and parent- regionalization. After taking into account the age, the child interactions at 12, 18, and 24 months of child age. sex, the network and the juridical status of the Of these families, 96 were in the control group, 89 institution, the study revealed a significant poorer families were in the father-alcoholic-only group, and acceptability of regionalization by most of medical 30 families were in the group with two alcohol- specialty groups (anesthetists, obstetricians, midwives problem parents. Child compliance with parents during and "private practice" professionals) compared with cleanup situations after free play was measured at 18 neonatologists, or by "private" professionals and 24 months. The focus of this paper is on four (professionals working in private clinics and "private measures of compliance: committed compliance, practice" professionals) compared with professionals passive noncompliance, overt resistance, and defiance. working in university or community hospitals. The RESULTS: Sons of alcohol-problem parents exhibited study described also network setting up conditions higher rates of noncompliance compared with sons of related to its functioning. CONCLUSION: By nonalcoholic parents. Sons in the two-alcohol-problem identifying clearly professionals 'objections and parent group seemed to be following a trajectory expectations, this study should facilitate improvement toward increasing rates of noncompliance. Daughters in the organization of studied perinatal networks. in the two-alcohol-problem parent group followed an opposite pattern. Other risk factors associated with Davies JK, Bledsoe JM. Prenatal alcohol and drug exposures parental alcohol problems also predicted compliance, in adoption. Pediatr Clin North Am 2005; 52(5):1369- but in unexpected ways. CONCLUSIONS: Results 93, vii. indicate that early risk for behavioral undercontrol is Abstract: Prenatal alcohol and drug exposures are a present in the toddler period among sons of alcoholic significant concern in many domestic and international fathers, but not among daughters. adoptions. This article addresses the following substance exposures for children: alcohol, opiates, David S, Durif-Bruckert C, Durif-Varembont JP et al. tobacco, marijuana, cocaine, and methamphetamines. Perinatal care regionalization and acceptability by For each substance, we review the teratogenicity of the professionals in France. Rev Epidemiol Sante Publique exposure and identify the spectrum of 2005; 53(4):361-72. neurodevelopmental issues that can present in children Abstract: BACKGROUND: For twenty years, most of exposed to this substance. Diagnosis of the spectrum of industrial countries developed recommendations on fetal alcohol outcomes is also discussed. When regionalization of perinatal care. Perinatal possible, we provide country-specific statistics on regionalization is particularly aimed at improving exposure risks for adopted children. morbidity and mortality outcomes of low birth weight newborns by transferring pregnant women to the Davies P. Thanks to Jesse. Can Nurse 2002; 98(7):6-7. maternity units having a medical or neonatal environment suited to the risks incurred by mothers or Davila GW. Informed consent for obstetrics management: a babies. Perinatal regionalization cannot be effective 436
- 445. urogynecologic perspective. IntUrogynecol J Pelvic technique. Their comments were summarised and the Floor Dysfunct 2001; 12(5):289-91. major themes were extracted. The priority areas of Notes: GENERAL NOTE: KIE: KIE Bib: informed health and wellbeing recommended for regular consent collection include obesity and its determinants, Abstract: Obstetric management has been modified for pregnancy and breastfeeding, oral health, injury, social conditions with acute, short-term consequences (i.e. and emotional health and wellbeing, family breech presentation). It is timely to address those environment, community, health service utilisation, conditions related to the vaginal birth process which illness, and socioeconomic position. Population policy may have a delayed but significant negative impact on questions for each area were identified. the mother's quality of life (i.e. urinary and fecal CONCLUSION: In contrast to previous population incontinence) but which may be reduced by selectively survey programs nationally and internationally, this avoiding the vaginal birth process. The known possible study sought to extract contemporary policy-oriented consequences, and other associated risks and benefits, domains for inclusion in a strategic program of child should be discussed with the pregnant patient and her health data collection, using a stakeholder consultation spouse, in order to allow their input into the obstetric process to identify key domains and policy information decision-making process and to individualize needs. The outcomes are a rich and relevant set of management. Urogynecologists are in a unique, no- recommendations which will now be taken forward conflict-of-interest position to further the acceptance of into a regular statewide child health survey program. the concept of obstetrical informed consent. Cesarean delivery should not be seen as a failure of obstetric Davis L, Mohay H, Edwards H. Mothers' involvement in management, but rather as a safe and acceptable option caring for their premature infants: an historical to the vaginal delivery process, chosen after overview. J Adv Nurs 2003; 42(6):578-86. completing an informed decision-making process. Abstract: BACKGROUND: Advances in technology have resulted in increasing survival rates even for Davis A. Transatlantic lessons. Nurs Stand 2005; 19(41):69- extremely premature infants. While sophisticated 70. medical management is vital to infant survival, research has found that social factors and care giving Davis D, Loftus E, Follette WC. Commentary: How, when, processes are important predictors of infants' later and whether to use informed consent for recovered outcome. Consequently, evidence is accumulating to memory therapy. J Am Acad Psychiatry Law 2001; demonstrate the fundamental role of mothers and 29(2):148-59. families to the optimal developmental outcome of Notes: GENERAL NOTE: KIE: 70 refs. premature infants. AIM: The aim of the work reported GENERAL NOTE: KIE: KIE Bib: informed consent; here was to undertake an historical overview of mental health premature infant care practices to increase neonatal nurse's knowledge of the crucial role of mothers and Davis DS. Child's right to an open future. Hastings Cent Rep families in the care of their premature infants. 2002; 32(5):6; author reply 6. Understanding past practice and current trends can Notes: GENERAL NOTE: KIE: KIE Bib: genetic provide neonatal nurses with critical insight which will counseling assist in formulating current and future care. METHOD: Research and historical articles focusing on Davis E, Waters E, Wake M et al. Population health and maternal involvement in preterm infant care from the wellbeing: identifying priority areas for Victorian development of the incubator to the present time were children. Aust New Zealand Health Policy 2005; 2:16. examined. A search of the literature between 1960 and Abstract: BACKGROUND: Population health 2002 was conducted using the MEDLINE, CINAHL information, collected using soundly-designed and PSYCLIT databases. The search terms were methodologies, is essential to inform policy, research, premature infant, neonatal intensive care, history, and and intervention programs. This study aimed to derive maternal care. FINDINGS: Three major themes were policy-oriented recommendations for the content of a identified which reflect the development of neonatal health and wellbeing population survey of children 0- care. Firstly, over the last century advances in medical 12 years living in Victoria, Australia. RESULTS: and public health practice saw a decline in mortality Qualitative interviews were conducted with 54 rates for mothers and infants. Secondly, the application academic and policy stakeholders, selected to of this new knowledge resulted in the encompass a wide breadth of expertise in areas of institutionalization and professionalization of obstetric public health and inter-sectoral organisations relevant and neonatal care which, in turn, resulted in the to child health outcomes, including universities, isolation of infants from their mothers. Finally, government and non-government agencies across concurrent advances in infant research emphasized the Victoria. These stakeholders were asked to provide importance of mother-infant relationships to infants' advice on strategic priorities for child health developmental outcome, resulting in greater flexibility information (data) using a structured interview in hospital practices regarding parental contact with their infants. CONCLUSION: As biomedical advances 437
- 446. in technology continueto help smaller, sicker analyses identified two factors for each parent premature infants to survive, neonatal nurses are including logistic support of girls' activity (i.e., strategically placed to promote positive outcomes for enrolling girls in sports and driving them to events) and infants and their families through the integration of parents' explicit modeling (i.e., the extent to which social science and behavioural research into nursing parents used their own behavior to encourage their practice. daughters to be active). Mothers reported significantly higher levels of logistic support than fathers, whereas Davison KK, Birch LL. Predictors of fat stereotypes among fathers reported higher levels of explicit modeling than 9-year-old girls and their parents. Obes Res 2004; mothers. Although mothers and fathers tended to report 12(1):86-94. different methods of support, both methods were Abstract: OBJECTIVE: To assess familial links in fat associated with higher physical activity among girls. stereotypes and predictors of stereotypes among girls Finally, girls reported significantly higher levels of and their parents. RESEARCH METHODS AND physical activity when at least one parent reported high PROCEDURES: Fat stereotypes were assessed using a levels of overall support in comparison to no parents; questionnaire developed for this study. Participants no significant differences were identified for support indicated the extent to which they agreed with nine from one versus two parents. CONCLUSION: Results statements about thin people (e.g., thin people are from this study indicate the positive contribution that smart) and the same statements about fat people (e.g., parents can have on activity practices of their young fat people are smart). Predictors of fat stereotypes that daughters. were examined include weight status (BMI; girls and parents), education (parents), income (parents), self- Davison KK, Francis LA, Birch LL. Links between parents' investment in physical appearance (parents), and girls' television viewing behaviors: a longitudinal maladaptive eating attitudes (girls), and parenting examination. J Pediatr 2005; 147(4):436-42. practices and peer interactions focused on body shape Abstract: OBJECTIVE: This longitudinal study and weight loss (girls). RESULTS: Girls and parents examines links between parents' television (TV)-related exhibited fat stereotypes. Fathers who were more parenting practices and their daughter's daily TV educated and had a higher family income were more viewing hours. STUDY DESIGN: Participants likely to endorse fat stereotypes, as were mothers and included 173 non-Hispanic white girls and their parents fathers with a high investment in their physical who were examined when girls were age 9 and 11 appearance. Although no associations were found years. Girls' daily TV viewing hours, mothers' and between girls' and parents' fat stereotypes, girls were fathers' daily TV viewing hours, parents' use of TV as a more likely to endorse fat stereotypes when recreational activity, family TV co-viewing, and interactions with parents and peers focused on body parents' restriction of girls' access to TV were assessed. shape and weight loss. Girls were also more likely to RESULTS: Approximately 40% of girls exceeded the endorse fat stereotypes when they reported higher TV-viewing recommendations (ie, < or =2 hours/day). levels of maladaptive eating attitudes. No associations Girls watched significantly more TV when their were found between weight status and fat stereotypes. parents were high-volume TV viewers, relied heavily DISCUSSION: Although there was no association on TV as a recreational activity, watched TV with between girls' and parents' fat stereotypes, girls were them, and failed to limit their access to TV. A more likely to express negative attitudes about obesity parenting risk score was calculated by collapsing and obese persons when parenting practices and information across all parenting variables. In interactions with peers promoted a lean body type, comparison with girls exposed to 1 or fewer parenting suggesting that there may be an implicit link between risk factors at age 9, girls exposed to 2 or more the lean ideal and fat stereotypes. parenting risk factors were 5 to 10 times more likely to exceed TV viewing recommendations at age 9 and 11. Davison KK, Cutting TM, Birch LL. Parents' activity-related CONCLUSIONS: Efforts to reduce TV viewing among parenting practices predict girls' physical activity. Med children should encourage parents to limit their own Sci Sports Exerc 2003; 35(9):1589-95. TV viewing, reduce family TV viewing time, and limit Abstract: PURPOSE: Using a sample of 180 9-yr-old their children's access to TV. girls and their parents, this study examined (a) parents' activity-related parenting strategies and similarities and Dawes RM. The problem of child sexual abuse. Science differences in such strategies for mothers and fathers, 2005; 309(5738):1182-5; author reply 1182-5. and (b) links between activity-related parenting strategies and girls' physical activity patterns. Dawley K, Beam R. "My nurse taught me how to have a METHODS: Measures of girls' physical activity healthy baby and be a good mother:" nurse home included the Children's Physical Activity scale, visiting with pregnant women 1888 to 2005. Nurs Clin participation in organized sports, and physical fitness. North Am 2005; 40(4):803-15, xiii. We developed a questionnaire to assess ways in which Abstract: Nurse home visiting with pregnant women parents promote physical activity among their children. and new mothers in the early decades of the twentieth RESULTS: Exploratory and confirmatory factor 438
- 447. century was designedto improve birth and newborn Dayan L. Transmission of Neisseria gonorrhoeae from a outcomes, hasten Americanization of immigrant toilet seat. Sex Transm Infect 2004; 80(4):327. mothers, and improve their parenting skills. Today the Nurse Family Partnership home visitation program De Arellano MA, Waldrop AE, Deblinger E, Cohen JA, improves newborn and child outcomes by positively Danielson CK, Mannarino AR. Community outreach influencing maternal role attainment and significantly program for child victims of traumatic events: a decreasing maternal smoking and other substance community-based project for underserved populations. abuse, child abuse and neglect, and children's Behav Modif 2005; 29(1):130-55. emergency room visits. It also improves life Abstract: Behavioral and cognitive behavioral possibilities for vulnerable young women by treatment interventions have been shown to be decreasing the interval and frequency of subsequent effective for the treatment of trauma-related problems pregnancies and reduces dependence on welfare by in children. However, many children and families in increasing workforce participation. This article reviews need of treatment do not have adequate access to the history of home visits by nurses to pregnant women services and do not have access to effective, evidence- and demonstrates the benefits achieved by these based treatment services. The present article describes programs today. a community-based program that provides in-home and in-school treatment services, based on behavioral and Dawson A. The determination of 'best interests' in relation to cognitive behavioral approaches to addressing trauma- childhood vaccinations. Bioethics 2005; 19(2):188- related emotional and behavioral problems in children. 205. Notes: GENERAL NOTE: KIE: 37 fn. De Bellis MD. Abuse and ACTH response to corticotropin- GENERAL NOTE: KIE: KIE Bib: immunization; releasing factor. Am J Psychiatry 2002; 159(1):157; informed consent/minors author reply 157-8. Abstract: There are many different ethical arguments that might be advanced for and against childhood De Bellis MD. Developmental traumatology: a contributory vaccinations. In this paper I will explore one particular mechanism for alcohol and substance use disorders. argument that focuses on the idea that childhood Psychoneuroendocrinology 2002; 27(1-2):155-70. vaccinations are justifiable because they are held to be Abstract: Early childhood traumatic experiences, such in the best interests of a particular child. Two issues as childhood maltreatment, are associated with an arise from this idea. The first issue is how best interests enhanced risk of adolescent and adult alcohol and are to be determined in the case of childhood substance use disorders (defined as DSM-IV alcohol or vaccinations. The second issue is what follows from substance abuse or dependence). Maltreated children this to justify potential interventions within the family and adolescents manifest dysregulation of major in relation to such vaccinations. I argue that best biological stress response systems including adverse interests must be characterised objectively in such influences on brain development. Dysregulation of situations and that this means that, in at least some biological stress response systems may lead to an cases, parental decision-making about vaccinating their enhanced vulnerability for psychopathology, children may be overridden. particularly posttraumatic stress disorder (PTSD) and depression. These negative affect disorders may put a Dawson A. The determination of the best interests in relation child at increased risk for adolescent or young adult to childhood immunisation. Bioethics 2005; 19(1):72- onset alcohol or substance use disorders. Thus, studies 89. in developmental traumatology may prove to be critical Notes: GENERAL NOTE: KIE: 37 fn. in the effort to attempt to link the neurobiology of GENERAL NOTE: KIE: KIE Bib: immunization; maltreatment-related PTSD with the neurobiology of informed consent/minors alcohol and substance use disorders and in developing Abstract: There are many different ethical arguments early strategies for the prevention of adolescent and that might be advanced for and against childhood adult alcohol and substance use disorders. vaccinations. In this paper I explore one particular argument that focuses on the idea that such De Bellis MD. Developmental traumatology: the vaccinations are justifiable because they are held to be psychobiological development of maltreated children in the best interests of a particular child. Two issues and its implications for research, treatment, and policy. arise from this idea. The first issue is how best interests Dev Psychopathol 2001; 13(3):539-64. are to be determined in this case. The second issue is Abstract: In this review, a developmental traumatology what follows from this to justify potential interventions model of child maltreatment and the risk for the within the family in relation to such vaccinations. I intergenerational cycle of abuse and neglect using a argue that best interests must be characterised mental health or posttraumatic stress model was objectively in such situations and that this means that, described. Published data were reviewed that support in at least some cases, parental decision-making about the hypothesis that the psychobiological sequelae of vaccinating their children may be overridden. child maltreatment may be regarded as an 439
- 448. environmentally induced complexdevelopmental implicating the existence of dysfunction in the primary disorder. Data to support this view, including the auditory cortex and adjacent anterior auditory cortex of descriptions of both psychobiological and brain the STG in adult PTSD. METHODS: Anatomic maturation studies in maltreatment research, magnetic resonance imaging (MRI) volumetric analysis emphasizing the similarities and differences between of the superior temporal gyrus were performed in 43 children, adolescents, and adults, were reviewed. Many maltreated children and adolescents with PTSD and 61 suggestions for important future psychobiological and nonmaltreated healthy control subjects. RESULTS: brain maturation research investigations as well as Unadjusted STG gray matter volumes were larger in public policy ideas were offered. maltreated subjects with PTSD than in control subjects, whereas STG white matter volumes were smaller in De Bellis MD, Broussard ER, Herring DJ, Wexler S, Moritz maltreated subjects with PTSD than in control subjects. G, Benitez JG. Psychiatric co-morbidity in caregivers After adjusting for differences in cerebral volume, and children involved in maltreatment: a pilot research right, left, and total superior temporal gyrus volumes study with policy implications. Child Abuse Negl were relatively larger in PTSD subjects compared with 2001; 25(7):923-44. control subjects. After covarying for differences in Abstract: OBJECTIVE: The purpose of this study was cerebral gray matter volumes, regression analysis to determine the lifetime incidence of mental disorders showed that PTSD subjects had significantly greater in caregivers involved in maltreatment and in their STG gray matter volumes in most, and in particularly maltreated child. METHODS: Lifetime DSM-III-R and right-sided STG measurements. Furthermore, findings IV psychiatric diagnoses were obtained for 53 of significant side-by-diagnosis interactions for STG maltreating families, including at least one primary and STG gray but not white matter STG volumes caregiver and one proband maltreated child or suggest that there is a more pronounced right > left adolescent subject (28 males, 25 females), and for a asymmetry in total and posterior STG volumes but a comparison group of 46 sociodemographically, similar loss of the left > right asymmetry seen in total, anterior, nonmaltreating families, including one proband healthy and posterior STG gray matter volumes in PTSD child and adolescent subject (22 males, 22 females). subjects compared with control subjects. RESULTS: Mothers of maltreated children exhibited a CONCLUSIONS: These STG findings may suggest significantly greater lifetime incidence of anxiety developmental alterations in maltreatment-related disorders (especially post-traumatic stress disorder), pediatric PTSD. mood disorders, alcohol and/or substance abuse or dependence disorder, suicide attempts, and comorbidity de Bode S, Firestine A, Mathern GW, Dobkin B. Residual of two or more psychiatric disorders, compared to motor control and cortical representations of function control mothers. Natural fathers or mothers' live-in following hemispherectomy: effects of etiology. J mates involved in maltreatment exhibited a Child Neurol 2005; 20(1):64-75. significantly greater lifetime incidence of an alcohol Abstract: Fifteen posthemispherectomy children were and/or substance abuse or dependence disorder examined to assess residual motor function of the compared to controls. The majority of maltreated paretic side using the 74-point Fugl-Meyer Assessment children and adolescents reported anxiety disorders, of Motor Recovery scale. The degree of residual motor especially post-traumatic stress disorder (from control differed for upper and lower extremities, with witnessing domestic violence and/or sexual abuse), hand function being most severely impaired. mood disorders, suicidal ideation and attempts, and Posthemispherectomy motor outcomes also differed as disruptive disorders. Most maltreated children (72%) a function of etiology: cortical dysplasia, perinatal suffered from comorbidity involving both emotional infarct, and Rasmussen's encephalitis. Children whose and behavioral regulation disorders. CONCLUSIONS: intractable seizures resulted from perinatal middle Families involved in maltreatment manifest significant cerebral artery stroke demonstrated the most spared histories of psychiatric comorbidity. Policies which motor function. To detect cortical areas that target identification and treatment of comorbidity may represented motor control of the hemiparetic side, we contribute to breaking the intergenerational focused on voluntary control of the affected lower transmission of maltreatment. extremity. Seven of our patients were able to carry out a foot dorsiflexion paradigm during functional De Bellis MD, Keshavan MS, Frustaci K et al. Superior magnetic resonance imaging, and these results were temporal gyrus volumes in maltreated children and compared with activations found in normal controls. adolescents with PTSD. Biol Psychiatry 2002; All children showed activations in the sensorimotor 51(7):544-52. network ipsilateral to the affected side. The perinatal Abstract: BACKGROUND: The structure and function infarct group demonstrated greater activity in the of the superior temporal gyrus (STG), a structure cingulate cortex, whereas the Rasmussen's encephalitis involved in receptive and nonverbal auditory and group had significant activations in the insula, language processing, is understudied in posttraumatic suggesting etiology-specific differences in stress disorder (PTSD). Event-related potential reorganization. These findings are discussed in the abnormalities were previously reported in PTSD, framework of our understanding of mechanisms of 440
- 449. cortical plasticity inthe injured brain and its relevance population. The lower gingival and vestibular oral to neurologic rehabilitation. We suggest that imaging mucosa was chosen as the study area. The blood vessel techniques are important tools in identifying cortical area was determined, and the oral vascular networks regions underlying functional reorganization. were characterized by analyzing their complexity (D, at Furthermore, detection of such areas might become a two scales: D 1-46, D 1-15), tortuosity (Dmin), and basis for specific training promoting the optimal randomness (L-Z) of the vascular loops. Infants with reorganization of cortical networks to enhance motor BPD showed a significantly lower blood vessel area as control. well as a higher vascular network complexity (D 1-46, D 1-15, and L-Z) than control subjects (p < 0.0001). de Boer J. Chips help diagnosis of childhood cancers. Trends Our findings provide a new early clinical sign in BPD Cell Biol 2001; 11(8):323. and stress the importance of an early disorder in the oral mucosal vascularization process in the disease De Felice C, Bianciardi G, Parrini S, Laurini RN, Latini G. pathogenesis. Congenital oral mucosal abnormalities in true umbilical cord knots. Biol Neonate 2004; 86(1):34-8. De Giorgio F, De Mercurio D, Vetrugno G, Abbate A. Abstract: OBJECTIVE: The pathogenesis and clinical Shaken-baby syndrome: a challenging diagnosis. Med significance of true umbilical cord knots remain Sci Law 2005; 45(2):182-3. controversial. Here, we tested the hypothesis of the presence of congenital oral mucosal changes in de Oliveira MI, Camacho LA, Tedstone AE. Extending newborns with true umbilical cord knots. STUDY breastfeeding duration through primary care: a DESIGN: Seven consecutive infants with true systematic review of prenatal and postnatal umbilical cord knots and 50 gestational age- and sex- interventions. J Hum Lact 2001; 17(4):326-43. matched controls were enrolled. The proportion of oral Abstract: This literature review provides an overview frenulum abnormalities and the two-dimensional of the effectiveness of strategies and procedures used vascular network geometry [fractal dimension, D, at to extend breastfeeding duration. Interventions carried two scales: D(1-46), and D(1-15), with the relative out during pregnancy and/or infant care conducted in Lempel-Ziv complexity, (L-Z)], were analyzed. primary health care services, community settings, or RESULTS: Infants with true umbilical cord knots hospital clinics were included. Interventions covering showed significantly higher proportions of mandibular only the delivery period were excluded. Interventions frenulum agenesis compared to controls (p = that were most effective in extending the duration of 0.000006). The oral vascular networks of these infants breastfeeding generally combined information, exhibited a significantly higher D(1-46) and D(1-15) (p guidance, and support and were long term and < 0.0001, respectively), and higher L-Z values (p < intensive. During prenatal care, group education was 0.0001) than control networks. CONCLUSION: These the only effective strategy reported. Home visits used findings indicate the presence of significant congenital to identify mothers' concerns with breastfeeding, assist oral mucosal changes in newborn infants with true with problem solving, and involve family members in umbilical cord knots, thus suggesting a previously breastfeeding support were effective during the unrecognized association between true umbilical cord postnatal period or both periods. Individual education knots and a subclinical extracellular matrix disorder. sessions were also effective in these periods, as was the combination of 2 or 3 of these strategies in de Felice C, Latini G, Parrini S et al. Oral mucosal interventions involving both periods. Strategies that microvascular abnormalities: an early marker of had no effect were characterized by no face-to-face bronchopulmonary dysplasia. Pediatr Res 2004; interaction, practices contradicting messages, or small- 56(6):927-31. scale interventions. Abstract: An abnormal pulmonary vasculature has been reported as an important component of de San Lazaro C, Harvey R, Ogden A. Shaking infant bronchopulmonary dysplasia (BPD). We tested the trauma induced by misuse of a baby chair. Arch Dis hypothesis of an early abnormal vascular network Child 2003; 88(7):632-4. pattern in infants with BPD. Fifteen infants with BPD Abstract: A 2 month old infant presented with bilateral (nine boys and six girls; gestational age 27.5 +/- 2.0 subdural haemorrhages and bilateral subhyaloid wk; birth weight 850 +/- 125 g) and 15 sex- and haemorrhage. The parent admitted to forceful bouncing gestational age-matched infants (nine boys and six of the child in a baby rocker. Experiments showed that girls; gestational age 27.6 +/- 2.6 wk; birth weight 865 violent rocking in the chair could produce extreme +/- 135 g) were examined on postnatal days 1 and 28. alternating acceleration/deceleration forces in excess of BPD infants showed a significantly higher prevalence those induced by shaking alone. Such handling could of histologic chorioamnionitis (p = 0.009), as well as not be interpreted as accidental mismanagement and higher intubation duration (p = 0.0004), oxygen the abusive nature of the process was graphically supplementation (p < 0.0001), and initial illness shown in video recordings of the experiment. severity (p = 0.0002) than the BPD-negative Prosecution resulted in a conviction for cruelty, and a 441
- 450. suspended sentence. perceive and/or experience serious problems that make it difficult for them to attend clinic and even prevent de The G, Zetterstrom R. Mother-child health research them from doing so. These problems include both the (IRN-MCH): achievements and prospects of an way they are treated at the clinics (especially the international network. Acta Paediatr 2005; 94(7):964-7. problem of verbal abuse) as well as the actual services Abstract: The Inter-Academy Panel (IAP) is critical delivered (no medicines, no help, disorganised, long about the scarce support to mother-child health (MCH) waiting periods, being turned away). The main problem research in developing countries. At the request of the experienced by the HCWs with service delivery seems IAP, a group of members of the French and Swedish to be a heavy workload, as well as the fact that many Academies of Science have arrived at the conclusion mothers do not come for follow-up visits. that an efficient network between scientists in resource- CONCLUSION: Efforts to increase the accessibility of poor and industrialized countries will facilitate MCH PHC clinics in Duncan Village should focus on research in developing countries. The priorities for improving the relationship between mothers and such a network have been listed as follows: The present HCWs and the heavy workload experienced by these organization for the MCH website at the Pasteur workers. Institute in Paris should be adapted to better promote collaboration between scientists from industrialized De Vise D. Years after giving marrow, the return gift of and developing countries.To provide short-term meaning: Alabama donor goes to Arundel to see the courses for young scientists from developing countries young girl he saved. Washington Post 2005; B1, B7. in the design of research protocols, and in the writing Notes: GENERAL NOTE: KIE: KIE Bib: organ and of scientific reports and manuscripts.To organize tissue donation workshops on various topics of relevance for MCH in developing countries in order to create new research De Vogli R, Birbeck GL. Potential impact of adjustment networks for scientific collaboration between policies on vulnerability of women and children to industrialized and resource-poor countries.To establish HIV/AIDS in sub-Saharan Africa. J Health Popul Nutr collaboration between non-governmental organizations 2005; 23(2):105-20. (NGOs) that support MCH research in developing Abstract: This paper evaluates the potential impact of countries.Topics for such collaborative studies and the adjustment policies of the International Monetary Fund way in which they may be performed are summarized. and the World Bank on the vulnerability of women and children to HIV/AIDS in sub-Saharan Africa. A de Villiers A, Koko-Mhlahlo K, Senekal M. Nutritional conceptual framework, composed of five different well-being of young children in Duncan Village, East pathways of causation, is used for the evaluation. London, South Africa: accessibility of primary health These five pathways connect changes at the macro care clinics. Public Health Nutr 2005; 8(5):520-32. level (e.g. removal of food subsidies) with effects at the Abstract: OBJECTIVE: The aim was to contribute to meso (e.g. higher food prices) and micro levels (e.g. the nutritional well-being of young children living in exposure of women and children to commercial sex) Duncan Village by investigating factors that influence that influence the vulnerability of women and children clinic attendance of mothers and to formulate to HIV/AIDS. Published literature on adjustment recommendations for optimisation of accessibility of policies and socioeconomic determinants of HIV/AIDS primary health care (PHC) clinics in the area. among women and children in sub-Saharan Africa was DESIGN: PHC clinic accessibility was evaluated by reviewed to explore the cause-effect relationships assessing the experiences of mothers who attended included in the theoretical framework. Evidence clinics in the area as well as the experiences of health suggests that adjustment policies may inadvertently care workers (HCWs) in these clinics of service produce conditions facilitating the exposure of women delivery and its recipients (mothers/children), using the and children to HIV/AIDS. Complex research designs focus group technique. The ATLAS/ti program was are needed to further investigate this relationship. A used to analyse the data in the following steps: shift in emphasis from an individual approach to a preparation and importing of the data, getting to know socioeconomic approach in the study of HIV infection and coding the data, retrieval and examination of codes among women and children in the developing world is and quotations, creation of families and creation of suggested. Given the potential for adjustment policies networks. SETTING: Duncan Village, a low socio- to exacerbate the AIDS pandemic among women and economic urban settlement in East London, South children, a careful examination of the effects of these Africa. SUBJECTS: Focus group discussions (four to policies on maternal and child welfare is urgently seven participants per group) were conducted with four needed. groups of mothers who do not attend PHC clinics, six with mothers who do attend the clinics (including de Waal R, Hugo R, Soer M, Kruger JJ. Predicting hearing pregnant women) and four groups of HCWs. loss from otoacoustic emissions using an artificial RESULTS: Four networks that provide a summary of neural network. S Afr J Commun Disord 2002; 49:28- all the major trends in the data were created. The 39. results clearly indicate that mothers in Duncan Village 442
- 451. Abstract: Normal andimpaired pure tone thresholds measures: Frequencies of neonatal withdrawal, (PTTs) were predicted from distortion product congenital malformations, childhood onset medical otoacoustic emissions (DPOAEs) using a feed-forward problems, developmental delay, and behaviour artificial neural network (ANN) with a back- disorders. RESULTS: Neonatal withdrawal was seen in propagation training algorithm. The ANN used a map 20% of those exposed to antiepileptic drugs. of present and absent DPOAEs from eight DPgrams, Congenital malformations occurred in 14% of exposed (2f1-f2 = 406-4031 Hz) to predict PTTs at 0.5, 1, 2 and pregnancies, compared with 5% of non-exposed sibs, 4 kHz. With normal hearing as < 25 dB HL, prediction and developmental delay in 24% of exposed children, accuracy of normal hearing was 94% at 500, 88% at compared with 11% of non-exposed sibs. After 1000, 88% at 2000 and 93% at 4000 Hz. Prediction of excluding cases with a family history of developmental hearing-impaired categories was less accurate, due to delay, 19% of exposed children and 3% of non- insufficient data for the ANN to train on. This research exposed sibs had developmental delay, 31% of exposed indicates the possibility of accurately predicting children had either major malformations or hearing ability within 10 dB in normal hearing developmental delay, 52% of exposed children had individuals and in hearing-impaired listeners with facial dysmorphism compared with 25% of those not DPOAEs and ANNs from 500-4000 Hz. exposed, 31% of exposed children had childhood medical problems (13% of non-exposed sibs), and 20% de Wit K, Davis K. Nurses' knowledge and learning had behaviour disorders (5% of non-exposed). experiences in relation to the effects of domestic abuse CONCLUSION: Prenatal antiepileptic drug exposure on the mental health of children and adolescents. in the setting of maternal epilepsy is associated with Contemp Nurse 2004; 16(3):214-27. developmental delay and later childhood morbidity in Abstract: Nurse researchers are yet to direct substantial addition to congenital malformation. attention towards addressing and understanding nurses' experiences of learning about and caring for child and Dean M. UK starts long-overdue reform to social services. adolescent victims of domestic abuse. This lack of Lancet 2002; 360(9342):1308. recognition has resulted in the marginalisation of this issue. This paper seeks to explore nurses' present Dearden K, Altaye M, De Maza I et al. The impact of understanding and experiences of learning about the mother-to-mother support on optimal breast-feeding: a effects of domestic abuse on the mental health of controlled community intervention trial in peri-urban children and adolescents. The research utilised an Guatemala City, Guatemala. Rev Panam Salud Publica interpretive case study approach within a naturalistic 2002; 12(3):193-201. paradigm. Snowball sampling of nursing staff within Abstract: OBJECTIVE: To assess the impact that a two mental health units was used. Data were collected mother-to-mother support program operated by La using semi-structured in-depth interviews with each Leche League Guatemala had on early initiation of participant. Using a constant comparative method and breast-feeding and on exclusive breast-feeding in peri- hermeneutic dialectical process both the commonalities urban Guatemala City, Guatemala. MATERIALS AND and differences regarding participants' multiple realities METHODS: A population census was conducted to were identified. Three major categories emerged within identify all mothers of infants < 6 months of age, and the data. These were education, resources and nurses' the mothers were then surveyed on their breast-feeding role. It was apparent that nurses' knowledge and practices, in two program communities and two control education about the effects of domestic abuse on the communities. Data collection for this follow-up census mental health of children and adolescents negatively and survey was carried out between November 2000 impacted on nurses' ability to provide appropriate care. and January 2001, one year after a baseline census and The research has clear implications for mental health survey had been conducted. RESULTS: At follow-up, nursing education, practice and future research. 31% of mothers in the program communities indicated that counselors had advised them about breast-feeding, Dean JC, Hailey H, Moore SJ, Lloyd DJ, Turnpenny PD, 21% said they had received a home visit, and 16% Little J. Long term health and neurodevelopment in reported attending a support group. Community wide children exposed to antiepileptic drugs before birth. J rates of early initiation of breast-feeding were Med Genet 2002; 39(4):251-9. significantly higher in program areas than in the Abstract: OBJECTIVE: To investigate the frequency of control communities, at both baseline and follow-up. neonatal and later childhood morbidity in children However, the change over time in early initiation in exposed to antiepileptic drugs in utero. DESIGN: program communities was not significantly different Retrospective population based study. SETTING: from the change in control communities. Community Population of the Grampian region of Scotland. wide rates of exclusive breast-feeding were similar in PARTICIPANTS: Mothers taking antiepileptic drugs program and control sites and did not change in pregnancy between 1976 and 2000 were ascertained significantly from baseline to follow-up. However, of from hospital obstetric records and 149 (58% of those the mothers in the program communities who both eligible) took part. They had 293 children whose health received home visits and attended support groups, 45% and neurodevelopment were assessed. Main outcome of them exclusively breast-fed, compared to 14% of 443
- 452. women in programcommunities who did not Deering CG, Cody DJ. Communicating with children and participate in those two activities. In addition, women adolescents. Am J Nurs 2002; 102(3):34-41; quiz 42. who were exposed to mother-to-mother support activities during the year following the baseline census Deftos LJ. Ethics and genetics. N Engl J Med 2003; and survey were more likely than mothers exposed 349(19):1870-2; author reply 1870-2. before that period to exclusively breast-feed. This Notes: GENERAL NOTE: KIE: 5 refs. suggests that the program interventions became more GENERAL NOTE: KIE: KIE Bib: confidentiality/legal effective over time. CONCLUSIONS: This study does aspects; genetic screening not provide evidence of population impact of La Leche League's intervention after one year of implementation. DeGarmo DS, Patterson GR, Forgatch MS. How do In peri-urban Guatemala, long-term community-based outcomes in a specified parent training intervention interventions, in partnership with existing health care maintain or wane over time? Prev Sci 2004; 5(2):73- systems, may be needed to improve community wide 89. exclusive breast-feeding rates. Abstract: In a randomized prevention trial, 238 recently separated mothers and their young sons were assigned Deater-Deckard K, Lansford JE, Dodge KA, Pettit GS, Bates to either Parent Management Training (PMT) or a JE. The development of attitudes about physical comparison group. Families were intensively assessed punishment: an 8-year longitudinal study. J Fam at baseline and at each 6-month interval through 30 Psychol 2003; 17(3):351-60. months. To understand the effects of PMT, we first Abstract: We examined young adolescents' evaluated effect sizes among family variables over endorsement of parental use of corporal punishment to time. Second, because observed parenting was the elucidate processes underlying the intergenerational target of PMT, we hypothesized a sequential pattern of transmission of discipline strategies. The community structured changes within and between individuals. sample was ethnically and socioeconomically diverse. Using constructs with mismatched sources of data, we Mothers completed interviews and questionnaires when conducted a set of latent growth mediational analyses the target children were entering kindergarten (n = 566) to test hypothesized mechanisms explaining change. and in 6th and 8th grades. Adolescents completed Effect sizes indicated that parenting changed first questionnaires when they were in 8th grade (n = 425). within 12 months, followed by changes in boy Adolescents' attitudes about corporal punishment behaviors and finally changes in maternal depression varied widely. Those adolescents who had been within 30 months. Unique follow-up findings indicated spanked by their own mothers were more approving of that intervention effects on reductions in maternal this discipline method, regardless of the overall depression were mediated by reductions in boy frequency, timing, or chronicity of physical discipline externalizing; intervention effects on externalizing they had received. However, there was no correlation were mediated by reductions in boy depression. As among adolescents for whom physical maltreatment in expected, increases in effective parenting predicted early or middle childhood was suspected. reductions in child behavior problems. PMT effects on internalizing were direct and indirect, partially Deblinger E, Runyon MK. Understanding and treating mediated by parenting practices. Results are discussed feelings of shame in children who have experienced from a system's perspective on PMT amplifiers. maltreatment. Child Maltreat 2005; 10(4):364-76. Abstract: Feelings of shame have been found to be an DeGrazia D. Identity, killing, and the boundaries of our important mediating factor in influencing a child's existence. Philos Public Aff 2003; 31(4):413-42. recovery from abuse. This article conceptualizes the Notes: GENERAL NOTE: KIE: 44 fn. development and maintenance of shame in the GENERAL NOTE: KIE: KIE Bib: abortion; aftermath of experiencing child sexual and/or physical determination of death/brain death; personhood abuse. Research is reviewed that may shed light on the impact of shame and dysfunctional attributions with a DeGroff CG, Bhatikar S, Hertzberg J, Shandas R, Valdes- view toward understanding how this type of painful Cruz L, Mahajan RL. Artificial neural network-based emotional suffering can be prevented and/or treated. method of screening heart murmurs in children. Trauma-focused interventions that have demonstrated Circulation 2001; 103(22):2711-6. efficacy in helping children overcome feelings of Abstract: BACKGROUND: Early recognition of heart shame are described. Directions for future research that disease is an important goal in pediatrics. Efforts in may further our understanding of the development, developing an inexpensive screening device that can impact, and treatment of feelings of shame are assist in the differentiation between innocent and suggested. pathological heart murmurs have met with limited success. Artificial neural networks (ANNs) are Deech R. Assisted reproductive techniques and the law. Med valuable tools used in complex pattern recognition and Leg J 2001; 69(Pt 1):13-24. classification tasks. The aim of the present study was to train an ANN to distinguish between innocent and 444
- 453. pathological murmurs effectively.METHODS AND related potential (ERP) results obtained in infants RESULTS: Using an electronic stethoscope, heart during phoneme discrimination tasks and compare sounds were recorded from 69 patients (37 pathological them to results from the adult literature. The striking and 32 innocent murmurs). Sound samples were similarities observed both in behavior and ERPs processed using digital signal analysis and fed into a between initial and mature stages suggest a continuity custom ANN. With optimal settings, sensitivities and in processing and neural structure. We argue that specificities of 100% were obtained on the data infants have access at the beginning of life to phonemic collected with the ANN classification system representations, which are modified without training or developed. For future unknowns, our results suggest implicit instruction, but by the statistical distributions the generalization would improve with better of speech input in order to converge to the native representation of all classes in the training data. phonemic categories. CONCLUSION: We demonstrated that ANNs show significant potential in their use as an accurate Delahanty DL, Nugent NR, Christopher NC, Walsh M. diagnostic tool for the classification of heart sound data Initial urinary epinephrine and cortisol levels predict into innocent and pathological classes. This technology acute PTSD symptoms in child trauma victims. offers great promise for the development of a device Psychoneuroendocrinology 2005; 30(2):121-8. for high-volume screening of children for heart disease. Abstract: BACKGROUND: Previous research examining biological correlates of posttraumatic stress Degue S, DiLillo D. Understanding perpetrators of disorder (PTSD) in children has suggested that children nonphysical sexual coercion: characteristics of those with chronic PTSD have altered levels of who cross the line. Violence Vict 2004; 19(6):673-88. catecholamines and cortisol compared to similarly Abstract: Sexual coercion is defined here as a form of traumatized children who do not meet diagnostic male sexual misconduct in which nonphysical tactics criteria. The present study extended these findings by (e.g., verbal pressure) are utilized to gain sexual examining whether urinary hormone levels collected contact with an unwilling female partner. This study soon after a trauma were related to subsequent acute compares the risk characteristics of sexually coercive PTSD symptoms in child trauma victims. METHODS: (n=81) and nonoffending college males (n=223) across Initial 12-h urine samples were collected from 82 several domains. Results revealed that sexual coercers children aged 8-18 admitted to a Level 1 trauma center. differed from nonoffenders in that they more often Collection was begun immediately upon admission, subscribed to rape myths, viewed interpersonal and samples were assayed for levels of catecholamines violence as more acceptable, reported greater hostility and cortisol. PTSD and depressive symptomatology toward females, and perceived male-female were assessed 6 weeks following the accident. relationships as more inherently adversarial. In RESULTS: Initial urinary cortisol levels were addition, compared to nonoffenders, sexually coercive significantly correlated with subsequent acute PTSD males showed stronger indicators of promiscuity and symptoms (r=0.31). After removing the variance delinquency, reported more psychopathic personality associated with demographic variables and depressive traits, had more empathic deficits, and were more symptoms, urinary cortisol and epinephrine levels likely to have experienced certain forms of childhood continued to predict a significant percentage (7-10%) abuse. In most respects, coercers did not differ from of the variance in 6-week PTSD symptoms. those who reported engaging in more severe forms of Examination of boys and girls separately suggested that sexual assault involving the use of physical force. significance was primarily driven by the strength of the These results suggest important differences between relationships between hormone levels and acute PTSD nonoffending males and those who "cross the line" by symptoms in boys. CONCLUSIONS: The present engaging in sexually coercive acts. In addition, findings suggest that high initial urinary cortisol and consistent parallels can be drawn between the epinephrine levels immediately following a traumatic predictors of sexual coercion identified in this study event may be associated with increased risk for the and those documented in the sexual aggression (e.g., development of subsequent acute PTSD symptoms, forcible rape) literature. especially in boys. Dehaene-Lambertz G, Gliga T. Common neural basis for Delaney-Black V, Covington C, Ondersma SJ et al. phoneme processing in infants and adults. J Cogn Violence exposure, trauma, and IQ and/or reading Neurosci 2004; 16(8):1375-87. deficits among urban children. Arch Pediatr Adolesc Abstract: Investigating the degree of similarity between Med 2002; 156(3):280-5. infants' and adults' representation of speech is critical Abstract: BACKGROUND: Exposure to violence in to our understanding of infants' ability to acquire childhood has been associated with lower school language. Phoneme perception plays a crucial role in grades. However, the association between violence language processing, and numerous behavioral studies exposure and performance on standardized tests (such have demonstrated similar capacities in infants and as IQ or academic achievement) in children is adults, but are these subserved by the same neural unknown. It is also not known whether violence substrates or networks? In this article, we review event- exposure itself or subsequent symptoms of trauma are 445
- 454. primarily responsible fornegative outcomes. evidence; look to other clinical sources for best OBJECTIVE: To examine the relationship between practice ideas; evaluate what you have; and make a violence exposure and trauma-related distress and decision to maintain the status quo, gather more data, standardized test performance among early school-aged or change practice. This clinical project is an example urban children, controlling for important potential of the collaborative, interdisciplinary nature of EBP, confounders. DESIGN: A total of 299 urban first-grade and it is also an example of the collaborative work children and their caregivers were evaluated using self- among differently skilled nurses. In this instance, a report, interview, and standardized tests. MAIN clinically based nurse identified a practice problem and OUTCOME MEASURES: The child's IQ (Wechsler recruited a nurse researcher to help design, analyze, Preschool and Primary Scale of Intelligence--Revised) and evaluate the findings from an interview study. The and reading ability (Test of Early Reading Ability, results are being implemented via nursing leadership to second edition) were the outcomes of interest. change practice. RESULTS: After controlling for confounders (child's gender, caregiver's IQ, home environment, Demaurex CG, Geyer-Smadja I, Ansermet F. [Role of socioeconomic status, and prenatal exposure to secondary prevention in a specialized consultation for substance abuse) violence exposure was related to the sexual abuse and negligence]. Rev Med Suisse child's IQ (P =.01) and reading ability (P =.045). Romande 2001; 121(7):507-12. Trauma-related distress accounted for additional variance in reading ability (P =.01). Using the derived DeMause L. The evolution of childrearing. J Psychohist regression equation to estimate effect sizes, a child 2001; 28(4):362-451. experiencing both violence exposure and trauma- related distress at or above the 90th percentile would be DeMause L. The evolution of the psyche and society. J expected to have a 7.5-point (SD, 0.5) decrement in IQ Psychohist 2002; 29(3):238-85. and a 9.8-point (SD, 0.66) decrement in reading achievement. CONCLUSION: In this study, exposure Denison R. HIV is a magnifying glass. WORLD 2001; to violence and trauma-related distress in young (124):3. children were associated with substantial decrements in IQ and reading achievement. Denning AS, Tuttle LK, Bryant VJ, Walker SP, Higgins JR. Ascertaining women's choice of title during pregnancy Delavier-Fosse S. [Role of the pediatric psychiatrist at the and childbirth. Aust N Z J Obstet Gynaecol 2002; hearing of young victims]. Soins Pediatr Pueric 2001; 42(2):125-9. (200):38-9. Abstract: METHODS: A questionnaire was administered to 958 women attending the antenatal Dell'Orfano S. The meaning of spiritual care in a pediatric clinic at Mercy Hospital for Women, Melbourne, to setting. J Pediatr Nurs 2002; 17(5):380-5. ascertain their choice of title during pregnancy Abstract: In the previous issue of the Journal of Midwifery, nursing and medical staff (376 in total) Pediatric Nursing, one type of evidence-based practice were also invited to respond to a similar questionnaire. (EBP) format was provided for potential nurse scholars RESULTS: The response rate was 73.6% from the who utilize the EBP process [MacPhee, M. (2002). survey of all women who were overwhelmingly in Journal of Pediatric Nursing, 17(4);313-20]. There are, favour of being called 'patient' as their first choice however, many potential formats to present evidence- (34%), followed by 'other' (20%) and then 'mother' based clinical practice innovations. I am eager to work (19%). Virtually all women requesting 'other' wished to with nurses who have been involved in promoting be called by their name. Women wishing to be called evidence-based nursing practice. The Journal of 'patient' for first choice did not significantly differ from Pediatric Nursing will use this column as a forum for the remainder of the study group in age, gestation, sharing evidence-based clinical practice innovations, number of previous pregnancies, or number of such as case studies, clinical teaching exemplars, and children. When women from the Family Birth Centre interdisciplinary programs highlighting collaborative (FBC) were analysed as a separate group, they had a practice among nurses and other health care clear preference to be called 'other' (unanimously, by professionals. Please contact me at their name) than the general antenatal population (odds maura80521@yahoo.com for editorial advice and ratio (OR) 5.1; 95% confidence interval (CI) 3.1, 8.3; p assistance. The following article is a clinical < 0.0001). The staff survey, with a response rate of contribution from a nurse on the Neurosurgery- 84%, also demonstrated that 'patient' was the most Rehabilitation Unit of The Children's Hospital, Denver. popular first choice for patient title. Medical staff were This evidence-based clinical project evolved from a significantly more likely to choose 'patient' (OR 4.2, nurse's recognition of the importance of spiritual care 95% CI 2.3, 7.7; p < 0.0001), though the term 'patient' for families of children with serious brain injuries. It is was the preferred choice of all staff. an example of how an EBP formula can facilitate change and innovation. Start with a clinical problem; Denninghoff KR, Knox L, Cunningham R, Partain S. get help; look to the literature for best research 446
- 455. Emergency medicine: competenciesfor youth violence past 12 months was 10.4% (95% confidence interval prevention and control. Acad Emerg Med 2002; [CI], 9.7%-11.1%), 22.6% (95% CI, 21.6%-23.6%), 9(9):947-56. and 3.9% (95% CI, 3.4%-4.4%), respectively. Thirty- Abstract: By any standard one wishes to apply, the eight percent of asthmatic subjects had visited the impact of violence on the health and safety of the emergency department or have been hospitalized, and public is significant. The expression of violence among 50% reported lost school days and workdays. Seventy- children in the United States has increased significantly six percent of sampled asthmatic patients were during the modern era. Homicide and suicide are the considered to be atopic. CONCLUSIONS: The burden second and third leading causes of death in youths 15- of disease and societal consequences of allergic entities 24 years of age. The emergency department (ED) is a in urban settings in countries such as Colombia are of common site for the care of these victims, and because concern but are largely ignored, perhaps because of the victims often become assailants, the emergency care misconception that these diseases are of public health provider needs to know the epidemiology, treatment, importance only in industrialized nations. and methods for prevention of youth violence in order to curtail the cycle. A multidisciplinary task force was Dennis TA, Brotman LM. Effortful control, attention, and convened by the Centers for Disease Control and aggressive behavior in preschoolers at risk for conduct Prevention (CDC)-funded Southern California Center problems. Ann N Y Acad Sci 2003; 1008:252-5. of Academic Excellence on Youth Violence Prevention Abstract: This work examines distinct aspects of and the Keck School of Medicine at the University of effortful control and attention predicted aggression in a Southern California to define competencies for health group of children at elevated risk for the development professionals in youth violence prevention and control. of conduct problems. Results suggested that behavioral Three levels of competence were identified: the inhibition, rather than attentional control, best generalist level, which should be obtained by all health predicted maternal reports of child aggressive professionals; the specialist level, which should be behaviors. obtained by health professionals such as emergency medicine providers, who frequently work with Deodhar J. Telemedicine by email--experience in neonatal populations affected by violence; and a third, or scholar care at a primary care facility in rural India. J Telemed level, to be acquired by health professionals who wish Telecare 2002; 8 Suppl 2:20-1. to become experts not only in the care, but also in Abstract: During an 18-month study period, research and advocacy. This article reports the details teleconsultations were conducted by email between a of this group's efforts and applies them to emergency neonatal intensive care unit at an urban teaching care provider education. These competencies should hospital in western India and a rural primary care shape the development of curricula for the span of centre 40 km away. There were email consultations emergency medical training from emergency medical about 182 newborn babies; these consultations services scholastic training to postgraduate continuous comprised 309 messages sent from the primary care medical education. centre and 272 messages from the teaching hospital. The average reply time was 11.3 h. Thirty-eight babies Dennis R, Caraballo L, Garcia E et al. Asthma and other were referred to the intensive care unit at the teaching allergic conditions in Colombia: a study in 6 cities. hospital after these consultations. The remaining 144 Ann Allergy Asthma Immunol 2004; 93(6):568-74. babies were managed at the primary care centre. Abstract: BACKGROUND: No detailed information is Telemedicine helped in the diagnosis, referral, available on the burden and impact of allergic diseases treatment and follow-up of patients. The cost of the simultaneously for adults and children in Colombia and email service was estimated to be Rs12,000 and the most Latin American countries. OBJECTIVES: To savings in avoided transfer were estimated to be investigate the prevalence of asthma, allergic rhinitis, Rs546,000, a cost-benefit ratio of 1:45. and atopic dermatitis symptoms in 6 cities in Colombia; to measure patient expenses and school days DePompei R, Frye D, DuFore M, Hunt P. Traumatic Brain and workdays lost; to describe disease severity; and to Injury Collaborative Planning Group: a protocol for determine levels of total and specific IgE in asthmatic community intervention. J Head Trauma Rehabil 2001; subjects. METHODS: A multistage stratified random 16(3):217-37. sample selection of schools with subjects aged 5 to 18 Abstract: OBJECTIVE: The Traumatic Brain Injury years in each city was used. Guardian subjects selected Collaborative Planning Group was formed in were contacted, and home visits were arranged. December 1992 to address service gaps and better use Subjects aged 1 to 4 years and older than 19 years were agencies and their programs to meet the specialized also selected randomly by systematic sampling based needs of individuals with traumatic brain injury (TBI). on the addresses of the subjects aged 5 to 18 years. SETTING: The group meetings served as the Subjects with asthma symptoms were invited to interagency link between service providers for provide a blood sample. RESULTS: Information was comprehensive planning and problem solving. obtained from 6,507 subjects. The prevalence of OUTCOME MEASURES: This article focuses on the asthma, rhinitis, and atopic dermatitis symptoms in the 447
- 456. three main tasksof this group: (1) interagency case research/research design planning among participating agencies; (2) provision of Abstract: The term "false memories" has been used to training and networking opportunities for service refer to suggestibility experiments in which whole providers working with this population; (3) events are apparently confabulated and in media development of creative funding mechanisms for accounts of contested memories of childhood abuse. community education and support services to assist Since 1992 psychologists have increasingly used the individuals to live and work in the community. term "false memory" when discussing memory errors METHODS: The methods used to organize the for details, such as specific words within lists. Use of collaborative, direct it toward the three main tasks, and the term to refer to errors in details is a shift in maintain it without any agency funding are outlined. language away from other terms used historically (e.g., RESULTS: Data collected about the 21 persons served "memory intrusions"). We empirically examine this in the past 3 years is provided, and protocol forms are shift in language and discuss implications of the new shared. CONCLUSION: This model of collaboration use of the term "false memories." Use of the term throughout a countywide area has been used as a basis presents serious ethical challenges to the data- for similar development in several other states. interpretation process by encouraging over- generalization and misapplication of research findings Depoortere E, Checchi F, Broillet F et al. Violence and on word memory to social issues. mortality in West Darfur, Sudan (2003-04): epidemiological evidence from four surveys. Lancet Desai N, Mathur M. Selective transmission of multidrug 2004; 364(9442):1315-20. resistant HIV to a newborn related to poor maternal Abstract: BACKGROUND: Violence in Darfur, Sudan, adherence. Sex Transm Infect 2003; 79(5):419-21. has rendered more than one million people internally Abstract: OBJECTIVES: To report perinatal displaced. An epidemiological study of the effect of transmission of multidrug resistant (MDR) HIV related armed incursions on mortality in Darfur was needed to to variable maternal adherence antenatally. provide a basis for appropriate assistance to internally METHODS: Case study including review of clinic displaced people. METHODS: Between April and records, adherence information, laboratory data, and June, 2004, we did retrospective cluster surveys among HIV genotyping results in mother and infant. 215?400 internally displaced people in four sites of RESULTS: Poor maternal adherence to clinic visits West Darfur (Zalingei, Murnei, Niertiti, El Geneina). and antiretroviral therapy contributed to detectable Mortality recall periods covered both the pre- viraemia antenatally. When tested for the first time at displacement and post-displacement periods in age 6 months, the infant was found to have virus with Zalingei, Murnei, and Niertiti, but not in El Geneina. resistance to multiple drugs. In this case, prophylaxis Heads of households provided dates, causes, and places with zidovudine (AZT) failed to prevent the of deaths, and described the family structure. transmission of the MDR strain. CONCLUSIONS: FINDINGS: Before arrival at displacement sites, Perinatal transmission of MDR HIV can occur despite mortality rates (expressed as deaths per 10?000 per standard peripartum prophylaxis with AZT. Perinatal day), were 5.9 (95% CI 2.2-14.9) in Zalingei, 9.5 (6.4- prophylaxis should be tailored to the mother's treatment 14.0) in Murnei, and 7.3 (3.2-15.7) in Niertiti. Violence history and resistance profile. Paediatric HIV caused 68-93% of these deaths. People who were killed specialists should be prepared to deal with a small, but were mostly adult men (relative risk 29.1-117.9 slowly increasing number of babies with a "nightmare" compared with children younger than 15 years), but multidrug resistant virus with limited treatment included women and children. Most households fled options. because of direct village attacks. In camps, mortality rates fell but remained above the emergency DesGeorges J. Family perceptions of early hearing, benchmark, with a peak of 5.6 in El Geneina. Violence detection, and intervention systems: listening to and persisted even after displacement. Age and sex learning from families. Ment Retard Dev Disabil Res pyramids of surviving populations were skewed, with a Rev 2003; 9(2):89-93. deficit in men. INTERPRETATION: This study, which Abstract: As universal newborn hearing systems was done in a difficult setting, provides (screening, diagnosis, intervention) are being epidemiological evidence of this conflict's effect on established around the world, the success of children civilians, confirming the serious nature of the crisis, who are identified to be deaf and hard of hearing is and reinforcing findings from other war contexts. critically impacted by parent's reactions, acceptance, and advocacy for their child. It is imperative for DePrince AP, Allard CB, Oh H, Freyd JJ. What's in a name professionals who are creating systems for Early for memory errors? Implications and ethical issues Hearing, Detection, and Intervention to understand and arising from the use of the term "false memory" for learn from families' experiences in order to improve errors in memory for details. Ethics Behav 2004; this process. This manuscript will identify the areas in 14(3):201-33. which parents have spoken out about the professionals Notes: GENERAL NOTE: KIE: 28 refs. they have encountered through the system: what GENERAL NOTE: KIE: KIE Bib: behavioral parents wish for in a healthy, productive relationship 448
- 457. with professionals; andhow parents can play a part in Haemophilus influenzae type b, 0.81 (0.52-1.27) for advocating for a system in which families needs are hepatitis B vaccine, 1.16 (0.72-1.89) for varicella met so that infants identified to be deaf or hard of vaccine, and 0.92 (0.53-1.57) for acellular pertussis- hearing can reach their full potential. containing vaccines. Compared with children who had not received hepatitis B vaccine, the OR of diabetes DeStefano F, Mullooly JP, Okoro CA et al. Childhood was 0.51 (0.23-1.15) for children vaccinated at birth vaccinations, vaccination timing, and risk of type 1 and 0.86 (0.54-1.35) for those first vaccinated against diabetes mellitus. Pediatrics 2001; 108(6):E112. hepatitis B at 2 months of age or later. Race and Notes: CORPORATE NAME: Vaccine Safety Datalink ethnicity and family history of diabetes were Team independently associated with risk of type 1 diabetes, Abstract: OBJECTIVES: To evaluate suggested but adjustment for these factors did not materially alter associations between childhood vaccinations, the ORs for any of the vaccines. CONCLUSIONS: In particularly against hepatitis B and Haemophilus this large, population-based, case-control study, we did influenzae type b, and risk of developing type 1 not find an increased risk of type 1 diabetes associated diabetes; and to determine whether timing of with any of the routinely recommended childhood vaccination influences risk. METHODS: We vaccines. Our study adds to previous research by conducted a case-control study within 4 health providing data on newer vaccines, including hepatitis maintenance organizations (HMOs) that participate in B, acellular pertussis, and varicella vaccines. For the the Vaccine Safety Datalink project of the Centers for older vaccines, our results are generally in agreement Disease Control and Prevention. Study eligibility was with previous studies in not finding any increased risks. restricted to children who met the following criteria: 1) Ours is the first epidemiologic study to evaluate the born during 1988 through 1997; 2) HMO member possibility that timing of vaccination is related to risk since birth; 3) continuously enrolled for first 6 months of clinical diabetes in children. Our results on hepatitis of life; and 4) at least 12 months of HMO membership B vaccine do not support the hypothesis; risk of type 1 before diabetes incidence date (or index date for diabetes was not different between infants vaccinated controls) unless incidence date was before 12 months at birth and those who received their first vaccination of age. All 4 HMOs maintain registries of their later in life. The results of our study and the members who have diabetes, and we used the registries preponderance of epidemiologic evidence do not to identify potential cases of diabetes. We conducted support an association between any of the chart reviews to verify that potential cases met the recommended childhood vaccines and an increased risk World Health Organization epidemiologic case of type 1 diabetes. Suggestions that diabetes risk in definition for type 1 diabetes mellitus (ie, a physician's humans may be altered by changes in the timing of diagnosis of diabetes plus treatment with daily insulin vaccinations also are unfounded. injections). We defined the incidence date of diabetes as the first date that the child received a diagnosis of Deutchman M, Roberts RG. VBAC: protecting patients, diabetes. We attempted to match 3 controls to each defending doctors. Am Fam Physician 2003; case. Controls had the same eligibility criteria as cases 67(5):931-2, 935-6. and were matched to individual cases on HMO, sex, date of birth (within 7 days), and length of health plan DeVeber G. In pursuit of evidence-based treatments for enrollment (up to the incidence or index date). The paediatric stroke: the UK and Chest guidelines. Lancet index date for controls was defined as the incidence Neurol 2005; 4(7):432-6. date of the case to which the control was matched. Abstract: BACKGROUND: Arterial ischaemic stroke Chart abstraction was performed by trained chart and cerebral sinovenous thrombosis are increasingly abstractors using standardized forms. In addition to seen in infants and children. Incidence ranges from two complete vaccination histories, the chart abstraction to six per 100,000 children a year. Adverse outcome forms for both cases and controls included information including death, neurological deficits, and reduced on sociodemographic characteristics, selected medical quality of life affect most children with stroke. conditions, history of breastfeeding, and family Residual neurological deficits last many decades, for medical history. We used conditional logistic the rest of a patient's life. Of major concern is the risk regression to estimate the odds ratio (OR) of diabetes of recurrent stroke, which affects up to 25% of children associated with vaccination, with vaccine exposure who have arterial ischaemic stroke after the newborn defined as before the diabetes incidence date (or index period. Children with ischaemic stroke are empirically date for controls). RESULTS: Two hundred fifty-two treated with antithrombotics including antiplatelet confirmed cases of diabetes and 768 matched controls (aspirin and clopidogrel) and anticoagulant (heparins met the study eligibility criteria. The OR (95% and warfarin) drugs. No randomised controlled trials confidence interval) for the association with type 1 have been done besides those in patients with sickle- diabetes was 0.28 (0.07-1.06) for whole cell pertussis cell disease and adult trial data are not directly vaccine (predominantly in combination as diphtheria, applicable to paediatric stroke due to maturational tetanus toxoids and pertussis vaccine), 1.36 (0.70-2.63) differences in coagulation and vascular systems as well for measles-mumps-rubella, 1.14 (0.51-2.57) for as different stroke mechanisms. RECENT 449
- 458. DEVELOPMENTS: National andinternational preschoolers. These data suggest that a specific type of networks of clinical and basic researchers focused on insecure attachment, a coercive pattern, is associated paediatric stroke are now developing. Recently with disruptive behavior in preschoolers. Also, the data published cohort and case-controlled studies are are consistent with previous findings of associations elucidating stroke mechanisms, outcomes, and among marital dissatisfaction, ineffective parenting treatment safety in children. Two sets of guidelines practices, and disruptive behavior. have been published in the past 6 months. These guidelines differ both in the scope of treatments and Dewey KG, Cohen RJ, Nommsen-Rivers LA, Heinig MJ. subgroups of patients with stroke they cover; however, Implementation of the WHO Multicentre Growth both focus on ischaemic stroke beyond the newborn Reference Study in the United States. Food Nutr Bull period. There are areas of agreement-for children with 2004; 25(1):S84-9. sickle-cell disease and stroke, both guidelines Abstract: The World Health Organization (WHO) recommend initial and maintenance transfusion therapy Multicentre Growth Reference Study (MRGS) North to reduce the proportion of sickle-cell haemoglobin to American site was Davis, California. For the less than 30%. For children with sinovenous longitudinal cohort (0-24 months), 208 infants were thrombosis or arterial stroke due to dissection or enrolled between January and December 1999 from cardiac embolism, both guidelines recommend five area hospitals at which nearly all Davis women anticoagulant therapy with warfarin or low molecular give birth. The target sample size was lower in the weight heparin for 3-6 months. However, the United States than in the other sites, because guidelines diverge in their recommendations for the recruitment in the United States was restricted to initial treatment of non-haemorrhagic arterial mothers who were willing to exclusively breastfeed for ischaemic stroke, one recommending aspirin and the at least 4 months and continue breastfeeding for at least other 5-7 days of anticoagulants. The guidelines also 12 months. For the cross-sectional component, a differ in their recommendations for long-term mixed-longitudinal design was used, which required treatment of children after arterial ischaemic stroke, approximately 500 subjects. The subjects were one set recommending maintenance aspirin in all recruited by going door-to-door, with the sampling patients and the other only in children with scheme based on the distribution of the subjects of the vasculopathy. These differences arise from both a lack longitudinal study within the city. The cross-sectional of sufficient evidence and the differing views of sample was recruited between January and July 2001. neurologists and haematologists in the treatment of Major challenges during implementation were paediatric cerebral thrombosis. WHERE NEXT?: maintaining daily communication with hospital Multicentre studies and networks provide increasingly personnel and scheduling home visits. precise data regarding mechanisms, outcomes, and treatment safety in paediatric stroke. These data and Dhanda RK, Reilly PR. Legal and ethical issues of newborn networks will enable clinical trials to address areas of screening. Pediatr Ann 2003; 32(8):540-6. divergent opinion and improve the outcome from Abstract: Newborn screening raises many ethical and childhood stroke in the near future. legal concerns, from the bioethics issues commonly faced with genetic testing and the practice of informed DeVito C, Hopkins J. Attachment, parenting, and marital consent to the classical medical ethics questions that dissatisfaction as predictors of disruptive behavior in surround resource allocation. This mandatory, state- preschoolers. Dev Psychopathol 2001; 13(2):215-31. based healthcare intervention has not met with the Abstract: The aim of this study was to examine if an resistance that one might have anticipated, yet it is still insecure coercive attachment pattern is associated with not integrated into society to its full potential. While disruptive behavior in preschoolers, as well as to there is room for newborn screening programs to examine the concurrent and joint effects of attachment improve on the technical, ethical, and legal fronts, this pattern, marital dissatisfaction, and ineffective should not discourage policymakers, physicians, parenting practices on disruptive behavior. Participants scientists, and other stak-holders from learning from included 60 preschoolers and their mothers, recruited the successful aspects of its implementation and from three sites to ensure an adequate range of applying these lessons to other, related technologies. disruptive behavior. The Preschool Assessment of Attachment (Crittenden, 1992) was used to measure Dhondt JL. Implementation of informed consent for a cystic attachment pattern. Results of an analysis of variance fibrosis newborn screening program in France: low revealed that children in the coercively attached dyads refusal rates for optional testing. J Pediatr 2005; 147(3 scored significantly higher on the measure of disruptive Suppl):S106-8. behavior than either the defended or secure children. Abstract: OBJECTIVES: The French Association for Results of a hierarchical regression analysis indicated Neonatal Screening implemented cystic fibrosis that the combination of a coercive pattern of neonatal screening (CF NBS) region by region in attachment, marital dissatisfaction, and permissive France, from the beginning of the year 2002 to early parenting practices accounted for a significant 2003. The program uses an immunoreactive proportion of the variance in disruptive behavior in 450
- 459. trypsinogen/DNA testing algorithmon dried blood partners shared the same philosophical goals. Faculty samples obtained at 3 days of age. Incorporation of and staff with different skills were needed during the DNA testing necessitated compliance with official start-up and the sustained development phases of the regulations and French "bioethics" laws: the need for a program. written consent from the patient/guardian and specific circulation of the prescription, sample, and results. To Diaz-Rossello JL. A difficult ethics issue. Lancet 2004; fulfill these obligations, the Ethics and Genetics 364(9447):1751-2; author reply 1752. committee of the French Association for Neonatal Notes: GENERAL NOTE: KIE: KIE Bib: human Screening recommended that informed consent should experimentation/informed consent be obtained for all neonates at birth by having the parents sign directly on the sampling paper. This study Dick T. Poor little kid: confronting suspicious injuries in was designed to evaluate the effect of the educational children. Emerg Med Serv 2004; 33(7):28. efforts used to obtain informed consent on acceptance of CF NBS. STUDY DESIGN: Data from the Dickens BM, Cook RJ. The management of severely screening center in Lille, France, were analyzed to malformed newborn infants: the case of conjoined determine the rate of refusal of CF NBS in the 18 twins. Int J Gynaecol Obstet 2001; 73(1):69-75. months after initiation of the informed consent process. Notes: GENERAL NOTE: KIE: 19 refs. RESULTS: The number of refusals for CF NBS GENERAL NOTE: KIE: KIE Bib: patient care/minors declined from 0.8% at the start of the program to 0.2% Abstract: The birth of 'Siamese' twins in August 2000 at the end of the first year of the new process for whose parents refused to consent to surgery for obtaining written consent. CONCLUSIONS: Efforts to separation required English courts to decide whether inform parents and professionals resulted in a the twins could lawfully be separated despite that significant decrease in the number of refusals for CF refusal when one twin would certainly die as a direct NBS. surgical result. The Court of Appeal unanimously upheld the trial judge's decision to authorize surgery, Diamond EF. Karl Brandt in the dock. Linacre Q 2004; taking account of principles of family law, criminal law 71(4):308-15. and human rights law. Parental duties to the viable twin Notes: GENERAL NOTE: KIE: KIE Bib: eugenics; were found consistent with the justification of euthanasia; fraud and misconduct allowing, without intending, natural death of the non- viable twin. The right to human dignity of both twins Diamond R, Litwak E, Marshall S, Diamond A. supported the justification of separation surgery. The Implementing a community-based oral health care decision did not elevate physicians' choices over program: lessons learned. J Public Health Dent 2003; parents', but subjected both to the law. The hospital 63(4):240-3. was found entitled to bring the case to court, but not Abstract: OBJECTIVES: The objective of this paper is obliged; it could have declined surgery in conformity to report key findings of a process evaluation that may with the parents' wishes. be useful to other institutions seeking to implement a community-based oral health care program primarily Dickinson A. A new "time out". Parents who want to targeting children in dentally underserved discipline their misbehaving kids should apply the communities. By partnering with community-based hiatus to themselves. Time 2001; 157(6):89. organizations, public schools, and community health care providers, the Columbia University School of Oral Didion J, Gatzke H. The Baby Think It Over experience to and Dental Surgery (SDOS) established the prevent teen pregnancy: a postintervention evaluation. Community DentCare Network (DentCare) in the Public Health Nurs 2004; 21(4):331-7. Harlem and Washington Heights/Inwood Abstract: An evaluation was conducted to describe the neighborhoods of northern Manhattan. These low- personal impact of the "In Your Care" pregnancy income neighborhoods are characterized by poor oral prevention intervention program using Baby Think It health and have been designated by the federal Over infant simulator. Data was collected regarding the government as health professions shortage areas. attitudes, actual and intended sexual practices, feelings, METHODS: The method used in the process and opinions of participants 2 or 3 years after the evaluation was open-ended qualitative interviewing by intervention. Student recommendations for program a sociologist with extensive experience in this continuation and improvement were also solicited. methodology aided by a participant-observer within the Male and female 11(th) grade students in rural and DentCare program. RESULTS: The heterogeneity of suburban Midwestern communities, who had the two communities required different strategies and experienced the program 2 or 3 years earlier, resources to gain trust and acceptance. Fundamental completed surveys and were interviewed in focus changes were required of SDOS over a 10-year period, groups. Participants vividly recalled and described the beginning with prioritizing community service into a simulated experience in statements that reflected primary mission. Collaborating with medical clinics insight and feelings about parental responsibility and facilitated the implementation of the network when the 451
- 460. the consequences ofteen pregnancy. The teens also follows the EBP process of: (1) identifying a clinical made several recommendations for enhancing the problem and stating a clinical question that focuses the program. The findings suggest that simulated process; (2) doing a literature search for best research experiences can be a powerful strategy for effective evidence; (3) using query techniques, such as phone learning about complex decisions regarding the risks of calls and e-mails, to determine best clinical practice sexual activity and the realities of parenting. among similar institutions; and (4) drawing a practice conclusion-to accept the status quo, to instigate change Didziokiene A, Zemaitiene N. [Psychological state of abused of practice, or to do more research. This project was an children of risk group]. Medicina (Kaunas) 2005; interdisciplinary effort orchestrated by the surgical 41(1):59-66. programs nurses at Boston Children's Hospital. Abstract: The aim of this study was to describe the psychological peculiarities of physically abused DiFranza JR, Savageau JA, Rigotti NA et al. Development schoolchildren of risk group. The survey was based on of symptoms of tobacco dependence in youths: 30 the data gathered using anonymous questionnaire. month follow up data from the DANDY study. Tob Indicators, chosen for evaluation of psychological well- Control 2002; 11(3):228-35. being of schoolchildren, were the following: loneliness, Abstract: OBJECTIVE: To determine if there is a happiness, ability to make contacts and socialize with minimum duration, frequency or quantity of tobacco peers, sense of coherence, self-esteem, and suicidal use required to develop symptoms of dependence. tendencies. The sample of 211 schoolchildren, aged 10 DESIGN AND SETTING: A retrospective/prospective to 16 year from seventeen Kaunas secondary schools longitudinal study of the natural history of tobacco participated in the survey. The sampling was made on dependence employing individual interviews the basis of lists of socially and pedagogically conducted three times annually in two urban school neglected schoolchildren. It has been established that systems over 30 months. Detailed histories of tobacco psychological well-being of physically abused use were obtained including dates, duration, frequency, schoolchildren, in comparison with the ones not quantity, patterns of use, types of tobacco, and abused, was worse. Physically abused children more symptoms of dependence. PARTICIPANTS: A cohort often felt loneliness and unhappiness, found it more of 679 seventh grade students (age 12-13 years). MAIN difficult to make friends, were more often OUTCOME MEASURES: The report of any of 11 characterized by low self-esteem and weak sense of symptoms of dependence. RESULTS: Among 332 coherence. The relationship between physical abuse subjects who had used tobacco, 40% reported and suicidal tendencies was established; suicidal symptoms, with a median latency from the onset of tendencies among physically abused schoolchildren monthly smoking of 21 days for girls and 183 days for were six times more frequent than among those, who boys. The median frequency of use at the onset of did not suffer violence (78.5% and 12.5%). Almost all symptoms was two cigarettes, one day per week. The schoolchildren, attributed to the group with high risk report of one or more symptoms predicted continued for suicide, were physically abused (29.0% and 1.9%, smoking through the end of follow up (odds ratio (OR) respectively). 44, 95% confidence interval (CI) 17 to 114, p < 0.001). CONCLUSIONS: Symptoms of tobacco dependence Diehl D, Gray C, O'Connor G. The school community commonly develop rapidly after the onset of council: creating an environment for student success. intermittent smoking, although individuals differ New Dir Youth Dev 2005; (107):65-72, table of widely in this regard. Girls tend to develop symptoms contents. faster. There does not appear to be a minimum nicotine Abstract: A model of community-school partnerships is dose or duration of use as a prerequisite for symptoms developing within a school district in Evansville, to appear. The development of a single symptom Indiana. Based on a full-service community school strongly predicted continued use, supporting the theory philosophy, the model started in one elementary school that the loss of autonomy over tobacco use begins with in the Evansville-Vanderburgh School Corporation and the first symptom of dependence. has expanded into a districtwide initiative called the School Community Council. The council is made up of Dillard JP, Tluczek A. Information flow after a positive over seventy community organizations and social newborn screening for cystic fibrosis. J Pediatr 2005; service agencies working together to establish full- 147(3 Suppl):S94-7. service schools as places of community and to enhance Abstract: OBJECTIVES: To provide a model of the youth and family development. information processes instigated by a positive result on a newborn screening for cystic fibrosis and to analyze Difazio R. Creating a halo traction wheelchair resource their implications for future research. METHOD: We manual: using the EBP approach. J Pediatr Nurs 2003; reviewed research conducted at Wisconsin and 18(2):148-52. elsewhere. RESULTS: We identified 6 distinct phases Abstract: This article describes a clinically based of information flow. CONCLUSION: Although project that used evidence-based practice (EBP). It continued attention to genetic counseling is clearly warranted, research on information flow after newborn 452
- 461. screening should: 1)look beyond genetic counseling to linked to provide regional services and coordination on include a variety of information sources including a statewide basis. family, friends, and the Internet; 2) appreciate that families vary in their willingness to acquire cystic Dimond B. Legal aspects of consent 14: organ removal, fibrosis-related information; and 3) should seek to retention, storage. Br J Nurs 2001; 10(18):1212-4. better understand how this information moves through Notes: GENERAL NOTE: KIE: 14 refs. social networks. GENERAL NOTE: KIE: KIE Bib: informed consent; organ and tissue donation Dimatteo MR. The role of effective communication with Abstract: Case Scenario: Sarah was born with a children and their families in fostering adherence to congenital heart condition. Unfortunately, the pediatric regimens. Patient Educ Couns 2004; subsequent operation proved unsuccessful and Sarah 55(3):339-44. died. Sarah's parents were asked if they would agree to Abstract: Adherence to pediatric health enhancement, a post mortem being performed to assist in research so disease prevention, and medical treatment, particularly that in future such conditions could be successfully for chronic disease, can be challenging because of operated upon. The parents agreed and subsequently demanding regimens, children's progressing they were notified that the body was available for developmental stages, and varying family perspectives disposal. They decided upon a cremation. Several years and relationships. This review examines adherence in later, following an inquiry into the pathology services the context of communication among providers, of the hospital, they were notified by the Chief pediatric patients, and their families. The focus is on: Executive's department that Sarah's heart, lungs, liver the delivery of prevention and treatment information; and other organs had been retained. The parents were trust in the therapeutic relationship; beliefs and shocked. What is the law? attitudes in shaping acceptance of health care messages; social and cultural norms; building patient Dionne L. Conduct becoming. JEMS 2004; 29(3):106-17. and family commitment to behavior change; family habits; barriers and pressures faced by patients and DiRusso SM, Chahine AA, Sullivan T et al. Development of their families; the role of social networks and social a model for prediction of survival in pediatric trauma support in fostering adherence, and the effects of patients: comparison of artificial neural networks and family cohesiveness and family conflict. The unique logistic regression. J Pediatr Surg 2002; 37(7):1098- challenges of fostering preventive health care and 104; discussion 1098-104. treatment for chronic disease in the context of Abstract: BACKGROUND/PURPOSE: There is a transition to adolescence are also considered, and paucity of outcome prediction models for injured effective clinical solutions are reviewed. children. Using the National Pediatric Trauma Registry (NPTR), the authors developed an artificial neural Dimmick SL, Burgiss SG, Robbins S, Black D, Jarnagin B, network (ANN) to predict pediatric trauma death and Anders M. Outcomes of an integrated telehealth compared it with logistic regression (LR). METHODS: network demonstration project. Telemed J E Health Patients in the NPTR from 1996 through 1999 were 2003; 9(1):13-23. included. Models were generated using LR and ANN. Abstract: An integrated telehealth network that linked A data search engine was used to generate the ANN three hospitals, a federally qualified health care clinic with the best fit for the data. Input variables included with six sites, a county dental clinic, and patient homes anatomic and physiologic characteristics. There was a was developed and implemented using both private and single output variable: probability of death. Assessment federal funding. The goal of the network was to deliver of the models was for both discrimination (ROC area 10 different medical, dental, and behavioral health under the curve) and calibration (Lemeshow-Hosmer services to a rural community. The network served C-Statistic). RESULTS: There were 35,385 patients. patients from nine different counties and two states. The average age was 8.1 +/- 5.1 years, and there were Outcomes from the disease management programs for 1,047 deaths (3.0%). Both modeling systems gave congestive heart failure and diabetes, as well as crisis excellent discrimination (ROC A(z): LR = 0.964, ANN telehealth and teledental health, were reported. Results = 0.961). However, LR had only fair calibration, for the diabetes disease management program whereas the ANN model had excellent calibration (L/H increased the number of diabetics who brought their C stat: LR = 36, ANN = 10.5). CONCLUSIONS: The blood sugar under control. Additionally, based on authors were able to develop an ANN model for the hospital days per patient per year with and without prediction of pediatric trauma death, which yielded intervention, and the cost of intervention by telehealth, excellent discrimination and calibration exceeding that it was projected that the national cost of care for CHF of logistic regression. This model can be used by hospitalizations could be reduced from 8 billion dollars trauma centers to benchmark their performance in to 4.2 billion dollars. This telehealth network can serve treating the pediatric trauma population. as a model for integrating health services in each county of the state. Once each county had an integrated Diseth TH. Dissociation in children and adolescents as telehealth network, the county networks could be 453
- 462. reaction to trauma--anoverview of conceptual issues to a control condition or the ATP intervention. and neurobiological factors. Nord J Psychiatry 2005; Analyses focus on the longitudinal effects of the ATP 59(2):79-91. intervention on self-reported substance use through Abstract: The discovery of trauma as an aetiological middle school and the 1st year of high school (Grades factor in mental dissociation is more than a century old, 6, 7, 8, and 9). Levels of engagement in the selected but neurobiological research in the last decade has and indicated interventions were somewhat less than started to clarify a neurobiological basis that may shed expected. Despite relatively low levels of engagement, light on the complex symptomatology observed in the intervention reduced initiation of substance use in traumatized children. Dysfunctional stress responses, both at-risk and typically developing students. These emotional-based style of functioning, hyperarousal, findings are discussed with respect to lessons learned anxiety, irritability, impulsivity, disengaged attention about parent engagement, optimizing strategies for and educational underachievement may thus begin to schoolwide implementation, and the promise of be better understood. The aim of this overview is to embedding family interventions within the public give an update on the concept of dissociation and the school ecology. links to new neurobiological findings, hopefully to reduce unawareness, wrong diagnostics or even neglect Dixon JK. Kids need clean air: air pollution and children's of dissociative symptomatology by clinicians in child health. Fam Community Health 2002; 24(4):9-26. and adolescent psychiatry in the Nordic countries. A Abstract: Air pollution affects children's health in many systematic overview of studies of mental dissociation ways, including reduced lung function, increased in children and adolescents published over the last morbidity, increased use of health care services, and decade disclosed a total of 1019 references; 309 papers infant mortality. Information on the relationship of air regarding the concept of dissociation, memory, trauma pollution and children's health is discussed, with a and the neurobiological correlates were studied in focus on the diversity of research methods used to detail. The assumption of a trauma-genic basis of understand this relationship. Decisions affecting air dissociation is still most discussed in the literature. The quality ultimately are made through political and social importance of other childhood trauma in addition to processes. Health care and health promotion sexual abuse is outlined, focusing on childhood practitioners who are concerned about the health of interpersonal trauma. Recent research on traumatized children should provide leadership for advocacy to children and adolescents has demonstrated some promote environmental health in our communities. permanent neurochemical as well as functional and structural abnormalities in brain areas that are involved Dmitrieva OA. [Development of forensic medical expertise in the integrative process of cognition and memory. of sexual conditions in men]. Sud Med Ekspert 2005; This research begins to clarify the cerebral basis and 48(3):18-21. mechanisms for the trauma-related dissociation Abstract: The necessity of new methodological observed in dissociative (conversion) disorders, post- approaches in forensic medical examination of sexual traumatic stress disorder (PTSD) and somatoform male conditions are discussed basing on the analysis of disorders. New perspectives on the nature of questionnaire surveys of isolated groups of men and subcortical processes linking the phenomena of forensic medical examinations of male victims accused dissociation and traumatic experiences may have of sexual crimes. How to update expertise of sexual important implications for the understanding of male conditions including investigations of anorectal dissociative disorders in children and adolescents. They and erectile dysfunctions in shown. may be regarded as complex environmentally induced developmental, supporting the view that PTSD and Dmitrieva TN, Oades RD, Hauffa BP, Eggers C. somatization disorders may be specific forms of Dehydroepiandrosterone sulphate and corticotropin dissociative processes to be categorized together with levels are high in young male patients with conduct dissociative (conversion) disorders as "trauma-related disorder: comparisons for growth factors, thyroid and dissociative disorders". gonadal hormones. Neuropsychobiology 2001; 43(3):134-40. Dishion TJ, Kavanagh K, Schneiger A, Nelson S, Kaufman Abstract: Childhood conduct disorder (CD) may NK. Preventing early adolescent substance use: a originate in a stressful upbringing, and be associated family-centered strategy for the public middle school. with unusual physical or sexual development and Prev Sci 2002; 3(3):191-201. thyroid dysfunction. We therefore explored circulating Abstract: The Adolescent Transitions Program (ATP) levels of hormones from adrenal, gonadal and growth promotes student adjustment and reduces risk within a hormone axes associated with stress, aggression and public school setting, focusing primarily on parenting development in 28 CD patients and 13 age-matched practices using a tiered, multilevel prevention strategy. healthy children (10-18 years old). The CD group had A description is given of the program, levels of higher levels of dehydroepiandrosterone sulphate engagement, and intervention effects. Within each (DHEA-S), corticotropin (ACTH) and free tri- school, multiethnic students (N = 672) and their iodothyronine (fT(3)) if under 14 years. There were no families were randomly assigned at the individual level 454
- 463. differences for gonadalhormones or maturity ratings adolescents with cancer, this research is still in a which were not associated with aggression. Smaller formative but exciting stage. Two nurse researchers physical measures in CD children correlated with and their teams laid the foundation for this research DHEA-S and growth factors (e.g. insulin-like growth through their individual studies and collaborative factor I) increased ACTH and fT(3) correlated with multisite studies. In general, children and adolescents restless-impulsive ratings, and DHEA-S with from 10 through 18 years of age were primarily 'disruptive behaviour'. Imbalances in the adrenal and studied; few studies focused on preschool children. growth axes may have neurotropic repercussions in Given the fact that these are rare populations, sample development. sizes were generally small, limiting power and generalizability. Gender, ethnicity, and socioeconomic do Espirito Santo ME, Etheredge GD. HIV prevalence and status were rarely considered in analyses. Most studies sexual behaviour of male clients of brothels' prostitutes used cross-sectional designs, although several included in Dakar, Senegal. AIDS Care 2003; 15(1):53-62. short-term longitudinal or repeated measure designs. Abstract: This study reports the results of research To date, longitudinal designs focused on long-term designed to determine the prevalence of HIV infection outcomes have not been conducted. There were only a in a group of male clients of brothel prostitutes, and to few qualitative studies. There was limited use of describe characteristics associated with HIV infection conceptual models or theories, and inadequate attention in Dakar, Senegal. Clients come from the lower portion was paid to broader ecological perspectives in the of the social scale rather than from the middle class or children's lives. Studies included a focus on global from the wealthier groups of the population. A symptoms and on individual symptoms, particularly significant number of these men did not use condoms pain and fatigue. Few focused on nausea and vomiting. with their regular partners, and another group reported Operationalization of symptom distress generally sexual contact with occasional partners with whom involved adapting instruments designed for adults. A condom use was not usual. Additionally, for a fraction, more explicit employment of a developmental science condoms were not systematically used either with perspective in future studies would call for more prostitutes or with partners. HIV prevalence in clients longitudinal designs that conceptualize the symptom appeared to be much higher than the prevalence in the experience from the perspective of the child and that general population and HIV-infected clients were older view their responses as complex and multidimensional than HIV-negative clients. The significant association in nature. This would necessitate measuring clusters of between HIV infection and age can be explained by the symptoms at multiple levels (e.g., emotional, fact that older clients probably have been exposed to behavioral, and biophysiological) using developmental prostitution longer. HIV-positive clients had more data collection methods. Furthermore, attention needs contact with prostitutes during the previous seven days, to be paid in conceptualizing studies to ecological and in addition they also had more occasional sexual factors related to families, social networks, encounters than did the HIV-negative clients. This communities, and ethnicity, as well as to the ecology of demonstrates that a multiplicity of sexual partners the health care system, which likely influences the increases the risk of HIV infection beyond the contact symptom experience of children. with prostitutes for this group of men. Dodge J. Roy Meadow. Lancet 2005; 366(9484):451. Dobrin L, Rosenzweig J. The role of school nurses in recognizing, reporting, and preventing child abuse. Dogra N. What do children and young people want from School Nurse News 2005; 22(3):12, 14. mental health services? Curr Opin Psychiatry 2005; 18(4):370-3. Docherty SL. Symptom experiences of children and Abstract: PURPOSE OF REVIEW: The purpose of this adolescents with cancer. Annu Rev Nurs Res 2003; paper is to review the literature reporting on children 21:123-49. and young people's views on child and adolescent Abstract: This paper examines nursing research mental health services. RECENT FINDINGS: The focused on the symptom experiences of children and review demonstrates that there is limited research adolescents with cancer, and the extent to which the exploring the views of children and young people perspective and methods of developmental science regarding mental health services. Despite its have been used in this research. CINALH, MEDLINE, limitations, the research available shows that young and PSYCHLIT were searched for publications people, their parents and healthcare providers often between 1990 and 2002. The researcher or research have different expectations of services. Young people team had to include a nurse or developmentally want accessible services staffed by those they are able oriented researchers from other disciplines. Studies to trust and who demonstrate an ability to listen; above focused exclusively on pain were excluded because of all, young people want to be involved in the decisions recent published reviews. While nurse researchers have made about them. SUMMARY: To date, children and contributed influential knowledge related to symptom young people have not been actively engaged or experiences and symptom distress in children and involved in service development. This is an evolving field and we need to ensure that existing evidence is 455
- 464. taken into accountas well as investigating further the identify the characteristics of the perpetrators and of views of young people. Child and adolescent mental victims under 16 years, the relationship of the victim to health services need to consider how we serve young the accused and the circumstances of the offence. people, particularly children, whose perspectives may Sixty-four men singly accused of killing a single child differ from those of their parents. victim are described in detail. They were characterized by relatively young age and a lack of long-term stable Doherty IA, Padian NS, Marlow C, Aral SO. Determinants relationships. Previous psychiatric contact and/or a and consequences of sexual networks as they affect the history of self-harm was noted in one-third of cases. spread of sexually transmitted infections. J Infect Dis Over half of the group had a criminal record and 2005; 191 Suppl 1:S42-54. previous violence to children was noted in 28% of Abstract: Because pathogens spread only within the cases. Fathers or surrogate fathers accounted for nearly unique context of a sexual union between people when two-thirds of the accused. In terms of the victims, one person is infectious, the other is susceptible to new children under six months were at greatest risk. Nearly infection, and condoms are not used to prevent one-third of victims were the biological offspring of transmission, the epidemiological study of sexually the accused. Sexually motivated homicide accounted transmitted infections (STIs) is particularly for approximately 18.7% of deaths. Victim behaviours challenging. Social network analysis entails the study and domestic disharmony acted as precipitants in 64% of ties among people and how the structure and quality of the cases, with 54.7% of the victims dying as a result of such ties affect individuals and overall group of physical beatings. Alcohol consumption at the dynamics. Although ascertaining complete sexual material time was more common than noted in networks is difficult, application of this approach has previous studies of child homicide. provided unique insights into the spread of STIs that traditional individual-based epidemiological methods Dombrowski MA, Anderson GC, Santori C, Burkhammer do not capture. This article provides a brief background M. Kangaroo (skin-to-skin) care with a postpartum on the design and assessments of studies of social woman who felt depressed. MCN Am J Matern Child networks, to illustrate how these methods have been Nurs 2001; 26(4):214-6. applied to understanding the distribution of STIs, to Abstract: The mother in this case study had numerous inform the development of interventions for STI known risk factors for postpartum depression and was control. in rehabilitation for drug abuse. She was crying at 2 hours postbirth and expressing feelings of sadness as Dolan M, Fullam R. Factors influencing treatment entry in her baby was being unwrapped for her first kangaroo sex offenders against children. Med Sci Law 2005; care (KC) experience. Thereafter, during our research 45(4):303-10. protocol, her self-reported depression scores decreased Abstract: The study examined the psychosocial rapidly and had disappeared by 32 hours postbirth. A characteristics of 99 sex offenders against children benefit of KC requiring systematic study is that KC referred for treatment to a forensic community sex may lessen maternal depression. There is new offender programme. The subjects had high levels of knowledge that some functions of the maternal HPA substance misuse problems and personality disorder axis become dampened during the last trimester of but low rates of Axis I disorder. Subjects accepted for pregnancy as the placenta increases its secretion of treatment could not be distinguished from those corticotrophin-releasing hormone. The sudden loss of rejected as unsuitable on the Child Sex Questionnaire the placenta following delivery, accompanied by a (CSQ) (Beckett et al., 1994), apart from the question suppressed HPA axis, may have an effect on mood on whether or not subjects believed it was wrong to during the immediate postpartum period. Perhaps have sexual contact with children. Substance misuse, appropriate reactivation of the maternal HPA axis can antisocial personality disorder and past criminal history be triggered following birth by the stimulation inherent did not determine whether subjects were accepted or in KC, thereby minimizing risk for postpartum rejected. Differences in scores on actuarial measures of depression. risk (STATIC-99) were also not significant. Clinicians' ratings of motivation, level of denial and poor social Domok I. Factors and facts in Hungarian HIV/AIDS skills were the key factors determining rejection for epidemic, 1985-2000. Acta Microbiol Immunol Hung treatment. Reconviction rates in the treatment group 2001; 48(3-4):299-311. were low (7%) at five-year follow-up. Abstract: In Hungary among others there were some special factors, which shaped the outcome of Dolan M, Guly O, Woods P, Fullam R. Child homicide. Med HIV/AIDS epidemic. (1) In the early period of Sci Law 2003; 43(2):153-69. pandemic the "iron curtain" delayed and limited the Abstract: Between 1967 and 1988, 69 cases of single importation of HIV to Hungary. (2) In 1985, at the time perpetrator/single victim child homicide resulted in of detection of first HIV infected persons the remands into custody in the Yorkshire region. Sixty- etiological diagnostic tools were already commercially four of these cases were examined retrospectively to available and laboratory facilities have been created immediately for HIV antibody tests in networks of 456
- 465. blood banks, publichealth and venereological services. about 10 ACEs which included: childhood abuse (3) Laboratory facilities together with introduced (emotional, physical, and sexual), neglect (emotional health regulations resulted in (a) elimination of and physical), witnessing domestic violence, parental possibility of nosocomial HIV transmission by blood, marital discord, and living with substance abusing, blood products and organ transplantation; (b) efficient mentally ill, or criminal household members. The case finding and contact tracing in population groups bivariate relationship between each of these 10 ACEs potentially playing a significant role in spreading of was assessed, and multivariate linear regression models infection; (c) opportunities for voluntary HIV testing were used to describe the interrelatedness of ACEs free of charge. (4) Broad scale education and after adjusting for demographic factors. RESULTS: information activities have been developed from the Two-thirds of participants reported at least one ACE; beginning by governmental and non-governmental 81%-98% of respondents who had experienced one organizations alike. (5) Parenteral drug abuse did not ACE reported at least one additional ACE (median: play a role in spreading of HIV, so far. The above 87%). The presence of one ACE significantly increased factors resulted in a slowly developing moderate the prevalence of having additional ACEs, elevating epidemic. The facts are as follows. By the end of 2000 the adjusted odds by 2 to 17.7 times (median: 2.8). The altogether 879 HIV positive (666 male, 100 female and observed number of respondents with high ACE scores 113 anonymous) persons have been notified, 377 (344 was notably higher than the expected number under the male and 33 female) of whom showed already the assumption of independence of ACEs (p <.0001), characteristic features of AIDS and 229 died. 29% of confirming the statistical interrelatedness of ACEs. registered HIV positive persons have been foreigners CONCLUSIONS: The study provides strong evidence originating from 56 countries. The cumulative that ACEs are interrelated rather than occurring incidence rate of AIDS was 38 per million population. independently. Therefore, collecting information about 73% of Hungarian HIV positive persons and 72% of exposure to other ACEs is advisable for studies that patients with AIDS belonged to transmission group of focus on the consequences of a specific ACE. men having sex with men. The age of HIV positive Assessment of multiple ACEs allows for the potential persons at the time of detection was between 20 and 49 assessment of a graded relationship between these years in 81% and 72% of them resided in or around childhood exposures and health and social outcomes. Budapest. Donker GA, Fleming DM, Schellevis FG, Spreeuwenberg P. Donaghy G. CPHVA MacQueen Award 2005. Leading by Differences in treatment regimes, consultation example. Community Pract 2005; 78(12):449. frequency and referral patterns of diabetes mellitus in general practice in five European countries. Fam Pract Donato R, Shanahan M. The economics of child sex- 2004; 21(4):364-9. offender rehabilitation programs: beyond Prentky & Abstract: BACKGROUND: In many European Burgess. Am J Orthopsychiatry 2001; 71(1):131-9; countries, maturity onset diabetes mellitus (DM) is to a discussion 140-1. large extent managed in general practice. OBJECTIVE: Abstract: In a 1990 article in this journal, Prentky and Our aim was to compare management of DM in Burgess examined cost-effectiveness of the general practice in five European countries in order to rehabilitation of child molesters. Their estimates were contribute to international guidelines on the based on the tangible costs of incarceration and management of DM by GPs. METHODS: Routine particular recidivism rates. This paper extends those monitoring of patients presenting with DM was findings by estimating the intangible costs of child performed during a 12 month period (1999-2000) to sexual abuse and a range of recidivism rates. The result GPs in established sentinel practice surveillance is to focus greater attention on the efficacy of treatment networks in five European countries (Belgium, Croatia, programs and the potential economic damage done to England, Spain and The Netherlands). Results were children by child molesters. stratified by age and country. RESULTS: The proportion of patients treated by diet only varied from Dong M, Anda RF, Felitti VJ et al. The interrelatedness of 13% (The Netherlands) to 25% (Spain); diet and oral multiple forms of childhood abuse, neglect, and antidiabetics from 51% (England) to 62% (Belgium); a household dysfunction. Child Abuse Negl 2004; combination of diet and insulin varied from 15% 28(7):771-84. (Belgium and Croatia) to 26% (The Netherlands); and Abstract: OBJECTIVE: Childhood abuse and other a combination of diet, oral antidiabetics and insulin adverse childhood experiences (ACEs) have was <10% in all countries. In the older age groups, historically been studied individually, and relatively insulin is prescribed most frequently in The little is known about the co-occurrence of these events. Netherlands. Spain and Croatia show high consultation The purpose of this study is to examine the degree to rates for DM; England and The Netherlands show low which ACEs co-occur as well as the nature of their co- rates. Referral percentages vary considerably between occurrence. METHOD: We used data from 8,629 adult countries (highest in Croatia). CONCLUSIONS: members of a health plan who completed a survey National differences found included the use of insulin in the elderly, the consultation frequency in general 457
- 466. practice and thereferral rate to ophthalmologist and symptoms). All patients met DSM-IV criteria for a diabetic specialists. Further quantitative and qualitative disruptive behavior disorder (oppositional defiant studies are needed to explore the needs for support in disorder of conduct disorder) in addition to research diabetes management in general practice in Europe. criteria. RESULTS: "Outer-directed irritability" most clearly distinguished patients from controls (effect size Donohoe M. The evidence base for shaken baby syndrome: 4.1) and did not correlate with other mood measures. meaning of signature must be made explicit. BMJ Patients and controls showed no to minimal differences 2004; 329(7468):741; author reply 741. on internalizing symptoms. CONCLUSION: Disruptive behavior disordered children and Donohoe M. Evidence-based medicine and shaken baby adolescents characterized by outer-directed irritability syndrome: part I: literature review, 1966-1998. Am J exist, can be identified, and should be further Forensic Med Pathol 2003; 24(3):239-42. investigated, especially since they are potentially treatable. Donoso E. [Inequalities in infant mortality in Santiago]. Rev Med Chil 2004; 132(4):461-6. Dopfner M, Rothenberger A, Sonuga-Barke E. Areas for Abstract: BACKGROUND: Social and economical future investment in the field of ADHD: preschoolers inequalities have an adverse effect on infant mortality. and clinical networks. Eur Child Adolesc Psychiatry AIM: To test if the poorest communities of Santiago 2004; 13 Suppl 1:I130-5. have the highest rates of infant mortalilty. MATERIAL Abstract: BACKGROUND: Two areas ripe for future AND METHODS: Variables were obtained from the investment in the field of ADHD are identified. ADHD year 2000 Vital Statistics yearbook and the National in the preschool years is a key area for future study and Socioeconomic Characterization inquiry. Infant development. Many questions relating to its validity mortality was correlated with the mean income of and diagnosis remain unanswered, although there is a households, the population below the threshold of growing demand for treatment in daily practice. The poverty and the unemployed population of the 32 lack of conformity of diagnosis and treatment of municipalities of the Santiago Province. The ratio and children with ADHD in daily practice to international the difference in mortality rates between the best-practice guidelines represent unsolved problems. communities with the higher and lower incomes and Investment in ADHD networks connecting different the attributable population risk for infant mortality in services and different professions across European the Province of Santiago was calculated. RESULTS: nations may help to reduce these problems. Infant mortality was positively correlated with the OBJECTIVE: To describe recent developments and population below the threshold of poverty (r=0.383; future trends in relation to preschool ADHD and p=0.03) and the unemployed population (r=0.437; ADHD clinical network. METHODS: Selective review p=0.012) and inversely correlated with the mean and interpretation of empirical data. CONCLUSION: household income (r=-0.522; p=0.002). Infant Further studies are required to disentangle the various mortality in the poorest community was 2.2 times pathways into ADHD during preschool especially in higher than in the richest one. The difference in rates relation to the background of early gene-environment was 6.6/1000 live births. The attributable population interaction. This will improve the management of risk determined that it is possible to reduce infant death preschoolers with ADHD especially in the area of by 57.8%. CONCLUSIONS: In the Province of prevention and risk reduction. There will be an Santiago, the poorest communities have the highest increasing demand for networks for the diagnosis and infant mortality. treatment of children with ADHD. Donovan SJ, Nunes EV, Stewart JW et al. "Outer-directed Dormitzer CM, Gonzalez GB, Penna M et al. The irritability": a distinct mood syndrome in explosive PACARDO research project: youthful drug youth with a disruptive behavior disorder? J Clin involvement in Central America and the Dominican Psychiatry 2003; 64(6):698-701. Republic. Rev Panam Salud Publica 2004; 15(6):400- Abstract: OBJECTIVE: To examine whether "outer- 16. directed irritability," a mood construct from the adult Abstract: OBJECTIVE: To estimate the occurrence and literature, characterizes a subgroup of disruptive school-level clustering of drug involvement among behavior disordered children and adolescents school-attending adolescent youths in each of seven previously shown to improve on divalproex, a mood countries in Latin America, drawing upon evidence stabilizer. METHOD: A sample (N = 20) of disruptive from the PACARDO research project, a multinational youth (aged 10-18 years) entering a divalproex collaborative epidemiological research study. treatment study of temper and irritable mood swings METHODS: During 1999-2000, anonymous self- was compared to normal controls (N = 18) on measures administered questionnaires on drug involvement and of aggression/irritability directed against others related behaviors were administered to a cross- (externalizing symptoms) and on aggression/ irritability sectional, nationally representative sample that against self, anxiety, and depression (internalizing included a total of 12,797 students in the following seven countries: Costa Rica (n = 1,702), the Dominican 458
- 467. Republic (n =2,023), El Salvador (n = 1,628), two pilot HIAs and from these to develop guidance on Guatemala (n = 2,530), Honduras (n = 1,752), HIA. METHODS: Case study 1 compared three Nicaragua (n = , 419), and Panama (n = 1,743). (The possible future scenarios for developing transport in PACARDO name concatenates PA for Panama, CA for Edinburgh, based on funding levels. It used a literature Centroamerica, and RDO for Republica Dominicana). review, analysis of local data and the knowledge and Estimates for exposure opportunity and actual use of opinions of key informants. Impacts borne by different alcohol, tobacco, inhalants, marijuana, cocaine population groups.were compared using grids. Case (crack/coca paste), amphetamines and study 2 assessed the health impacts of housing methamphetamines, tranquilizers, ecstasy, and heroin investment in a disadvantaged part of Edinburgh, using were assessed via responses about questions on age of published literature, focus groups with community first chance to try each drug, and first use. Logistic groups and interviews with professionals. RESULTS: regression models accounting for the complex survey Disadvantaged communities bore more detrimental design were used to estimate the associations of effects from the low transport investment scenario, in interest. RESULTS: Cumulative occurrence estimates the areas of: accidents; pollution; access to amenities, for alcohol, tobacco, inhalants, marijuana, and illegal jobs and social contacts; physical activity; and impacts drug use for the overall sample were, respectively: on community networks. The housing investment had 52%, 29%, 5%, 4%, and 5%. In comparison to females, greatest impact on residents' mental health, by reducing males were more likely to use alcohol, tobacco, overcrowding, noise pollution, stigma and fear of inhalants, marijuana, and illegal drugs; the odds ratio crime. CONCLUSION: Although there is no single estimates were 1.3, 2.1, 1.6, 4.1, and 3.2, respectively. 'blueprint' for HIA that will be appropriate for all School-level clustering was noted in all countries for circumstances, key principles to inform future HIA alcohol and tobacco use; it was also noted in Costa were defined. HIA should be systematic; involve Rica, El Salvador, Guatemala, and Panama for illegal decision-makers and affected communities; take into drug use. CONCLUSIONS: This report sheds new account local factors; use evidence and methods light on adolescent drug experiences in Panama, the appropriate to the impacts identified and the five Spanish-heritage countries of Central America, importance and scope of the policy; and make practical and the Dominican Republic, and presents the first recommendations. estimates of school-level clustering of youthful drug involvement in these seven countries. Placed in relation Douyon R, Herns Marcelin L, Jean-Gilles M, Page JB. to school survey findings from North America and Response to trauma in Haitian youth at risk. J Ethn Europe, these estimates indicate lower levels of drug Subst Abuse 2005; 4(2):115-38. involvement in these seven countries of the Americas. Abstract: In order to characterize undesirable behavior For example, in the United States of America 70% of (drug use, fighting, criminal activity) among Haitian surveyed youths had tried alcohol and 59% had youth at risk and determine the relationship between smoked tobacco. By comparison, in these seven traumatic experience and that kind of behavior, countries, only 51% have tried alcohol and only 29% investigators recruited 292 Haitian youths via networks have smoked tobacco. Future research will help to of informal social relations in two zones of clarify explanations for the observed variations across Miami/Dade County strongly identified with Haitian different countries of the world. In the meantime, ethnicity. Each recruit responded to an interview strengthening of school-based and other prevention schedule eliciting sociodemographic information and efforts in the seven-country PACARDO area may help self-reported activities, including involvement in these countries slow the spread of youthful drug youth-dominated groups. They also reported traumatic involvement, reduce school-level clustering, and avoid experience. Clinicians administered CAPS to a subset the periodic epidemics of illegal drug use that have of those respondents who self reported traumatic been experienced in North America. experience. Staff ethnographers selected respondents for in-depth interviews and family studies to provide Douglas M, Archer P. Shaken baby syndrome-related contextual depth for findings of the interview schedule traumatic brain injuries: statewide surveillance and the CAPS assessments. Although traumatic findings. J Okla State Med Assoc 2004; 97(11):487-90. experience may still play a role in mental health outcomes among children, childhood victimization Douglas MJ, Conway L, Gorman D, Gavin S, Hanlon P. among Haitian children does not appear to be related to Developing principles for health impact assessment. J the drug use and undesirable behaviors associated with Public Health Med 2001; 23(2):148-54. unsupervised youth, including formation of gangs. Abstract: BACKGROUND: Policies and practice in many sectors affect health. Health impact assessment Dowdell EB. Grandmother caregiver reactions to caring for (HIA) is a way to predict these health impacts, in order high-risk grandchildren: I could write a book. J to recommend improvements in policies to improve Gerontol Nurs 2005; 31(6):31-7. health. There has been debate about appropriate Abstract: During the past decade there has been an methods for this work. The Scottish Executive funded increase in the prevalence of grandmothers raising their the Scottish Needs Assessment Programme to conduct grandchildren because of parental drug use and child 459
- 468. neglect and maltreatmentin the United States. A study peaked between 2100 and 0259, especially on Friday was designed and conducted to examine the and Saturday night. The most common injury was to relationship between caregiver burden and caregiver the head. Some 75.3% of A&E attenders were physical health for grandmothers raising their high-risk discharged home. The average stay in hospital was two grandchildren. The sample consisted of 104 days and six deaths were recorded. Those living in the grandmothers. The findings indicated that caregiver most deprived areas were nearly four times more likely physical health correlated strongly with level of burden to be admitted than those in the least deprived areas and financial status. Further analysis suggests physical (175.9 per 1000 compared with 45.1 per 1000). health variables had an observable impact on caregiver CONCLUSIONS: This study shows assault is burden. Because this study indicates, from descriptive predominately a male phenomenon, worst in the and correlational statistics, that the well-being of the evenings and at weekends, and is positively related to grandmother and grandchild are both linked to the deprivation. It is probable that the levels recorded will grandmother's physical health, there are numerous be an underestimate, however with some additions to nursing interventions that may support a positive the information collected hospital records could create outcome for both. The provision of emotional and the basis for a comprehensive surveillance system. psychosocial support, coupled with health education and periodic health evaluations, are known to improve Dozor J. Loss and the midwifery community. Midwifery a grandmother's perception of her own health. Nurses Today Int Midwife 2002; (61):46. can use the measures of caregiver burden to develop care plans targeting the health issues most likely to Draper ES, Manktelow BN, McCabe C, Field DJ. The improve a grandmother's functional ability to remain potential impact on costs and staffing of introducing the primary caregiver for a high-risk grandchild. clinical networks and British Association of Perinatal Medicine standards to the delivery of neonatal care. Downie RS. Research on dead infants. Theor Med Bioeth Arch Dis Child Fetal Neonatal Ed 2004; 89(3):F236- 2003; 24(2):161-75. 40. Notes: GENERAL NOTE: KIE: 22 refs.; 23 fn. Notes: CORPORATE NAME: British Association of GENERAL NOTE: KIE: KIE Bib: human Perinatal Medicine experimentation/informed consent; human Abstract: OBJECTIVE: To produce models to estimate experimentation/minors the impact of introducing clinical networks and the Abstract: This paper examines the ethical problems that 2001 BAPM standards to the delivery of neonatal care. arise when research is carried out after autopsy on dead DESIGN: Prospective observational study using a infants. It compares the right of parents against that of geographically defined population and data collected the public interest in matters of research on dead by questionnaire on staffing levels and cot availability. minors. The basis for the respect that is widely SETTING: Trent Health Region UK. SUBJECTS: All accorded to the body of a dead person is examined and infants born to Trent resident mothers at or before 32 is shown to ground the parental interest. A discussion weeks gestation between 1 January 1998 and 31 of the nature of the family suggests that 'informed December 1999. Staffing numbers and cot availability consent' is not the best term to apply to the process of for neonatal care in 2001. METHODS: A modelling parental consultation. Some reasons are provided exercise was carried out using information for all against using this term in the context in which bereaved neonatal admissions for Trent resident infants. Three parents are consulted about autopsy and research on models were investigated: (a). the current care their dead infants. It is suggested that a term such as provision; (b). a network where three lead centres 'authorize' might better apply to this situation. provided the intensive care for the region and the remaining units provided either high dependency or Downing A, Cotterill S, Wilson R. The epidemiology of special care alone; (c). a network where six lead assault across the West Midlands. Emerg Med J 2003; centres provided the intensive care for the region and 20(5):434-7. the remaining units provided either high dependency or Abstract: OBJECTIVES: The purpose of this study is special care alone. Overall costings, staffing levels, and to look at accident and emergency (A&E) attendances cot requirements were calculated for each model. Data and admissions after assault in the West Midlands NHS on staffing levels and cot availability were used to region across a wide range of acute units. METHODS: calculate current care provision costings. RESULTS: This study used data from two sources, the A&E The current cost of running the service is Minimum Data Set and the Hospital Episode Statistics approximately pound 33.35 million, although a database. Analyses were based on data from 12 of the proportion of nursing posts are currently unfilled. 21 acute trusts in the West Midlands NHS region for Estimates for the introduction of a three centre model the period 1 April 1999 to 31 March 2000. RESULTS: meeting BAPM 2001 standards range from pound Analyses were performed on 15 969 A&E attendances 37.31 to pound 43.40 million. Equivalent figures for and 1596 admissions. Some 67.4% of attenders and the six centre model were: pound 36.32 to pound 42.62 84.2% of those admitted were male. The mean age of million. Approximately 370 and 230 babies a year the patients was between 27 and 29 years. Attendance would be involved in transfer in the three and six 460
- 469. centre models respectively.This is in contrast with 374 interaction, family environment, and social support. and 368 urgent transfers that actually took place in When documentation and evaluation of practice and its 1998 and 1999 respectively. CONCLUSION: The costs effect on outcomes proved a considerable challenge, associated with the introduction of managed clinical the authors developed a classification system to networks and meeting BAPM standards of care are not describe practice in three areas: situations addressed, excessive, especially when considered against the interventions used, and referrals made. The article likely implementation timetable of perhaps 7-10 years. describes challenges surrounding program Attracting and retaining sufficient staff will pose the development, implementation, and evaluation. major challenge. Drummond JE, Weir AE, Kysela GM. Home visitation Drenning MG. A vacated appellate opinion begs the programs for at-risk young families. A systematic question: are municipalities liable to provide competent literature review. Can J Public Health 2002; 93(2):153- EMT services? Health Care Law Mon 2002; 9-14. 8. Abstract: BACKGROUND: This systematic literature Dresser R. Standards for family decisions: replacing best review is stimulated by the perceived need of interests with harm prevention. Am J Bioeth 2003; investigator, practice and policy stakeholders for a 3(2):54-5. complete but parsimonious summary of key elements Notes: GENERAL NOTE: KIE: 4 refs. of programs that use home visitation for at-risk young GENERAL NOTE: KIE: KIE Bib: patient care/minors families as the major delivery method. OBJECTIVES: To describe the program components, practices, Drummond J, Fleming D, McDonald L, Kysela GM. outcomes, and reliability of the evaluation approaches. Randomized controlled trial of a family problem- METHODS: Computer and hand searches of literature solving intervention. Clin Nurs Res 2005; 14(1):57-80. were carried out. Reports of established programs, Abstract: Adaptive problem solving contributes to from the last five years, that describe home visitation individual and family health and development. In this services to at-risk families were included. A article, the effect of the cooperative family learning comprehensive data collection tool was used in the approach (CFLA) on group family problem solving and analysis of the findings. FINDINGS: Improvements on cooperative parenting communication is described. over the previous five years were seen in the following A pretest or posttest experimental design was used. areas: use of early intervention model, inclusion of Participant families were recruited from Head Start comparison groups and adequate sampling. programs and exhibited two or more risk factors. DISCUSSION: Challenges remain in development, Participant preschool children were screened to have targeting and reporting of home visitation practice, two or more developmental delays. Direct behavioral overall lack of impact, differential effects by program observation measures were used to determine group site, retention of participants and appropriate family problem solving and cooperative parenting measurement. communication outcomes. Few group family problem- solving behaviors were coded, and they displayed little Dryfoos J. Full-service community schools: a strategy--not a variability. However, intervention parents increased the program. New Dir Youth Dev 2005; (107):7-14, table length of time they played and extended the of contents. cooperative parent-child interactions. The evidence Abstract: The concept that drives the emerging full- shows that CFLA has the potential to enhance parental- service community school movement is this: Schools modeling of cooperative behavior while engaged in cannot address all the problems and needs of play activities with preschoolers. Direct measurement disadvantaged children, youth, and families. of group family problem solving was difficult. Community schools are operated jointly by school Solutions are suggested. systems and community agencies, are open extended hours, and may provide the site for after-school Drummond JE, Weir AE, Kysela GM. Home visitation programs, primary-care health services, mental health practice: models, documentation, and evaluation. counseling, parent education and involvement, and Public Health Nurs 2002; 19(1):21-9. community development. No two community schools Abstract: This article presents an evaluation of an in- are alike. They grow out of a planning process that home support program for at-risk mothers and their involves all stakeholders, school personnel, children. The program was multidisciplinary and was community-based organizations, city and county focused on development of parenting capacity and government, parents, and students. The Quitman Street child-development competencies. The authors examine Community School in Newark, New Jersey, issues and problems that resulted from the blending of exemplifies this approach. two models of practice-stabilization/crisis intervention and early intervention/health promotion-and describe Dube SR, Anda RF, Felitti VJ, Edwards VJ, Croft JB. the outcome-based evaluation that was used to assess Adverse childhood experiences and personal alcohol initial and ongoing child development, parent-child abuse as an adult. Addict Behav 2002; 27(5):713-25. 461
- 470. Abstract: Adult alcoholabuse has been linked to outcomes for 20th century birth cohorts, suggesting childhood abuse and family dysfunction. However, that the effects of ACEs on the risk of various health little information is available about the contribution of problems are unaffected by social or secular changes. multiple adverse childhood experiences (ACEs) in Research showing detrimental and lasting combination with parental alcohol abuse, to the risk of neurobiologic effects of child abuse on the developing later alcohol abuse. A questionnaire about childhood brain provides a plausible explanation for the abuse, parental alcoholism and family dysfunction consistency and dose-response relationships found for while growing up was completed by adult HMO each health problem across birth cohorts, despite members in order to retrospectively assess the changing secular influences. independent relationship of eight ACEs to the risk of adult alcohol abuse. The number of ACEs was used in Dubois CM, Gianella D, Chaves-Vischer V, Haenggeli CA, stratified logistic regression models to assess their Deonna T, Roulet Perez E. Speech delay due to a impact on several adult alcohol problems in the prelinguistic regression of epileptic origin. presence or absence of parental alcoholism. Each of the Neuropediatrics 2004; 35(1):50-3. eight individual ACEs was associated with a higher Abstract: A 2-year-old boy presented with an early risk alcohol abuse as an adult. Compared to persons form of benign partial epilepsy with centro-temporal with no ACEs, the risk of heavy drinking, self-reported spikes (BCERS) and a severe speech delay. Family alcoholism, and marrying an alcoholic were increased video analysis revealed an early regression of babbling twofold to fourfold by the presence of multiple ACEs, and stagnation since the age of 12 months. Complete regardless of parental alcoholism. Prevention of ACEs recovery occurred with anti-epileptic treatment. The and treatment of persons affected by them may reduce deficit corresponded to a transient speech apraxia the occurrence of adult alcohol problems. attributed to an epileptic disconnection of networks coordinating speech articulation. This observation is, to Dube SR, Felitti VJ, Dong M, Giles WH, Anda RF. The the best of our knowledge, the first demonstration that impact of adverse childhood experiences on health delayed emergence of language can be due to an problems: evidence from four birth cohorts dating back epileptic dysfunction interfering with prelinguistic to 1900. Prev Med 2003; 37(3):268-77. skills and therefore mimicking a developmental delay. Abstract: BACKGROUND: We examined the relationship of the number of adverse childhood DuBois DL, Silverthorn N. Do deviant peer associations experiences (ACE score) to six health problems among mediate the contributions of self-esteem to problem four successive birth cohorts dating back to 1900 to behavior during early adolescence? A 2-year assess the strength and consistency of these longitudinal study. J Clin Child Adolesc Psychol 2004; relationships in face of secular influences the 20th 33(2):382-8. century brought in changing health behaviors and Abstract: We investigated deviant peer associations as conditions. We hypothesized that the ACE score/health a mediator of the influences of general and peer- problem relationship would be relatively "immune" to oriented self-esteem on problem behavior using data secular influences, in support of recent studies from a 2-year longitudinal study of 350 young documenting the negative neurobiologic effects of adolescents. Measures of problem behavior included childhood stressors on the developing brain. substance use (alcohol use, smoking) and antisocial METHODS: A retrospective cohort study of 17,337 behavior (fighting, stealing). Using latent growth curve adult health maintenance organization (HMO) modeling and covariance structure analysis, an members who completed a survey about childhood extension of a model proposed by DuBois et al. (2002) abuse and household dysfunction, as well as their was evaluated for each type of problem behavior. health. We used logistic regression to examine the Findings revealed that lower general self-esteem and relationships between ACE score and six health greater peer orientation in self-esteem each predicted problems (depressed affect, suicide attempts, multiple deviant associations with peers and that deviant peer sexual partners, sexually transmitted diseases, associations, in turn, were associated with higher levels smoking, and alcoholism) across four successive birth and rates of change in problem behavior. Deviant peer cohorts: 1900-1931, 1932-1946, 1947-1961, and 1962- associations mediated the associations of general and 1978. RESULTS: The ACE score increased the risk for peer-oriented self-esteem with levels and rates of each health problem in a consistent, strong, and graded change in problem behavior such that direct paths from manner across four birth cohorts (P < 0.05). For each self-esteem to problem behavior generally were unit increase in the ACE score (range: 0-8), the nonsignificant. adjusted odds ratios (ORs) for depressed affect, STDs, and multiple sexual partners were increased within a Dubow SR, Giardino AP, Christian CW, Johnson CF. Do narrow range (ORs: 1.2-1.3 per unit increase) for each pediatric chief residents recognize details of of the birth cohorts; the increase in risk for suicide prepubertal female genital anatomy: a national survey. attempts was stronger but also in a narrow range (ORs: Child Abuse Negl 2005; 29(2):195-205. 1.5-1.7). CONCLUSIONS: Growing up with ACEs Abstract: OBJECTIVE: To evaluate how well a group increased the risk of numerous health behaviors and 462
- 471. of recently trainedpediatric chief residents could label faced challenges of not having financial resources, not anatomic structures on two different photographs of living with the child, and lacking knowledge or skills. female prepubertal genitalia. Additionally, the study CONCLUSIONS: This group of fathers appears to be sought to explore aspects of pediatric training in sexual clearly committed to their children, despite significant abuse and clinical practice issues surrounding the challenges. There are a variety of ways that routine genital examination. METHOD: A 38-item pediatricians can help facilitate their positive questionnaire was mailed to pediatric chief residents at involvement in children's lives, and they may well all of the officially listed pediatric residency-training contribute to the health and development of such high- programs in the continental US. Comparisons were risk children. made between this study and the responses to two previous surveys, which asked a more heterogeneous Dudzinski DM, Sullivan M. When agreeing with the patient group of physicians to label one of the photographs is not enough: a schizophrenic woman requests used in the study. The second photograph was added pregnancy termination. Gen Hosp Psychiatry 2004; because of its improved clarity of each anatomic 26(6):475-80. structure when compared to the first photograph used Notes: GENERAL NOTE: KIE: 39 refs. in the previous studies. The study also asked about GENERAL NOTE: KIE: KIE Bib: abortion; patient clinical practice issues surrounding the prepubertal care/mentally disabled genital examination. RESULTS: An overall response Abstract: In this article, we discuss the ethical dilemma rate of 73% was achieved and analysis was done on health care providers faced when Rebecca, a pregnant 139 respondents. One-half of chief residents thought schizophrenic patient who lacked decision-making that their training during residency on sexual abuse was capacity, inconsistently requested elective pregnancy inadequate for practice. Sixty-four percent of chief termination. When a patient's decision-making capacity residents correctly labeled the hymen on the is severely impaired, how does the physician balance photograph used in the previous studies, which was not obligations to protect the patient from harm significantly different from the 62% and 59% of (beneficence) while also respecting her reproductive physicians who correctly labeled the hymen in the preferences and decisions (respect for autonomy)? previous surveys. In the second photograph, which Rebecca suffers from polysubstance abuse and more clearly displayed the various anatomic structures, paranoid schizophrenia characterized by disorganized 71% correctly labeled the hymen. CONCLUSION: thought and speech, auditory hallucinations, and Pediatric chief residents reported variable amounts of delusional ideas. She arrived 14+ weeks pregnant and training on issues pertaining to child sexual abuse unaccompanied at an obstetric clinic requesting an during residency, think that this time was inadequate, abortion. This is her second and final request. On all and, while doing slightly better than a more diverse prior and subsequent occasions, she was either group of previously studied physicians, did not achieve ambivalent or said she wanted to continue the 100% accuracy in identifying basic genital structures pregnancy. After the consulting psychiatrist determined correctly on two different photographs. that she lacked decision-making capacity, steps were taken to address ethical and clinical issues. The steps Dubowitz H, Lane W, Ross K, Vaughan D. The involvement included treating her schizophrenia to see if she could of low-income African American fathers in their regain decision-making capacity; identifying a children's lives, and the barriers they face. Ambul surrogate and using a shared decision-making model; Pediatr 2004; 4(6):505-8. and devising strategies to protect Rebecca and her fetus Abstract: OBJECTIVE: To examine the involvement without resorting to excessive paternalism. Rebecca of fathers in the lives of low-income African American continued her pregnancy. Due to poor adherence to 8-year-old children, and the barriers they face. medical regimen and inadequate social support, METHODS: The sample was comprised of 117 fathers Rebecca's schizophrenia was poorly controlled and she or father figures of 8-year-olds in families participating continued to use drugs during the pregnancy. She in a longitudinal study of child development and delivered a term baby who was soon removed from her maltreatment. The men were asked a series of open- custody. Despite some people's desire to protect ended questions pertaining to their involvement in the Rebecca by complying with her request for abortion, children's lives. Their responses were audiotaped and we conclude that to do so would be ethically transcribed. Major themes and subthemes were unjustified. To treat a decisionally impaired patient's identified and coded on NVIVO software. RESULTS: requests for abortion as autonomous is disrespectful of The men conveyed a strong sense of commitment to the vulnerable patient because such paternalism fails to the children, identifying many issues reported by white respect the patient's liberty and the surrogate's and middle class men, such as providing support and authority. affection and teaching values and skills. They raised the need to protect the children and help take care of Dulac O. What is West syndrome? Brain Dev 2001; them when sick, some adding that they did not feel 23(7):447-52. confident doing so. They saw discipline as one of their Abstract: The combination of axial spasms in clusters, roles, but described this as difficult for them. The men hypsarrhythmia, and psychomotor delay beginning in 463
- 472. the first yearof life defines West syndrome. Variants Dumbill J. Widening the midwifery network. RCM of this classical triad comprise variations of age of Midwives 2005; 8(7):320. onset ranging from the first month to 4 years, spasms that may be asymmetrical or combined with focal Duncan RE, Savulescu J, Gillam L, Williamson R, Delatycki seizures, asymmetrical, synchronous or fragmented MB. An international survey of predictive genetic hypsarrhythmia, and psychomotor function which may testing in children for adult onset conditions. Genet be delayed, deteriorated or normal. These variations Med 2005; 7(6):390-6. mainly seem to depend on etiology, and specific Abstract: PURPOSE: Predictive genetic testing is patterns have been identified for the various causes. offered to asymptomatic adults even when there is no Most causes relate to non-progressive uni- or effective prophylaxis or treatment. Testing of young multifocal cortical lesions, although some are due to people in similar circumstances is controversial, and inborn errors of metabolism. Ten to 20% exhibit no guidelines recommend against it. We sought to evidence of brain lesion and are considered idiopathic. document descriptive examples of the occurrence of This condition is intermediary between epilepsy in genetic testing in young people for nonmedical which the disorder is limited to paroxysmal events reasons, in the countries where guidelines exist. during which time the patient returns to his prior METHODS: Clinical geneticists in the USA, Canada, condition, and status epilepticus in which the UK, Australia, and New Zealand were surveyed about paroxysmal activity is not interrupted. Here, there are the occurrence and outcomes of testing in both paroxysmal events and a continuous non- asymptomatic young people for conditions where no convulsive paroxysmal activity that contributes to the prophylaxis or treatment exists and onset is usually in deterioration. In the present understanding of adulthood. RESULTS: Of 301 responses, details were pathophysiology, spasms seem to involve subcortical provided of 49 cases where such testing had occurred. structures, whereas hypsarrhythmia affects cortical The most common condition tested for was Huntington areas, also causing psychomotor deterioration. Disease. In 22 cases (45%), the young person tested Deafferentation of subcortical structures by the was immature, defined as under the age of 14 years. continuous spiking and slow wave activity could Results were disclosed to only two immature minors account for release of autonomic activity in the basal and in three cases parents experienced clinically ganglia. Cortical paroxysmal activity could be caused significant anxiety related to how they would pass on by age-related hyperexcitability linked to the information to their gene positive child. In 27 cases development of cortical neuronal networks throughout (55%), the young person tested was mature. Results infancy. The mode of action of steroid and vigabatrin were disclosed to 26 mature minors and it was reported therapies, the two therapies with demonstrated that two individuals experienced an adverse event. efficacy, can be explained on this basis. Consistent follow-up did not take place and findings represent the minimum frequency of adverse events. Dumas JE, Lynch AM, Laughlin JE, Phillips Smith E, Prinz The majority of respondents agree with existing RJ. Promoting intervention fidelity. Conceptual issues, guidelines but many believe each case must be methods, and preliminary results from the EARLY considered individually. CONCLUSION: Clinicians ALLIANCE prevention trial. Am J Prev Med 2001; agree with existing guidelines regarding predictive 20(1 Suppl):38-47. testing in young people, but choose to provide tests for Abstract: Fidelity refers to the demonstration that an nonmedical reasons in specific cases. experimental manipulation is conducted as planned. In outcome research, an intervention can be said to satisfy Dunifon R, Kowaleski-Jones L. Who's in the house? Race fidelity requirements if it can be shown that each of its differences in cohabitation, single parenthood, and components is delivered in a comparable manner to all child development. Child Dev 2002; 73(4):1249-64. participants and is true to the theory and goals Abstract: This study examined four questions: (1) How underlying the research. Demonstrating the fidelity of does family structure (specifically, single parenthood, an intervention is a key methodologic requirement of married parent, and cohabitating parent) affect any sound prevention trial. This paper summarizes key children's delinquency and math test scores? (2) Do conceptual and methodologic issues associated with these effects differ by race? (3) Do parenting practices intervention fidelity, and describes the steps taken to mediate the links between family structure and promote fidelity in EARLY ALLIANCE, a large-scale children's outcomes? and (4) Does this mediation differ prevention trial currently testing the effectiveness of by race? Unlike some previous work in this area, the family, peer, and school interventions to promote present study distinguished between the effects of competence and reduce risk for conduct disorder, single parenthood and cohabitation. Using fixed-effects substance abuse, and school failure. The paper presents techniques to control for unobserved heterogeneity preliminary results (Trial Year 1) that demonstrate between children in the various family structures, content and process fidelity for two of these single parenthood was found to be associated with interventions, and discusses how the EARLY reduced well-being among European American ALLIANCE methodology may be generalized to children, but not African American children. address fidelity issues in other prevention studies. Cohabitation was associated with greater delinquency 464
- 473. among African Americanchildren, and lower math onset versus persistence of children's mental health scores among European American children. No problems. METHOD: Data were collected from 1022 evidence was found to indicate that parenting mediated parents of 4-8-year-old children as part of the the links between family structure and children's Promoting Adjustment in Schools Project (PROMAS). outcomes. Finally, it was found that for African The FRFC-P assessed children's exposure to risk across American children, measures of maternal warmth and five domains: adverse life events and instability (ALI); the provision of rules had direct effects on children's family structure and SES (SES); parenting practices delinquency. (PAR); parental verbal conflict and mood problems (VCM); and parental antisocial and psychotic Dunn J, O'Connor TG, Cheng H. Children's responses to behaviour (APB). RESULTS: The FRFC-P had conflict between their different parents: mothers, satisfactory test-retest reliability and construct validity, stepfathers, nonresident fathers, and nonresident but modest internal consistency. Risk assessed by the stepmothers. J Clin Child Adolesc Psychol 2005; PAR domain was the most important determinant of 34(2):223-34. mental health problem onset, while the PAR, VCM, Abstract: Children who have experienced parental and APB domains were the strongest predictors of separation have potentially 3 sets of parents whose mental health problem persistence. CONCLUSIONS: relationships may impact on them: mother and former These findings highlight the importance of considering partner, mother and stepfather, and father and new risk factors for onset separately from risk factors for partner. Children's accounts of their response to persistence of mental health problems and indicate that conflict between these different parental dyads were the studied population may benefit the most from studied, in relation to the quality of their relationships preventive interventions that address parenting with these parents assessed with child interviews and practices and treatment interventions that address questionnaires, and to maternal reports of the children's parenting practices, and parental mood problems, adjustment, in a sample of 159 children growing up in conflict, antisocial behaviour, and psychiatric different family settings. Involvement in conflict within disorders. 1 parental dyad was chiefly unrelated to such involvement in conflict between the other parental Dye T, Wojtowycz M, Applegate M, Aubry R. Women's dyads. In contrast, there was evidence for "spillover" willingness to share information and participation in effects in relationships within families; for instance, prenatal care systems. Am J Epidemiol 2002; high frequencies of conflict between parents were 156(3):286-91. linked to more troubled parent-child relationships. Abstract: With the expanded use of computerized Children were more likely to side with the parent to databases to gather information, a concomitant interest whom they were biologically related than with in using databases for public health purposes has stepparents. Involvement in mother-nonresident father developed. The authors investigated correlates of conflict and in mother-stepfather conflict were both consenting to participate in such databases. The associated with adjustment problems, independent of Regional Perinatal Data System combines electronic the qualities of positivity and conflict in the birth certificate information with questions asked of all relationship between child and parent. Implications for women delivering a livebirth. Each woman is asked to views on "family boundaries" are considered. consent to share information with 1) her obstetric provider, 2) her infant's pediatric provider, and 3) an Dunne MP, Najman JM. Is dyspareunia unrelated to early immunization registry. From 1996 to 1999, women sexual abuse? Arch Sex Behav 2005; 34(1):28-30, 57- who responded to the consent question and whose 61; author reply 63-7. livebirth did not result in death or adoption were included. Odds ratios with 95% confidence intervals Dwyer SB, Nicholson JM, Battistutta D. Population level denoted the magnitude of association for refusing assessment of the family risk factors related to the consent. Women who were "self-pay" (odds ratio = 2.0, onset or persistence of children's mental health 95% confidence interval: 1.7, 2.4), foreign born (odds problems. J Child Psychol Psychiatry 2003; 44(5):699- ratio = 1.9, 95% confidence interval: 1.7, 2.1), and 711. aged 40 or more years (odds ratio = 2.0, 95% Abstract: BACKGROUND: Despite their great confidence interval: 1.6, 2.3) were more likely to refuse potential to inform intervention planning, screening to share data. Women eligible for but not participating instruments that assess children's exposure to multiple, in the Special Supplemental Nutrition Program for non-behavioural risk factors are rare. The Family Risk Women, Infants, and Children were significantly more Factor Checklist-Parent (FRFC-P), was designed to likely to not share their information with others (odds facilitate community risk factor profiling and ratio = 1.5, 95% confidence interval: 1.3, 1.6), after subsequent intervention planning. The aims of the controlling for confounders. Refusing to share current study were to establish the psychometric information with other sources is not random, and properties of the FRFC-P and to examine the relative women refusing consent often do not participate in importance of family risk factors in relation to the publicly available programs. 465
- 474. Dyer C. Diagnosisof "shaken baby syndrome" still valid, and within a trusting relationship. Key supporters appeal court rules. BMJ 2005; 331(7511):253. identified were the mother's mother, the partner, and the midwife employed in a teenage pregnancy Dyer O. GMC to investigate pathologist who failed to notice coordinator role. Health professionals need to further adopted infant s injuries. BMJ 2003; 327(7416):640. explore the ways in which relationships may be developed and sustained that provide the range of Dykes F. 'Supply' and 'demand': breastfeeding as labour. Soc support required by adolescent mothers to enable them Sci Med 2005; 60(10):2283-93. to continue breastfeeding. Abstract: This paper presents findings from a recent critical ethnographic study conducted in two maternity East PL, Khoo ST. Longitudinal pathways linking family units in England, UK. The study explored the factors and sibling relationship qualities to adolescent influences upon 61 women's experiences of substance use and sexual risk behaviors. J Fam Psychol breastfeeding within the postnatal ward setting. 2005; 19(4):571-80. Participant observations of 97 encounters between Abstract: This 3-wave, 5-year longitudinal study tested midwives and postnatal women, 106 focused the contributions of family contextual factors and interviews with postnatal women and 37-guided sibling relationship qualities to younger siblings' conversations with midwives were conducted. Basic, substance use, sexual risk behaviors, pregnancy, and organising and global themes were constructed sexually transmitted disease. More than 220 non-White utilising thematic networks analysis. The metaphor of families participated (67% Latino and 33% African the production line, with its notions of demand and American), all of which involved a younger sibling efficient supply, illustrated the experiences of (133 girls and 89 boys; mean age = 13.6 years at Time breastfeeding women. They conceptualised 1) and an older sister (mean age = 17 years at Time 1). breastfeeding as a 'productive' project, yet expressed Results from structural equation latent growth curve deep mistrust in the efficacy of their bodies. Their modeling indicated that qualities of the sibling emphasis centred upon breast milk as nutrition rather relationship (high older sister power, low than relationality and breastfeeding. Women referred to warmth/closeness, and low conflict) mediated effects the demanding and unpredictable ways in which their from several family risks (mothers' single parenting, baby breached their temporal and spatial boundaries. older sisters' teen parenting, and family's receipt of aid) They sought strategies to cope with the uncertainty of to younger sibling outcomes. Model results were this embodied experience in combination with their generally stronger for sister-sister pairs than for sister- concerns regarding returning to a 'normal' and brother pairs. Findings add to theoretical models that 'productive' life. The hospital setting and health worker emphasize the role of family and parenting processes in practices played a contributing and reinforcing role. shaping sibling relationships, which, in turn, influence The paper discusses ways of re-establishing trust in adolescent outcomes. women's bodies and breastfeeding, while respecting difference and diversity. It argues for embracing the Edleson JL, Daro D, Pinderhughes H. Finding a common concepts of embodiment and relationality whilst agenda for preventing child maltreatment, youth avoiding a return to essentialism. This requires violence, and domestic violence. J Interpers Violence collective efforts to erode deeply embedded cultural 2004; 19(3):279-81. understandings of women's bodies centering upon disembodied and efficient production. Edward HG, Evers S. Benefits and barriers associated with participation in food programs in three low-income Dykes F, Moran VH, Burt S, Edwards J. Adolescent mothers Ontario communities. Can J Diet Pract Res 2001; and breastfeeding: experiences and support needs--an 62(2):76-81. exploratory study. J Hum Lact 2003; 19(4):391-401. Abstract: Our objective was to identify the benefits and Abstract: The experiences and support needs of barriers associated with participation in food programs. adolescent mothers who commenced breastfeeding We did a content analysis of focus groups with parents were elicited using focus groups and in-depth (n=21), teachers (n=10), project staff (n=21), and semistructured interviews. The study took place in the children (n=17) in three low-income Ontario North West of England, UK. The qualitative data were communities. The key benefits identified by the three analyzed using thematic networks analysis. Five adult groups were hunger alleviation and social contact themes related to experiences emerged: feeling opportunities for both parents and children. Parents watched and judged, lacking confidence, tiredness, also benefited from volunteering with and/or discomfort, and sharing accountability. A further 5 participating in food programs because neighbourhood themes were developed to describe the adolescents' support networks developed. Teachers reported that support needs: emotional support, esteem support, children who attended breakfast programs became instrumental support, informational support, and more attentive in school. The food programs also network support. These forms of support were most provided an opportunity for nutrition education. effective when provided together in a synergistic way Offering food as part of all community programs (not 466
- 475. just those designedto increase food availability) modulated inputs into a global percept and the ability encouraged participation and increased attendance. to extract the resultant global percept from a noisy Children thought that attending food programs kept environment. them healthy, and helped them work harder in school. Parents' pride was the main barrier to participation in Eftekhar B, Mohammad K, Ardebili HE, Ghodsi M, programs; however, parents who were actively Ketabchi E. Comparison of artificial neural network involved in program delivery did not feel stigmatized and logistic regression models for prediction of accepting food. To encourage participation, nutrition mortality in head trauma based on initial clinical data. professionals should collaborate with local residents to BMC Med Inform Decis Mak 2005; 5(1):3. develop and implement community-based food Abstract: BACKGROUND: In recent years, outcome programs. prediction models using artificial neural network and multivariable logistic regression analysis have been Edwards C, Dunham DN, Ries A. Our-component model for developed in many areas of health care research. Both counseling clients with traumatic childhood abuse. these methods have advantages and disadvantages. In Psychol Rep 2003; 93(1):143-50. this study we have compared the performance of Abstract: To treat the effects of traumatic childhood artificial neural network and multivariable logistic abuse effectively, we propose a model which regression models, in prediction of outcomes in head incorporates information from neurophysiological, trauma and studied the reproducibility of the findings. psychoeducational, cognitive, and social work METHODS: 1000 Logistic regression and ANN literature. The four components of the model reflect the models based on initial clinical data related to the GCS, broad range of explanations for pathology posed by tracheal intubation status, age, systolic blood pressure, researchers and also support the breadth of respiratory rate, pulse rate, injury severity score and the interventions available for use with survivors of outcome of 1271 mainly head injured patients were childhood abuse. The model relies on individualized compared in this study. For each of one thousand pairs assessment and treatment related to the physiological of ANN and logistic models, the area under the response to abuse, faulty learning, cognitive and receiver operating characteristic (ROC) curves, psychological problems, and social effects of abuse. Hosmer-Lemeshow (HL) statistics and accuracy rate This model contributes to the literature by providing a were calculated and compared using paired T-tests. comprehensive framework complementary to many RESULTS: ANN significantly outperformed logistic theoretical orientations, is useful across the helping models in both fields of discrimination and calibration disciplines, and appropriate in multidisciplinary but under performed in accuracy. In 77.8% of cases the settings. area under the ROC curves and in 56.4% of cases the HL statistics for the neural network model were Edwards VT, Giaschi DE, Dougherty RF et al. superior to that for the logistic model. In 68% of cases Psychophysical indexes of temporal processing the accuracy of the logistic model was superior to the abnormalities in children with developmental dyslexia. neural network model. CONCLUSIONS: ANN Dev Neuropsychol 2004; 25(3):321-54. significantly outperformed the logistic models in both Abstract: Children with dyslexia and children fields of discrimination and calibration but lagged progressing normally in reading performed several behind in accuracy. This study clearly showed that any perceptual tasks to determine (a) the psychophysical single comparison between these two models might not measures that best differentiate children with dyslexia reliably represent the true end results. External from children with average reading abilities; (b) the validation of the designed models, using larger extent of temporal processing deficits in a single, well- databases with different rates of outcomes is necessary defined group of children with dyslexia; and (c) the co- to get an accurate measure of performance outside the occurrence of visual and auditory temporal processing development population. deficits in children with dyslexia. 4 of our 12 psychophysical tasks indicated differences in temporal Egle UT, Ecker-Egle ML, Nickel R, van Houdenhove B. processing ability between children with dyslexia and [Fibromyalgia as a dysfunction of the central pain and children with good reading skills. These included 2 stress response]. Psychother Psychosom Med Psychol auditory tasks (dichotic pitch perception and FM tone 2004; 54(3-4):137-47. discrimination) and 2 visual tasks (global motion Abstract: Fibromyalgia is often understood as a perception and contrast sensitivity). The battery of 12 syndrome mainly characterised by widespread pain and tasks successfully classified 80% of the children into tenderness and "unexplained" etiology and their respective reading-level groups. Within the group pathogenesis. In the last years evidence is growing that of children with dyslexia who had temporal processing biological as well as psychosocial stress play a deficits, most were affected in either audition or vision; pathogenetic key-role. Beginning with the general few children were affected in both modalities. The function and development of the stress response system observed deficits suggest that impaired temporal the actual knowledge of its relationship with central processing in dyslexia is most evident on tasks that pain-processing mechanisms is reviewed. Early require the ability to synthesize local, temporally adverse childhood experiences can impair the function 467
- 476. of the stresssystem all over the lifespan. Subsequently, every three to four crashes. The total number of deaths research evidence for the role of stress in the due to RTAs was significantly higher than was the etiopathogenesis of fibromyalgia is summarised. number of deaths due to the use of firearms in Psychological as well as psychobiological commission of robbery. Police reports relative to the consequences are outlined. Finally, an integrative use of firearms during armed robberies indicate that of model of fibromyalgia is proposed, which may put a total of the 652 victims who were killed, 348 (68.1%) several pieces of a biopsychosocial puzzle together. were the armed robbers, 134 (26.2%) were bystanders, This model offers an approach for the differentiation of and 29 (5.7%) were policemen. CONCLUSIONS: The subgroups and a clinical orientation for developing an enormity of the problems of traumatic deaths from adequate therapy for the individual patient. RTAs and armed robberies in a developing country has been highlighted. Egle UT, Hardt J, Nickel R, Kappis B, Hoffmann SO. [Long-term effects of adverse childhood experiences - Ehlers CL, Wall TL, Garcia-Andrade C, Phillips E. Visual Actual evidence and needs for research1/2]. Z P3 findings in Mission Indian youth: relationship to Psychosom Med Psychother 2002; 48(4):411-34. family history of alcohol dependence and behavioral Abstract: There is evidence from some prospective and problems. Psychiatry Res 2001; 105(1-2):67-78. several retrospective studies that early biological and Abstract: Native Americans have some of the highest psychosocial stress in childhood is associated with rates of alcohol abuse and dependence, yet risk factors long-term vulnerability to various mental and physical for problem drinking remain relatively unknown. The diseases. In the last few years research findings have amplitude of the P3 component of the event-related accumulated on those emotional, behavioural and potential (ERP) has been suggested to be an index of psychobiological factors which are responsible for the 'vulnerability to alcoholism', especially when it is mediation of these lifelong consequences. They are the elicited by visual tasks in younger individuals. Visual cause of an increased risk of somatization and other P3 tasks, however, have not been previously mental disorders. Particularly anxiety, depression and investigated in Native American youth. One hundred personality disorders often result in high-risk behaviour and four Mission Indian youth between the ages of 7 that itself is associated with physical disease and 13 years participated in the study. ERPs were (cardiovascular disorders, stroke, viral hepatitis, type 2 collected using two visual target paradigms: a facial diabetes, chronic lung diseases) as well as with discrimination and an estimation of line orientation aggressive behaviour. A survey on the current task. Analyses of covariance revealed that participants knowledge of how these various factors interact is with a first degree family history of alcoholism had presented and a bio-psychopathological model of lower P3 component amplitudes in frontal leads to the vulnerability is educed. Implications for future research facial discrimination task. Lower P3 amplitudes, in are outlined and contrasted to actual political trends in posterior areas, were found in the line discrimination Germany. task in children who scored above the 75th percentile in delinquent behaviors on the Achenbach Child Ehikhamenor EE, Ojo MA. Comparative analysis of Behavior Checklist. These findings are consistent with traumatic deaths in Nigeria. Prehospital Disaster Med investigations in non-Indian populations demonstrating 2005; 20(3):197-201. that the late positive component of the event related Abstract: INTRODUCTION: The number of deaths potential is sensitive to both familial history of alcohol due to trauma from road traffic accidents (RTAs), and dependence as well as personal history of externalizing from the use of firearms either for homicide or armed behaviors. robbery, ethnic conflicts, and other events, such as flooding, explosions from petroleum products, and Ehrensaft MK. Interpersonal relationships and sex religious violence, is on the rise in Nigeria. This differences in the development of conduct problems. preliminary study is a comparative analysis of the Clin Child Fam Psychol Rev 2005; 8(1):39-63. frequency of deaths caused by RTAs and the deaths Abstract: This article investigates the role of caused by the use of firearms during armed robbery. interpersonal relationships in shaping sex differences in The study sought to identify the number of traumatic the manifestation, etiology, and developmental course deaths caused by RTAs or armed robbery as well as the of conduct problems and their treatment needs. The number of victims who sustained injuries in the process review examines whether: (1) Girls' conduct problems of RTA or armed robberies. METHODS: An are more likely than boys' to manifest as a function of indigenous, non-governmental organization (NGO) disrupted relationships with caretakers and peers; (2) network was used to abstract data for the frequency of For girls more than for boys, the outcomes of conduct RTAs associated with death or injuries and for deaths problems in adolescence and adulthood, and related caused by armed robberies and was supplemented with treatment needs, are more likely to be a consequence of data obtained from the Nigerian police. RESULTS: For the quality of interpersonal relationships with others, RTAs, the victims included drivers, passengers, and particularly opposite-sex peers and partners. Evidence pedestrians. In 3,032 cases of RTAs, the total number reviewed suggests that boys and girls share many of deaths was 1,239 (29.1%): one Nigerian dies for similarities in their expression of conduct problems, 468
- 477. but that arelational perspective does unify important of 102 children (86%) responded. This represented differences. There is fair evidence that girls with 56% girls and 44% boys aged 8 to 12 years. Sixty-nine conduct problems are more likely to come to the of 90 (77%) of the parents returned the survey. Ninety- attention of authorities because of chaotic, unstable six percent of the children owned a bicycle. A total of family relationships, and to express antisocial behavior 87.5% of children owned a bicycle helmet. Eighty in the context of close relationships; there is stronger percent of the time children ride their bicycles on the evidence that the course and outcomes of conduct road or sidewalk, with less then 20% on marked trails problems in females versus males pertain to or parks. Parents reported that their children wear a interpersonal relationship impairments. Those sex helmet 90% of the time. In contrast, children report no differences map onto specific differences in treatment helmet use in up to 61% of riding instances (P <.05). needs. Further empirical testing of the proposed Parents themselves do not wear a helmet in greater then relational model is indicated. 60% when riding, which is correlated by their children. Seventy-one percent of the children report that they Ehrensaft MK, Cohen P, Brown J, Smailes E, Chen H, ride unsupervised the majority of the time. Johnson JG. Intergenerational transmission of partner CONCLUSIONS: Bicycle and bicycle helmet violence: a 20-year prospective study. J Consult Clin ownership is high among this study group. There is a Psychol 2003; 71(4):741-53. significant possibility that children will ride Abstract: An unselected sample of 543 children was unsupervised, in at-risk situations, without wearing a followed over 20 years to test the independent effects helmet. Parental perceptions about bicycle helmet use of parenting, exposure to domestic violence between by their children may not accurately reflect true parents (ETDV), maltreatment, adolescent disruptive utilization. In this study group parents appear as poor behavior disorders, and emerging adult substance abuse role models for their children. Injury prevention disorders (SUDs) on the risk of violence to and from an strategies need to focus on children and adults to adult partner. Conduct disorder (CD) was the strongest improve effectiveness. risk for perpetrating partner violence for both sexes, followed by ETDV, and power assertive punishment. Eiden RD, Edwards EP, Leonard KE. Predictors of effortful The effect of child abuse was attributable to these 3 control among children of alcoholic and nonalcoholic risks. ETDV conferred the greatest risk of receiving fathers. J Stud Alcohol 2004; 65(3):309-19. partner violence; CD increased the odds of receiving Abstract: OBJECTIVE: The purpose of this study was partner violence but did not mediate this effect. Child (1) to examine the association between fathers' physical abuse and CD in adolescence were strong alcoholism and children's effortful control and (2) to independent risks for injury to a partner. SUD mediated examine the role of parental warmth and toddler the effect of adolescent CD on injury to a partner but temperament as mediators or moderators of this not on injury by a partner. Prevention implications are relationship. METHOD: Families were recruited highlighted. through New York State birth records when their infant was age 12 months. The final sample consisted of 226 Ehrlich PF, Longhi J, Vaughan R, Rockwell S. Correlation families (116 boys) constituting two major groups: a between parental perception and actual childhood nonalcoholic group consisting of parents with no or patterns of bicycle helmet use and riding practices: few current alcohol problems (n = 102) and a father implications for designing injury prevention strategies. alcoholic group (n = 124). Families were assessed J Pediatr Surg 2001; 36(5):763-6. when their child was ages 12, 18, 24 and 36 months. Abstract: BACKGROUND/PURPOSE: Bicycle RESULTS: Results indicate that boys of alcoholic injuries account for 10% of all pediatric traumatic fathers exhibit lower overall levels of effortful control deaths. Bicycle helmets have proven to decrease than boys of nonalcoholic fathers. For boys, fathers' morbidity and mortality, yet trauma data show low warmth over the second year of life mediated the helmet use among injured children. However, owning a association between fathers' alcoholism and effortful bicycle helmet does not universally result in a child control. Maternal warmth was a unique predictor of wearing a helmet. Furthermore, we hypothesize that effortful control for boys. For girls, fathers' alcoholism parental perception of their children's use of the bicycle was associated with lower paternal warmth, which was helmet may not reflect accurately true utilization by in turn a significant predictor of effortful control. Child their child. To investigate this hypothesis the authors activity level and negative affect were associated with examined both parents' and their children's reports of effortful control for boys but did not account for bicycle ownership, supervision, riding patterns, and significant variance when entered in regression models helmet use. METHODS: A random sample of grade 5 with fathers' alcoholism and parenting variables. and 6 students (ages 8 to 12) and their parents were CONCLUSIONS: Sons of alcoholic fathers are at an surveyed about bicycle ownership, riding patterns, increased risk of problems in self-regulation when they supervision, and helmet use. The children and their are ages 2 to 3 years. Paternal warmth mediates the guardians responded independently to the association between fathers' alcoholism and self- questionnaire. Statistical analysis was performed using regulation for both boys and girls, although the nature the chi(2) test when indicated. RESULTS: Eighty-eight of mediation may vary by child gender. 469
- 478. Eiden RD, LeonardKE, Hoyle RH, Chavez F. A presents four current negative reinforcement models transactional model of parent-infant interactions in that emphasize withdrawal, classical conditioning, self- alcoholic families. Psychol Addict Behav 2004; medication and opponent-processes. For each model, 18(4):350-61. the paper outlines central aspects of dependence, Abstract: This study examined the transactional nature conceptualization of dependence development and of parent-infant interactions over time among alcoholic influences that the model might have on current and and nonalcoholic families. The sample consisted of 222 future measures of dependence. Understanding how families assessed at 12, 18, and 24 months of child age. drug dependence develops will be an important part of Results indicated that infant behavior did not influence future successful tobacco dependence measurement, parental behavior across time, but parental behavior prevention and treatment strategies. was longitudinally predictive of infant behavior during play interactions. Higher paternal alcohol consumption Eklund JM, Klinteberg BA. Childhood behaviour as related at 12 months was longitudinally predictive of negative to subsequent drinking offences and violent offending: parental behavior at 24 months. Other significant risk a prospective study of 11- to 14-year-old youths into factors included marital conflict, fathers' depression, their fourth decade. Crim Behav Ment Health 2003; and fathers' education. Results highlight the nested 13(4):294-309. nature of risk in alcoholic families and the direction of Abstract: BACKGROUND: Childhood hyperactivity influence from parent to child during interactions and has previously been found to be closely connected to suggest that 1 pathway to risk among these children is subsequent alcohol problems and violent offending through negative parent-infant interactions. among men considered to be without major mental disorders. For others, these associations might be Eigsti IM, Cicchetti D. The impact of child maltreatment on moderated or confounded by other factors, expressive syntax at 60 months. Dev Sci 2004; 7(1):88- predominantly comorbid conduct disorder. AIMS: The 102. purpose of the study was to investigate aspects of Abstract: Although child maltreatment has often been childhood hyperactive behaviour in relation to alcohol described as leading to language deficits, the few well- or violent offences in adult life, taking the possible controlled investigations of language acquisition in confounders of early criminality and aggressive maltreated children have focused on language content behaviour into account. Method A total of 192 young rather than form, or have used qualitative rather than male law breakers and 95 non-criminal controls were quantitative measures. This study examines syntactic followed from age 11-14 years into their thirties. complexity in 19 maltreated and 14 nonmaltreated Information on aspects of hyperactivity, aggressive preschool-aged children. Mother-child dyads behaviour, early criminality and later offences was participated in play sessions that were transcribed and included in the analyses. RESULTS: The results scored for the presence of morphosyntactic forms in supported the hypothesis that aspects of childhood child speech and for specific sentence constructions in hyperactive behaviour were significantly associated maternal speech. Findings indicated that child with later drinking offences and violent offending. maltreatment was associated with language delay in Further analyses revealed attention difficulties to be the both vocabulary and production of syntactic structures. component of hyperactivity most contributing to the There were also qualitative differences in relationship. When taking possible confounding characteristics of maternal utterances between variables into consideration, attention difficulties were maltreating and comparison groups. Because related to subsequent violent offending among boys maltreatment initially occurred before age 2, this study with early criminality, independently of early highlights the long-lasting negative influence of aggressive behaviour. Early criminality, attention maltreatment on language development and also difficulties and aggressive behaviour, however, often provides the first demonstration of child language co-occurred in the same individual. Subsequent delays and differences in maternal speech within a drinking offences or violent offending appeared seven single maltreatment sample. times more often among individuals with all early behavioural problems as compared with those who had Eissenberg T. Measuring the emergence of tobacco no such problems. CONCLUSION: Complex antisocial dependence: the contribution of negative reinforcement behaviours in adult life commonly represent models. Addiction 2004; 99 Suppl 1:5-29. persistence of complex childhood behavioural Abstract: This review of negative reinforcement difficulties, but among young law breakers there does models of drug dependence is part of a series that takes appear to be a subgroup of boys with a main problem the position that a complete understanding of current of attention difficulties who go on to violent offending, concepts of dependence will facilitate the development even in the absence of early manifestation of of reliable and valid measures of the emergence of aggression. tobacco dependence. Other reviews within the series consider models that emphasize positive reinforcement El-Sheikh M, Elmore-Staton L. The link between marital and social learning/cognitive models. This review conflict and child adjustment: parent-child conflict and summarizes negative reinforcement in general and then perceived attachments as mediators, potentiators, and 470
- 479. mitigators of risk.Dev Psychopathol 2004; 16(3):631- children's adjustment. The significant moderation 48. effects indicate that parent-child conflict is a robust Abstract: Parent-child conflict and perceived vulnerability factor for internalizing problems. attachments to parents were examined as predictors, mediators, and moderators in the marital conflict-child Elcioglu O, Aksoy S, Gunduz T. Children's rights and a adjustment connection in a sample of older children sample study on accidents in children groups aged 0-5 and young adolescents. After controlling for marital years old in the light of parents' responsibility in conflict, parent-child conflict predicted additional Turkey. Saudi Med J 2004; 25(4):470-3. unique variance mainly for children's externalizing Abstract: OBJECTIVE: Most frequent reasons for the problems, and attachments to parents accounted for accidents seen in children under 5 years of age who unique variance in children's externalizing and have a right to be cared and protected are negligence internalizing problems. Moderation effects illustrated and carelessness. In this study, judicial cases were that a higher level of parent-child conflict was a compiled from children between the age of 0 to 5, who vulnerability factor, whereas a secure attachment was a had been injured due to severe family negligence. protective factor, for behavior problems associated METHODS: Files of cases were obtained from with marital conflict. Mediation effects were also archives with file numbers, indicating cases obtained evident and supported the proposition that parent-child from the records of the hospital and police were studied conflict and attachment to parents mostly are partial retrospectively. The gender, age, and type of mediators of effects in the marital conflict-child application of patients, the type of interference, and the outcomes link. The findings illustrate the aggregation, results obtained from the procedure were studied. This potentiation, and amelioration of risk for adjustment study encompasses the results of cases at Osmangazi problems associated with marital conflict, and highlight University Training, Practice and Research Hospital, the importance of assessing multiple systems within the Eskisehir, Turkey, between September 1999 and March family. 2001. RESULTS: Forty of 113 cases (35.4%) were due to poisoning from drugs. The main reasons were El-Sheikh M, Flanagan E. Parental problem drinking and unawareness of children regarding the harm of drugs, children's adjustment: family conflict and parental putting drugs in reach of children and easy access to depression as mediators and moderators of risk. J drugs from pharmacies without prescription. On the Abnorm Child Psychol 2001; 29(5):417-32. other hand, the recognition of international measures Abstract: We examined marital conflict, parent-child by the Turkish government is a guarantee for the conflict, and maternal and paternal depression children's rights. CONCLUSION: Our study implies symptoms as mediators and moderators in the that, as suggested by other researchers, the associations between fathers' and mothers' problem investigation of measures to prevent injuries due to drinking and children's adjustment. A community negligence and the application of these measures will sample of 6-12-year-old boys and girls and their certainly improve the welfare of society. mothers, fathers, and teachers participated. Marital conflict, parent-child conflict, and maternal depression Eldredge S, Piha S, Levin F. Building the San Francisco symptomatology each functioned as a mediator of the Beacons. New Dir Youth Dev 2002; (94):89-108. association between father's problem drinking and Abstract: San Francisco's Beacon Initiative is designed children's externalizing and internalizing problems, and to foster youth development on a large scale. Its maternal depression symptoms accounted partially for intermediary, Community Network for Youth the link between father's problem drinking and Development, used a theory of change process to forge children's social problems. For mother's problem consensus and create a road map to guide this large drinking, marital conflict, parent-child conflict, and collaborative toward its long-term goals. maternal depression symptoms each mediated the association with children's externalizing problems. Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Further, parent-child conflict explained partially the Clin North Am 2003; 50(4):781-800, viii. link between mother's problem drinking and Abstract: Teen birth rates have decreased steadily over internalizing problems, and marital conflict accounted the past decade, but the United States still has the for the association between mother's problem drinking highest birth rates among all developed countries. and social problems. When the mediators were Young women who give birth as adolescents are likely simultaneously examined, parent-child conflict was the to have poor school performance, and come from most robust mediator of the association between families with low socioeconomic status, a history of parental problem drinking and externalizing problems, teen pregnancies, and low maternal education. The and maternal depression symptomatology was the most fathers of babies who are born to teen mothers are consistent mediator of the relation between parental likely to be unsuccessful in school, have limited problem drinking and internalizing problems. Further, earnings, have high rates of substance use, and have parent-child conflict and paternal and maternal trouble with the law. Infants who are born to teen depression symptoms each interacted with parental mothers are at risk for low birth weight and physical problem drinking to moderate some domains of 471
- 480. neglect and abuse;at school age, these children are Ellenbogen MA, Hodgins S. The impact of high neuroticism more likely than children born to adult women to have in parents on children's psychosocial functioning in a trouble with school achievement, and they are at risk population at high risk for major affective disorder: a for becoming teen mothers or fathers themselves. family-environmental pathway of intergenerational Programs that are successful in reducing teen birthrates risk. Dev Psychopathol 2004; 16(1):113-36. are usually multifactorial and combine comprehensive Abstract: Behavioral genetic studies indicate that sexuality education with youth development activities; nongenetic factors play a role in the development of reduction in repeat pregnancies is associated with home bipolar and major depressive disorders. The trait of visits by nurses combined with long-acting neuroticism is common among individuals with major contraceptive use. affective disorders. We hypothesized that high neuroticism among parents affects the family Elgar FJ, McGrath PJ, Waschbusch DA, Stewart SH, Curtis environment and parenting practices and thereby LJ. Mutual influences on maternal depression and child increases the risk of psychosocial problems among adjustment problems. Clin Psychol Rev 2004; offspring. This hypothesis is tested in a sample of 24(4):441-59. participants at high and low risk for major affective Abstract: Often undetected and poorly managed, disorders, which contained parents with bipolar maternal depression and child adjustment problems are disorder (55), major depression (21), or no mental common health problems and impose significant disorder (148) and their 146 children between 4 and 14 burden to society. Studies show evidence of mutual years of age. Parents with high neuroticism scores were influences on maternal and child functioning, whereby characterized by low psychosocial functioning, poor depression in mothers increases risk of emotional and parenting, more dependent stressful life events, and the behavioral problems in children and vice versa. use of more emotion-focused and less task-oriented Biological mechanisms (genetics, in utero coping skills. High neuroticism in parents was environment) mediate influences from mother to child, associated with internalizing and externalizing while psychosocial (attachment, child discipline, problems among the children, as assessed by parent modeling, family functioning) and social capital (social and teacher ratings on the Child Behavior Checklist resources, social support) mechanisms mediate and clinician ratings. The results suggest that high transactional influences on maternal depression and neuroticism in parents with major affective disorders is child adjustment problems. Mutual family influences in associated with inadequate parenting practices and the the etiology and maintenance of psychological creation of a stressful family environment, which are problems advance our understanding of pathways of subsequently related to psychosocial problems among risk and resilience and their implications for clinical the offspring. interventions. This article explores the dynamic interplay of maternal and child distress and provides Ellerbrock TV, Chamblee S, Bush TJ et al. Human evidence for a biopsychosocial model of mediating immunodeficiency virus infection in a rural community factors with the aim of stimulating further research and in the United States. Am J Epidemiol 2004; contributing to more inclusive therapies for families. 160(6):582-8. Abstract: In 1986, a population-based survey of human Elias M, Choudhury N, Sibinga CT. Cord blood from immunodeficiency virus (HIV) infection in a rural collection to expansion: feasibility in a regional blood Florida community showed that HIV prevalence was bank. Indian J Pediatr 2003; 70(4):327-36. 28/877 (3.2%, 95% confidence interval (CI): 2.0, 4.4). Abstract: This article reviews the various aspect of the In 1998-2000, the authors performed a second experimental phase preceding the establishment of an population-based survey in this community and a case- umbilical cord blood (UCB) bank within a regular control study to determine whether HIV prevalence and blood bank, a situation totally different from that of de risk factors had changed. After 609 addresses had been novo establishing a cord blood bank having human and randomly selected for the survey, 516 (85%) residents financial resources. An ethically approved two-year were enrolled, and 447 (73%) were tested for HIV. study has been conducted to determine the technical HIV prevalence was 7/447 (1.6%, 95% CI: 0.4, 2.7) in feasibility, and the practical problems that might be western Palm Beach County and 5/286 (1.7%, 95% CI: encountered such as public compliance, the additional 0.2, 3.3) in Belle Glade (p=0.2 in comparison with workload, introduction of new activities ranging from 1986). Independent predictors of HIV infection in both collection and processing to progenitor expansion, 1986 and 1998-2000 were having a history of sexually infectious disease testing, development of a quality transmitted disease, number of sex partners, and control system, record keeping and documentation, exchanging money or drugs for sex. A history of development of specific procedures and definitions of having sex with men was a risk factor among men in requirements. The cost benefit aspect, which will 1986 but not in 1998-2000; residence in specific ultimately depend on the frequency of units release, neighborhoods was a risk factor in 1998-2000 but not was not considered in this study. in 1986. The authors conclude that heterosexually acquired HIV infection did not spread throughout the community between 1986 and 1998 but persisted at a 472
- 481. low level indiscrete neighborhoods. Interventions partner and almost 90% had dependent children. In the targeting HIV-endemic neighborhoods will be needed previous month, 17% had been assaulted and 35% to further reduce HIV prevalence in this area. raped by clients. Unwanted pregnancy was common; 86% had had at least one abortion. Compared with Elliott V. Speaking up for children. Interview by Catharine women in rural towns, township sex workers were Sadler. Nurs Stand 2004; 18(19):59. younger (median age 22 vs. 26), saw more clients (median 9 vs. 4 per week) and earned more from sex Ells AL, Kherani A, Lee D. Epiretinal membrane formation work (up to 63-90 euros vs. 12 euros per week). Issues is a late manifestation of shaken baby syndrome. J of alternative sources of income, safety for sex workers AAPOS 2003; 7(3):223-5. and the conditions which create the necessity for sex Abstract: Shaken baby syndrome is a constellation of work are vital to address. The question of number of injuries resulting from the intentional shaking type clients and the nature of sex work have obvious movement of a child who is usually younger than 3- implications for HIV/STI prevention policy. years-old. This rapid acceleration-deceleration movement of the head is responsible for lesions Elsig C, Schopper C, Anthony M, Gramigna R, Boker H. attributed to shearing forces placed on the vitreoretinal [In-patient hypnotherapeutic trauma exposure for structures and meningeal vessels across the dura. The posttraumatic stress disorder: a case report]. Psychiatr ophthalmic findings include intraocular hemorrhages, Prax 2002; 29(2):97-100. perimacular retinal folds, and peripheral retinoschisis Abstract: This paper describes the treatment of a in the presence of intracranial injuries such as subdural patient with the diagnoses of a borderline personality hematomas without obvious external signs of head disorder and posttraumatic stress disorder (DSM-IV trauma. We describe a case of late development of an and ICD-10) within the setting of a psychiatric ward epiretinal membrane in a child with a history of shaken spezializing in depression. For purposes of controlled baby syndrome and propose a differential diagnosis list re-exposure to the patient's trauma, a hypnotherapeutic for epiretinal membrane formation in the pediatric age method was chosen. A significant reduction of group. symptoms, in particular the intrusions and the hyperarousal, was observed. Of great importance in the Elman JL. Connectionist models of cognitive development: successful outcome of this case is the integration of where next? Trends Cogn Sci 2005; 9(3):111-7. hypnotherapy into a multi-dimensional treatment Abstract: Over the past two decades, connectionist concept including group therapy, physical therapy and models have generated a lively debate regarding the anxiety-reducing self-management therapy. This underlying mechanisms of cognitive development. This approach facilitated the development of trust and debate has in turn led to important empirical research security in the patient required for the hypnotherapeutic that might not have occurred otherwise. More recently, intervention and minimized the splitting tendencies advances in developmental neuroscience present a new specific to borderline patients. Further discussion is set of challenges for modelers. In this article, I review centered on the difficulties arising in the context of an some of the insights that have come from modeling emergency ward setting with its high intensity work, focusing on (1) explanations for the shape of atmosphere encompassing the danger of change; (2) new views on how knowledge may be retraumatization of this special group of patients. represented; (3) the richness of experience. The article Finally several aspects of the clinical implications of concludes by considering some of the new challenges this method are addressed. and opportunities for modeling cognitive development. Elster NR. HIV and art: reproductive choices and Elmore-Meegan M, Conroy RM, Agala CB. Sex workers in challenges. J Contemp Health Law Policy 2003; Kenya, numbers of clients and associated risks: an 19(2):415-30. exploratory survey. Reprod Health Matters 2004; Notes: GENERAL NOTE: KIE: KIE Bib: AIDS; 12(23):50-7. reproductive technologies; selection for treatment Abstract: In Kenya in 1999, an estimated 6.9% of women nationally said they had exchanged sex for Eminson M, Jureidini J. Concerns about research and money, gifts or favours in the previous year. In 2000 prevention strategies in Munchausen Syndrome by and 2001, in collaboration with sex workers who had Proxy (MSBP) abuse. Child Abuse Negl 2003; formed a network of self-help groups, we conducted an 27(4):413-20. exploratory survey among 475 sex workers in four Abstract: There would seem to be three motives for rural towns and three Nairobi townships, regarding research into Munchausen Syndrome by Proxy where they worked, the number of clients they had and (MSBP) abuse; first to enhance treatment; second to the risks they were exposed to. Participants were enhance our understanding of the psychopathology of identified by a network of social contacts in the seven those who carry out the abuse; and third to find centres. Most of the women (88%) worked from bars, interventions to prevent its occurrence. We will argue hotels, bus stages and discos; 57% lived with a stable that only the first justification is valid. The second and 473
- 482. third should bequestioned for several reasons boys with conduct problems (6-13 years, mean including: MSBP abuse is the wrong kind of event to age=9.60 years) referred to public child psychiatric think of in terms of categorical diagnosis; rare events units in Sweden were studied with data elicited from are inherently difficult to predict; and better research caregivers. Conduct-problem boys with many callous- targets are available. We propose that research energy unemotional traits had significantly more pervasive, would be more productively directed towards varied and aggressive disruptive behavioural problems furthering our understanding of somatization and than boys low on these traits had. Higher levels of certain problematic aspects of modern pediatric conduct problems in subjects with callous-unemotional practice. We offer suggestions as to appropriate areas traits were not explained by confounding presence of for research. DSM-IV attention-deficit hyperactivity disorder and oppositional defiant disorder/conduct disorder Emiroglu FN, Kurul S, Akay A, Miral S, Dirik E. symptoms. Boys with callous-unemotional traits also Assessment of child neurology outpatients with experienced poorer household circumstances and lived headache, dizziness, and fainting. J Child Neurol 2004; in families under high stress. Interestingly, they less 19(5):332-6. often received help in school from special teachers but Abstract: Neurologic symptoms such as headache, were more often diagnosed with dysthymia than boys vertigo, dizziness, and fainting can create a diagnostic low on callous-unemotional traits. We conclude that problem in pediatric neurology practice because they callous-unemotional traits might designate a subgroup are also the most common presenting symptoms of of boys with different aetiology to their conduct psychiatric disorders. Children, especially adolescents, problems and possibly with specific treatment needs. who are often admitted with such autonomic However, the findings need to be replicated with larger symptoms, are frequently misdiagnosed. In this study, samples. we aimed to investigate the psychiatric morbidity and comorbidity rate in children and adolescents presenting Engels RC, Vermulst AA, Dubas JS, Bot SM, Gerris J. with neurologic symptoms such as headache, vertigo, Long-term effects of family functioning and child and syncope. We investigated 31 children who characteristics on problem drinking in young presented with these symptoms. All children were adulthood. Eur Addict Res 2005; 11(1):32-7. evaluated for their medical history and had a physical Abstract: Several studies have shown that disturbances and neurologic examination. We attempted to rule out a in the parent-child relationship in childhood are related possible organic etiology. All patients received a to patterns of alcohol abuse in adolescence and young complete laboratory examination (blood count, adulthood. Recently some researchers, however, argue electroencephalography), pediatric cardiology and that whether poor parenting is detrimental depends on otorhinolaryngology consultations, and a caloric test. specific child characteristics. Hence, instead of All patients were assessed according to Diagnostic and examining overall effects of parenting, it might be Statistical Manual of Mental Disorders-IV (DSM-IV) more appropriate to search for specific child- criteria. The majority of the patients (93.5%) received a environment effects that lead to problematic drinking psychiatric diagnosis according to the DSM-IV criteria. patterns. In this paper, we investigate the interplay Most of these patients were adolescents and female. between child characteristics (lack of self-control and Psychosocial stressors such as academic problems, aggression) and parenting on problematic alcohol use familial dysfunction, parental psychopathology, and in young adulthood. Data were used from a child sexual abuse were associated with somatic longitudinal study that followed 301 children and their symptoms. The results of this study demonstrated the parents for a period of 10 years. Both parents and their importance of differential diagnosis and psychiatric children were interviewed on parenting practices and comorbidity in a pediatric neurologic outpatient child characteristics when the child was a young population. Treatment should be directed at adolescent (mean age of 12 years at time 1) and biopsychosocial integrity, and a multidisciplinary extensive information on problematic alcohol use was treatment approach should be applied. gathered when the participants were young adults (mean age was 22 at time 3). Findings showed strong Enebrink P, Andershed H, Langstrom N. Callous- effects of childhood aggression (men only) and poor unemotional traits are associated with clinical severity family functioning on enhanced levels of problem in referred boys with conduct problems. Nord J drinking in young adulthood. Further, the combination Psychiatry 2005; 59(6):431-40. of high levels of aggression and low levels of family Abstract: Clinical practice with the heterogeneous functioning were related to problem drinking in men, group of children that present with conduct problems whereas the combination of low parental control and may benefit from improved formats for diagnostic low levels of affection expression were related to subtyping. We investigated whether high levels of problem drinking in women. callous-unemotional traits (i.e. lack of empathy, remorselessness and shallow affects) would England M. Planning and emotional health of abused adult differentiate clinic-referred conduct-problem boys from children caregivers. Can J Nurs Res 2005; 37(3):10-33. those low on such traits. A consecutive series of 41 Abstract: The purpose of this study was to explore 474
- 483. markers associated withthe advance-planning patterns extent and continuity of maltreatment. METHOD: The and emotional health of adult child caregivers pre- study consists of children reported for maltreatment selected for their history of childhood abuse within the (N=519) from the larger LONGSCAN study cohort. family. An informational decision grid and two Lifetime maltreatment data were collected from CPS classification procedures were used to organize and records and coded into two chronicity constructs: link 246 written plans of 50 adults providing nearly 6 "developmental" and "calendar" definitions. Variables hours of care per day to a cognitively impaired parent. for age at first report, frequency, extent and continuity Results revealed 3 constellations of plans describing of maltreatment reports also were constructed. hands-on person-centred, instrumental, and grief-based Hierarchical regression analyses were utilized to approaches to caregiver planning. The 31 participants determine the extent to which the various chronicity taking an instrumental approach to planning were constructs contributed to the prediction of child significantly more likely than the 17 taking a grief- outcomes. RESULTS: The most salient definition of driven approach to report experiences of abandonment, chronicity, in terms of its effects on child behavioral betrayal, suicidal ideation, and use of alcohol. The 2 and emotional functioning, varied by outcome. The participants taking a person-centred approach reported developmental definition was found to have the most significantly less emotional arousal and risk for loss of balanced sensitivity across outcomes. Among other health and did not recount experiences of distress or significant findings, extent and continuity of emotion-focused coping. Nurses can use the findings to maltreatment contributed respectively to the prediction highlight and strengthen the decision-making and of behavior and emotional trauma symptoms. Early age parental-care capacities of caregivers traumatized in at first report was a predictor of poor daily living skills. childhood. CONCLUSION: Chronicity is a complex construct. Findings indicate there are multiple parameters that English DJ, Bangdiwala SI, Runyan DK. The dimensions of make up the chronicity construct itself that may be maltreatment: introduction. Child Abuse Negl 2005; important for understanding child outcomes. 29(5):441-60. Abstract: This special issue includes an introduction Engstrom K, Diderichsen F, Laflamme L. Parental social and seven papers exploring dimensions of determinants of risk for intentional injury: a cross- maltreatment including type, severity, chronicity, and sectional study of Swedish adolescents. Am J Public substantiation status of referrals to CPS, utilizing a Health 2004; 94(4):640-5. subsample of the LONGSCAN studies. Each paper Abstract: OBJECTIVES: We investigated the effect of examines one of the dimensions of maltreatment from family social and economic circumstances on various perspectives to determine if different intentional injury among adolescents. METHODS: We conceptualizations of a dimension, examined in conducted a cross-sectional register study of youths isolation, account for different amounts of variation in aged 10 to 19 years who lived in Sweden between 1990 child outcomes. A final paper assesses the relationship and 1994. We used socioeconomic status, number of of the combined maltreatment dimensions, including parents in the household (1- or 2-parent home), receipt interactions, on a single sample of maltreated children of welfare benefits, parental country of birth, and from the LONGSCAN study. This final paper explores population density as exposures and compiled relative the individual contribution of the "best" risks and population-attributable risks (PARs) for self- conceptualizations of the maltreatment dimensions in inflicted and interpersonal violence-related injury. relation to each other, and to the 10 child outcomes of RESULTS: For both genders and for both injury types, interest. Implications of the findings from these papers receipt of welfare benefits showed the largest crude for future research on dimensions of child maltreatment and net relative risks and the highest PARs. The are discussed in two independent commentaries. socioeconomic status-related PAR for self-inflicted injury and the PAR related to number of parents in the English DJ, Graham JC, Litrownik AJ, Everson M, household for interpersonal violence-related injury also Bangdiwala SI. Defining maltreatment chronicity: are were high. CONCLUSIONS: Intentional-injury there differences in child outcomes? Child Abuse Negl prevention and victim treatment need to be tailored to 2005; 29(5):575-95. household social circumstances. Abstract: OBJECTIVE: For nearly 25 years researchers have suggested that better taxonomic systems Ennett CM, Frize M, Charette E. Improvement and conceptualizing and reliably differentiating among automation of artificial neural networks to estimate different dimensions of maltreatment are required. This medical outcomes. Med Eng Phys 2004; 26(4):321-8. study examines the utility of three different Abstract: The lengthy process of manually optimizing a characterizations of one dimension of maltreatment, feedforward backpropagation artificial neural network chronicity, to predict child behavioral and emotional (ANN) provided the incentive to develop an automated functioning in a sample of maltreated children. A system that could fine-tune the network parameters secondary objective of the study is to examine without user supervision. A new stopping criterion was additional parameters of maltreatment inherent in our introduced--the logarithmic-sensitivity index--that definitions of chronicity: age at first report to CPS, manages a good balance between sensitivity and 475
- 484. specificity of theoutput classification. The automated interactive teaching strategies were more effective than network automatically monitored the classification programs focused on knowledge and attitudes and performance to determine when was the best time to favoring traditional didactic instruction. The present stop training-after no improvement in the performance study compared current school practice against measure (either highest correct classification rate, evidence-based standards for "effective content" and lowest mean squared error or highest log-sensitivity "effective delivery," derived from the Tobler findings. index value) occurred in the subsequent 500 epochs. Respondents were the lead staff who taught substance Experiments were performed on three medical use prevention in the 1998-1999 school year in a databases: an adult intensive care unit, a neonatal national sample of public and private schools that intensive care unit and a coronary surgery patient included middle school grades (N = 1,795). Results database. The optimal network parameter settings indicate that most providers (62.25%) taught effective found by the automated system were similar to those content, but few used effective delivery (17.44%), and found manually. The results showed that the automated fewer still used both effective content and delivery networks performed equally well or better than the (14.23%). Those who taught an evidence-based manually optimized ANNs, and the best classification program (e.g., Life Skills Training, Project ALERT), performance was achieved using the log-sensitivity however, were more likely to implement both effective index as a stopping criterion. content and delivery, as were those teachers who were recently trained in substance use prevention and were Ennett CM, Frize M, Walker CR. Influence of missing comfortable using interactive teaching methods. The values on artificial neural network performance. findings indicate that the transfer to practice of Medinfo 2001; 10(Pt 1):449-53. research knowledge about school-based substance use Abstract: The problem of databases containing missing prevention programming has been limited. values is a common one in the medical environment. Researchers must find a way to incorporate the Enright PL, Goodwin JL, Sherrill DL, Quan JR, Quan SF. incomplete data into the data set to use those cases in Blood pressure elevation associated with sleep-related their experiments. Artificial neural networks (ANNs) breathing disorder in a community sample of white and cannot interpret missing values, and when a database is Hispanic children: the Tucson Children's Assessment highly skewed, ANNs have difficulty identifying the of Sleep Apnea study. Arch Pediatr Adolesc Med 2003; factors leading to a rare outcome. This study 157(9):901-4. investigates the impact on ANN performance when Notes: CORPORATE NAME: Tucson Children's predicting neonatal mortality of increasing the number Assessment of Sleep Apnea study of cases with missing values in the data sets. Although Abstract: BACKGROUND: The Tucson Children's previous work using the Canadian Neonatal Intensive Assessment of Sleep Apnea study (TuCASA) was Care Unit (NICU) Network s database showed that the designed to investigate the prevalence and correlates of ANN could not correctly classify any patients who died objectively measured sleep-related breathing disorder when the missing values were replaced with normal or (SBD) in preadolescent Hispanic and white children. mean values, this problem did not arise as expected in OBJECTIVE: To describe the associations of SBD and this study. Instead, the ANN consistently performed elevation in resting blood pressure in the first 239 better than the constant predictor (which classifies all children enrolled in TuCASA. DESIGN: Children cases as belonging to the outcome with the highest between the ages of 6 and 11 years (45% girls and 51% training set a priori probability) with a 0.6-1.3% Hispanic) from elementary schools of the Tucson improvement over the constant predictor. The Unified School District were enrolled in this sensitivity of the models ranged from 14.5-20.3% and prospective cohort study. Resting systolic and diastolic the specificity ranged from 99.2- 99.7%. These results blood pressure, sleep symptoms, and parental smoking indicate that nearly 1 in 5 babies who will eventually status were obtained during evening home visits, die are correctly classified by the ANN, and very few followed by overnight unattended home babies were incorrectly identified as patients who will polysomnography. RESULTS: The mean (SD) systolic die. These findings are important for patient care, and diastolic blood pressures were 98.4 (10.6) mm Hg counselling of parents and resource allocation. and 62.0 (8.9) mm Hg, respectively. Fifteen children had hypertension. The mean (SD) respiratory Ennett ST, Ringwalt CL, Thorne J et al. A comparison of disturbance index (2%), defined as the number of current practice in school-based substance use apneas and hypopneas per hour of sleep associated prevention programs with meta-analysis findings. Prev with a 2% oxygen desaturation, was 2.3 (3.8) events Sci 2003; 4(1):1-14. per hour. Factors independently associated with Abstract: The series of seminal meta-analytic studies of systolic and diastolic blood pressure elevation were school-based substance use prevention program studies obesity, sleep efficiency, and respiratory disturbance conducted by the late Nancy S. Tobler and colleagues index (2%). CONCLUSIONS: In preadolescent concluded that programs with content focused on social children, elevated blood pressure is associated with influences' knowledge, drug refusal skills, and generic SBD and obesity, as previously noted in adults. The competency skills and that use participatory or control of obesity in childhood may be important to 476
- 485. reduce the daytimeconsequences of SBD and to reduce Ensor T, Dave-Sen P, Ali L, Hossain A, Begum SA, Moral the risks of life-long hypertension. H. Do essential service packages benefit the poor? Preliminary evidence from Bangladesh. Health Policy Ensminger ME, Juon HS, Fothergill KE. Childhood and Plan 2002; 17(3):247-56. adolescent antecedents of substance use in adulthood. Abstract: In 1998 Bangladesh began a sector wide Addiction 2002; 97(7):833-44. approach (SWAp) to the extension of health care to Abstract: AIMS: To examine childhood antecedents of vulnerable groups in the country. The central feature of marijuana and cocaine use in adulthood. DESIGN: this approach is the funding of an essential service Epidemiological, longitudinal cohort study of African package (ESP) emphasizing maternal care, certain American first graders (age 6) followed to age 32. communicable diseases and child health. This study PARTICIPANTS: Children (N=1242) and families in examines the way in which public sector expenditures the 57 first grade classrooms from Woodlawn, an are distributed by comparing the actual beneficiaries of inner-city community in Chicago. First grade teachers, spending with the target groups identified by the sector mothers and children provided assessments over the strategy. It finds that while the ESP is helping to target life course. During adulthood, 952 participants were re- resources at priority services, considerable barriers to interviewed. MEASUREMENTS: First grade teacher access by vulnerable groups persist. The study suggests behavior ratings, readiness for school tests, self-reports a number of issues that need to be addressed to of adolescent drug use, social bonds and adult self- improve the performance of the programme. First, reports of drug use were the primary variables. improved targeting requires greater emphasis on the FINDINGS: Males who were both shy and aggressive process of access to key services. Secondly, improving in first grade were more likely to be adult drug users the efficiency of service provision at primary level is a compared to those who were neither. Shy females in key element to increasing access, since individual first grade were less likely to be adult marijuana users primary providers are often not ready to provide the than non-shy females. Adolescent social bonds did not standard of care required by the ESP approach to moderate the relationships of earlier childhood services. Finally, the system of financial control and behavior to adult drug use. Males who had a management needs to be modified in order to make 'high/superior' readiness to learn scores in first grade allocations more responsive to the priorities determined were less likely to be cocaine users as adults, even by the SWAp. Given the widespread adoption of the though in earlier work we showed that they were more ESP approach to health care, the paper also suggests a likely to initiate adolescent drug use. Females scoring wider research agenda that examines its impact in other as poor performers in first grade were less likely to countries and evaluates this worldwide experiment in ever use cocaine compared to females with higher health service prioritization. scores. CONCLUSIONS: The combination of shy and aggressive behavior is an important antecedent for later Epstein RA. It did happen here: fear and loathing on the male drug use and may help distinguish those who will vaccine trail. Health Aff (Millwood) 2005; 24(3):740- be persistent users in adulthood from those who 3. experiment in adolescence. Abstract: Adverse publicity that placed undue emphasis on a possible connection between autism and Ensor T, Ali L, Hossain A, Ferdousi S. Projecting the cost of the measles-mumps-rubella (MMR) vaccine and essential services in Bangladesh. Int J Health Plann vaccines containing thimerosal made parents in the Manage 2003; 18(2):137-49. United Kingdom reluctant to allow their children to Abstract: Utilizing a study of the costs of providing receive the vaccine. The same concerns have played essential services in rural areas in Bangladesh themselves out in the U.S. Food and Drug projections of the cost of expanding services to the Administration's decision to recommend removal of entire rural population are derived. These estimates are thimerosal from other vaccines, even as the individual based on the current system of primary care, the autism claims have been rejected. That demographic structure of the population and recommendation, based on unsubstantiated safety normatives for desired utilization. Scenarios make use concerns, reveals a deep-seated institutional of known demographic characteristics of average rural overreaction that is more likely to cost lives than to areas together with information on disease prevalence. save them. The estimates highlight a number of difficulties involved in deriving costs and in comparing the cost- Erkanli A, Soyer R, Angold A. Bayesian analyses of effectiveness of service provision. The integrated longitudinal binary data using Markov regression nature of much primary care, both in terms of the models of unknown order. Stat Med 2001; 20(5):755- technical exploitation of joint costs and clinical 70. diagnostic and treatment protocols, means that treating Abstract: We present non-homogeneous Markov services in isolation is likely to lead to inexact regression models of unknown order as a means to estimates of service cost. The context of any costs assess the duration of autoregressive dependence in derived is required in order to make comparisons. longitudinal binary data. We describe a subject's transition probability evolving over time using logistic 477
- 486. regression models forhis or her past outcomes and children. METHOD: A cross-sectional population- covariates. When the initial values of the binary based survey from October 1996 through March 1997 process are unknown, they are treated as latent using a self-weighted and equal probability sample of variables. The unknown initial values, model Turkish toddlers (N = 638) was conducted. The Child parameters, and the order of transitions are then Behavior Checklist Total Problem scores and estimated using a Bayesian variable selection approach, Household Questionnaire reports by parent informant via Gibbs sampling. As a comparison with our source (response rate 94.3%) were examined for the approach, we also implement the deviance information effects of child gender, age, urban/suburban/rural criterion (DIC) for the determination of the order of residence, and geographic region using multiple transitions. An example addresses the progression of regression analyses. RESULTS: Overall, the total substance use in a community sample of n = 242 problem scores placed 11.9% of the children in the American Indian children who were interviewed clinically significant range and 18.6% of the children in annually four times. An extension of the Markov model the borderline range. Urban residence was significantly to account for subject-to-subject heterogeneity is also correlated with the Total Problem scores, discussed. Internalization and Externalization scores, and six Child Behavior Checklist syndrome scale scores. The Ernst M, Grant SJ, London ED, Contoreggi CS, Kimes AS, child's age, gender, or parental employment status did Spurgeon L. Decision making in adolescents with not affect Total Problem scores. With respect to the behavior disorders and adults with substance abuse. Child Behavior Checklist syndrome scale, girls had Am J Psychiatry 2003; 160(1):33-40. higher Anxious/Depressed scores than boys, and 2- Abstract: OBJECTIVE: The study assessed the validity year-olds had higher Somatic Complaints scores than of the Gambling Task as a test of decision-making the 3-year-old children. None of the children with ability in adolescents and examined whether reported emotional and behavioral problems were adolescents with behavior disorders, who are at risk for referred to any mental health services. CONCLUSION: substance abuse, have deficits in decision making As part of a national mental health policy in Turkey, similar to those exhibited by adults with substance there is an urgent need to develop early childhood abuse. METHOD: Performance on the Gambling Task intervention services that emphasize home visits, in two testing sessions separated by 1 week was center-based child care in the community, and assessed in 64 12-14-year-old adolescents (31 healthy, caregiver and provider education and training. 33 with externalizing behavior disorders) and 52 adults (22 healthy, 30 with substance abuse). RESULTS: The Escobar GJ, Braveman PA, Ackerson L et al. A randomized healthy adolescents and the healthy adults had similar comparison of home visits and hospital-based group performance on the Gambling Task. Adolescents with follow-up visits after early postpartum discharge. behavior disorders performed more poorly than healthy Pediatrics 2001; 108(3):719-27. adolescents, but only in the second testing session. In Abstract: OBJECTIVE: Short postpartum stays are adults, overall Gambling Task performance did not common. Current guidelines provide scant guidance on differ between the healthy and substance abuse groups how routine follow-up of newly discharged mother- at either testing session, indicating no difference in infant pairs should be performed. We aimed to learning of decision-making strategies between groups. compare 2 short-term (within 72 hours of discharge) However, adults with substance abuse performed more follow-up strategies for low-risk mother-infant pairs poorly than healthy adults during an early stage of the with postpartum length of stay (LOS) of <48 hours: task, when participants presumably begin to understand home visits by a nurse and hospital-based follow-up the rewards and penalties involved in the task but are anchored in group visits. METHODS: We used a not yet sure of the actual risk of incurring penalities. randomized clinical trial design with intention-to-treat CONCLUSIONS: The Gambling Task can be used analysis in an integrated managed care setting that with adolescents. Testing with the Gambling Task serves a largely middle class population. Mother-infant revealed a deficit in decision making in adolescents pairs that met LOS and risk criteria were randomized to with behavior disorders, who are at risk for substance the control arm (hospital-based follow-up) or to the abuse. This deficit may represent a vulnerability factor intervention arm (home nurse visit). Clinical utilization for the development of substance abuse. and costs were studied using computerized databases and chart review. Breastfeeding continuation, maternal Erol N, Simsek Z, Oner O, Munir K. Behavioral and depressive symptoms, and maternal satisfaction were emotional problems among Turkish children at ages 2 assessed by means of telephone interviews at 2 weeks to 3 years. J Am Acad Child Adolesc Psychiatry 2005; postpartum. RESULTS: During a 17-month period in 44(1):80-7. 1998 to 1999, we enrolled and randomized 1014 Abstract: OBJECTIVE: Within the framework of the mother-infant pairs (506 to the control group and 508 Mental Health Surveys of Turkey, the authors to the intervention group). There were no significant investigated the distribution and prevalence of parent- differences between the study groups with respect to reported behavioral and emotional problems in a maternal age, race, education, household income, nationally representative sample of 2- to 3-year-old parity, previous breastfeeding experience, early 478
- 487. initiation of prenatalcare, or postpartum LOS. There almost all of the centers chose to enroll participants were no differences with respect to neonatal LOS or through medical care facilities, they had to develop Apgar scores. In the control group, 264 mother-infant independent staffs and structures because of the pairs had an individual visit only, 157 had a group visit overburdened medical care system. Some of the only, 64 had both a group and an individual visit, 4 had lessons learned by the centers include the importance a home health and a hospital-based follow-up, 13 had of continuous funding, building community no follow-up within 72 hours, and 4 were lost to partnerships to conduct culturally appropriate research, follow-up. With respect to outcomes within 2 weeks hiring bilingual and bicultural staff from the after discharge, there were no significant differences in community, prioritizing research goals, developing newborn or maternal hospitalizations or urgent care biorepositories to ensure future utility of samples, visits, breastfeeding discontinuation, maternal instituting quality control procedures for all aspects of depressive symptoms, or a combined clinical outcome specimen and data collection, maintaining frequent measure indicating whether a mother-infant pair had contact with study participants, ensuring ethical any of the above outcomes. However, mothers in the conduct of the research in a changing medical-legal home visit group were more likely than those in the climate, and communicating results in a timely and control group to rate multiple aspects of their care as appropriate manner to participants and the wider excellent or very good. These included the preventive community. All centers underestimated the necessary advice delivered (76% vs 59%) and the skills and start-up time, staff, and costs in conducting these birth abilities of the provider (84% vs 73%). Mothers in the cohort studies. Despite the logistical complexity and home visit group also gave higher ratings on overall added expenses, all centers emphasize the importance satisfaction with the newborn's posthospital care (71% of studying the impact of environmental exposures on vs 59%), as well as with their own posthospital care those children most at risk, those living in minority and (63% vs 55%). The estimated cost of a postpartum low-income communities. These centers present home visit to the mother and the newborn was $265. In barriers encountered, solutions found, and contrast, the cost of the hospital-based group visit was considerations for future research, with the hope that $22 per mother-infant pair; the cost of an individual the lessons learned can help inform the planning and 15-minute visit with a registered nurse was $52; the conduct of the National Children's Study. cost of a 15-minute individual pediatrician visit was $92; and the cost of a 10-minute visit with an Espo M, Kulmala T, Maleta K, Cullinan T, Salin ML, obstetrician was $92. CONCLUSIONS: For low-risk Ashorn P. Determinants of linear growth and predictors mothers and newborns in an integrated managed care of severe stunting during infancy in rural Malawi. Acta organization, home visits compared with hospital- Paediatr 2002; 91(12):1364-70. based follow-up and group visits were more costly but Abstract: Stunting is common among children under 5 achieved comparable clinical outcomes and were y of age in sub-Saharan Africa. Several risk factors associated with higher maternal satisfaction. Neither have been associated with poor growth but few studies strategy is associated with significantly greater success have prospectively addressed the development of linear at increasing continuation of breastfeeding. This study growth faltering and stunting during the first year of had limited power to identify group differences in life. The present study was designed to analyse typical rehospitalization and may not be generalizable to growth among rural Malawian infants, focusing higher-risk populations without comparable access to particularly on the impact of birth size, adherence to integrated hospital and outpatient care. feeding guidelines and morbidity in the development of severe stunting during infancy. A community-based Esen UI. Autonomy of the pregnant woman. J R Soc Med cohort of 613 singleton newborns was prospectively 2003; 96(5):254-5. followed by monthly home visits. Data were collected on the children's socioeconomic background, maternal Eskenazi B, Gladstone EA, Berkowitz GS et al. size and weight gain during pregnancy, birth events, Methodologic and logistic issues in conducting morbidity, breastfeeding and complementary feeding, longitudinal birth cohort studies: lessons learned from growth and mortality. Univariate and multivariate the Centers for Children's Environmental Health and analyses were used to determine associations between Disease Prevention Research. Environ Health Perspect predictor variables and poor linear growth. The 2005; 113(10):1419-29. proportions of stunted infants (Height-for-age Z-score Abstract: In anticipation of the National Children's < -2) at 3, 6 and 9 mo of age were 27%, 51%, and 63%, Study, lessons can be learned from the smaller birth respectively. At I y of age, over two-thirds (71%) of cohort studies conducted by five Centers for Children's the infants were at least moderately (HAZ < -2) and Environmental Health and Disease Prevention 31% severely stunted (HAZ < -3). CONCLUSION: Research funded by the National Institute of The strongest predictor of severe stunting at 12 mo of Environmental Health Sciences and the U.S. age was small birth size. Other variables independently Environmental Protection Agency. The populations associated with this outcome included inappropriate studied are diverse in ethnicity and social class and complementary feeding, high morbidity, maternal short reside in urban and rural environments. Although stature, male gender, and home delivery. Faltering of 479
- 488. linear growth startedsoon after birth and continued Estevez E, Musitu G, Herrero J. The influence of violent throughout infancy. Interventions increasing birth size behavior and victimization at school on psychological could have a significant role in the prevention of early distress: the role of parents and teachers. Adolescence childhood stunting. The ideal strategy should also 2005; 40(157):183-96. emphasize the importance of appropriate infant feeding Abstract: This study examined the role of adolescents' and decreasing the number of illness episodes amongst interactions with both parents and teachers in the the infants. relationship between violent behavior/victimization at school and adolescent psychological distresss Estahbanati HK, Bouduhi N. Role of artificial neural (depression and stress). Participants were 983 Spanish networks in prediction of survival of burn patients-a adolescents (mean age 13.7 years) from four public new approach. Burns 2002; 28(6):579-86. schools in the Valencian Community. Statistical Abstract: A burn patient may require the most analyses were carried out using structural equation complicated treatment regimes encountered among modeling. Results showed victimization to be directly trauma victims. Predicting the outcome of such and positively related to psychological distress. treatment depends on several factors which have non- Moreover, victimization was associated with negative linear relationships. Traditional methods in prediction father-adolescent communication, which mediated a are "logistic regression" and "maximum likelihood". In part of the influence of victimization on distress. this study, an artificial neural network (ANN) is used Regarding school-based violent behavior, no direct for computing survival among burn patients admitted effect on psychological adjustment was found. Results to the "Motahary Burn Center", during a 1 year period showed, however, an indirect effect: violent behavior (1996-1997). Fifteen different observations, such as negatively influenced communication with parents and total body surface area (TBSA), rescue time, admission interaction with teachers which, in turn, was related to period, surgery, inhalation injuries, etc. were obtained, poor psychological adjustment. This model accounted retrospectively. A normal feed forward ANN was for 47.7% of the variance in psychological distress. developed by Thinkspro software. It has 15 input-units, Findings are discussed in relation to previous research two hidden layers, and one output-unit. Survival was on adolescent psychosocial adjustment, and directions higher in males, those in whom early fluid resuscitation for future research are suggested. had been initiated and in patients in the middle of the age spectrum (P<0.0001). Strong correlations with Ethier K, St Lawrence JS. The role of early, multilevel youth these factors were noted.In the training phase, the development programs in preventing health risk ANNs accuracy reached 90%. In this study, the ANN behavior in adolescents and young adults. Arch Pediatr has been applied for the first time to predict burn Adolesc Med 2002; 156(5):429-30. victim survival. This study can enable a different view point to help burn center physicians in the prediction of Etikan I, Caglar MK. Prediction methods for babies' birth survival of their patients. weight using linear and nonlinear regression analysis. Technol Health Care 2005; 13(2):131-5. Estell DB, Farmer TW, Cairns BD, Clemmer JT. Self-report Abstract: The aim of this study is to determine more weapon possession in school and patterns of early accurate prediction methods between linear and non- adolescent adjustment in rural african american youth. linear methods for prediction of babies' birth weight J Clin Child Adolesc Psychol 2003; 32(3):442-52. among maternal demographic characteristics. Three Abstract: Examined 345 6th-grade rural African hundred pregnant women were included in the study. American youth (189 boys, 156 girls) over 3 years with Blood glucose level before and after ingestion of regard to carrying weapons in school. Recent glucose load, age, body mass index, % of change in investigations with nationally representative and urban weight during pregnancy, height, gestational age, samples have shown that carrying weapons in school parity, and fetal sex were collected as independent fits into a larger pattern of problem behaviors, variables and baby birth weight as dependent variable. including aggression and substance use, which are In linear regression, least squares estimation method supported by affiliations with other deviant youth. was used to estimate parameters. Non-linear regression Very little work to date has specifically examined method was performed using neural network model weapon carrying in rural African American youth. This with multilayer perceptrons, back propagation method study found that weapon carriers in the first year were was preferred as learning algorithm. Coefficient of primarily male, more aggressive, and had higher rates determination, R2, of the linear regression equation of substance use than noncarriers. Concurrent peer was found 59.8% and the standard error of the estimate affiliations were not related to weapon carrying in the was calculated as 325.69 gr. In non-linear regression first year. However, among those who were not carriers method R2 value was also found 59.8% and standard in the 1st year, transitioning into weapon carrying was error of estimate was calculated as 320.30 gr. related to both individual marijuana use and peer-group According to the results of the present study, one aggression and marijuana use. Finally, over the 3 years method is not significantly better than the other. When of the study, weapon carriers tended to maintain their "accuracy in prediction" is aimed, it is better to use the high levels of aggression, drinking, and marijuana use. two methods and compare the results, and then decide 480
- 489. on the selectionof the favourable method. preenrollment and 47% postenrollment. Among 2,519 contacts whose immunity status was susceptible or Etiler N, Velipasaoglu S, Aktekin M. Risk factors for overall unknown, the vaccination start/finish rate was and persistent diarrhoea in infancy in Antalya, Turkey: 45%/41%. Site-specific adjusted relative risks of a cohort study. Public Health 2004; 118(1):62-9. household noncompliance compared with Texas were Abstract: The aim of this study was to identify factors 2.14 (Michigan), 1.96 (Georgia), and 1.30 that influence the incidence of diarrhoea in infancy. (Connecticut). Mother's birth in the United States The study was a prospective cohort study conducted in increased the relative risk of household noncompliance two primary healthcare unit areas in Antalya, Turkey. (1.32). Home visits, implemented only in Texas, most A total of 204 infants were followed until they were likely account for higher compliance rates in that state. aged 1 year. Morbidity surveillance and anthropometric Findings may indicate that many perinatal programs measurements were carried out by home visits every 2 could achieve higher overall rates of infant and contact months. The average incidences were found to be 2.76 identification; pre- and postvaccination serologic episodes per child-year for overall diarrhoea and 18.56 testing in contacts and infants, respectively; and episodes per 100 child-years for persistent diarrhoea. contact hepatitis B vaccination. Relative risks, confidence intervals and logistic regression analyses were used to assess the Euler GL, Copeland JR, Rangel MC, Williams WW. associations. For both overall diarrhoea and persistent Antibody response to postexposure prophylaxis in episodes, increased risks were associated with having infants born to hepatitis B surface antigen-positive an uneducated mother (RR=1.89 and 5.33, women. Pediatr Infect Dis J 2003; 22(2):123-9. respectively) and a self-employed father (RR=1.89 and Abstract: BACKGROUND: Annually 20,000 infants 3.77, respectively). Among environmental factors, are born to hepatitis B surface antigen (HBsAg)- living in a slum was associated with both overall positive US women. Without prophylaxis 30% risk (RR=1.68) and persistent (RR=2.69) diarrhoea, chronic hepatitis B virus infection, and 25% of those whereas living in a crowded house (RR=1.70), having risk dying from resulting liver cirrhosis or liver cancer no kitchen (RR=2.27) or having an unhygienic toilet as adults. METHODS: We attempted to interview each (RR=1.93) were found to be significant for overall HBsAg-positive pregnant woman reported to the health episodes alone. Factors related to the infant were department between 1992 and 1997, to provide their preterm birth (RR=1.64), low birth weight (RR=2.05), infants with immunoprophylaxis at birth and in the and first breastfeed given more than 1 h after birth clinic or home and to serotest at 9 to 15 months of age. (RR=1.64). Nutritional status was also associated with RESULTS: Of 879 women reported, 92% enrolled; overall or persistent diarrhoea: underweight children 787 delivered 796 live infants; 91% of infants received (RR=2.15, persistent diarrhoea only), stunted children hepatitis B immunoglobulin; 98, 95 and 89% received (RR=1.67 and 2.14, respectively) or wasted children hepatitis B vaccine (HepB) Doses 1, 2 and 3, (RR=1.54 and 3.20, respectively). By logistic respectively; and 80% were serotested. Of these 2.2% regression analysis, both overall and persistent were HBsAg-positive and 97% had antibody to HBsAg diarrhoea were found to be associated with mother's (anti-HBs) of > or =10 mIU/ml. Anti-HBs education. concentrations measured in 504 infants were 10 to 99 mIU/ml (25%), 100 to 999 mIU/ml (43%) and > or Euler GL, Copeland J, Williams WW. Impact of four urban =1000 mIU/ml (29%). Serotesting was less likely perinatal hepatitis B prevention programs on screening among infants of mothers <20 years of age [odds ratio and vaccination of infants and household members. (OR) 2.5]; white, non-Hispanic (OR 2.8); or with a Am J Epidemiol 2003; 157(8):747-53. household income of <$15,000/year (OR 2.0). Lower Abstract: During 1992-2000, the authors studied antibody titers were found when serotesting at 4 to 12 compliance with perinatal hepatitis B prevention months than at <4 months after HepB-3 (OR 1.8 to recommendations, including vaccination of household 4.4), with HepB-3 receipt <6 months after HepB-2 (OR contacts, at four metropolitan sites in Connecticut, 2.5) and when household income was <$15,000/year Georgia, Texas, and Michigan. Demographic and (OR 2.1). CONCLUSIONS: Centralized case hepatitis B-related knowledge, attitudes, practices, and management with home visits resulted in high rates of barrier data were collected on pregnant women testing complete immunoprophylaxis and postvaccination positive for hepatitis B surface antigen and on their testing among infants born to HBsAg-positive women. infants, children, and household and sexual contacts. Perinatal immunoprophylaxis was immunogenic under Generalized estimating equations with repeated routine public health use, with higher anti-HBs titers measures in a multivariable model were used to obtain occurring in infants tested <4 months postvaccination. adjusted relative risks of household noncompliance. In Because infants in households with low income had 1,458 households studied, 1,490 infants and 3,502 higher rates of nonprotective antibody responses, they other contacts were identified. Among infants, may benefit from extra efforts to ensure that serotesting vaccination start/finish rates were 92%/72%, and 73% is conducted postvaccination. were serotested postvaccination. Prevaccination serotesting rates among contacts were 22% Evander E, Holst H, Jarund A et al. Role of ventilation 481
- 490. scintigraphy in diagnosisof acute pulmonary increased deposition of body fat, and a higher summary embolism: an evaluation using artificial neural index of total allostatic load. Previous findings that networks. Eur J Nucl Med Mol Imaging 2003; children who face more cumulative risk have greater 30(7):961-5. psychological distress were replicated among a sample Abstract: The purpose of this study was to assess the of rural children and shown to generalize to lower value of the ventilation study in the diagnosis of acute perceptions of self-worth. Prior cumulative risk pulmonary embolism using a new automated method. research was further extended through demonstration Either perfusion scintigrams alone or two different of self-regulatory behavior problems and elevated combinations of ventilation/perfusion scintigrams were learned helplessness. used as the only source of information regarding pulmonary embolism. A completely automated method Evans R. Children living with domestic violence. Emerg based on computerised image processing and artificial Nurse 2001; 9(6):22-6. neural networks was used for the interpretation. Three artificial neural networks were trained for the diagnosis Evans WD, Finkelstein EA, Kamerow DB, Renaud JM. of pulmonary embolism. Each network was trained Public perceptions of childhood obesity. Am J Prev with 18 automatically obtained features. Three Med 2005; 28(1):26-32. different sets of features originating from three sets of Abstract: BACKGROUND: Obesity has been scintigrams were used. One network was trained using identified as an epidemic by the Centers for Disease features obtained from each set of perfusion Control and Prevention. Rates of unhealthy body scintigrams, including six projections. The second weight among children and adolescents have tripled network was trained using features from each set of since the 1980s to 15%. Media coverage of obesity has (joint) ventilation and perfusion studies in six also increased, and the public is now highly aware of projections. A third network was trained using features obesity-related health threats facing adults and from the perfusion study in six projections combined children. METHODS: RTI International sponsored a with a single ventilation image from the posterior view. representative survey of U.S. households (n =1047) A total of 1,087 scintigrams from patients with that included detailed questions about perceptions of suspected pulmonary embolism were used for network the severity, causes, and public support for specific training. The test group consisted of 102 patients who intervention strategies to combat childhood obesity. had undergone both scintigraphy and pulmonary Logistic regressions were calculated to examine angiography. Performances in the test group were differences in support by sociodemographic measured as area under the receiver operation characteristics. RESULTS: Respondents considered characteristic curve. The performance of the neural childhood obesity to be as serious as other major network in interpreting perfusion scintigrams alone childhood health threats, such as tobacco use and was 0.79 (95% confidence limits 0.71-0.86). When one violence, but not as serious as drug abuse. They ventilation image (posterior view) was added to the supported most school-, community-, and media-based perfusion study, the performance was 0.84 (0.77-0.90). strategies that involved offering health information, This increase was statistically significant ( P=0.022). limiting unhealthy food promotion, and increasing The performance increased to 0.87 (0.81-0.93) when healthy nutrition and physical activity choices, but all perfusion and ventilation images were used, and the were generally opposed to regulatory and tax- or cost- increase in performance from 0.79 to 0.87 was also based interventions. Logistic regressions revealed statistically significant ( P=0.016). The automated significantly greater support for some interventions method presented here for the interpretation of lung among highly educated individuals and women, and scintigrams shows a significant increase in lower support among parents with children at home. performance when one or all ventilation images are CONCLUSIONS: This study demonstrates that there is added to the six perfusion images. Thus, the ventilation strong public support for interventions aimed at study has a significant role in the diagnosis of acute reducing overweight and obesity among children and lung embolism. adolescents. It also shows specific school, community, and media interventions that the public supports and Evans GW. A multimethodological analysis of cumulative opposes, and what consequences the public will accept risk and allostatic load among rural children. Dev in combating childhood obesity. These findings can Psychol 2003; 39(5):924-33. help policymakers and public health professionals Abstract: This study merged two theoretical constructs: design and implement appropriate interventions. cumulative risk and allostatic load. Physical (crowding, noise, housing quality) and psychosocial (child Evans WD, Ulasevich A, Blahut S. Adult and group separation, turmoil, violence) aspects of the home influences on participation in youth empowerment environment and personal characteristics (poverty, programs. Health Educ Behav 2004; 31(5):564-76. single parenthood, maternal highschool dropout status) Abstract: This study examined adult and group were modeled in a cumulative risk heuristic. Elevated influences on youth participation in youth cumulative risk was associated with heightened empowerment (YE) Statewide Youth Movement cardiovascular and neuroendocrine parameters, 482
- 491. Against Tobacco Useprograms. Adults provide Fair E, Murphy TV, Golaz A, Wharton M. Philosophic individual guidance to youth groups and through objection to vaccination as a risk for tetanus among existing tobacco control networks affect the social children younger than 15 years. Pediatrics 2002; context in which YE programs are implemented. The 109(1):E2. authors tested hypotheses about the direct and indirect Abstract: OBJECTIVES: Although safe and effective relationships between adults, groups, and youth vaccines are available to protect against tetanus in the collective participation. They used data from adults and United States and vaccination rates are high, cases of youths to develop a measurement model of four higher tetanus among children continue to occur. The order factors: adult involvement, group structure, group objectives of this article are to describe reported cases climate, and collective participation. They tested of tetanus in children in the United States and to relationships between these factors in a structural identify the reasons for lack of protection against equation model. Results showed that adult involvement tetanus. METHODS: We reviewed all cases of tetanus did not have a meaningful direct effect on group factors in children <15 years of age that were reported to the or collective participation. Group factors mediated the National Notifiable Diseases Surveillance System from relationship between adult involvement and collective 1992 through 2000. Cases were defined by physician participation. Further research is needed on how to diagnosis. We verified the information in the case measure adult involvement and its relationship to youth reports with state and local health departments. participation. RESULTS: From 1992 through 2000, 15 cases of tetanus in children <15 years of age were reported from Fagan AA. The short- and long-term effects of adolescent 11 states. Twelve cases were in boys. Two cases were violent victimization experienced within the family and in neonates <10 days of age; the other 13 cases were in community. Violence Vict 2003; 18(4):445-59. children who ranged in age from 3 to 14 years. The Abstract: Adolescents face high rates of victimization, median length of hospitalization was 28 days; 8 yet little is known regarding the criminal consequences children required mechanical ventilation. There were of these experiences. Using data from the National no deaths. Twelve (80%) children were unprotected Youth Survey, this investigation compared the relative because of lack of vaccination, including 1 neonate and combined effects of adolescent violent whose mother was not vaccinated. Among all victimization perpetrated by family and nonfamily unvaccinated cases, objection to vaccination, either members on self-reported criminal offending from religious or philosophic, was the reported reason for adolescence to early adulthood. The results choosing not to vaccinate. CONCLUSION: The demonstrate that both types of violence have an majority of recent cases of tetanus among children in immediate and sustained impact on criminal the United States were in unvaccinated children whose involvement, although the effect is somewhat stronger parents objected to vaccination. Parents who choose for nonfamily victimization, and for both types, the not to vaccinate their children should be advised of the relationship tends to weaken over time. In addition, seriousness of the disease and be informed that tetanus those experiencing both types of victimization report a is not preventable by means other than vaccination. higher frequency of offending compared to those experiencing only one type. The findings indicate the Faith MS, Berkowitz RI, Stallings VA, Kerns J, Storey M, need for prevention programs aimed at decreasing the Stunkard AJ. Parental feeding attitudes and styles and prevalence of adolescent victimization, as well as child body mass index: prospective analysis of a gene- intervention efforts to help victims from becoming environment interaction. Pediatrics 2004; 114(4):e429- offenders. 36. Abstract: BACKGROUND: Parental feeding styles Fahey A, Day NA, Gelber H. Tele-education in child mental were linked to child weight in cross-sectional studies, health for rural allied health workers. J Telemed which were unable to test the direction of effect. Telecare 2003; 9(2):84-8. Prospective studies can best establish causal Abstract: We developed a tele-education programme in relationships among such variables. OBJECTIVE: We child mental health for rural allied health workers. The tested the 2-year stability of parental feeding attitudes programme was delivered in two parts, each consisting and styles and investigated whether these variables of six sessions. Videoconferencing at 384 kbit/s was predict child body mass index (BMI) z scores 2 years used. Satisfactory retention rates were maintained later. We evaluated whether these associations were throughout. Participants consistently reported increases dependent on children's predisposition to obesity. in knowledge and skills as a result of attending the METHODS: Participants were 57 families enrolled in programme. The project resulted in a high rate of an Infant Growth Study of children born at high risk or reported changes to practice. An unanticipated outcome low risk for obesity, on the basis of maternal was the value placed on the opportunities for local prepregnancy overweight or leanness. Children were networking provided by the project for participants. evaluated for weight and height at 3, 5, and 7 years of Videoconferencing can deliver effective professional age. Measures of parental feeding attitudes and styles development to allied health workers in child mental were ascertained with the Child Feeding Questionnaire health. at 5 and 7 years of age. Correlation and multiple 483
- 492. regression analyses testedwhether parental feeding duration of breast-feeding. styles at age 5 predicted increased child BMI z scores 2 years later. RESULTS: Parental feeding attitudes and Fallot RD, Harris M. A trauma-informed approach to styles were stable for child ages of 5 to 7 years. With screening and assessment. New Dir Ment Health Serv respect to feeding attitudes, perceived responsibility at 2001; (89):23-31. age 5 predicted reduced child BMI z scores at age 7 Abstract: Universal trauma screening and specific among low-risk families, whereas child weight concern trauma assessment methods are necessary to and perceived child weight predicted increased child developing collaborative relationships with trauma BMI z scores among high-risk families. With respect to survivors and offering appropriate services. feeding styles, monitoring predicted reduced child BMI z scores at age 7 among low-risk children. In contrast, Fals-Stewart W, Kelley ML, Cooke CG, Golden JC. restriction predicted higher BMI z scores and pressure Predictors of the psychosocial adjustment of children to eat predicted reduced BMI z scores among high-risk living in households of parents in which fathers abuse children. These associations remained significant after drugs: the effects of postnatal parental exposure. controlling for child weight status at age 3. Addict Behav 2003; 28(6):1013-31. CONCLUSIONS: The relationship between parental Abstract: The purpose of this study was to examine the feeding styles and child BMI z scores depends on child relationship between the psychosocial adjustment of obesity predisposition, suggesting a gene-environment children living in households of parents (N=112) in interaction. Among children predisposed to obesity, which fathers were entering treatment for substance elevated child weight appears to elicit restrictive abuse and the following sets of variables: (a) parents' feeding practices, which in turn may produce sociodemographic characteristics, (b) parents' dyadic additional weight gain. Parenting guidelines for adjustment, (c) fathers' substance use severity, and (d) overweight prevention may benefit from consideration parents' psychological adjustment. Mothers did not of child characteristics such as vulnerability to obesity meet current criteria for a psychoactive substance use and current weight status. disorder on alcohol or other drugs; moreover, based on reports by parents, none of the children was not Falceto OG, Giugliani ER, Fernandes CL. Influence of exposed prenatally to illicit drugs. Results of parental mental health on early termination of breast- hierarchical-by-blocks regression analyses revealed feeding: a case-control study. J Am Board Fam Pract that each of the variable sets made a significant unique 2004; 17(3):173-83. contribution to the prediction of children's psychosocial Abstract: BACKGROUND: The WHO recommends adjustment. Furthermore, the following variables exclusive breast-feeding for babies up to 6 months of within the sets were also found to be significant: (a) age. The association between maternal mental health parents' age, (b) weekly family income, (c) frequency and breast-feeding duration is contradictory. This is a of male-to-female physical aggression between the case-control study to investigate this association. parents, (d) frequency of fathers' substance use during METHODS: 153 families with 4-month-old babies the previous year, (e) diagnosis of antisocial from an urban area in southern Brazil were personality disorder of fathers, and (f) mothers' level of investigated: in 51 families, breast-feeding had being psychological distress. discontinued (cases); in 102, babies were being breast- fed (controls). Two researchers evaluated maternal and Fanslow J. Responding to partner abuse: understanding its paternal mental health during home visits using consequences, and recognising the global and historical semistructured interviews and scales. RESULTS: context. N Z Med J 2004; 117(1202):U1073. Disorders were found in 59% of case mothers versus 48% of control mothers. Depression was the most Faraone SV. Improving mental health care for children and prevalent disorder affecting both mothers and fathers. adolescents: a role for prevention science. World We did not identify a statistically significant Psychiatry 2005; 4(3):155-6. association between maternal mental disorder at 4 months after delivery and early termination of breast- Faraone SV. The scientific foundation for understanding feeding. When the mother had mental problems during attention-deficit/hyperactivity disorder as a valid the first month after delivery, however, she was twice psychiatric disorder. Eur Child Adolesc Psychiatry as likely to interrupt breast-feeding. Among the 2005; 14(1):1-10. mothers with mental disorders during puerperium, 76% Abstract: Continued questioning of the validity of a still had the problem 4 months postpartum. An diagnosis of attention-deficit/hyperactivity disorder association was observed between maternal and (ADHD) has created uncertainties about its paternal mental health. CONCLUSIONS: Parental management in the minds of many clinicians and the mental health does not seem to be associated with public. Inaccurate beliefs about the validity of ADHD breast-feeding at 4 months in this culture setting where hinder the clinical care of many ADHD patients and most mothers have good family and social support for lead to confusion about the need to seek out or accept breast-feeding. Maternal mental disorders during treatment. Critics describe ADHD as a diagnosis used puerperium, however, may negatively affect the 484
- 493. to label difficultchildren who are not ill but whose together and the technical process for doing so, behavior is at the extreme end of normal. They further financing mechanisms, range of anticipated contend that, far from having a biological basis, ADHD information-users and their method of access to the results from poor parenting and ineffective teaching integrated system, and common internal and external practices. Such attitudes do much to further stigmatize challenges and strengths that the health departments patients and their families and increase the burden of face. The evidence suggests a trend towards more this debilitating condition. This review attempts to efficient and thoughtful use of the multiplicity of address these challenges by presenting evidence to information systems within public health departments show that ADHD meets the criteria for a valid as programs consolidate and share data and expand psychiatric diagnosis. Not only does it cause specific electronic communication with their external partners disabling symptoms that frequently persist into in the health care delivery system to improve children's adulthood, but many studies show it has a biological health. basis and a characteristic response to treatment. Such data support the idea that ADHD is a valid diagnostic Feinfield KA, Baker BL. Empirical support for a treatment category. program for families of young children with externalizing problems. J Clin Child Adolesc Psychol Faria MA Jr. Should physicians routinely inquire about 2004; 33(1):182-95. guns? No: this inquiry is an invasion of privacy. West J Abstract: We evaluated the efficacy of a manualized Med 2001; 175(3):149. multimodal treatment program for young externalizing Notes: GENERAL NOTE: KIE: 5 refs. children. Families were assigned randomly to an GENERAL NOTE: KIE: KIE Bib: professional patient immediate 12-week parent and child treatment relationship condition (n = 24) or to a delayed-treatment condition (n = 23). Parents had high attendance, high satisfaction Farver JA, Xu Y, Eppe S, Fernandez A, Schwartz D. with treatment, and increased knowledge of behavior Community violence, family conflict, and preschoolers' management principles. Relative to the waitlist socioemotional functioning. Dev Psychol 2005; condition, treatment parents reported statistically and 41(1):160-70. clinically significant reductions in child behavior Abstract: This study examined the relations among problems, improved parenting practices (i.e., increased family conflict, community violence, and young consistency, decreased power assertive techniques), an children's socioemotional functioning and explored increased sense of efficacy, and reduced parenting how children's social cognition and mothers' stress. There was a trend toward parents improving psychological functioning may mediate the outcomes their attitudes toward their children. In considering the associated with this exposure. Mothers of 431 Head process of change, we found evidence that improved Start preschoolers completed questionnaires about their parenting practices mediated reductions in child family demography, exposure to community violence, behavior problems and that child improvements family conflict, and children's distress symptoms. mediated changes in parent attitudes and stress. Five Children were administered a social cognition months following treatment, teachers reported assessment, and teachers rated their behavior. Results significant improvements in child behaviors, whereas showed that mothers' reports of children's co- parents reported that reductions in child behavior witnessing of community violence were positively problems and parenting stress were maintained. associated with police department crime rates, children's distress symptoms, and teachers' ratings of Feitshans IL. Protecting posterity: the occupational aggression. A path analysis revealed that children's physician's ethical and legal obligations to pregnant social awareness and mothers' depressive symptoms workers. Occup Med 2002; 17(4):673-85. partially mediated the effects of community violence Abstract: This article describes Federal and and family conflict on outcomes for children. international codes and laws that relate to protection from reproductive hazards in the workplace. Fehrenbach SN, Kelly JC, Vu C. Integration of child health Occupational health practitioners are advised to shift information systems: current state and local health their approach from managing the technical aspects department efforts. J Public Health Manag Pract 2004; needed to protect individual workers to the more global Suppl:S30-5. approach of effecting policy and supporting Abstract: Public health departments at the state and enforcement in the realm of reproductive health. This local levels are pursuing integration strategies to broader view will not only better protect women and consolidate child health information systems to children but will better serve the interest of society in improve child health. Eighteen health departments replacing all existing workers and perpetuating were interviewed in this exploratory research study to civilization for posterity. gather information to describe their current activities related to integrating child health information systems. Fekkes M, Pijpers FI, Verloove-Vanhorick SP. Bullying Results illustrate the common systems being brought behavior and associations with psychosomatic 485
- 494. complaints and depressionin victims. J Pediatr 2004; study of stressful chilhood experiences]. Prax 144(1):17-22. Kinderpsychol Kinderpsychiatr 2003; 52(8):547-59. Abstract: OBJECTIVES: To assess the association Abstract: A population-based analysis of over 17,000 between bullying behavior and a wide variety of middle-class American adults undergoing psychosomatic health complaints and depression.Study comprehensive, biopsychosocial medical evaluation design In a cross-sectional study, 2766 elementary indicates that three common categories of addiction are school children age 9 to 12 years filled out a strongly related in a proportionate manner to several questionnaire on bullying behavior and health specific categories of adverse experiences during complaints. Three groups-bullied children, active childhood. This, coupled with related information, bullies, and children who both bully and are bullied- suggests that the basic cause of addiction is were compared with the group of children not involved predominantly experience-dependent during childhood in bullying behavior. Subsequently, risks for and not substance-dependent. This challenge to the psychosomatic symptoms and depression were usual concept of the cause of addictions has significant calculated by means of odds ratios. RESULTS: Bully implications for medical practice and for treatment victims had significantly higher chances for depression programs. and psychosomatic symptoms compared with children not involved in bullying behavior. Odds ratios were as Felitti VJ. [The relationship of adverse childhood follows: headache, 3.0; sleeping problems, 2.4; experiences to adult health: Turning gold into lead]. Z abdominal pain, 3.2; bed-wetting, 2.9; feeling tired, Psychosom Med Psychother 2002; 48(4):359-69. 3.4; and depression, 7.7. Children who actively bullied Abstract: The Adverse Childhood Experiences (ACE) did not have a higher chance for most of the Study is a long term, in-depth analysis of over 17,000 investigated health symptoms. CONCLUSIONS: Being adult Americans, matching their current health status bullied is strongly associated with a wide range of against adverse childhood experiences that occurred on psychosomatic symptoms and depression. These average a half-century earlier. We found that such associations are similar to the complaints known to be adverse childhood experiences are quite common associated with child abuse. Therefore, when such although typically concealed and unrecognized; that health complaints are presented, pediatricians and other they still have a profound effect a half century later, health care workers should also be aware of the although now transmutated from psychosocial possibility that a child is being bullied to take experience into organic disease; and that they are the preventive measures. main determinant of the health and social well-being of the nation. Our findings are of direct importance to the Feldman R, Klein PS. Toddlers' self-regulated compliance to everyday practice of medicine and psychiatry because mothers, caregivers, and fathers: implications for they indicate that much of what is recognized as theories of socialization. Dev Psychol 2003; 39(4):680- common in adult medicine is the result of what is not 92. recognized in childhood. The ACE Study challenges as Abstract: To compare children's socialized behavior to superficial the current conceptions of depression and parents and nonparental agents, this study examined addiction, showing them to have a very strong dose- self-regulated compliance to mothers and caregivers-- response relationship to antecedent life experiences. an early form of internalization--in 90 toddlers, half of whom were also observed with fathers. Adults were Felland L, Benoit AM. Communities play key role in observed in play, teaching, and discipline sessions with extending public health insurance to children. Issue the child and were interviewed on child-rearing Brief Cent Stud Health Syst Change 2001; (44):1-4. philosophies. Child cognition and emotion regulation Abstract: Nearly all low-income children are now were assessed, and naturalistic observations were eligible for public health insurance coverage through conducted at child-care locations. Mean-level and rank- Medicaid or the State Children's Health Insurance order stability were found in child compliance to the 3 Program (SCHIP), but millions of eligible children still adults. Child emotion regulation and adult warm lack coverage. Increasingly, states have turned to local control in a discipline situation were related to self- communities to assist with SCHIP outreach. The regulated compliance to the mother, caregiver, and Center for Studying Health System Change's (HSC) father. Compliance to parents correlated with parental recent site visits to 12 nationally representative sensitivity and philosophies, and compliance to the communities found many organizations not caregiver correlated with child cognition and social traditionally involved in public health insurance involvement when child-care quality was controlled. activities--such as schools, employers and religious and Maternal sensitivity and warm control discipline community groups--playing important outreach roles. predicted compliance to the caregiver but not vice Local social service agencies, health departments and versa. Results are consistent with theoretical positions providers also are helping children gain coverage. For on the generalization of socialization from the mother policy makers seeking to increase enrollment, these to nonmaternal agents. community efforts offer a valuable road map. Local SCHIP outreach generally is considered successful but Felitti VJ. [Origins of addictive behavior: evidence from a is costly. And, state budget shortfalls and reduced 486
- 495. federal SCHIP fundingcould threaten outreach efforts. Ferdinand RF, Blum M, Verhulst FC. Psychopathology in adolescence predicts substance use in young adulthood. Felt-Lisk S, Gold MR. Do quality improvement strategies Addiction 2001; 96(6):861-70. for Medicaid enrollees differ in Medicaid-dominant Abstract: AIMS: To investigate prospective versus commercial managed care organizations? Am J associations between psychopathology in adolescence Manag Care 2003; 9(12):806-16. and tobacco, alcohol and drug use in young adulthood. Abstract: OBJECTIVE: To examine whether it matters, DESIGN: A sample of 787 10-14-year-olds from the in terms of quality improvement initiatives and access Dutch general population was prospectively followed- to commercial networks, whether states contract with up across an 8-year interval. The Child Behavior Medicaid-dominant or commercial managed care Checklist (CBCL) was administered at initial plans. STUDY DESIGN: A 2001 telephone survey of assessment, and at 2- and 4-year follow-ups. Substance Medicaid managed care plans in 11 states that together abuse was assessed with the Young Adult Self-Report account for about half of the national Medicaid (YASR) at 8-year follow-up. FINDINGS: The Thought managed care enrollment. METHODS: The survey was Problems scale of the CBCL was the strongest developed in consultation with a panel of individuals predictor of alcohol use, while smoking was predicted knowledgeable about Medicaid managed care. by the Thought Problems and Delinquent Behavior Information on plan characteristics and network design scales. The strongest association with drug use in was obtained from the plan CEO or person most young adulthood was for the CBCL Delinquent knowledgeable about the topics. The rest of the data Behavior scale. Predictive value of predictors in early were obtained from the person the CEO named as most adolescence was as important as in late adolescence. knowledgeable about quality improvement initiatives. CONCLUSION: To investigate pathways towards RESULTS: Surveyed plans reported an extensive array substance use in young adulthood, studies assessing a of quality improvement initiatives. Programs are in broad range of possible predictors, including Thought many ways similar across Medicaid-dominant and Problems, at different developmental stages of commercial plans. Medicaid-dominant plans tend to adolescence, are needed. specialize more in conditions of greatest priority to Medicaid beneficiaries. Commercial plans tend to Ferguson TJ. Mapping shame and its functions in develop programs for accreditation by the National relationships. Child Maltreat 2005; 10(4):377-86. Committee for Quality Assurance, and to limit Abstract: Articles in this issue examine how measurement specific to the Medicaid population. They experiences of shame, together with its effects on draw on their commercial networks to support the anger, are involved in maltreatment's sequelae. Authors Medicaid product line, but how much they expand identify mechanisms through which these emotions provider access is not clear. Both types of programs result from, and adversely affect, victims' concurrent face barriers that limit the effectiveness of the plans' and later adjustment. Using Leary's (1999) analysis of initiatives. CONCLUSION: This study shows similar paradoxes in research concerning self-esteem, extensive development of quality initiatives in this commentary pinpoints dilemmas and consequences Medicaid managed care plans, with limited differences implied in this special issue regarding shame. These across Medicaid-dominant and commercial plans. include whether shame should be accentuated as the central emotional mediator or moderator in Fenwick J, Barclay L, Schmied V. Struggling to mother: a maltreatment sequelae, inferring particular attributions, consequence of inhibitive nursing interactions in the regulatory goals, or consequences based on extant neonatal nursery. J Perinat Neonatal Nurs 2001; measures of shame and construing these as outcomes 15(2):49-64. or causes in maltreatment sequelae. Questions are Abstract: This paper reports on one aspect of a raised concerning the diverse functions of shame, alone grounded theory study of women's experiences of and in combination with anger or guilt, the steps mothering in the nursery. Over 60 hours of interview needed to reveal these various functions, and their data with 28 Australian women were analyzed. The implications for therapeutic interventions with analysis revealed that mothering in the nursery was a survivors of abuse. Adopting this approach three-way interaction. "Struggling to mother" was the acknowledges that expressions of shame may label given to the major category that represented how sometimes help victims negotiate relational hazards women responded to unsatisfactory nursing encounters. and treats shame as a signal or coeffect in maltreatment The findings illuminate how inhibitive nursing sequelae. interactions relegate women to the periphery of care and engender an array of negative emotional responses Fergusson DM, Goodwin RD, Horwood LJ. Major that leave women feeling inconsequential to the depression and cigarette smoking: results of a 21-year welfare of their infant. Ultimately this has implications longitudinal study. Psychol Med 2003; 33(8):1357-67. for how women take up their role as mothers in the Abstract: BACKGROUND: The aim of this paper was nursery and for their sense of confidence, competence, to examine the association between major depression and connection with their infant. and cigarette smoking among young adults in a birth cohort before and after adjusting for confounding 487
- 496. factors. METHOD: Datawere gathered over the course childhood for psychosocial functioning in adulthood. J of the Christchurch Health and Development Study Child Psychol Psychiatry 2005; 46(8):837-49. (CHDS). The CHDS is a longitudinal study of a birth Abstract: BACKGROUND: This paper seeks to extend cohort of 1265 New Zealand children studied to age research into the adult sequelae of childhood conduct 21. Data were gathered by interview on: (a) major problems by investigating the associations between depression over the period 16-21 years; (h) daily conduct problems in middle childhood and smoking and nicotine dependence over the period from psychosocial outcomes in adulthood. METHOD: Data 16-21 years. In addition, the study included extensive were gathered during the course of a 25-year information on social, family, and behavioural factors longitudinal study of a birth cohort of New Zealand in childhood and adolescence. RESULTS: Young young people. Information was collected on: a) parent people meeting DSM-IV criteria for major depression and teacher reports of child conduct problems at ages had elevated rates of daily smoking and nicotine 7, 8 and 9 years; b) measures of crime, substance use, dependence. These associations were reduced mental health, sexual/partner relationships, substantially by control for potential confounding child education/employment; c) confounding factors, and adolescent factors. Nonetheless, even after such including childhood, family and educational control, major depression was associated with characteristics. RESULTS: There were statistically increased rates of daily smoking (IRR = 1.19; 95% CI significant associations between childhood conduct = 1.03, 1.39) and elevated rates of nicotine dependence problems from 7-9 years and risks of adverse outcomes (OR = 1.75; 95% CI = 1.13, 2.70). CONCLUSIONS: across all domains of functioning. After control for The results suggest that much of the association confounding factors the associations between conduct between smoking and depression reflects common problems and education/employment outcomes became confounding factors that are associated with both statistically non-significant. Associations persisted for outcomes. Nonetheless, even after control for these other outcomes (crime, substance dependence, mental factors there is evidence of a possible causal linkage health and sexual/partner relationships). Children in the between smoking and depression. The direction of most disturbed 5% of the cohort had rates of these causality between smoking and depression remains outcomes that were between 1.5 and 19 times higher unknown. than rates for the least disturbed 50% of the cohort. The associations between conduct problems and adult Fergusson DM, Horwood LJ. The Christchurch Health and outcomes were similar for males and females. Development Study: review of findings on child and CONCLUSIONS: Childhood conduct problems were adolescent mental health. Aust N Z J Psychiatry 2001; associated with a wide range of adverse psychosocial 35(3):287-96. outcomes (crime, substance use, mental health, Abstract: OBJECTIVE: This paper provides an sexual/partner relationships) even after control for overview of the Christchurch Health and Development confounding factors. The results reinforce the need for Study (CHDS) and a summary of findings relating to greater investment into interventions to address these child and adolescent mental health. METHOD: The problems. CHDS is a longitudinal study of a birth cohort of 1265 children born in the Christchurch (New Zealand) urban Ferre Navarete F, Palanca I. Mental health care in Madrid. region during mid 1977. This cohort has now been Eur Psychiatry 2005; 20 Suppl 2:S279-84. studied from birth to age 21. RESULTS: The paper Abstract: AIM: To describe principles and examines the ways in which the study has been able to characteristics of mental health care in Madrid. examine a wide range of issues. Key issues examined METHOD: Based on existing data, service provision, include: (i) measurement of disorder (respondent number of professionals working in services, funding effects; dimensionality; scales vs categories); (ii) arrangements, pathways into care, user/carer prevalence and treatment of disorder; (iii) stability and involvement and specific issues are reported. continuity of disorders; (iv) the contribution of risk and RESULTS: In Madrid, mental health services are aetiological factors (e.g. lead exposure, parental organized into 11 zones/areas, divided into 36 districts, divorce, child abuse, family adversity, sexual where there is a mental health outpatient service with a orientation) to psychosocial adjustment; and (v) the multi-disciplinary team. Home treatment and psychosocial consequences of mental health problems psychosocial rehabilitation services have been in adolescence. CONCLUSIONS: The study findings developed. Specialist programmes exist for vulnerable illustrate the many advantages of a longitudinal study, client groups, including Children and Adolescents, such as the CHDS, in providing methodologically Addiction/Alcohol and Older People. The Madrid sound, theoretically relevant and cost effective research Mental Health Plan (2003-2008) is regarded as the key that caters for the interests of multiple end-users driver in implementing service improvement and including the scientific community, clinicians and increased mental health and well-being in Madrid. It applied policy makers. has a meant global budget increase of more than 10% for mental health services. Results of the first 2 years Fergusson DM, Horwood LJ, Ridder EM. Show me the child are: an increase in mental health staff employed (17%), at seven: the consequences of conduct problems in four new hospitalization units, 50% increase in places 488
- 497. for children andadolescents Day Hospitals, 62 new Ferris I Tortajada J, Berbel Tornero O, Ortega Garcia JA et beds in long care residential units, development of al. [Risk factors for pediatric malignant bone tumors]. specific programmes for the homeless and gender- An Pediatr (Barc) 2005; 63(6):537-47. based violence, a significant investment in information Abstract: INTRODUCTION: Cancer is the result of the systems (450 new computers) and development of best interaction of two kinds of determinants: genetic practice and operational guidelines. Mental health (endogenous) and environmental (exogenous). In the system was put to the test with Madrid's March 11th last few decades, pediatric oncology as a whole has terrorist attack. A Special Mental Health Plan for progressed, including knowledge of malignant osseous Affected people was developed. DISCUSSION: Unlike tumors (MOT). Although advances have been made in some European countries, public mental health service diagnostic and therapeutic aspects, little progress has is the main heath care provider. There are no voluntary taken place in our knowledge of the risk factors agencies bcollaborating with mental health care. involved in their etiopathogenesis. Objective: This Continuity of care and coordination between all mental review has three objectives: a) to provide an update on health resources is essential in service delivery. MOT-related risk factors in the child and adult Increased demand of care for minor psychiatric population; b) to disseminate knowledge of the main disorders, children and adolescent mental health care, MOT-related risk factors among our colleagues in and implementation of rehabilitation and residential order to promote research into these factors, diagnosis facilities for chronic patients are outstanding and future prevention, and c) to request help from our challenges similar to those in other European capitals. colleagues in the Environment and Pediatric Cancer Overall, the mental health system had successfully research project. MATERIAL AND METHODS: We coped with last year's increased care demand after performed a systematic review of the literature March 11th terrorist attack in Madrid. published in the last 30 years on risk factors implicated in the etiopathogenesis of MOT, using Medline, Ferreira AL. [Follow-up of child abuse victims: challenges Cancerlit, Science Citation Index and Embase. The for the pediatrician]. J Pediatr (Rio J) 2005; 81(5 search profiles used were: pediatric/childhood Suppl):S173-80. malignant bone tumors, pediatric/ childhood bone Abstract: OBJECTIVE: To review practical questions cancer/neoplasm, osteosarcoma/bone sarcoma/Ewing's about the initial assistance and follow-up of child abuse sarcoma and risk factors/etiology/epidemiology. The victims and their families by pediatricians. SOURCES most interesting articles were selected and the most OF DATA: A literature review was carried out using relevant references contained therein were retrieved. the MEDLINE and LILACS databases, including the RESULTS: MOT represent 6-7 % of all pediatric years 2000 to 2005. Some articles from past years and neoplasms. The most frequent types are osteosarcoma books were included due to their importance. (OS) and Ewing's sarcoma (ES), representing 56 % and SUMMARY OF THE FINDINGS: Initial assistance is 34 % respectively. OS-related risk factors are the one of the most important actions by health following: a) previous osseous disease (Paget's professionals for the protection of abused children in disease); b) familial-genetic factors (hereditary different healthcare sectors (community, outpatient retinoblastoma, Li-Fraumeni syndrome, Rothmund- clinics, emergency rooms and infirmary), and it is Thompson syndrome, Bloom syndrome, familial OS, fundamental for the reduction of immediate and long- Diamond-Blackfan anemia); c) chemical factors term negative consequences of violence. The protection (antineoplastic drugs); d) physical factors (ionizing services cannot monitor all the families under their radiation); e) biologic factors; f) parental occupation, responsibility and most child abuse cases are not even and g) other factors (artificial osseous implants and reported to those institutions; therefore, regular follow- traumatisms). ES-related risk factors are the following: up by a pediatrician is advisable. It is important to a) ethnic-cultural (Caucasian race); b) genetic factors; provide the family with support and guidance until the c) parental occupation (herbicide, pesticide and child is safe. The main challenges are: to be involved fertilizer exposure); d) maternal obstetric history, and without causing more violence; to consider all the e) other factors (parental smoking and inguinal hernia). family as the focus of attention, including the family CONCLUSIONS: Most causes of MOT are unknown. members who have committed the assault, helping Based on different levels of scientific evidence, the them to change inadequate behaviors; to develop main factors implicated in the etiopathogenesis of OS specific abilities to carry out this work, which must be are: Paget's disease, hereditary retinoblastoma, Li- multiprofessional, interdisciplinary and intersectoral. Fraumeni syndrome, antineoplastic drugs, and ionizing CONCLUSIONS: Families face difficulties when their radiation. The main factors related to ES are: children are abused and when the situation gains Caucasian race, parental occupation, parental smoking, notoriety, demanding interventions from many and surgery for inguinal hernia. The main obstacles to institutions. In this process, a pediatrician can guide greater knowledge of MOT-related factors are: a) their and help them to guarantee the protection and healthy multiple origin; b) the low prevalence in the development of their children. To overcome population; c) lack of environmental health training in challenges, health professionals have to be technically pediatrics, and d) the low public and private investment and emotionally prepared. in this research field. 489
- 498. Ferris i TortajadaJ, Ortega Garcia JA, Garcia i Castell J, 64.5%: 68.6% among primary and 50.3% among Lopez Andreu JA, Berbel Tornero O, Crehua Gaudiza secondary school pupils. Major economic activities E. [Risk factors for neuroblastoma]. An Pediatr (Barc) included street trading (43.6%), selling in kiosks and 2005; 63(1):50-60. shops (25.4%) and farming (23.6%). No child was Abstract: INTRODUCTION: NB is the most frequent involved in bonded labour or prostitution. Girls were pediatric cancer arising in the sympathetic nervous more often involved in labour activities than boys system and represents a serious healthcare challenge (66.8% versus 62.1%, p = 0.048): this difference was because: 1) it is the most frequent neoplasm in the first most obvious with street trading (p = 0.0004). Most of decades of life; 2) it biological behavior is the children (82.2%) involved in labour activities did unpredictable (spontaneous regression, maturation to so on the instruction of one or both parents in order to ganglioneuroma, and localized and metastasized contribute to family income. Children of parents with variants); and 3) little is known about most of the risk low socio-economic status or of poorly educated factors involved in its etiopathogenesis. The objective parents were significantly involved in labour activities of this study was to disseminate knowledge of (p = 0.01 and p = 0.001 respectively). Child labour was constitutional and environmental (physical, chemical, also significantly associated with increasing number of biological and social) risk factors linked to the children in the family size (p = 0.002). A higher development of neuroblastoma (NB), with various prevalence rate of child labour was observed among levels of scientific evidence. To seek collaboration children living with parents and relations than among among pediatricians in the research project those living with unrelated guardians. CONCLUSION: "Environment and Pediatric Cancer". MATERIAL It is concluded that smaller family size, parental AND METHODS: We performed a systematic review education and family economic enhancement would of the literature published in the previous 25 years on reduce the pressure on parents to engage their children risk factors for NB diagnosed in the first two decades in labour activities. of life, using Medline, the Science Citation Index and Embase. Search profiles were: Fiese BH, Wamboldt FS, Anbar RD. Family asthma "neuroblastoma/childhood sympathetic nervous system management routines: connections to medical neoplasms and risk factors/etiology/epidemiology". adherence and quality of life. J Pediatr 2005; The most interesting articles and the most relevant 146(2):171-6. references contained therein were selected. RESULTS: Abstract: OBJECTIVES: To develop a reliable With greater or lesser scientific evidence, the following measure of asthma management routines and examine risk factors increase the risk of developing NB: genetic its association with health care utilization, medical factors; geographic factors; ethnic factors; adherence, and quality of life. STUDY DESIGN: socioeconomic factors; infectious factors; physical Families (n = 153) with a child with asthma, drawn factors; parental occupational exposure; gestational from two sites, participated in the study. Parents factors; and perinatal and maternal factors. Preventive completed the Asthma Routines Questionnaire, factors associated with a lower risk of developing NB Adherence to Clinical Trials interview, Functional are breastfeeding and intake of vitamin supplements Severity of Asthma Questionnaire, and Caregiver during pregnancy. CONCLUSIONS: The main barriers Quality of Life. Children completed the Pediatric to the identification of evidence-based risk factors Quality of Life. Electronic monitoring of medication involved in the development of NB are its complex use over a period of 12 months was available for biology and clinical course, its relative rarity and the children at one study site. RESULTS: A principal difficulty of performing epidemiological studies. component factor analysis revealed two dimensions to Research on constitutional and environmental factors the Asthma Routines Questionnaire: Medication involved in its etiopathogenesis should be stimulated. Routines and Routine Burden. Medication Routines The best preventive strategy is to recommend were related to medical adherence and to health care breastfeeding for more than 6 months. utilization. Routine Burden was related to caregiver and child quality of life. CONCLUSIONS: The Fetuga BM, Njokama FO, Olowu AO. Prevalence, types and Asthma Routine Questionnaire holds promise as a demographic features of child labour among school reliable assessment of family practices related to children in Nigeria. BMC Int Health Hum Rights 2005; medication use. The emotional burden of daily care can 5(1):2. be distinguished from medication use, which is more Abstract: BACKGROUND: To determine the closely linked to adherence issues. Targeted questions prevalence, types and demographic features of child during regular care may reveal family routine practices labour among school children in Nigeria. METHODS: amenable to intervention. A cross-sectional interview study of 1675 randomly selected public primary and secondary school pupils Figueiredo B, Bifulco A, Paiva C, Maia A, Fernandes E, aged 5 to less than 18 years was conducted in the Matos R. History of childhood abuse in Portuguese Sagamu Local Government Area of Ogun State, parents. Child Abuse Negl 2004; 28(6):669-82. Nigeria from October 1998 to September 1999. Abstract: OBJECTIVE: The study examines the self- RESULTS: The overall prevalence of child labour was reported prevalence of childhood physical and sexual 490
- 499. abuse in alarge sample of Portuguese parents. Finke L, Williams J, Ritter M et al. Survival against drugs: METHOD: Nearly 1,000 parents (506 mothers and 426 education for school-age children. J Child Adolesc fathers) were selected through public primary schools Psychiatr Nurs 2002; 15(4):163-9. from the Northern area of Portugal. All completed the Abstract: PROBLEM: Alcohol and drug use of young Portuguese version of the Childhood History school-age children continue to escalate. Questionnaire (CHQ) [Journal of Family Violence 5 Comprehensive, effective interventions are needed to (1990) 15]. RESULTS: Results show that the treat and prevent future alcohol and drug use. prevalence of abuse was 73%, but more severe physical METHODS: The alcohol and drug use of 69 school- abuse involving sequelae/injury was reported by 9.5%. age children participating in afterschool programs was Most physical abuses began prior to age 13, with half explored; parents completed a family climate scale. An continuing after age 13. No gender differences were investigator-developed educational program was found for rates of physical abuse. However, among the evaluated for its effect on self-efficacy of the children milder physical abuse without sequelae/injury, those to prevent drug and alcohol use. FINDINGS: Although women who experienced "whipping" or family climate scales indicated functioning families, "slapping/kicking" were more likely to do so from their 25% of the children indicated they have used drugs or mothers than fathers. Among men who were alcohol and 49% indicated a possible problem with "slapped/kicked" this was more likely to be from their alcohol or drugs being used at home by parents. A fathers. Low rates of sexual abuse were found at 2.6% significant correlation with a child's self-efficacy and with no gender or age differences. Lack of a supportive drug use was found. CONCLUSIONS: The educational adult in childhood related to the more severe abuses, program taught children survival skills to resist the use but only in adolescence. Portuguese rates of abuse were of alcohol and drugs. Children with a plan to resist the consistently lower than those reported in USA and use of drugs were more likely not to use drugs. Spanish studies using the CHQ. CONCLUSIONS: This is the first retrospective, self-report study of childhood Finkelhor D. The legacy of the clergy abuse scandal. Child abuse in a large sample of Portuguese parents and, Abuse Negl 2003; 27(11):1225-9. even with a participation rate of 69%, shows lower rates than in US and Spanish samples. Finkelstein N, Rechberger E, Russell LA et al. Building resilience in children of mothers who have co- Fikree FF, Pasha O. Role of gender in health disparity: the occurring disorders and histories of violence: South Asian context. BMJ 2004; 328(7443):823-6. intervention model and implementation issues. J Behav Health Serv Res 2005; 32(2):141-54. Findling RL, Steiner H, Weller EB. Use of antipsychotics in Abstract: Historically, children of parents with co- children and adolescents. J Clin Psychiatry 2005; 66 occurring substance abuse and mental health disorders Suppl 7:29-40. and histories of violence/trauma have been overlooked Abstract: The comparable efficacy and improved safety in behavioral health treatment systems. The Women, of the atypical antipsychotics compared with the Co-occurring Disorders and Violence Study (WCDVS) traditional antipsychotic agents in the treatment of was a 5-year initiative funded by the United States schizophrenia and other disorders in adults have Substance Abuse and Mental Health Services prompted the use of these agents in children and Administration (SAMHSA) that included a Children's adolescents. The atypical antipsychotics are Study that explored the treatment needs of children of increasingly being used in children and adolescents women with these multiple disorders. This article with a variety of different psychiatric diagnoses, describes the development of the Children's Study including schizophrenia, bipolar disorder, intervention that included clinical assessment, group autism/pervasive developmental disorders, conduct intervention, and resource coordination/advocacy for disorder, depression, anxiety disorders, tic disorders, children aged 5-10 to build resilience through delirium, and eating disorders. Unfortunately, clinical increasing coping skills, improving interpersonal use of these agents in pediatric patients has far relationships, and helping coalesce positive identity exceeded the limited evidence from randomized and self-esteem. Innovative procedures, including the controlled trials. This article reviews the available participation of consumer/survivor/recovering women evidence from the published literature on the use of the and mothers, in the planning, implementation, and atypical antipsychotics in children and adolescents with administrative applications of this intervention and schizophrenia, bipolar disorder, and maladaptive study are also highlighted. It is recommended that aggression associated with autism/pervasive programs begin to implement family-focused developmental disorders and conduct integrated treatment approaches that can potentially disorder/disruptive behavior disorders. increase protective factors for children affected by parental mental illness, substance abuse, and violence. Fine B. Being the voice for a child. Pediatr Ann 2004; 33(11):785-7. Fischer M, Barkley RA, Smallish L, Fletcher K. Young adult follow-up of hyperactive children: self-reported 491
- 500. psychiatric disorders, comorbidity,and the role of sites covered 12 months before initiation of the NAC childhood conduct problems and teen CD. J Abnorm through 3 years of the program. RESULTS: A total of Child Psychol 2002; 30(5):463-75. 371 patients were contacted and determined to be Abstract: We report on the psychiatric disorders eligible for the study, and 345 agreed to participate, present at young adult follow-up (Mean age 20-21 representing a recruitment rate of 93%. Of those, 15 years; 13+ year follow-up) and the comorbidity among withdrew and 24 were lost to follow-up monitoring them for a large sample of hyperactive (H; N = 147) after the initial contact. In addition, 57 were excluded and community control (CC; N = 71) children. The H from analysis because of relocation or for other group had a significantly higher risk for any nondrug reasons. Utilization data to determine rates of acute psychiatric disorders than the CC group (59% vs. care (emergency department visits and hospitalizations) 36%). More of the H group met criteria for ADHD were collected for 249 patients (100 NAC subjects and (5%); major depressive disorder (26%); and histrionic 149 control subjects). Acute care rates decreased for (12%), antisocial (21%), passive-aggressive (18%), and both the NAC and control groups from the year before borderline personality disorders (14%) at follow-up intervention to the last year of intervention, with no than the CC group. Severity of childhood conduct significant differences between the NAC and control problems contributed to the risk for passive-aggressive, groups. Participation in NAC programming affected borderline, and antisocial personality disorders. But it the acute care outcome; the NAC-low participation and only affected risk for antisocial personality after control groups did not differ but the NAC-high controlling for severity of teen conduct disorder (CD), participation group differed significantly from the which also contributed to the risk for these same 3 pooled control and NAC-low participation groups in disorders. Examination for comorbidity among these reductions in acute care rates. Both contacts with NAC disorders indicated that presence of either borderline or staff members and attendance at educational events antisocial personality disorder significantly increased were associated with changes toward stronger views the risk for major depression and the other significant that asthma can be managed (partial correlation = .27 personality disorders. More of the hyperactive group and partial correlation = .24, respectively). Structural had received various forms of mental health treatment equation modeling demonstrated that participation in during and since leaving high school than the control the NAC was associated with positive changes on the group. Results suggest that hyperactive children are at Index of Asthma Attitudes scale and lower rates of significant risk for at least 1 nondrug disorder in young acute care. Social isolation was associated with greater adulthood, principally major depression and several participation in the program and thus reduced care personality disorders, and that this risk is largely rates. CONCLUSIONS: The NAC reached its intended mediated by severity of CD at adolescence. audience, including those who were socially isolated, brought about changes in management practices, and Fisher EB, Strunk RC, Sussman LK, Sykes RK, Walker MS. was associated with promising reductions in acute care Community organization to reduce the need for acute rates among active participants in the program. care for asthma among African American children in low-income neighborhoods: the Neighborhood Asthma Fisher K, Kettl P. Teachers' perceptions of school violence. J Coalition. Pediatrics 2004; 114(1):116-23. Pediatr Health Care 2003; 17(2):79-83. Abstract: BACKGROUND: Low-income African Abstract: INTRODUCTION: Pediatric nurse Americans exhibit disproportionate prevalences, practitioners, especially those working in the school morbidity rates, and mortality rates for asthma. settings, often interact with children and teachers who OBJECTIVE: To determine whether a community- confront school violence. This descriptive study was based intervention, the Neighborhood Asthma conducted to obtain teachers' insights into the problems Coalition (NAC), conducted through a well-established of school violence. METHOD: Voluntary neighborhood organization in St. Louis could improve questionnaire surveys were distributed to 536 awareness of asthma, change attitudes about its care, elementary, middle, and high school teachers in a improve asthma management practices, and reduce the suburban school district in central Pennsylvania. need for acute care for asthma. METHODS: The NAC Seventy-four percent returned usable surveys (n = included educational programs for parents and 393). Data were tabulated and results are presented as children, promotional activities, and individualized percentages, frequencies, and chi-square analysis. support provided by trained neighborhood residents. RESULTS: Fifty-six percent of teachers believed that African American children, 5 to 14 years of age, with violence or the threat of violence had a direct impact at least 1 incident of acute care (emergency department on the quality of education they are able to provide. visit or hospitalization) within the previous year were Elementary school teachers were more likely to be enrolled from 8 zip code areas with low-income victims of a physical assault by a student (P =.0006) residents and high proportions of Medicaid-eligible and more likely to fear parents (P =.002) than were children, ie, 4 NAC neighborhoods and 4 comparable other teachers. DISCUSSION: Even in suburban control neighborhoods. Evaluations included quarterly schools, teachers are likely to be victimized and fear telephone interviews to assess asthma attitudes and students or their parents. This fear adversely affects the management and sites of care. Audits of acute care quality of education provided. Pediatric nurse 492
- 501. practitioners play asignificant role in addressing this understanding the phenomenology of memory public health concern. experiences and the concept of "recovered" memories of childhood sexual abuse are discussed. Fitzgerald A, Bailey M, Smith AC et al. Child development services: a multidisciplinary approach to professional Flanagan NM, MacLeod C, Jenkins MG, Wylie R. The education via videoconference. J Telemed Telecare Child Protection Register: a tool in the accident and 2002; 8 Suppl 3:S3:19-21. emergency department? Emerg Med J 2002; 19(3):229- Abstract: We have piloted a monthly series of 30. multidisciplinary case discussions via videoconference Abstract: AIMS: To determine the number of children in the area of child development. The project provided on the Child Protection Register (CPR) attending the a forum for clinical discussion of complex cases, peer accident and emergency (A&E) department and the review, professional development and networking for referral source, diagnostic category, and frequency allied health professionals and paediatricians. Six sites distribution for such attendances. To determine in Queensland participated in the project; each site whether lack of knowledge that a child is on the CPR presented at least one case for discussion. The results in failure to suspect non-accidental injury (NAI) videoconferences ran for 90 min each and were if the standard indicators of NAI have been sought. attended by an average of 26 health professionals. The METHODS: Access to the CPR was obtained. Records response rate for a questionnaire survey was 71%. The of each child attending the A&E departments of the respondents rated the effectiveness of case summaries United Hospitals Trust between June 1994 and May and the follow-up newsletter very positively. Despite 2000 were reviewed. RESULTS: Over the six years some early difficulties with the technical aspects of 191 children were on the CPR. Seventy nine (41%) videoconferencing, the evaluation demonstrated the attended A&E departments on 206 occasions. participants' satisfaction with the project and its Frequency of attendance ranged to 18 with a mean of relevance to their everyday practice. 2.6. Self referral was the commonest source of referral (81%) followed by general practitioners (13%), 999 Fitzgerald M. The development of nociceptive circuits. Nat calls (5%), and a small number from schools (1%). Rev Neurosci 2005; 6(7):507-20. Most presentations involved trauma-upper limb (21%), Abstract: The study of pain development has come into lower limb (14%), and head injury (8%). Almost all its own. Reaping the rewards of years of developmental cases of trauma were adjudged to be consistent with the and molecular biology, it has now become possible to history and NAI not suspected. Common childhood translate fundamental knowledge of signalling illnesses accounted for the remainder of presentations. pathways and synaptic physiology into a better Only six children were identified as being on the CPR understanding of infant pain. Research has cast new at the time of presentation. Concerns were raised in light on the physiological and pharmacological two other cases and concerns should have been raised processes that shape the newborn pain response, which in three other children. Social Services were alerted on will help us to understand early pain behaviour and to five occasions directly by the parents themselves. design better treatments. Furthermore, it has shown CONCLUSIONS: It is concluded that in the absence of how developing pain circuitry depends on non-noxious knowledge of the status of a child on the CPR sensory activity in the healthy newborn, and how early attending the A&E department, that screening for the injury can permanently alter pain processing. standard indicators of NAI is adequate to detect most cases of NAI. Fivush R, Edwards VJ. Remembering and forgetting childhood sexual abuse. J Child Sex Abus 2004; Flannery RB Jr, Hanson MA, Rego J Jr, Walker AP. 13(2):1-19. Precipitants of psychiatric patient assaults on staff: Abstract: Twelve white middle-class women who had preliminary empirical inquiry of the Assaulted Staff been severely sexually abused as children by a family Action Program (ASAP). Int J Emerg Ment Health member were asked to provide a narrative of their 2003; 5(3):141-6. abuse and discuss their subsequent remembering and Abstract: Although there has been extensive empirical forgetting of these experiences. Most claimed they had research on the characteristics of psychiatric patient undergone periods during which they had not recalled assailants and their staff victims, there has been a their abuse, but also claimed that they had never dearth of empirical research on the nature of the forgotten their experiences at another point during the precipitants of these patient/staff interactions. Building interview. Nine of the women had actively tried to on the few earlier studies, this year-long, retrospective, forget the abusive experiences, although 8 still empirical study of patient precipitants was conducted experienced recurrent and often relentless intrusive within the context of the Assaulted Staff Action memories. Our findings suggest that women with Program (ASAP) in ten public sector health care continuous memories may have longer and more facilities. Excessive sensory stimulation, staff coherent narratives than women without continuous restrictions on patient behaviors (restraints), and acute memories. Implications of these findings for psychosis were the most frequently occurring precipitants. There were no specific patterns to patient 493
- 502. assailant and staffvictim characteristics by assault development. However, pediatricians have obligations precipitant. The implications of this study and future to assess and advocate for the best interests of their research needs are addressed. patients. This requires that physicians reach out to their patients and take the time to listen to children and to Fleck LM. Children and organ donation: some cautionary involve them in their own care. The proper role of a remarks. Camb Q Healthc Ethics 2004; 13(2):161-6. child in planning care depends less on chronologic age than on developmental and personal capacity. Even Fledelius HC. Retinal haemorrhages in premature infants: a young children have a keen awareness of their own pathogenetic alternative diagnosis to child abuse. Acta clinical situations and options and should be involved Ophthalmol Scand 2005; 83(4):424-7. as best as is possible in decision making. All decision Abstract: PURPOSE: To present the occasional making for children should be collaborative among observation of retinal haemorrhages in premature patients, parents, and professionals. A situation babies, as a diagnostic alternative to those observed as including an involved child, an informed parent, and a part of shaken baby syndrome. METHODS: We caring and compassionate caregiver working carried out an observational study on 11 infants in collaboratively is most likely to result in optimal whom retinal and/or vitreous haemorrhages had been decisions for pediatric patients. Bartholome concluded observed within their first months of life. Ten infants in 1995 that pediatricians should respect children for were under surveillance for retinopathy of prematurity the persons they are in the process of becoming by (ROP), with gestational ages and birth weights in the being willing to assist them to participate to the extent ranges of 27--34 weeks and 790--1665 g, respectively. of their capacity in making decisions about their health. One infant was diagnosed with Zellweger's syndrome Combining that view with fostering respect for the and one received substitution therapy for coagulation strongly held beliefs and values of parents is the factor II deficiency. The last child had been delivered direction pediatricians should travel to make decisions at 38 weeks, weighing 2070 g; he died on day 5 from in the best interests of children. severe brain oedema with incarceration and extensive bilateral fundus bleeding. RESULTS: Four of the 11 Fleming CB, Haggerty KP, Catalano RF, Harachi TW, infants had some evidence of ROP, and two later Mazza JJ, Gruman DH. Do social and behavioral received retinal ablation therapy. Contrary to the quick characteristics targeted by preventive interventions absorption (<1-2 weeks only) usually seen in most predict standardized test scores and grades? J Sch newborn term infants, the ocular bleeding in preterms Health 2005; 75(9):342-9. was generally longstanding. A quick increase in Abstract: This study assessed whether characteristics of intracranial pressure probably played a role in the individuals that are predictors of youth problem lethal case with delivery near term, and one infant behavior such as substance use, delinquency, and received lung physiotherapy for pneumonia at the age violence also predict academic achievement. of 6 months. Some bleeding appeared to be truly Longitudinal data from 576 students participating in postnatal (i.e. it was observed as a new occurrence the Raising Healthy Children (RHC) project were during the course of surveillance). CONCLUSIONS: In analyzed. The RHC project is a study of students the series under study there was no suspicion of child recruited from a suburban Pacific Northwest school abuse. In term infants, retinal haemorrhages are district. Tenth-grade academic achievement was extremely rare except when due to shaking, but other measured by scores on a standardized test administered diseases should be ruled out, coagulopathies in to students in Washington State (as part of compliance particular. We suggest that prematurity as such is with the No Child Left Behind Act) and by student added to the list of possibly underlying causes when self-report of grades. Measures of social and behavioral retinal bleedings are evaluated in very small infants characteristics at seventh grade were based on data and shaken baby mechanisms are suspected. from student, parent, and teacher surveys. Researchers assessed overall correlations between 7th-grade Fleischman AR, Collogan L. Addressing ethical issues in predictors and 10th-grade academic achievement as everyday practice. Pediatr Ann 2004; 33(11):740-5. well as partial correlations adjusted for demographic Abstract: In primary-care practice, just as in critical characteristics and scores on an earlier achievement care, ethical dilemmas challenge pediatricians to make test, the Comprehensive Test of Basic Skills, in 4th choices in the best interests of their patients. Parents grade. Results indicated that higher levels of school are important to the growth and development of bonding and better social, emotional, and decision- children and have broad responsibility for making making skills were related to higher test scores and virtually all decisions regarding nutrition, clothing, higher grades. Lower test scores and lower grades were housing, education, religion, and medical care. predicted by elevated levels of attention problems, Society's deference to parental choice promotes the negative behavior of peers, and disruptive and value of family integrity, ensures the availability of an aggressive behavior. Lower test scores also were identifiable decision maker, and acknowledges the predicted by early use of alcohol and cigarettes. These legitimate role parents play in shaping their child's findings support the premise that school-based social development interventions that address specific risk 494
- 503. factors, curb earlymanifestations of antisocial 34). The range of estimates obtained in this study was behavior, and promote school bonding and social and narrower than that published by the WHO in the Health emotional skills are likely to improve student academic For All database. The range was further reduced by age achievement. standardization. In males aged 45 years and over, age standardized prevalence ranged from 39 (Slovenia) to Fleming DM, Schellevis FG, Falcao I, Alonso TV, Padilla 76 (Belgium) and in females from 37 (Slovenia) to 75 ML. The incidence of chickenpox in the community. (Belgium). There were no consistent gender differences Lessons for disease surveillance in sentinel practice in national prevalence rates. CONCLUSIONS: The networks. Eur J Epidemiol 2001; 17(11):1023-7. study demonstrates the capacity of sentinel practice Abstract: Sentinel practice networks have been networks to deliver data on the prevalence of known established in many European countries to monitor diabetes in persons over 45 years. National differences disease incidence in the community. To demonstrate in prevalence are less than hitherto reported. the value of sentinel networks an international study on Prevalence in Belgium measured in all ages and in 45 the incidence of chicken pox has been undertaken. years and over males and females was higher than in Chickenpox was chosen as an acute condition for the seven other countries. which incidence data are important to the determination of health policy on vaccine use. The Fletcher AC, Rollins A, Nickerson P. The extension of project examined the incidence of chickenpox reported school-based inter- and intraracial children's in sentinel networks in England and Wales, The friendships: influences on psychosocial well-being. Am Netherlands, Portugal and Spain (two regional J Orthopsychiatry 2004; 74(3):272-85. networks) in January-June 2000 and the potential Abstract: Children's (N=142) school friendships with underestimate from patients who did not consult. An same versus different race peers were coded for investigation of secondary household contact cases was prevalence and the extent to which parents maintained undertaken. Reported incidence of chickenpox (all social relationships with these friends (a proxy for ages) in England and Wales was 25 per 10,000, in The extension of friendships beyond the school context). Netherlands 13 per 10,000, in Portugal 21 per 10,000, Membership in integrated versus nonintegrated social in Spain Castilla y Leon 27 per 10,000 and in Spain networks at school was unassociated with psychosocial Basque 55 per 10,000. Analysis of secondary contact well-being. Out-of-school extension of interracial cases suggested underestimation of incidence between friendships was linked with greater social competence 2.4% in Spain Castilla y Leon and 32.2% in The among Black children. Black children whose Netherlands. There was a trend towards incidence at an friendships with both same and different race peers earlier age in England and Wales and in The were extended beyond the school context reported Netherlands compared with Portugal and Spain. Whilst higher levels of self-esteem. there was little problem in reliably identifying the number of incident cases in the recording networks and Flores E, Cicchetti D, Rogosch FA. Predictors of resilience relating the non-consulting contact cases to them, the in maltreated and nonmaltreated Latino children. Dev security of the denominator remains a problem where Psychol 2005; 41(2):338-51. networks are comprised of differing categories of Abstract: To date, few studies have sought to health care provider. It is essential that numerator and investigate the effects of child maltreatment and denominator information are made available processes influencing maladaptation and resilience in specifically for each category. Latino children. In the current investigation, multiple aspects of functioning, personal resources, and Fleming DM, Schellevis FG, Van Casteren V. The relationship features were examined in school-age prevalence of known diabetes in eight European maltreated and nonmaltreated Latino children. countries. Eur J Public Health 2004; 14(1):10-4. Maltreated Latino children were found to have fewer Abstract: BACKGROUND: The prevalence of diabetes areas of resilient functioning. Ego-resiliency and ego- has been proposed as a European Community Health control, as personal resources, and the ability to form a Indicator. The prevalence of diabetes known to general positive relationship with an adult figure outside of the practitioners (GPs) in different European countries has immediate family predicted resilience. However, been investigated and the usefulness of sentinel certain aspects of interpersonal functioning were practice networks in delivering prevalence data on differentially related to resilience for maltreated and diabetes has been evaluated. METHODS: Patients nonmaltreated Latino children. These findings have presenting with diabetes in a 12 month period implications for understanding how resilience can be (1999/2000) to GPs in established European sentinel promoted in maltreated and nonmaltreated Latino practice surveillance networks in eight European children. countries were registered. Estimates of prevalence were standardized to the 1998 European population. Flouri E. Psychological and sociological aspects of parenting RESULTS: All-age prevalence reported in the network and their relation to suicidal behavior. Arch Suicide populations was lowest in Slovenia (male 16, female Res 2005; 9(4):373-83. 16 per 1000) and highest in Belgium (male 31, female 495
- 504. Abstract: The articlereviews the evidence on the role Foege W. Managing newborn health in the global of childhood adversities, family structure, and community. Am J Public Health 2001; 91(10):1563-4. parenting in youth suicidal behavior, and suggests that Abstract: The largest health disparities in the world are future suicide research could benefit from investigating found in maternal and neonatal mortality figures how parenting can protect against suicidal behavior in between the industrialized countries and the poorest young people at risk. It discusses how empirical studies sections of the poorest countries. Young lives would be have moved from routinely including various saved if the skills and knowledge that have been operationalizations of "non-optimal" parenting as a accumulated by health workers around the world could "risk factor" for adolescent suicidal behavior to be readily applied. The problems reside with lack of identifying pathways of influence and buffer effects. It management resources rather than lack of scientific argues that measures (both at the micro and the macro knowledge. "The Healthy Newborn: A Reference level) that target vulnerable populations such as parents Manual for Program Managers" is a graduate course in with weak material and social resources, low social and management aimed at providing health to newborns emotional support, mental health problems and few and healthy newborns to communities. networks, and high-risk children might be beneficial in preventing youth suicidal behaviors. Folayan MO, Fakande I, Ogunbodede EO. Caring for the people living with HIV/AIDS and AIDS orphans in Flowers A, Lanclos NF, Kelley ML. Validation of a Osun State: a rapid survey report. Niger J Med 2001; screening instrument for exposure to violence in 10(4):177-81. African American children. J Pediatr Psychol 2002; Abstract: The aim of the study is to obtain the views 27(4):351-61. and opinions of People Living with HIV/AIDS Abstract: OBJECTIVE: To provide concurrent validity (PLWHAS), community leaders and other stake data for the KID-SAVE as a screening instrument for holders (care providers and AIDS orphans), so as to exposure to violence in African American children, to assess the role of Non-Governmental Organisations in explore demographic differences in KID-SAVE scores, the control of HIV infection with the purpose of and to provide preliminary reliability data on a parent making appropriate recommendations for policy version of the KID-SAVE. METHOD: Questionnaire formulation on issues related to the health and care of data were collected regarding exposure to violence, PLWHAs. A qualitative research was carried out using children's behavior and symptoms, and family in-depth interview method with a questionnaires as a aggression. A sample of 182 children and their parents guide. In all, 12 seropositives, 13 community leaders participated. RESULTS: Both parent and child report and 34 AIDS orphans were interviewed. Results of violence exposure was significantly related to the indicate that there was a lack of networking between child's psychological adjustment as endorsed by both the six Non-Governmental Organisations working in parents and children. Also, significant relationships the state in relation to HIV/AID. Also, none of these were obtained between parent report of their child's PLWHAs had concrete plans for the future of their exposure to violence and the presence of family children, though they all expressed some form of violence. CONCLUSIONS: The KID-SAVE appears to anxiety about their children's future. The burden of care be a promising instrument for the assessment of of AIDS orphans often fall on the maternal family exposure to violence, specifically in African American members. Top on the list of the problem of AIDS children, and may be applicable in a variety of clinical orphans was their poor education due to financial settings. difficulties. There is the need for the government to provide, support, encourage and monitor the activities Fluharty CW. Toward a community-based national rural of the Non-Governmental Organisations and network policy: the importance of the social services sector. with them so as to maximise the benefits that can be Child Welfare 2002; 81(5):663-88. obtained from the role they play in HIV/AIDS Abstract: Although discussions of rural America's management. challenges have surfaced at regular intervals over the past half-century, the issue is receiving significantly Fontes LA. Introduction: those who do not look ahead, stay greater substantive policy discussion today, as a behind. Child Maltreat 2001; 6(2):83-8. dialogue regarding the development of a more integrative, community-based, national rural policy Forbes BJ, Christian CW, Judkins AR, Kryston K. Inflicted begins to emerge. This article outlines this unique childhood neurotrauma (shaken baby syndrome): "rural policy moment," assesses the potential for a ophthalmic findings. J Pediatr Ophthalmol Strabismus community-based rural policy for our nation, and 2004; 41(2):80-8; quiz 105-6. discusses the critical role rural social services practice Abstract: Inflicted childhood neurotrauma (shaken and policy play in supporting these opportunities to baby syndrome) is the term used for violent, address the significant challenges faced by rural nonaccidental, repetitive, unrestrained acceleration- people. deceleration head and neck movements, with or without blunt head trauma, combined with a unique, 496
- 505. age-related biomechanical sensitivityin children implications for both sociomoral and cognitive typically younger than 3 years. This syndrome is development. typically characterized by a combination of fractures, intracranial hemorrhages, and intraocular hemorrhages. Forman EM, Davies PT. Assessing children's appraisals of Retinal hemorrhage is the most common ophthalmic security in the family system: the development of the finding, and usually occurs at all levels of the retina. In Security in the Family System (SIFS) scales. J Child recent years, increasing pressure has been placed on Psychol Psychiatry 2005; 46(8):900-16. ophthalmologists to render diagnostic interpretations of Abstract: BACKGROUND: Although delineating the the retinal findings in children suspected to be victims, processes by which children appraise the family as a which may have great forensic implications in criminal source of security from their collective experiences in proceedings. New research has increased our the family subsystem has assumed center stage in many understanding of the pathophysiology of retinal conceptualizations of child development, the dearth of hemorrhages, the importance of specifically measures of child adaptation in the family system has characterizing the types, patterns, and extent of these hindered empirical advances. Therefore, this study retinal hemorrhages, and the differential diagnosis. introduced and tested the psychometric properties of the Security in the Family System (SIFS) scales, a new Forbes GB, Jobe RL, White KB, Richardson RM. measure designed to assess children's appraisals of Perceptions of the Jackson-Timberlake Super Bowl security in their family as a whole. METHODS: The incident: role of sexism and erotophobia. Psychol Rep SIFS was administered to 853 10-15-year-old 2005; 96(3 Pt 1):730-2. schoolchildren and readministered to a smaller Abstract: 201 college women's and 179 men's subsample two weeks later. Additional data was impressions of the Jackson-Timberlake Super Bowl gathered from children, caregivers and teachers using a incident were related to measures of benevolent variety of instruments tapping family instability, sexism, hostile sexism, and erotophobia. For both cohesion, and conflict; parenting warmth and women and men high benevolent sexism was psychological control; child externalizing and correlated (.17-.24) to perceptions that the incident was internalizing symptoms; parent-child and interparental degrading and that agents (e.g., MTV, NFL, insecurity; and children's reactions to conflict Hollywood) other than the actors were responsible for simulations. RESULTS: Consistent with models of the incident, whereas high erotophobia was correlated emotional security in the family, exploratory and (.29-.39) to perceptions that the incident was confirmatory factor analyses yielded three reliable (i.e., degrading, attributable to others, and personally good internal consistency, test-retest reliability) upsetting. dimensions of family security: Preoccupation, Security, and Disengagement. Concurrent and prospective Ford KK. "First, do no harm"--the fiction of legal parental associations between the SIFS scales and measures of consent to genital-normalizing surgery on intersexed family functioning, children's psychological problems, infants. Yale Law Policy Rev 2001; 19(2):469-88. and insecurity in specific family relationships Notes: GENERAL NOTE: KIE: Ford, Kishka-Kamari supported the validity of the SIFS. Support for the GENERAL NOTE: KIE: 144 fn. discriminant validity of the SIFS was evidenced by its GENERAL NOTE: KIE: KIE Bib: informed specific patterns of relations with children's consent/minors psychological problems and ability to predict psychological problems after controlling for insecurity Forman DR, Kochanska G. Viewing imitation as child in specific family subsystems. CONCLUSIONS: responsiveness: a link between teaching and discipline Results indicate that the SIFS is a psychometrically domains of socialization. Dev Psychol 2001; sound tool capable of advancing family process 37(2):198-206. models, and that family security is a viable construct Abstract: The authors observed 106 children's imitation whose factors parallel already-identified patterns of and responses to maternal control at 14 and 22 months. children's security in other family relationships. Imitation was observed in a teaching task in which mothers modeled 3 standard pretend-play sequences. Forrest KA. Toward an etiology of dissociative identity Responses to control were observed in typical disorder: a neurodevelopmental approach. Conscious discipline contexts. Girls imitated more than boys. Cogn 2001; 10(3):259-93. Responsive imitation measures were coherent and Abstract: This article elaborates on Putnam's "discrete longitudinally stable and correlated significantly with behavioral states" model of dissociative identity responsiveness to maternal control. The authors disorder (Putnam, 1997) by proposing the involvement propose that a young child's willingness to imitate his of the orbitalfrontal cortex in the development of DID or her parent in a teaching context and to comply in a and suggesting a potential neurodevelopmental control context both reflect a responsive or receptive mechanism responsible for the development of stance toward parental socialization. The consistency multiple representations of self. The proposed of children's responsiveness across contexts has "orbitalfrontal" model integrates and elaborates on theory and research from four domains: the 497
- 506. neurobiology of theorbitalfrontal cortex and its Fourneret P, Desombre H, de Villard R, Revol O. [Interest protective inhibitory role in the temporal organization of propranolol in the treatment of school refusal of behavior, the development of emotion regulation, anxiety: about three clinical observations]. Encephale the development of the self, and experience-dependent 2001; 27(6):578-84. reorganizing neocortical processes. The hypothesis Abstract: School refusal anxiety is a being proposed is that the experience-dependent pathopsychological disorder which touches the young maturation of the orbitalfrontal cortex in early abusive child, between 8 and 13 years. Even if the school environments, characterized by discontinuity in dyadic refusal is studied for a long time, there is not still socioaffective interactions between the infant and the consensus as for the specific definition of this disorder caregiver, may be responsible for a pattern of lateral or on the best way of treating it. Nevertheless, inhibition between conflicting subsets of self- accountable of long-lasting difficulties in school representations which are normally integrated into a integration, its short and medium term consequences unified self. The basic idea is that the discontinuity in are serious and well known: school desertion, mood the early caretaking environment is manifested in the disorder and behavioral problems. Speed and quality of discontinuity in the organization of the developing the medico-psychological and educational child's self. interventions represent a important factor for evolution and prognosis. Although, psychological interventions Forsyth BW. Psychological aspects of HIV infection in remain essential, sometimes the interest of an children. Child Adolesc Psychiatr Clin N Am 2003; associated psychotropic medication should be 12(3):423-37. discussed. This one can indeed either improve their Abstract: Despite advances in the pharmaceutical results or supporting their installations. Despite more treatment of HIV disease, there are still an increasing than twenty controlled trials in the pediatric population, number of people living with the disease, and an no definitive psychopharmacological treatment data increasing number of children and adolescents are exist for anxiety disorder in childhood and especially personally affected by the epidemic. The psychological for school refusal disorder. The majority of the studies effects on these children are significant and relate not stress as well the interest of benzodiazepines as only to a parent's degree of illness and the threat of tricyclic antidepressants but without being able to death but also to the association of the disease with specify the possible superiority of a chemical on the substance abuse and the pervasive effects of the stigma other. On the other hand, the side effects of each one that surround it. To intervene optimally on behalf of are well-documented, in particular for the these children, programs must be multidisciplinary and benzodiazepines (potential abuse, sedation, potential take a holistic approach to address specific social and desinhibition, mnemonic disorder), limiting thus their psychological issues and ensure stability in a child's uses in child. In this work, we would like to emphasize care giving. the interest of propranolol in the treatment of somatic symptoms usually met in school refusal anxiety. Fortunata B, Kohn CS. Demographic, psychosocial, and Although beta-blockers have been used in the treatment personality characteristics of lesbian batterers. of neurovegetative symptoms associated with Violence Vict 2003; 18(5):557-68. situational anxiety disorders, there is no controlled data Abstract: Prevalence of domestic violence (DV) in and only some open data to guide pediatric use for lesbian and heterosexual relationships appears to be anxiety disorders in children. Nevertheless, prescribed similar. Despite this, few studies have examined factors with low posology and in substitution of associated with DV in lesbian relationships, and even benzodiazepine, this medication enabled us in three fewer have examined characteristics of lesbian severe clinical cases to shorter notably the time of batterers. Demographic and psychosocial school rehabilitation. Well tolerated on the clinical characteristics and personality traits were examined in level, with a greater efficiency on the somatic signs 100 lesbians in current relationships (33 Batterers and related to anxiety than benzodiazepines and with not 67 Nonbatterers). Results indicated that Batterers were having their side effects, this therapeutic can constitute more likely to report childhood physical and sexual a significant support in the psychological treatment of abuse and higher rates of alcohol problems. Results these children. However, these present results require from the MCMI-III indicated that, after controlling for to be confirm by other observations, which will be lead Debasement and Desirability indices, Batterers were perhaps to a controlled study. more likely to report aggressive, antisocial, borderline, and paranoid personality traits, and higher alcohol- France D. Battle of the faithful. Catholics are voicing hurt dependent, drug-dependent, and delusional clinical and anger over the church's sexual-abuse crisis. Is the symptoms compared to Nonbatterers. These results hierarchy listening? Newsweek 2002; 139(24):49. provide support for social learning and psychopathology theoretical models of DV and clinical France D. Confessions of a fallen priest. Newsweek 2002; observations of lesbian batterers, and expand our 139(13):52-4, 56. current DV paradigms to include information about same-sex DV. 498
- 507. France D. Aday of atonement. Newsweek 2002; in early childhood after prenatal cocaine exposure in 5 139(25):80-1. domains: physical growth; cognition; language skills; motor skills; and behavior, attention, affect, and Francis PJ, Calver DM, Barnfield P, Turner C, Dalton RN, neurophysiology. DATA SOURCES: Search of Champion MP. An infant with methylmalonic aciduria MEDLINE and Psychological Abstracts from 1984 to and homocystinuria (cblC) presenting with retinal October 2000. STUDY SELECTION: Studies selected haemorrhages and subdural haematoma mimicking for detailed review (1) were published in a peer- non-accidental injury. Eur J Pediatr 2004; 163(7):420- reviewed English-language journal; (2) included a 1. comparison group; (3) recruited samples prospectively in the perinatal period; (4) used masked assessment; Franck L, Lefrak L. For crying out loud: the ethical and (5) did not include a substantial proportion of treatment of infants' pain. J Clin Ethics 2001; subjects exposed in utero to opiates, amphetamines, 12(3):275-81. phencyclidine, or maternal human immunodeficiency Notes: GENERAL NOTE: KIE: Franck, Linda; Lefrak, virus infection. DATA EXTRACTION: Thirty-six of Linda 74 articles met criteria and were reviewed by 3 authors. GENERAL NOTE: KIE: 32 refs. Disagreements were resolved by consensus. DATA GENERAL NOTE: KIE: KIE Bib: patient care/drugs; SYNTHESIS: After controlling for confounders, there patient care/minors was no consistent negative association between prenatal cocaine exposure and physical growth, Franck LS. Research with newborn participants: doing the developmental test scores, or receptive or expressive right research and doing it right. J Perinat Neonatal language. Less optimal motor scores have been found Nurs 2005; 19(2):177-86. up to age 7 months but not thereafter, and may reflect Abstract: Research ethics encompass debate about heavy tobacco exposure. No independent cocaine what research topics matter, for example in relation to effects have been shown on standardized parent and social values and individual needs, and debate about teacher reports of child behavior scored by accepted how to conduct research in an ethical manner, for criteria. Experimental paradigms and novel statistical example in relation to protecting the rights of manipulations of standard instruments suggest an vulnerable research participants. Research in the association between prenatal cocaine exposure and neonatal intensive care unit (NICU), where critically ill decreased attentiveness and emotional expressivity, as infants receive expensive and often invasive treatment, well as differences on neurophysiologic and raises unique issues with regard to what research attentional/affective findings. CONCLUSIONS: should be conducted and how to conduct it in an ethical Among children aged 6 years or younger, there is no manner. This discussion addresses the neonatal nurse's convincing evidence that prenatal cocaine exposure is role in setting the research agenda in neonatal care- associated with developmental toxic effects that are influencing what topics are researched and serving as different in severity, scope, or kind from the sequelae lead investigators on studies, and highlights their role of multiple other risk factors. Many findings once in ensuring that research is conducted correctly- thought to be specific effects of in utero cocaine protecting the rights of infant participants and their exposure are correlated with other factors, including families. The involvement of neonatal nurses in prenatal exposure to tobacco, marijuana, or alcohol, research ethics has been a valuable contribution to the and the quality of the child's environment. Further development of the field. A greater level of replication is required of preliminary neurologic involvement is now needed, particularly at the policy findings. level where funding and procedural issues are decided. New approaches are also needed and could involve Frank G. Patient wins EMTALA appeal: case underscores more direct collaboration between nurses and parents. that ED documentation of admission/care refusal is crucial. J Emerg Nurs 2001; 27(2):176-8. Franco A, Alvarez-Dardet C, Ruiz MT. Effect of democracy on health: ecological study. BMJ 2004; Frank R, Finch BK. Los Anos de la Crisis: an examination 329(7480):1421-3. of change in differential infant mortality risk within Mexico. Soc Sci Med 2004; 59(4):825-35. Frank DA, Augustyn M, Knight WG, Pell T, Zuckerman B. Abstract: The main aim of the present analysis is to test Growth, development, and behavior in early childhood the possibility that the period of economic hardship following prenatal cocaine exposure: a systematic characterizing Mexico over the decade 1986-1996 has review. JAMA 2001; 285(12):1613-25. negatively influenced infant health outcomes. Data on Abstract: CONTEXT: Despite recent studies that failed births from two installments of the Encuesta Nacional to show catastrophic effects of prenatal cocaine de la Dinamica Demografica, a nationally exposure, popular attitudes and public policies still representative demographic survey, are used to reflect the belief that cocaine is a uniquely dangerous determine whether a reduction in mortality differentials teratogen. OBJECTIVE: To critically review outcomes has paralleled the overall drop in the national infant mortality rate. The findings indicate that the decrease 499
- 508. observed in theoverall infant mortality rate has been providers in six cities. We then mailed a survey to a matched by decreases in several disparities at the same random sample of private practice family physicians time that it has been marred by increases in others. The and pediatricians and public health nurses who data support the possibility that where you live has immunize children. The overall survey response rate become an increasingly salient factor in determining was 77%, and the final sample size was 544. the odds of infant mortality. High parity, low education RESULTS: Focus group findings indicated that parents and unemployment status have also become more rarely refused vaccines but occasionally resisted salient factors in predicting post neonatal infant specific vaccines. Parents who were unsure about mortality risk in the more recent period as compared to vaccinating were open to discussions about vaccines the earlier period. As Mexico's infant mortality rate with a trusted provider. Most of these parents agreed to begins to stabilize in the near future, this research immunize after discussing concerns with their provider. highlights the need to re-focus our research efforts on In a subsequent survey of providers, respondents the causes and consequences of differential mortality estimated that they immunized a mean of 3536 (median trends. 1560) children annually. The reported mean number of refusals per 1000 children age >18 years immunized Frankel G. Charismatic doctor at vortex of vaccine dispute: was 7.2 (median 0.4), with varicella vaccine being the experts argue over findings, but specialist sees possible most commonly refused. Means did not vary by region MMR link to autism. Washington Post 2004; A1, A20. or specialty. Providers indicated that fear of side effects Notes: GENERAL NOTE: KIE: KIE Bib: heard about from media/word of mouth was the most immunization commonly expressed reason for parents to refuse vaccines (52%). Religious (28%) or philosophical Franz HB. [Gynecologic injuries, management]. Kongressbd (26%) reasons or belief that the disease was not Dtsch Ges Chir Kongr 2001; 118:632-4. harmful (26%) were less common reasons. Providers Abstract: Accidental trauma to the female perineum is reported that few parents refused because of anti- relatively rare and occurs most often in the 4- to 12- government sentiment (8%). CONCLUSIONS: year-old age group. Vulva and vaginal trauma are the Providers indicate low vaccine refusal rates within result of straddle injuries, accidental penetration, offices of traditional primary care providers and in intercourse, sexual abuse and motor vehicle accidents. public health clinics. Strategies for efficient provider- Injuries to the genitalia require typical surgical repair patient communication are needed to address parental and, in association with anogenital or urogenital concerns about vaccines. injuries, a multidisciplinary approach. Fredriksson GE, Hogberg U, Lundman BM. Postpartum care Franz R. Environmental dangers pose a threat to children's should provide alternatives to meet parents' need for skin. Dermatol Nurs 2001; 13(4):308, 311. safety, active participation, and 'bonding'. Midwifery 2003; 19(4):267-76. Fraser J. Victoria's story. Pract Midwife 2003; 6(8):4-5. Abstract: OBJECTIVE: To describe new parents' choice of the type of maternity care they wanted to Fraser J. When a simple 'yes' or 'no' is not enough. Pract receive, the family suite (FS) or an early discharge Midwife 2005; 8(9):42-3. (ED), and to gain a better understanding of parents' experiences of different postnatal care alternatives. Freckelton I. Munchausen Syndrome bx proxy and criminal DESIGN: A qualitative study using semi-structured prosecutions for child abuse. J Law Med 2005; interviews. The interviews were analysed by content 12(3):261-6. analysis. SETTING AND PARTICIPANTS: Eleven couples and one mother, including both first-time and Fredrickson DD, Davis TC, Arnould CL et al. Childhood experienced parents. Six families received care at a FS immunization refusal: provider and parent perceptions. while the others chose an ED within 24 hours after Fam Med 2004; 36(6):431-9. birth. MEASUREMENTS AND FINDINGS: The Notes: GENERAL NOTE: KIE: 31 refs. postpartum period was experienced as an unpredictable GENERAL NOTE: KIE: KIE Bib: immunization; time for new parents, when the need for safety, treatment refusal/minors participation in decision-making, and 'bonding' was felt Abstract: BACKGROUND AND OBJECTIVES: to be central and decisive to their choice of care. The Parental concerns may contribute to immunization type of care that the parents felt best met their needs refusals and low infant immunization rates. Little varied according to the mother's assessment of her own knowledge is available about how often and why and the baby's health status, the parents' requirements parents refuse immunizations for their children. This and experience and the way in which they, as parents, study was conducted to estimate, based on reports from handled the opportunities and demands of different health care providers and parents, the frequency of and environments. However, the opportunities for the reasons for immunization refusal. METHODS: In parents to choose the form of care they considered best 1998, we conducted 32 focus groups of parents and for their family were limited. PRACTICAL IMPLICATIONS: To best fulfil parents' wishes and 500
- 509. needs in postnatalcare alternative care forms are While similarities and differences arose, universal needed. Also, a way to treat the family as a whole on perspectives and practices emerged among the parents an individual family basis must be found and parents of that are discussed as prevailing themes. Results suggest newborn babies should be allowed to choose the form that the parents' struggle, systemic barriers, and the of care they consider best. urban environment are the greatest challenges facing families. Addressing these challenges will contribute to Free MM. Cross-cultural conceptions of pain and pain establishment of truly equitable and effective control. Proc (Bayl Univ Med Cent) 2002; 15(2):143-5. interventions for urban children, whether deaf or hard Abstract: Pain is a ubiquitous feature of the human of hearing, their parents, and other family members. experience. This paper presents an anthropology of pain. Anthropology is defined as the cross-cultural and Freeman B, Iron Cloud-Two Dogs E, Novins DK, LeMaster comparative study of human behavior. Pain can be PL. Contextual issues for strategic planning and acute and episodic, and pain can be constant and evaluation of systems of care for American Indian and uninterrupted. Acute pain, lasting for minutes or hours, Alaska Native communities: an introduction to Circles is reported at some time by virtually all adults and by of Care. Am Indian Alsk Native Ment Health Res most juveniles and is indicated by the cries and facial 2004; 11(2):1-29. expressions of toddlers and infants. This universality of Abstract: This introduction to the evaluation pain as a part of the human condition has been component of the Circles of Care initiative includes established by the research of many biological, background on the nature of the initiative, Center for physical, and social scientists. Ethnographers, Mental Health Services support for developing systems physicians, and public health experts describe pain of care for youth with emotional disturbances, and an complaints for a variety of modern, industrial societies overview of the systems of care approach. The and traditional, undeveloped societies. Pain is the most prevalence, unique challenges, and the historical, frequent complaint brought to the offices of physicians political, and cultural context of health care delivery in North America, and it is a focus of attention in the for American Indian and Alaska Native peoples are literate medical traditions of China, India, and Islamic also discussed. cultures. Hence, the study of pain and the cultural perceptions of pain are prominent foci of Freeman J. Mandatory abuse training--new developments for anthropologists. Given that the goal of medicine is to an old law! Iowa Med 2002; 92(4):26-7. offer medical care to all people who seek it, the practice of modern medicine may be assisted by an Freeman M. Whose life is it anyway? Med Law Rev 2001; exploration of the possibility of cultural differences in 9(3):259-80. medical beliefs and practices in the multiethnic and Notes: GENERAL NOTE: KIE: Freeman, Michael racially diverse patient populations today. GENERAL NOTE: KIE: 172 fn. GENERAL NOTE: KIE: KIE Bib: patient care/minors Freedman LP, Waldman RJ, de Pinho H, Wirth ME, Chowdhury AM, Rosenfield A. Transforming health Fremy D. [Improving the medical treatment of minors who systems to improve the lives of women and children. are victims of sexual assault or physical abuse: a Lancet 2005; 365(9463):997-1000. receiving center and partnership between a psychiatric hospital and university hospital]. Sante Publique Freeman B, Dieterich CA, Rak C. The struggle for language: (Bucur) 2003; 15 Spec No:179-84. perspectives and practices of urban parents with Abstract: The aim of the partnership is the children who are deaf or hard of hearing. Am Ann Deaf establishment and operation of a centre open 24 hours a 2002; 147(5):37-44. day which receives and treats adults and underage Abstract: Research is scarce on young children with victims of sexual assault and physical abuse coming hearing impairments growing up in urban from the greater metropolitan area of Besancon. The environments. A qualitative study was used to explore centre also provides the victims and their families with and describe the perspectives and practices of these adapted forensic and psychotherapeutic assistance. The children's parents. An ethnographic approach enabled mechanisms to carry out the project will be set out in a documentation of parents' routines, daily activities, contract between the two hospitals, including the thoughts (perceptions), and behaviors (practices). In- resources of the two institutions. The centre will fit into depth interviews and observations were the primary the existing network of partners which is already data sources. Data collection occurred within a 6- operational in Besancon. The role of the University of month period. Research questions focused on efforts Besancon and the Faculty of Medicine will be to parents make independently and with others (e.g., promote research in the field of physical abuse, its educational staff, family members) to facilitate and causes and effects, and to train future physicians who support their child's efforts to communicate and acquire will later be in charge of handling these types of cases language. Nine parents, two grandparents, and six staff in their careers. members disclosed their perspectives and practices. 501
- 510. French AP. Wildchild. J Am Acad Child Adolesc in some children who did not initially show high levels Psychiatry 2005; 44(1):1; author reply 1-2. of conduct problems and this predictive relationship seemed to be strongest for girls in the sample who were Frenkel DA. Legal regulation of surrogate motherhood in high on CU traits but who did not show significant Israel. Med Law 2001; 20(4):605-12. conduct problems. Notes: GENERAL NOTE: KIE: 18 refs. GENERAL NOTE: KIE: KIE Bib: surrogate mothers Fricke BL, Racadio JM, Duckworth T, Donnelly LF, Tamer Abstract: The Israeli Law on surrogate motherhood RM, Johnson ND. Placement of peripherally inserted demands a preconception agreement to include central catheters without fluoroscopy in children: initial payments to be made to the surrogate mother. catheter tip position. Radiology 2005; 234(3):887-92. Surrogacy arrangements with family members are Abstract: PURPOSE: To determine how often forbidden. Commercial surrogacy is allowed and placement of peripherally inserted central catheters encouraged. The Law causes many problems. Validity (PICCs) without imaging guidance results in an of consent given by surrogate mothers is doubtful. initially correct central venous catheter tip location. Possible future psychological harm are ignored. There MATERIALS AND METHODS: This study was is a danger of "commodification" of children. Abusing approved by the hospital's institutional review board, women of low socio-economic status as breeding which waived the requirement for informed consent. In machines may be another outcome. No clear a children's hospital, 843 PICCs were placed in 698 responsibility is imposed on the "intended parents" for patients (age range, 0 days to 26 years; mean, 6.9 an impaired child. The law ignores possibility of years) during a 14-month study period. All PICCs were divorce or death of the "intended parents" before the placed by a specialized team of PICC nurses and child's birth. Splitting motherhood is another social interventional radiology technologists in an problem that has to be dealt with. So far the sperm of angiography suite with the supervision of pediatric the husband from the "intended parents" has to be used, interventional radiologists. All catheters were threaded but further steps may follow. It is not certain that a blindly to a previously estimated length by either a policy of "positive eugenics" will not develop. PICC nurse or a pediatric interventional radiologist, according to National Association of Vascular Access Frenz P, Videla C. A public-health campaign to raise Networks guidelines, and the initial PICC tip location awareness of children's wellbeing with images drawn was then determined by means of spot fluoroscopy. by children. Lancet 2005; 366(9493):1324-9. PICC tips were regarded as central if they resided anywhere within the superior vena cava (SVC). All Freyd JJ. Memory for abuse: what can we learn from a catheters were then manipulated with intermittent prosecution sample? J Child Sex Abus 2003; 12(2):97- fluoroscopic guidance to achieve a final central 103. position in the distal third of the SVC. A chi2 test was used to compare initial and final PICC tip locations Frick PJ, Cornell AH, Barry CT, Bodin SD, Dane HE. according to patient age, catheter size, accessed vein, Callous-unemotional traits and conduct problems in the and need for radiologist assistance. A t test was used to prediction of conduct problem severity, aggression, and compare procedure time with and without radiologist self-report of delinquency. J Abnorm Child Psychol assistance. RESULTS: Analysis included 843 2003; 31(4):457-70. consecutively placed pediatric PICCs, of which 723 Abstract: The role of callous-unemotional (CU) traits (85.8%) had a noncentral initial PICC tip position and and conduct problems in predicting conduct problem required additional manipulation. After catheter severity, severity and type of aggression, and self- repositioning performed with intermittent fluoroscopic reported delinquency at a 1-year follow-up was guidance, a final central PICC tip location was investigated in a sample of 98 children (mean age achieved in 760 PICCs (90.2%). CONCLUSION: 12.43; SD = 1.72) recruited from a community-wide Pediatric PICC placement without fluoroscopic screening. Children with both CU traits and conduct guidance required catheter manipulation of initial PICC problems had a greater number and variety of conduct tip position in 723 cases (85.8%). PICC placement with problems at follow-up than children who at the fluoroscopic guidance is highly successful, and the screening had high levels of conduct problems alone. authors believe it is best performed in an angiography However, this poorer outcome for children with CU suite. traits could largely be accounted for by differences in initial level of conduct problem severity. Children with Friebert S, Kodish E. The right to decide. J Clin Oncol 2002; CU traits and conduct problems were also at risk for 20(19):4115-8. showing higher levels of aggression, especially proactive aggression, and self-reported delinquency. Frierson RL, Binkley MW. Prosecution of illicit drug use Importantly, these outcomes could not be solely during pregnancy: Crystal Ferguson v. City of explained by initial level of conduct problem severity. Charleston. J Am Acad Psychiatry Law 2001; Finally, CU traits predicted self-reported delinquency 29(4):469-73. 502
- 511. Frikke M, HansenK. Hemophagocytic lymphohistiocytosis significantly larger (23.6 +/- 14 vs 19.7 +/- 8.1 MB, (HLH). Pediatrics 2004; 114(4):1131-2. 35.6 +/- 12.5 vs 35.2 +/- 12 clips) than those done recently. Studies in patients with isolated ventricular Froehlich H, West DJ. Compliance with hepatitis B virus septal defect used comparable storage (23.7 +/- 8.9 vaccination in a high-risk population. Ethn Dis 2001; MB, 42.8 +/- 11.5 clips) to that of the group as a 11(3):548-53. whole. More complex congenital heart disease studies Abstract: OBJECTIVE: To quantify cultural barriers to were slightly larger-tetralogy of Fallot (28.2 +/- 19.5 hepatitis B virus (HBV) vaccination and parental MB, 43.4 +/- 13.9 clips), transposition of the great compliance with a specific vaccination protocol among arteries (30.6 +/- 17.4 MB, 40.3 +/- 16.7 clips), and a primarily among population of infants born at a single ventricle (29.7 +/- 19.6 MB, 39.9 +/- 12 clips)-- community hospital. METHODS: This study was although this trend was not significant. This study concurrent with an immunogenicity study of two suggests that digital pediatric echo is feasible using a vaccination schedules and occurred prior to the DICOM-compatible protocol with maintenance of inception of universal infant vaccination with hepatitis diagnostic integrity despite compression of study size B vaccine (HepB). In this study, parental pairs were to allow rapid archival storage and retrieval. interviewed, consent obtained, subjects were randomly assigned to each group, and first immunization was Froom J, Culpepper L, Green LA et al. A cross-national administered in the hospital. Follow-up contacts study of acute otitis media: risk factors, severity, and required for completion were documented. RESULTS: treatment at initial visit. Report from the International Of 260 eligible parental pairs interviewed, 175 (67%) Primary Care Network (IPCN) and the Ambulatory declined participation, mainly because of fears of Sentinel Practice Network (ASPN). J Am Board Fam vaccine side effects (55%) or ignorance of the hepatitis Pract 2001; 14(6):406-17. B virus (HBV) (30%). Of 85 infants enrolled in the Abstract: BACKGROUND: Treatment of acute otitis study, 28 (33%) were later withdrawn from the study; media (AOM) differs worldwide. The Dutch avoid 13 (46%) of these 28 infants were withdrawn at the antimicrobials unless fever and pain persist; the British request of parents. Each infant who completed the use them for 5 to 7 days, and Americans use them for study received 5 postcards, 10 phone calls, and 3 home 10 days. If effects of therapies are to be compared, it is visits. CONCLUSIONS: Families were unaware of the necessary to evaluate rates of risk factors, severity of risk of HBV infection and feared vaccination. Aversion attacks, and their influence on treatment decisions. We to subjecting an infant to pain was a principal reason wanted to compare the prevalence of risk factors for for failure to complete the study, and frequent contacts AOM and evaluate their association with severity of were required to ensure adherence. Existence of a safe attacks and of severity with antimicrobial treatment. and effective hepatitis B vaccine and universal METHODS: We undertook a prospective cohort study vaccination is unlikely to change deeply felt attitudes of 2,165 patients with AOM enrolled by primary care against vaccination. Current vaccination strategies physicians; 895 were enrolled from North America, must take these prejudices into account. 571 were enrolled from the United Kingdom, and 699 were enrolled from The Netherlands. The literature was Frommelt PC, Whitstone EN, Frommelt MA. Experience searched using the key words "acute otitis media," with a DICOM-compatible digital pediatric "severity," and "international comparisons." echocardiography laboratory. Pediatr Cardiol 2002; RESULTS: The prevalence of several AOM risk 23(1):53-7. factors differs significantly among patients from the Abstract: A digital pediatric echocardiography three country networks; these factors include race, laboratory, without videotape redundancy was parent smoking habits, previous episodes, previous established at Children's Hospital of Wisconsin in episodes without a physician visit, tonsillectomy or December 1998. To characterize the experience, 1198 adenoidectomy, frequency of upper respiratory tract consecutive patient studies were reviewed-50% from infections, day care, and recumbent bottle-feeding. the first 2 months after establishing the digital protocol Dutch children have the most severe attacks as defined and 50% from the last 2 months available. Each study by fever, ear discharge, decreased hearing during the was stored using a protocol that was based on capture previous week, and moderate or severe ear pain. In of single beat clips of relevant two-dimensional/color country-adjusted univariate analyses, increasing age, Doppler imaging and static frame spectral Doppler exposure to tobacco smoke, day care, previous attacks tracings. Studies were digitally compressed using a of AOM, previous attacks without physician care, past DICOM-compatible JPEG algorithm at 20:1 and edited prophylactic antimicrobials, ear tubes, adenoidectomy, with deletions of redundant clips to minimize archival and tonsillectomy all contribute to severity. Only storage needs. Study quality was uniformly excellent, country network, age, history of AOM, previous and no errors were attributable to the digital protocol or episode without physician care, and history of compression-related loss of information. The average adenoidectomy and tympanostomy tubes are study required 21.5 +/- 11.4 MB of storage space with independently related to increased severity, while 35.4 +/- 12.3 total clips/study captured. Studies current breast-feeding is protective. Severity of attacks reviewed from the earlier experience were not influences treatment decisions. Dutch children are least 503
- 512. likely to receiveantimicrobials, and even for severe J Stud Alcohol 2003; 64(4):472-83. attacks the British and Dutch physicians usually use Abstract: OBJECTIVE: This longitudinal study uses a amoxicillin or trimethoprim-sulfa; North American three-generation database involving measures of children with severe attacks are more likely to receive a grandparental and parental alcohol use disorder (AUD), broad-spectrum second-line antimicrobial. marital aggression and aggression to offspring to CONCLUSION: Dutch children have the highest predict early and later childhood aggression of third ratings in all severity measures, possibly reflecting generation offspring. Given the importance of parental decisions about care seeking for earaches. aggressive, undercontrolled behavior in the etiology of When comparing groups of patients with AOM, it is alcoholism, the purpose of this study was to construct a necessary to adjust for baseline characteristics. Severity statistical model of intergenerational aggression and of episode affects physician treatment decisions. alcoholism among family members. METHOD: Adoption of Dutch guidelines restricting use of Participants were a population-based sample of 186 antimicrobials for AOM in the United States could young sons of alcoholics and both biological parents result in annual savings of about $185 million. and 120 nonsubstance abusing families and their age- matched sons drawn from the same neighborhoods. Fujii A, Oshima K, Hamasaki M et al. Differential Extensive family data were collected at baseline and at expression of cytokines, chemokines and their 6 years postbaseline. Structural equation modeling receptors in follicular lymphoma and reactive follicular evaluated retrospective and prospective relationships hyperplasia: assessment by complementary DNA between grandparental and parental predictors of the microarray. Oncol Rep 2005; 13(5):819-24. sons' childhood aggression when they were 3-5 and 9- Abstract: Follicular lymphoma (FL) is pathologically 11 years of age. RESULTS: The final model showed categorised as a low-grade B-cell lymphoma and that grandparental marital aggression predicted histopathologically shows follicular proliferation of development of parental antisocial behavior, which neoplastic B cells. In the neoplastic follicles of FL, the predicted parental alcoholism and marital aggression presence of T cells, macrophages and follicular and partially mediated level of child aggression among dendritic cells (FDCs) suggests that these cells may their sons as preschoolers. Significant autostabilities in promote a favourable environment for the growth of level of child aggression, parental AUD and marital FL cells. Because FL cells are generally associated aggression were present in families over the 6-year with FDCs, FDCs may be considered an important interval. Marital aggression was a more important source of cytokines and chemokines. FDCs form the predictor of son's preschool aggression; direct parental framework for germinal centres and also provide aggression to the child was more important at 9-11. networks for nodules of FL. To evaluate the gene Child aggression at 3-5 also was a partial mediator of expression in neoplastic follicles of FL and reactive level of parent-to-child aggression at 9-11. follicles of reactive follicular hyperplasia (RFH), we CONCLUSIONS: Results indicate continuity of performed gene expression profiling of FL (n=5) and aggression across three generations and also indicate RFH (n=5) using complementary DNA (cDNA) that the child's pathway into risk for later AUD is not microarray of cytokines/chemokines and their simply mediated by parental alcoholism, but is carried receptors. FL and RFH exhibited a diffuse down- by other comorbid aspects of family functioning, in regulated profile compared with normal peripheral particular aggression. blood cells, which were used as controls, although some genes displayed up-regulated profiles. Fullerton JT, Thompson JB. Examining the evidence for The Hierarchical clustering analysis separated FL and RFH International Confederation of Midwives' essential into two distinct groups based on their gene expression competencies for midwifery practice. Midwifery 2005; profiles. FL cases exhibited significantly higher 21(1):2-13. expression of interleukin 3 receptor alpha (IL-3Ralpha) Abstract: OBJECTIVE: to present the evidence for than RFH. Immunohistochemically, neoplastic follicles inclusion of selected midwifery tasks (skills) as of FL frequently expressed IL-3Ralpha, especially in essential practice competencies for midwives FDCs, but not in FL cells. However, IL-3Ralpha throughout the world. The tasks addressed are those expression was rare or weak in the reactive follicles of presented to the International Confederation of RFH. These findings suggest the importance of the Midwives (ICM) Council of Delegates in 2002 for micro-environment for FL cell growth. Further studies discussion and adoption, based on the fact that during of cDNA microarray should provide new insight into field-testing, notable variance was encountered. KEY the molecular pathology of FL and may allow the CONCLUSIONS AND IMPLICATIONS FOR design of improved therapies. PRACTICE: evidence-based practice should be characterised by the use of best practices derived from Fuller BE, Chermack ST, Cruise KA, Kirsch E, Fitzgerald rigorous research, combined with and balanced by HE, Zucker RA. Predictors of aggression across three client perspectives and the expert judgement based on generations among sons of alcoholics: relationships the critical thinking of the clinician. Much of involving grandparental and parental alcoholism, child midwifery practice is considered an art based on aggression, marital aggression and parenting practices. common sense, tradition, and woman-centred 504
- 513. approaches to caring,as most of the women who seek considered that when parents force food on their child, midwifery care are healthy and require a health- this is a violation of the child's integrity. This view is promotion model of care that may not easily lend itself based on the idea that such actions restrict the child's to examination by scientists or clinicians. However, right to self-determination. In the participants' when intervention is indicated to save the lives of opinions, when the child is forced to sleep well, this is mother, baby, or both, those interventions must be not regarded as a violation of the child's integrity, but is based on the best available evidence from a variety of perceived as support of the child's autonomy. An sources leading to the most effective choices for action. underlying theoretical view may be that parents' time The ICM Essential Competencies for Midwifery can be saved if the child becomes independent of the Practice (2002) are based on evidence derived from a parents at as early an age as possible. variety of quantitative and qualitative methodologies. Expert clinical consensus may serve as to the best form Furman-Reznic M, Hiss J. Assessing child abuse. Isr Med of evidence at certain points in the evolution of Assoc J 2003; 5(2):152; author reply 152. knowledge. Every midwife needs to understand where the gaps exist in supporting traditional practices that Furtado EF, Laucht M, Schmidt MH. [Psychological have yet to be fully examined in a scientific manner. In symptoms in children of alcoholic fathers]. Z Kinder summary, a multi-matrix or triangulated approach may Jugendpsychiatr Psychother 2002; 30(4):241-50. be most appropriate to the delineation of evidence Abstract: OBJECTIVES: In spite of a growing interest underpinning best midwifery practice. in recent years in epidemiological research on behavior problems of children of alcoholics (COAs), few Funk RR, McDermeit M, Godley SH, Adams L. prospective longitudinal child psychiatric studies have Maltreatment issues by level of adolescent substance been conducted up to now. METHODS: In the abuse treatment: the extent of the problem at intake and Mannheim Study of Risk Children, an ongoing relationship to early outcomes. Child Maltreat 2003; prospective study of high risks, the data of 219 children 8(1):36-45. (26 COAs and 193 non-COAs) were analyzed from Abstract: Differences in self-reported victimization and birth to the age of 11 years. Sociodemographic data, outcomes for residential (n = 114) vs. outpatient (n = organic and psychosocial risk factors, the number and 73) substance abuse treatment samples were examined. severity of behavior problems, and the rate of Repeated measures MANOVAs for victimization level expansive and introversive disorders have been by level of care were performed on days of alcohol and investigated. RESULTS: The family status of the marijuana use and substance-related problems. COAs was characterized by the father's lower level of Residential treatment participants reported higher education as well as by socioeconomic difficulties and prevalence of victimization and higher levels of general more numerous adverse life events. Other psychosocial victimization but did not differ on acute (high) problems such as marital conflict and a lack of coping victimization at intake. Analyses revealed a significant mechanisms were also more frequent in COA families. interaction between follow-up outcomes and level of A significantly higher rate of expansive symptoms and care for adolescents with acute intake victimization. disorders was found in children of alcoholic fathers Adolescents placed in residential treatment were more from the age of two years on. CONCLUSIONS: likely to reduce their days of alcohol and marijuana use Children of alcoholic fathers represent a group at risk and past month substance-related problems at follow- for the early onset of psychiatric problems and are up. Adolescents with low intake levels of victimization deserving of more attention in prevention and early did not differ by level of care. Findings suggest that intervention programs. clinicians must carefully weigh placement recommendations for adolescents with maltreatment Gabris K, Tarjan I, Rozsa N. Dental trauma in children histories and that researchers should study ways to presenting for treatment at the Department of Dentistry increase outpatient treatment effectiveness for these for Children and Orthodontics, Budapest, 1985-1999. adolescents. Dent Traumatol 2001; 17(3):103-8. Abstract: Data on children with dental trauma who Funkquist EL, Carlsson M, Nyqvist KH. Consulting on presented for treatment at the Department of Dentistry feeding and sleeping problems in child health care: for Children and Orthodontics in Budapest over a what is at the bottom of advice to parents? J Child period of 15 years were analysed. The WHO guidelines Health Care 2005; 9(2):137-52. were used to classify the traumatic injuries. A total of Abstract: The aim of this study was to investigate and 590 children were involved, 810 teeth being affected. interpret ideas inherent in sleep and diet consultations Children aged 7-14 years made up 88% of the cohort. concerning infants in Swedish child health services. The male:female ratio was 58:42. The Data were obtained through semi-structured interviews permanent:primary ratio for the affected teeth was of professionals employed in these services. A 90:10. The teeth most commonly affected were the qualitative method with a phenomenological approach maxillary central incisors. In 70% of the cases, only was applied to analyse the data. The results indicate one tooth was traumatised. The incidence of dental that professionals have underlying conceptions. They 505
- 514. trauma peaked at10 years of age. The most common weight at home by research assistants, masked to group injury type observed was enamel-dentin crown allocation. RESULTS: No clinically important or fracture. The decreasing sequence of frequency of statistically significant group differences were found in etiological factors was playing, sports, falls, cycling, daily breastfeeding frequency (mean difference road accidents and fighting. Of the accidents, 65% experimental minus control = 0.1 feeds [95% occurred at school or at home. Seventy seven per cent confidence interval: -0.1-0.3]) or daily rate of infant of the patients presented for medical care in the first 3 weight gain (-1.1 g [-2.5-0.3]) based on intention-to- days after the accident. treat analyses. CONCLUSIONS: Follow-up by nurses after short postpartum hospital stays, in either the home Gadeyne E, Ghesquiere P, Onghena P. Longitudinal or a hospital-based clinic, of healthy infants discharged relations between parenting and child adjustment in at <36 hours seems associated with satisfactory infant young children. J Clin Child Adolesc Psychol 2004; breastfeeding outcomes. 33(2):347-58. Abstract: We studied the predictive relations between Gago LC, Wegner RK, Capone A Jr, Williams GA. reports of parenting behavior on the one hand and Intraretinal hemorrhages and chronic subdural academic achievement and reported behavior problems effusions: glutaric aciduria type 1 can be mistaken for of young children on the other hand. Data were shaken baby syndrome. Retina 2003; 23(5):724-6. gathered for 352 children and their parents from kindergarten to 2nd grade. The results indicated that in Gailhoustet L, Goulet O, Cachin N, Schmitz J. [Study of the academic domain, low supportive and high psychological repercussions of 2 modes of treatment of controlling parenting practices were modestly related adolescents with Crohn's disease]. Arch Pediatr 2002; to poor subsequent math achievement. Children's 9(2):110-6. externalizing and attention problem behavior was Abstract: No study has yet compared the respective clearly predictive of high levels of control in mothers psychological impact of corticotherapy and enteral and low levels of support in fathers. The combination nutrition in the treatment of Crohn's disease, and of high parental support and control was especially especially, the psychological problems linked to the associated with high levels of problem behavior. wearing of a nasogastric tube 24 hours a day. The goal However, when previous parenting and child of this study was to collect comparative information adjustment were taken into account, the magnitude of regarding the real-life experience and the feeling of the predictive power of parenting for child adjustment, these two treatments. PATIENTS AND METHODS: and of child adjustment for parenting, remained From September 1997 to February 1998 at the clinic of limited. inflammatory bowel diseases of the hospital Necker- Enfants malades, 51 patients aged 12 to 18 (average Gagnon AJ, Dougherty G, Jimenez V, Leduc N. 15) participated in this study. Thirty [15 on Randomized trial of postpartum care after hospital corticotherapy (CT); 15 on enteral nutrition (EN)] discharge. Pediatrics 2002; 109(6):1074-80. answered a questionnaire inspired by a similar Abstract: OBJECTIVE: Harmful effects of short Canadian questionnaire (Inflammatory Bowel Disease postpartum hospital stays include dehydration and Questionnaire), and 21 passed Spielberger's anxiety malnutrition of breastfed infants. These may be tests, Beck's depression tests and a psychological prevented by adequate breastfeeding frequency; interview. RESULTS: Treatment: According to the 30 however, rigorous research to determine the relative questionnaires the appreciation of the therapeutic effectiveness of various follow-up strategies in results was similar in the two treatments, the majority supporting breastfeeding frequency is absent. This of patients respected their treatment (only one patient study addressed the question, "Is there a difference in on EN ate secretly and two on CT stopped their breastfeeding frequency or infant weight gain for corticotherapy). Of the 15 EN questionnaires: nine out singleton infants discharged within 36 hours' of 15 patients responded well to the suspension of oral postpartum who received either community nurse feeding, two were hungry, nine experienced cravings (home visit) or hospital nurse (clinic) follow-up?" and ten avoided meals during their treatment. From a METHODS: A randomized, controlled trial was cosmetic point of view, six/14 (43%) found it difficult conducted at a university teaching hospital (3700 putting up with the nasogastric tube 24 hours a day, births/y) and affiliated community health centers. A and eight/15 (53%) on CT found the facial swelling consecutive sample of 586 healthy mother-infant pairs difficult to bear. According to the 21 psychological were recruited from January 1997 to September 1998 interviews, eight patients deemed EN efficient, while before discharge; 513 (87.5%) contributed data on 1 or only four felt the same about CT. Of the 11 EN more outcomes. Forty-eight-hour postpartum telephone psychological interview, no adolescent patients were contact and day 3 nurse contact in the home hungry, eight had cravings and nine avoided meals (experimental) or at the hospital (control) were during their treatment, seven mentioned they felt provided. The main outcomes measured were different and seven described how EN had upset the breastfeeding frequency and infant weight gain family's routine. Nine (82%) talked about how difficult assessed at 2 weeks' postpartum by maternal diary and it was to put up with the nasogastric tube 24 hours a 506
- 515. day from acosmetic standpoint while eight/ten (80%) Gaillard WD, Pugliese M, Grandin CB et al. Cortical on CT found the facial swelling difficult to live with. localization of reading in normal children: an fMRI Seven complained that they had been the victims of language study. Neurology 2001; 57(1):47-54. verbal abuse. Quality of life: According to the 30 Abstract: BACKGROUND: fMRI provides a questionnaires, eight/15 patients on EN missed an noninvasive means of identifying the location and average of 15 days of school against five/15 patients on organization of neural networks that underlie cognitive CT, ten patients judged that EN restricted their daily functions. OBJECTIVE: To identify, using fMRI, brain lives and nine mentioned the daily difficulties to wear a regions involved in processing written text in children. tube 24 hours a day. Tests: Spielberger's test of anxiety METHODS: The authors studied nine normal right- revealed that on average, the 11 patients on EN who handed native English-speaking children, aged 10.2 were interviewed suffered the first level of anxiety, years (range 7.9 to 13.3 years), with two paradigms: while the ten patients on CT felt the second level. As reading Aesop's Fables and "Read Response Naming" for the Beck's depression test, the 11 patients on NE (reading a description of an object that was then suffered the first level of depression on average, while silently named). Data were acquired using blood those on CT were subject to the second level. oxygen level-dependent fMRI. Group data were CONCLUSION: This study demonstrated that EN was analyzed with statistical parametric mapping; perceived as being more disruptive to patients daily individual data sets were analyzed with a region-of- lives than CT and defines the difficulties linked to the interest approach from individual study t maps. The suspension of oral feeding and the wearing of a naso- number of activated pixels was determined in brain gastric tube. The study also describes the difficulties regions and an asymmetry index (AI = [L - R]/[L + R]) involved in coping with the side effects of CT, one calculated for each region. RESULTS: The authors example being facial swelling which can be as found strong activation in the left middle temporal unpleasant from a cosmetic point of view as wearing of gyrus and left midfrontal gyrus and variable activation a naso-gastric tube. in left inferior frontal gyrus for both reading tasks in the group analysis (z > 5.5 to 9.1). All subjects had Gaillard WD, Balsamo LM, Ibrahim Z, Sachs BC, Xu B. strong left-sided lateralization for both tasks in fMRI identifies regional specialization of neural middle/superior temporal gyrus, inferior frontal gyrus, networks for reading in young children. Neurology and middle frontal gyrus (AI = 0.76 to 1.0 for t = 4). 2003; 60(1):94-100. Reading Fables activated twice as many pixels in Abstract: BACKGROUND: fMRI allows mapping of temporal cortex as the Read Response Naming task; neural networks underlying cognitive networks during activation in dorsolateral prefrontal cortex was similar development, but few studies have systematically for both tasks. Small homologous right middle examined children 7 and younger, in whom language temporal region activation was seen with reading a networks may be more diffusely organized than in fable. CONCLUSIONS: The neural networks that adults. OBJECTIVE: To identify neural networks process reading appear to be lateralized and localized during early reading consolidation in young children. by middle to late childhood. Reading text paradigms METHODS: The authors studied 16 normal, right- may prove useful for identifying frontal and temporal handed, native English-speaking children with a mean language-processing areas and for determining age of 7.2 years (range 5.8 to 7.9) with fMRI reading language dominance in children experiencing epilepsy paradigms adjusted for reading level. Data were or undergoing tumor surgery. acquired with the echoplanar imaging BOLD technique at 1.5 T. Group data were analyzed with statistical Gaitatzis A, Purcell B, Carroll K, Sander JW, Majeed A. parametric mapping (SPM-99); individual data sets Differences in the use of health services among people were analyzed with a region of interest approach from with and without epilepsy in the United Kingdom: individual study t maps (t = 4). The number of socio-economic and disease-specific determinants. activated pixels in brain regions was determined and an Epilepsy Res 2002; 50(3):233-41. asymmetry index (AI) ([L-R]/[L+R]) calculated for Abstract: We aim to examine the socio-economic, each region. RESULTS: In group analysis the authors demographic and disease-specific determinants in the found prominent activation in left inferior temporal use of health services by patients with epilepsy, occipital junction and left fusiform gyrus (Brodmann compared to people without epilepsy. We used data area [BA] 37), middle temporal gyrus (BA 21, 22), from the fourth national survey of morbidity in general middle frontal gyrus (BA 44, 45), and the practice, carried out in 1991-1992. Overall mean supplementary motor area. Activation was strongly annual number of consultations with general lateralized in middle frontal gyrus and Wernicke areas practitioners, home visits and referrals to secondary (AI 0.54, 0.62). Fourteen subjects had left-sided care per person were calculated for people with language lateralization, one was bilateral, and one had epilepsy, stratified by age, sex and socio-economic poor activation. CONCLUSIONS: The neural networks status. The proportion of patients consulting for certain that process reading are strongly lateralized and diseases or disease groups were also calculated for regionally specific by age 6 to 7 years. Neural patients with epilepsy. Results were compared to these networks in early readers are similar to those in adults. in people without epilepsy, and rate ratios were 507
- 516. calculated. Patients withepilepsy consulted twice as OUTCOME MEASURES: Rates of early discharge often, required three to four times more home visits, (<or=1-night stay after vaginal delivery and <or=3- and were referred to secondary care three times more night stay after cesarean section) and untimely follow- often than people without epilepsy, irrespective of age, up (no home or office visit within 2 days of early sex and social class. Among patients with epilepsy, discharge). RESULTS: Overall, 49.4% of newborns consultation rates and home visits were higher in were discharged early. Of these, 67.5% had untimely females, older people and people from the manual follow-up. The odds of early discharge were greater social classes. A higher proportion of patients with with lower incomes: the adjusted odds ratios (AORs) epilepsy consulted for neoplasms, haematological and (with 95% confidence intervals) were 2.06 (1.50-2.83) mental health disorders, dementia, stroke and for incomes <or=100% of poverty, 2.20 (1.65-2.93) for gastrointestinal bleeding. Older age and low social incomes from 101%-200% of poverty, and 2.24 (1.63- class were less strongly associated with health service 3.08) for incomes from 201%-300% of poverty. utilisation than in people without epilepsy, indicating Untimely follow-up was more likely for infants of that people with epilepsy lose much of the protective women with incomes <or=100% of poverty (AOR = effect of young age and high social class on health. 1.89 [1.13-3.17]) and 201%-300% of poverty (AOR = Factors contributing to the higher utilisation of health 1.78 [1.09-2.91]), Medicaid coverage (AOR = 1.73 services in people with epilepsy need to be studied [1.20-2.47]), Latina ethnicity (AOR = 1.47 [1.02- further and their effects taken into account in the 2.14]), and non-English language (AOR = 1.72 [1.16- organisation of health services for people with 2.55]). CONCLUSIONS: Despite an apparent decline epilepsy. in short stays after legislation, many newborns-- particularly from lower-income families--continue to Gajowy M, Simon W. [Child abuse, neglect and pregnancy be discharged early. Most newborns discharged early-- losses--combination and its psychological sequel]. particularly those with Medicaid and those from low- Psychiatr Pol 2002; 36(6):911-27. income, Latina, and non-English-speaking homes--do Abstract: The authors surveyed the literature focused not receive recommended follow-up. The most on childhood mistreatment and pregnancy loss. They socioeconomically vulnerable newborns are receiving present definitions and classifications of child abuse fewer postnatal services. (emotional, verbal, physical, sexual), child neglect (physical, emotional-intellectual) and pregnancy losses Galil A, Carmel S, Lubetzky H, Vered S, Heiman N. (especially miscarriage and abortion). In the second Compliance with home rehabilitation therapy by part of the paper a correlation between abuse and parents of children with disabilities in Jews and pregnancy loss is displayed as well as a correlation Bedouin in Israel. Dev Med Child Neurol 2001; between child abuse and neglect. The different kinds of 43(4):261-8. pregnancy losses are viewed as similar in aspect of Abstract: Among key points in making progress and psychological sequel, though their intensity and succeeding with a therapeutic programme for children particular character depends on the mother's with disabilities is parental compliance with the regime contribution to the loss of her child. In the last part, the for their child. The purpose of this study was to consequences of the above correlation are discussed. evaluate factors influencing compliance with home The clinical observations suggest, that abuse and therapy in the Jewish and Bedouin populations. Data neglect experienced in childhood increases the were collected by structured questionnaires. A total of probability of pregnancy loss in adulthood. On the 193 families participated (84% response rate) with other hand, the loss of on unborn child is one of the children who ranged in age from 6 months to 6 years factors causing child abuse and neglect. (mean age at first visit to the centre was 9.5 years in Jews and 16.1 years in Bedouin). Compliance was Galbraith AA, Egerter SA, Marchi KS, Chavez G, Braveman significantly lower among the Bedouin. Multivariate PA. Newborn early discharge revisited: are California regression analysis showed that the strongest newborns receiving recommended postnatal services? contributory factor in lack of compliance was being Pediatrics 2003; 111(2):364-71. Bedouin. The second factor was intensity of Abstract: CONTEXT: Responding to safety concerns, questioning destiny, indicating that parents with these federal and state legislation mandated coverage of feelings may be less likely to comply with therapeutic minimum postnatal stays and state legislation in regimes. Other factors which were associated with California mandated coverage of follow-up after early compliance were parents' education and socioeconomic discharge. Little is known about the postnatal services status: lower levels on these dimensions corresponded newborns are receiving. OBJECTIVE: To describe with lower parental compliance. These results were rates of early discharge and of timely follow-up for illuminated by a trial intervention programme for early-discharged newborns. DESIGN AND SETTING: Bedouin families which involved telephone contact, Retrospective, population-based cohort study using a translation facilities, and detailed explanations during 1999 postpartum survey in California. visits to the centre. Intervention increased the PARTICIPANTS: A total of 2828 infants of mothers compliance rate of the Bedouin appointments with with medically low-risk singleton births. MAIN specialists to 76% (91 of 120 appointments) thereby 508
- 517. reaching similar levelsto those of the Jewish group. responsibility. Although the health visitors supported These preliminary results indicate that the strong the principles underpinning Family Group association between non-compliance and being Conferences, they were unsure about how to put theory Bedouin may be due to factors of communication, and into practice. The need for more education and training that the Bedouin are receptive to therapeutic was strongly supported to enable the model to move interventions when communicated in their own from marginal to mainstream use. They also considered language. that Family Group Conferences could threaten interagency working, associated with issues relating to Galinowski A. [Borderline personality disorder]. Encephale professional responsibility. CONCLUSIONS: The 2005; 31 Pt 2:S73-5. results identified training and procedural issues that need to be addressed if Family Group Conferences are Gallagher C. Initiating a pediatric office-based quality to be introduced successfully within mainstream child improvement program. J Healthc Qual 2001; 23(2):4-9; protection practice. Insights from this study have led to quiz 9-10, 52. inclusion of Family Group Conferences in the local Abstract: This article describes a pediatric primary care child protection guidelines, with emphasis applied to network's initiative to implement an office-based interdisciplinary working, empowerment of families quality improvement (QI) program. First, network and professional staff, and education and training. physicians determined their priorities for quality improvement. Then primary care practitioners on the Galler JR, Waber D, Harrison R, Ramsey F. Behavioral Quality Committee (QC), representing each local group effects of childhood malnutrition. Am J Psychiatry practice, were educated about a physician-led QI 2005; 162(9):1760-1; author reply 1761. process. The four steps of this process are as follows: (1) Set quality aims, (2) determine measurements of Gandle EL. It sounds like child abuse--but is it? Am Fam improvements, (3) generate ideas for change, and (4) Physician 2002; 65(2):330, 332, 334. test changes. Next, the QC selected two initial projects- -office preparedness for pediatric emergencies and Gansky SA. Dental data mining: potential pitfalls and asthma management--and corresponding practical issues. Adv Dent Res 2003; 17:109-14. subcommittees were formed. The pediatricians Abstract: Knowledge Discovery and Data Mining identified QI practice changes they believed could be (KDD) have become popular buzzwords. But what implemented successfully to make a measurable exactly is data mining? What are its strengths and difference in children's healthcare. limitations? Classic regression, artificial neural network (ANN), and classification and regression tree Gallagher F, Jasper M. Health Visitors' experiences of (CART) models are common KDD tools. Some recent Family Group Conferences in relation to child reports (e.g., Kattan et al., 1998) show that ANN and protection planning: a phenomenological study. J Nurs CART models can perform better than classic Manag 2003; 11(6):377-86. regression models: CART models excel at covariate Abstract: AIMS AND BACKGROUND: The purpose interactions, while ANN models excel at nonlinear of this study was to explore Health Visitors' covariates. Model prediction performance is examined experiences of Family Group Conferences as part of with the use of validation procedures and evaluating Child Protection Planning in Hampshire, England. The concordance, sensitivity, specificity, and likelihood aim was to identify good practice, recognizing the ratio. To aid interpretation, various plots of predicted challenges of the approach and enabling probabilities are utilized, such as lift charts, receiver recommendations for improved collaboration to be operating characteristic curves, and cumulative framed. The Family Group Conferences model is based captured-response plots. A dental caries study is used on partnership, decision-making and family as an illustrative example. This paper compares the involvement and presents an alternative to case performance of logistic regression with KDD methods conferences. METHODS: A Husserlian of CART and ANN in analyzing data from the phenomenological approach was adopted, using taped Rochester caries study. With careful analysis, such as semi-structured interviews with four health visitors validation with sufficient sample size and the use of who had experience of Family Group Conferences. proper competitors, problems of naive KDD analyses Colaizzi's seven stages of phenomenological analysis (Schwarzer et al., 2000) can be carefully avoided. were used. FINDINGS: The four key categories related to the ability of the Family Group Conference model to Garbarino J, Bradshaw CP, Vorrasi JA. Mitigating the empower families; the need for health visitors to effects of gun violence on children and youth. Future receive appropriate education and training; Child 2002; 12(2):72-85. organizational; and professional issues. Health visitors Abstract: Countless children and youth are exposed to believed that Family Group Conferences could gun violence each year--at home, at school, in their empower families, but they felt unprepared to attend. communities, or through the media. Gun violence can Concerns were identified regarding confidentiality and leave lasting emotional scars on these children. This 509
- 518. article reviews researchregarding the psychological administered by mail to parents, teenagers, and effects of gun violence on children and youth, and teachers. RESULTS: Parents were more likely to rate offers suggestions for how parents, school ELGA teenagers than control subjects as in the administrators, and mental health workers can mitigate "abnormal" range for hyperactivity (8% vs 1%; these negative effects. Children exposed to gun difference: 7%; (95% confidence interval [CI]: 2-12), violence may experience negative short- and long-term peer relationship problems (19% vs 5%; difference: psychological effects, including anger, withdrawal, 14%; 95% CI: 6-21), and emotional problems (18% vs posttraumatic stress, and desensitization to violence. 7%; difference: 11%; 95% CI: 3-19), but not conduct All of these outcomes can feed into a continuing cycle problems (10% vs 5%; difference: 5%; 95% CI: -1 to of violence. Certain children may be at higher risk for 12)). Teachers reported a similar pattern. In contrast, negative outcomes if they are exposed to gun violence. compared with control subjects, ELGA teenagers did Groups at risk include children injured in gun violence, not rate themselves as having more problems with those who witness violent acts at close proximity, those peers, hyperactivity, conduct, depression, or low self- exposed to high levels of violence in their communities esteem. They reported more emotional problems but or schools, and those exposed to violent media. less delinquency, alcohol, cannabis, and other drug use. Parents, school administrators, and mental health CONCLUSIONS: Compared with mainstream workers all can play key roles in protecting children classmates, children who are born extremely early from gun violence and helping them overcome the continue to have higher levels of parent- and teacher- effects of gun-related trauma. The authors recommend reported emotional, attentional, and peer problems well a number of strategies that adults can adopt to help into their teens. However, despite these problems, they children cope with gun violence, such as increasing do not show signs of more serious conduct disorders, parental monitoring, targeting services to youth at risk delinquency, drug use, or depression. of violent activity, and developing therapeutic interventions to help traumatized young people. Gardner HB. Hypoxia leading to intracranial problems may be a retinal haemorrhage. Neuropathol Appl Neurobiol Garber M, Hunt SC, Arnold RM. Ask the ethicist: can an 2004; 30(2):192. HIV-positive woman be forced to take medicine to protect her fetus? Med Ethics (Burlingt, Mass) 2004; Gardner JM, Powell CA, Baker-Henningham H, Walker SP, 11(3):3, 12. Cole TJ, Grantham-McGregor SM. Zinc Notes: GENERAL NOTE: KIE: 5 refs. supplementation and psychosocial stimulation: effects GENERAL NOTE: KIE: KIE Bib: AIDS; fetuses; on the development of undernourished Jamaican treatment refusal children. Am J Clin Nutr 2005; 82(2):399-405. Abstract: BACKGROUND: Undernourished children Garcia DP. Living without immunizations--a new growing have poor levels of development that benefit from trend. J Ky Med Assoc 2005; 103(3):109-11. stimulation. Zinc deficiency is prevalent in undernourished children and may contribute to their Gardner F, Johnson A, Yudkin P et al. Behavioral and poor development. OBJECTIVE: We assessed the emotional adjustment of teenagers in mainstream effects of zinc supplementation and psychosocial school who were born before 29 weeks' gestation. stimulation given together or separately on the Pediatrics 2004; 114(3):676-82. psychomotor development of undernourished children. Notes: CORPORATE NAME: Extremely Low DESIGN: This was a randomized controlled trial with Gestational Age Steering Group 4 groups: stimulation alone, zinc supplementation Abstract: OBJECTIVES: To investigate behavioral and alone, both interventions, and control (routine care emotional problems and positive adjustment of 15-to only). Subjects were 114 children aged 9-30 mo and 16-year-olds who were born at extremely low below -1.5 z scores of the National Center for Health gestational age (ELGA), from the perspective of Statistics weight-for-age references who were recruited parents, teachers, and teenagers. METHODS: from 18 health clinics. Clinics were randomly assigned Prospective follow-up was conducted of birth cohorts, to receive stimulation or not; individual children were with classroom control subjects. All infants who were randomly assigned to receive zinc or placebo. The born before 29 weeks in 1983-1984 (mean gestational stimulation program comprised weekly home visits age: 27 weeks) to mothers who resided in 3 regions of during which play was demonstrated and maternal- the United Kingdom were studied. A total of 82% (179 child interactions were encouraged. The of 218) of survivors were traced at age 15 to 16. The supplementation was 10 mg Zn as sulfate daily or 150 in mainstream school were compared with age- placebo. Development (assessed by use of the Griffiths and gender-matched classroom control subjects (n = Mental Development Scales), length, and weight were 108). Behavioral and emotional problems, delinquency, measured at baseline and 6 mo later. Weekly morbidity peer relations, self-esteem, and hobbies, were assessed histories were taken. RESULTS: Significant by standardized, well-validated instruments, including interactions were found between zinc supplementation the Strengths and Difficulties Questionnaire, and stimulation. Zinc benefited the developmental quotient only in children who received stimulation, and 510
- 519. benefits from zincto hand and eye coordination were mother-twins relationship. The impossibility to greater in stimulated children. Zinc supplementation establish a dyadic relationship with each child creates alone improved hand and eye coordination, and feelings of frustration and guilt. The risk of child abuse stimulation alone benefited the developmental quotient, is increased in twins. The balanced psychoemotional hearing and speech, and performance. Zinc development of twins requires parental attitudes supplementation also reduced diarrheal morbidity but enhancing their individualization as opposed to their did not significantly improve growth. CONCLUSION: "collectivization". The risk of prematurity is ten times Zinc supplementation benefits development in increased in twins which increases the risks of undernourished children, and the benefits are enhanced developmental disabilities. Considering that the if stimulation is also provided. number of twin deliveries is rising in our country it is important to be aware of the problems experienced by Gardner JM, Walker SP, Powell CA, Grantham-McGregor the families and to improve the way material and S. A randomized controlled trial of a home-visiting psychological help is provided to them. intervention on cognition and behavior in term low birth weight infants. J Pediatr 2003; 143(5):634-9. Garg VK, Agarwalla A, Agrawal S, Deb M, Khanal B. Abstract: OBJECTIVES: To determine whether early Sexual habits and clinico-etiological profile of sexually psychosocial intervention with low birth weight term transmitted diseases in Nepal. J Dermatol 2001; (LBW-T) infants improved cognition and behavior and 28(7):353-9. to compare LBW-T with normal birth weight (NBW) Abstract: A total of 100 patients giving histories infants. STUDY DESIGN: A randomized controlled suggestive of sexually transmitted disease (STDs) and trial was carried out in Kingston, Jamaica, with 140 attending the dermatology OPD at BPKIHS (B.P. LBW-T infants (weight<2500 g). The intervention Koirala Institute of Health Sciences) in Nepal over a comprised weekly home visits by paraprofessionals for period of one year from 1st July 1999 to 30th June the first 8 weeks of life aimed at improving maternal- 2000 were included in this study. Out of 10,400 new child interaction. LBW-T and 94 matched NBW dermatology cases, a total of 100 cases (0.96%) of (weight 2500 to 4000 g) infants were recruited from the STDs were seen. Of these 73 were males, and the main maternity hospital. Main outcome measures were majority (53%) were in the age group of 21-30 years. problem solving (2 means-end tests: cover and support) Most of the patients were from Sunsari district (54%). and 4 behavior ratings at 7 months. Analyses used were The most common profession (21%) was businessman the t test for intervention effects and multiple followed by housewife (19%). The most common age regression to compare LBW and NBW infants. for first sexual contact was 16 to 19 years (45%). RESULTS: LBW-T intervened infants had higher Eleven percent had their first sexual contact at the age scores than LBW-T control infants on the cover test of 15 or below 15 years. Premarital sexual exposure (P<.05) and were more cooperative (P<.01) and happy was recorded in 17% of the unmarried males. There (P<.05). LBW-T control infants had poorer scores on were only 3 homosexuals and 1 bisexual patient. both the cover (P<.001) and support tests (P<.01), Multiple contacts were recorded in 55% of the patients. vocalized less (P<.02), and were less cooperative The most common source of contact was a commercial (P<.001), happy (P<.02), and active (P<.02) than NBW sex worker in 34.15%. Condoms were always used by infants. LBW-T intervened infants had lower scores only 7%. The various types of sexually trasmitted than NBW infants only on the support test (P<.05). diseases (STDs) were syphilis (31%) followed by CONCLUSIONS: Early low-cost intervention can condylomata acuminata (16%), herpes genitalis (15%), improve cognition and behavior of LBW-T infants in gonorrhoea (9%), and mixed infections (12%). Despite developing countries. their varied sexual behavior, none of the patients were HIV positive; however, it is always advisable to screen Garel M, Chavanne-De Weck E, Blondel B. [Psychological all STD patients for HIV antibody. consequences of twinship on the children and their parents]. J Gynecol Obstet Biol Reprod (Paris) 2002; Garno JL, Goldberg JF, Ramirez PM, Ritzler BA. Impact of 31(1 Suppl):2S40-5. childhood abuse on the clinical course of bipolar Abstract: This paper presents a synthesis about the disorder. Br J Psychiatry 2005; 186:121-5. psychological consequences of twinship based on a Abstract: BACKGROUND: Few investigations have review of the literature and on our clinical experience. examined the impact of childhood trauma, and domains During pregnancy, delivery and the immediate post- of childhood abuse, on outcome in bipolar disorder. partum, mothers experience physical and psychological AIMS: To evaluate the prevalence and subtypes of difficulties linked with increased medical risks for childhood abuse reported by adult patients with bipolar themselves and for the children. The twins mortality is disorder and relationship to clinical outcome. high before and after delivery. Grieving for one twin METHOD: Prevalence rates of childhood abuse were creates particular problems for parents. During first retrospectively assessed and examined relative to months after hospital discharge mothers encounter illness complexity in a sample of 100 patients at an material and emotional stress. They are caused by academic specialty centre for the treatment of bipolar overload of mothering tasks and the specificity of disorder. RESULTS: Histories of severe childhood 511
- 520. abuse were identifiedin about half of the sample and identify the plan choice equation. RESULTS: We were associated with early age at illness onset. Abuse found that caregivers with symptoms of depression subcategories were strongly inter-related. Severe were 26.3% more likely to report any unmet need, emotional abuse was significantly associated with 67.6% more likely to report unmet hospital and lifetime substance misuse comorbidity and past-year physician need, 66.1% more likely to report unmet rapid cycling. Logistic regression indicated a mental health care need and 38.8% more likely to significant association between lifetime suicide report unmet need for other health care services. attempts and severe childhood sexual abuse. Multiple Caregivers of children with poor psychological forms of abuse showed a graded increase in risk for adjustment were 26.3% more likely to report their child both suicide attempts and rapid cycling. had an unmet need and 92.3% more likely to report an CONCLUSIONS: Severe childhood trauma appears to unmet mental health care need. DISCUSSION: Our have occurred in about half of patients with bipolar analyses show that children whose caregivers disorder, and may lead to more complex experience symptoms of depression are significantly psychopathological manifestations. more likely to encounter difficulties obtaining needed medical and mental health care services. Furthermore, Gary FA, Baker M, Grandbois DM. Perspectives on suicide the findings reported here indicate that children with prevention among American Indian and Alaska native poor psychological adjustment are significantly more children and adolescents: a call for help. Online J likely to experience unmet needs for medical and Issues Nurs 2005; 10(2):6. mental health care services. Our study has some Abstract: Suicide rates among American Indian Alaska limitations. First, most of the children in our sample are Native (AIAN) children and adolescents are the highest African-American, so these findings may differ for in the United States. Risk factors for suicide among children of other races. Second, these findings may not AIAN youth include: strained interpersonal be applicable to CSHCN who reside in rural areas. relationships, family instability, depression, low self- Third, we recognize the possibility that child and esteem, and alcohol use or substance abuse. Protective caregiver mental health is potentially endogenous. factors include: caring family relationships, supportive IMPLICATIONS FOR HEALTH CARE PROVISION tribal leaders, and positive school experiences. AND USE: The mental health status of CSHCN and Carefully planned, culturally sensitive, comprehensive their caregivers are barriers to care. IMPLICATIONS programs that address the social determinants of health FOR HEALTH POLICIES: Policymakers should be outcomes such as poverty, school failure, familial concerned about the mental health status of children conflicts, and limited access to health care, should be with special health care needs and their caregivers as the focus of blueprints for change for these vulnerable such problems appear to be barriers to obtaining care. children. Moreover, culturally competent providers are Therefore, to adequately address the access problems key elements associated with reducing the suicide rates of children with special health care needs, policy must among AIAN children and adolescents. address the mental health problems of children and their caregivers. Providing mental health care for Gaskin DJ, Mitchell JM. Health status and access to care for caregivers and children has the potential for improving children with special health care needs. J Ment Health overall access for CSHCN. IMPLICATION FOR Policy Econ 2005; 8(1):29-35. FURTHER RESEARCH: Future research should Abstract: BACKGROUND: About 11-14% of children determine the causal relationship between mental with special health care needs (CSHCN) have unmet health problems of CSHCN and their caregivers and needs during a given year. Little is known about the the level unmet health care needs. determinants of unmet health care needs for CSHCN. AIMS OF THE STUDY: The objective of this study Gatrad AR, Sheikh A, Jacks H. Religious circumcision and was to explore the association between access to care the Human Rights Act. Arch Dis Child 2002; 86(2):76- (unmet needs) among CSHCN and their caregivers' 8. mental health status as well as children's mental health status. METHODS: We surveyed a random sample of Gatti U, Tremblay RE, Vitaro F, McDuff P. Youth gangs, 1,088 caregivers of CSHCN who resided in the District delinquency and drug use: a test of the selection, of Columbia during the summer and fall of 2002. In the facilitation, and enhancement hypotheses. J Child survey, we collected information on children's unmet Psychol Psychiatry 2005; 46(11):1178-90. needs mental health status (PARS) and their caregivers' Abstract: BACKGROUND: Three different mental health status (CES-D). We estimated the explanations have been given for the observation that association between mental health status determinants adolescent gang members report more delinquent of unmet needs adjusting for selection bias associated behaviour than their counterparts who do not affiliate with plan choice (partially capitated managed care with gangs: a) adolescents who commit more crimes versus FFS) with an instrumental variables probit join gangs (selection hypothesis); b) gang membership estimation technique. We used caregivers' preferences facilitates deviant behaviour (facilitation hypothesis); about physicians and hospitals networks, and whether c) selection and facilitation work interactively the caregiver and child had the same last name to (enhancement hypothesis). The aim of this study was to 512
- 521. test these hypotheses,while controlling for self- specific avoidable causes. The use of three reference reported delinquency, friends' delinquency, and values (the mean, the quintile with the greatest SEDI, individual as well as family characteristics. METHOD: and the optimal empirical reference value) makes it The sample included 756 boys first assessed when they possible to measure gaps that could be avoided. The attended kindergarten in disadvantaged areas of ratio of the lowest SEDI quintile to the empirical Montreal. Gang membership was assessed at the ages optimal reference value was 2.1 for AM, 2.0 for PYLL, of 14, 15 and 16 years. Delinquency and drug use data 1.7 for infant mortality, and 1.5 for HCAMR. were collected from self-reports and court files at the CONCLUSIONS: These results, which are consistent same ages. RESULTS: Gang members displayed far with those found in previous published sources, higher rates of delinquent behaviour and drug use than estimate the magnitude and pattern of variations among non-gang members. The results support the facilitation communes. The results also provide information, based model for transient gang members (i.e., youths in a on data for 1992, with which to start monitoring health gang during only one of the three periods considered) inequalities among small geographic areas, which were and the enhancement model for stable gang members communes in this particular case. Although (i.e., youths in a gang for at least two of the periods interventions for promoting equity tend to focus considered), for person and property offences. The exclusively on communes having lower socioeconomic association between gang membership and delinquency development and higher rates of avoidable mortality, persisted after introducing the control variables. reducing the latter implies a two-pronged approach: Additional analyses showed that the effect associated prioritizing interventions targeting underprivileged with belonging to a gang was beyond that of simply communes so as to foster equity, while attempting to having delinquent friends. CONCLUSION: Preventing cover the majority of communes in an effort to prevent the creation and participation in such gangs should avoidable mortality. reduce the frequency of antisocial behaviour during adolescence. Gautier T, Droit-Volet S. Attention and time estimation in 5- and 8-year-old children: a dual-task procedure. Behav Gattini C, Sanderson C, Castillo-Salgado C. [Using different Processes 2002; 58(1-2):57-66. indicators of preventable mortality as an approach to Abstract: This experiment tested the effect of a dual- measuring health inequalities in Chilean task on time reproduction in 5- and 8-year-olds. municipalities]. Rev Panam Salud Publica 2002; Children had to reproduce a stimulus duration lasting 12(6):454-61. for 6 or 12 s, during which they either did or did not Abstract: OBJECTIVES: To analyze differences in perform a concurrent non-temporal task (i.e. picture avoidable mortality among communes in Chile, using naming) both in low (LA) and high (HA) attentional different indicators as an operational approach to demand conditions. The results showed that children estimating health inequalities. METHODS: Small area reproduced shorter durations in the dual-task than in variation analysis in a sample of 117 of all 335 Chilean the single-task condition, whatever the duration value communes that existed in 1992. By using secondary used. However, this shortening effect was greater in the data, we developed and compared some avoidable- 5-year-olds than in the 8-year-olds. Furthermore, in the mortality indicators, such as potential years of life lost 5-year-olds, temporal reproductions were significantly (PYLL), avoidable mortality (AM) (based on shorter in both dual-tasks (LA or HA) than in the background and criteria drawn from the literature), single-task, whereas, in the 8-year-olds, differences health care avoidable mortality (HCAMR), and life reached significance only between the HA dual-task expectancy. A socioeconomic development index and the single-task. In the non-temporal task, the (SEDI) was also developed. The scope of the variation proportion of naming errors was also greater in the was estimated through the weighted variation dual-task than in the single-task, especially under high coefficient, the Gini coefficient, the ratio between the attentional demand, but it did not significantly differ values for the quintiles at both extremes of the SEDI between the two age groups tested. distribution, and the ratio of the lowest SEDI quintile to the group of municipalities having a SEDI greater Gauvin S, Le Moullec Y, Bremont F et al. Relationships than 0.90 (optimal empirical reference value). The between nitrogen dioxide personal exposure and socioeconomic pattern of variations was examined ambient air monitoring measurements among children through concentration curves and by comparing in three French metropolitan areas: VESTA study. communal quintiles based on their SEDI. RESULTS: Arch Environ Health 2001; 56(4):336-41. The various avoidable-mortality indicators used Abstract: In epidemiological studies, investigators have showed an inverse and statistically significant routinely used ambient air concentrations, measured by correlation with socioeconomic development, as well air-quality monitoring networks, to assess exposure of as with the profile of the various SEDI quintiles and subjects. When there is great spatial variability of with the majority of specific causes of avoidable ambient air concentrations or when there are specific mortality. The distribution profile of AM indicators indoor exposures, this approach may yield substantial among SEDI communal quintiles reflects the same exposure misclassification and distort the associations tendency, along with most of the mortality from between exposure and the health endpoints of interest. 513
- 522. In 3 Frenchmetropolitan areas, the cross-sectional Coventry N. Outcome evaluation of a statewide child relationships between 48 hr of nitrogen dioxide inpatient mental health unit. Aust N Z J Psychiatry personal exposure of 73 children and the corresponding 2003; 37(2):204-11. 48-hr background ambient air concentrations were Abstract: OBJECTIVE: To assess the impact of analyzed. The crude correlation between ambient air inpatient intervention, provided by a child mental concentrations and personal exposures was poor in all health unit in Victoria, Australia, on a number of key cities (r2 = .009 for Grenoble, r2 = .04 for Toulouse, child and family variables. METHOD: Pre-post test and r2 = .02 for Paris). These correlations were design with a four-month follow up was applied to improved when the authors took into account other assess changes across time. Twenty-nine parents, 42 ambient air or indoor air sources of nitrogen dioxide teachers, and 37 referrers provided reports on a series emissions (the corresponding multiple linear of child, parent, and family functioning measures. regression, r2, increased to .43 in Grenoble, .50 in RESULTS: Significant improvements in child Toulouse, and .37 in Paris). The main variables that behaviour and functioning, parenting competency and explained personal exposures were an index of traffic efficacy, parenting practices, and reduced parental intensity and proximity and use of a gas cooker at depression were observed over time. Changes in family home. The results of this study confirm that ambient functioning scores were not significant; however, air-monitoring site measurements are poor predictors univariate analysis indicated improvements in two of personal exposure. Investigators should carefully individual subscales. CONCLUSIONS: There is a lack characterize the proximity of roads occupied by dense of studies of the outcome of inpatient interventions of traffic to the home/school as well as indoor sources of children in psychiatric settings. However, as shown in nitric oxide emissions; both of these careful the present study, improvements in functioning can be characterizations will assist researchers in the detected and obtained with short-term interventions prediction of personal exposure in epidemiological that focus on both children and families. studies. Methodological shortcomings (i.e. absence of comparison groups) and lack of specificity in Gauvin S, Reungoat P, Cassadou S et al. Contribution of intervention variables, however, are difficulties yet to indoor and outdoor environments to PM2.5 personal be overcome in evaluation research of inpatient exposure of children--VESTA study. Sci Total Environ treatment. 2002; 297(1-3):175-81. Abstract: Several studies among adult populations Gay KD. The Circle of Parents program: increasing social showed that an array of outdoor and indoor sources of support for parents and caregivers. N C Med J 2005; particles emissions contributed to personal exposures 66(5):386-8. to atmospheric particles, with tobacco smoke playing a prominent role (J. Expo. Anal. Environ. Epidemiol. 6 Geddes JF, Plunkett J. The evidence base for shaken baby (1996) 57, Environ. Int. 24 (1998) 405, Arch. Environ. syndrome. BMJ 2004; 328(7442):719-20. Health 54 (1999) 95). The Vesta study was carried out to assess the role of exposure to traffic emissions in the Geddes JF, Tasker RC, Hackshaw AK et al. Dural development of childhood asthma. In this paper, we haemorrhage in non-traumatic infant deaths: does it present data on 68 children aged 8-14 years, living in explain the bleeding in 'shaken baby syndrome'? the metropolitan areas of Paris (n = 30), Grenoble (n = Neuropathol Appl Neurobiol 2003; 29(1):14-22. 15) and Toulouse (n = 23), France, who continuously Abstract: A histological review of dura mater taken carried, over 48 h, a rucksack that contained an active from a post-mortem series of 50 paediatric cases aged PM2.5 sampler. Data about home indoor sources were up to 5 months revealed fresh bleeding in the dura in collected by questionnaires. In parallel, daily 36/50, the bleeding ranging from small perivascular concentrations of PM10 in ambient air were monitored haemorrhages to extensive haemorrhage which had by local air quality networks. The contribution of ruptured onto the surface of the dura. Severe hypoxia indoor and outdoor factors to personal exposures was had been documented clinically in 27 of the 36 cases assessed using multiple linear regression models. (75%). In a similar review of three infants presenting Average personal exposure across all children was 23.7 with classical 'shaken baby syndrome', intradural microg/m3 (S.D. = 19.0 microg/m3), with local means haemorrhage was also found, in addition to subdural ranging from 18.2 to 29.4 microg/m3. The final model bleeding, and we believe that our findings may have explains 36% of the total between-subjects variance, relevance to the pathogenesis of some infantile with environmental tobacco smoke contributing for subdural haemorrhage. Recent work has shown that, in more than a third to this variability; presence of pets at a proportion of infants with fatal head injury, there is home, proximity of the home to urban traffic little traumatic brain damage and that the significant emissions, and concomitant PM10 ambient air finding is craniocervical injury, which causes concentrations were the other main determinants of respiratory abnormalities, severe global hypoxia and personal exposure. brain swelling, with raised intracranial pressure. We propose that, in such infants, a combination of severe Gavidia-Payne S, Littlefield L, Hallgren M, Jenkins P, 514
- 523. hypoxia, brain swellingand raised central venous cohorts. Heritability estimates were .49, .55 and .53 for pressure causes blood to leak from intracranial veins the aggressive domain, non-aggressive domain, and into the subdural space, and that the cause of the full-scales, respectively. These results are in contrast to subdural bleeding in some cases of infant head injury is previous research on antisocial behavior measured with therefore not traumatic rupture of bridging veins, but a the CBCL reporting higher heritability for aggressive phenomenon of immaturity. Hypoxia with brain versus non-aggressive domains. CONCLUSIONS: swelling would also account for retinal haemorrhages, Results suggest that individual symptoms of CD may and so provide a unified hypothesis for the clinical and be differentially heritable. Additionally, CD assessed neuropathological findings in cases of infant head using DSM-IV criteria may show differing patterns of injury, without impact or considerable force being heritability compared with estimates obtained for other necessary. measures of antisocial behavior such as the CBCL. Geist R, Grdisa V, Otley A. Psychosocial issues in the child Genuis SJ, Genuis SK. Implications of cyberspace with chronic conditions. Best Pract Res Clin communication: a role for physicians. South Med J Gastroenterol 2003; 17(2):141-52. 2005; 98(4):451-5; quiz 456-7, 477. Abstract: Psychosocial issues in children, adolescents Abstract: Through the presentation of three clinical and families who suffer with chronic illnesses require case reports and subsequent discussion, it is careful identification and treatment. Since more of demonstrated that physicians must begin to familiarize these young people survive into adulthood, their risk of themselves with the health-related implications of psychosocial distress and psychiatric illness is online communication, and must proactively address increased, although many adapt well. The literature is Internet use as it relates to health and well-being. vast, but limited in its usefulness: criteria for the Included case presentations highlight the following: the variables described, including chronicity and severity, established association between those seeking sexual are poorly defined; outcome measures are not partners through the Internet and an increased risk for standardized; and few randomized controlled clinical sexually transmitted disease; the implications of cyber- trials exist. This chapter focuses the attention of communication for young people and concerns related physicians on overt and covert signs of psychosocial to unsafe online behaviors including sharing distress in the patient and family with chronic illness. identifying information with strangers; the potential Common issues for all chronic diseases are discussed use of strategically constructed virtual identities to and a non-categorical approach is taken. The facilitate sexual exploitation; the impact of accelerated importance of the family as a focus of intervention is intimacy and disinhibition evident in online highlighted. The meaning and treatment of unexplained communication; and the invasive nature of Internet medical symptoms, non- adherence with treatment sexual harassment or bullying. Although it is recommendations, school refusal, sexuality and recognized that most online activities do not negatively substance use and abuse are discussed. affect health, doctors must be prepared to ask patients about Internet use and become involved in educating Gelhorn HL, Stallings MC, Young SE, Corley RP, Rhee SH, children, teenagers, and parents about safe online Hewitt JK. Genetic and environmental influences on relationships to promote optimal physical, mental, and conduct disorder: symptom, domain and full-scale social health. analyses. J Child Psychol Psychiatry 2005; 46(6):580- 91. George A, Ebrahim MK. Infant scald burns: a case of Abstract: BACKGROUND: We used variable negligence? Burns 2003; 29(1):95. threshold models which accounted for age and gender differences to investigate the genetic and Geraghty SR, Davidson BS, Warner BB et al. The environmental influences on DSM-IV conduct disorder development of a research human milk bank. J Hum (CD) at the level of symptoms, aggressive versus non- Lact 2005; 21(1):59-66. aggressive domains, and full-scale. METHOD: A Abstract: Although there are well-established clinical community sample of 1100 twin pairs (age 11-18) was human milk banks in the United States, there are no interviewed using the Diagnostic Interview Schedule milk banks specifically intended to foster research on for Children. RESULTS: Behavior genetic model human milk. The authors' goal was to establish a milk fitting suggested that genetic and environmental bank with a core data set to support exploratory and influences on individual symptoms varied by symptom. hypothesis-driven studies on human milk. Donations to The best-fitting models for aggressive and non- the Cincinnati Children's Research Human Milk Bank aggressive domains, and full-scale CD included are accepted within the context of ongoing, hypothesis- additive genetic effects and unique environmental driven research or on an ad hoc basis. Donors must effects only (AE models). These effects could be give informed consent, and scientists wishing to use the constrained across age cohorts and sex. The results samples must have Institutional review board approval suggest that using models that incorporate age- and for their use. Development of more research human gender-appropriate thresholds specific to each subject milk banks can potentially provide resources for we can account for prevalence differences between 515
- 524. multidisciplinary collaboration andadvance the study (200):8-9. of human milk and lactation. Getahun H. Marriage through abduction ('Telefa') in rural Gereda JE, Klinnert MD, Price MR, Leung DY, Liu AH. north west Ethiopia. Ethiop Med J 2001; 39(2):105-12. Metropolitan home living conditions associated with Abstract: A community based cross sectional study was indoor endotoxin levels. J Allergy Clin Immunol 2001; conducted in a rural district of North West Ethiopia 107(5):790-6. between February and April 1997 to determine the Abstract: BACKGROUND: Household endotoxin magnitude of marriage through abduction ('Telefa') and exposure in allergy and asthma has been gaining identify problems associated with it. Randomly attention for its dual potential to exacerbate these selected and currently married 1,168 women were conditions in individuals with established disease and interviewed. The prevalence of marriage through to abrogate atopy before disease onset. OBJECTIVE: abduction was 6.2% (72/1168). All the abductions We sought to better understand the home reported were only once in lifetime during the first environmental and lifestyle factors influencing house marriage. The median age at first marriage of abducted dust endotoxin levels. METHODS: From the homes of women was 13 years with a range of 13 (Minimum = 7 86 infants with wheeze in metropolitan Denver, and Maximum 20). About two third (66.7%) of Colorado, house dust endotoxin (detected with a abducted women had been married more than once in standardized Limulus Amebocyte Lysate assay) and their life time. Following a multivariate analysis in a common indoor allergen (Fel d 1, Can f 1, Der p 1, Der logistic regression model abducted women were likely f 1, and Bla g 1) contents were quantified. to be victims of abortion [Adjusted OR (95% CI) = Comprehensive home environment and lifestyle 1.71 (1.10-3.05)], marital instability [Adjusted OR questionnaires were completed during home visits by (95% CI) = 1.87 (1.10-3.18)], rape [Adjusted OR (95% trained study staff and parents. RESULTS: House dust CI) = 7.77 (3.78-15.95)] and domestic violence endotoxin levels were associated with only 2 home [Adjusted OR (95% CI) = 1.69 (1.11-2.81)]. The environmental features: animals in the home and the recognition of the magnitude and the associated health presence of central air conditioning. The strongest problems of marriage through abduction (Telefa) is positive associations were found with animals in the important. Appropriate strategies that address the home. Interestingly, the homes without cats or other health needs of abducted women must be designed. animals revealed a negative correlation between house Enforcing the judiciary system to discourage this dust Fel d 1 and endotoxin (P =.03). Central air harmful practice and empowerment of young girls and conditioning, especially during months of typical use, rural women is needed. was associated with lower house dust endotoxin levels. No significant associations between house dust Ghazvini A, Mullis RL. Center-based care for young endotoxin levels and home dampness, number of children: examining predictors of quality. J Genet household inhabitants or young children, cleaning Psychol 2002; 163(1):112-25. frequency, or presence of tobacco smokers in the home Abstract: The authors collected information from were found. CONCLUSIONS: Indoor endotoxin caregivers, trained observers, and parents to investigate exposure can be increased by the presence of animals quality elements in child-care programs designed for in the home and decreased with central air young children in center-based settings. Participants conditioning. In some homes without animals, where were 75 parents of children aged 15 to 36 months and allergen exposure adequate for sensitization still their caregivers from 13 child-care centers in a occurs, there are lower levels of house dust endotoxin. southeastern state. Observers collected indicators of Therefore in homes without animals, factors that program quality and process and structural quality influence allergen and endotoxin levels in house dust indicators, including adult-child ratio, group size, use probably differ. Households with detectable allergen of planned activities, use of child-designated space, levels but low endotoxin levels may provide a housekeeping activities, and caregiver-child predisposing environment for animal allergen interactions. Participants responded to questions sensitization. regarding their child-rearing beliefs, social support networks, perceived stress levels, and demographic Germain A. Reproductive health and human rights. Lancet characteristics. The best predictors of higher quality 2004; 363(9402):65-6. care and sensitive caregiver-child interaction in centers Notes: GENERAL NOTE: KIE: 17 refs. were specialized caregiver training, higher adult-child GENERAL NOTE: KIE: KIE Bib: reproduction ratios, use of planned activities, and less perceived stress by caregivers. Implications of these findings are Gerressu M, French RS. Using the Internet to promote discussed. sexual health awareness among young people. J Fam Plann Reprod Health Care 2005; 31(4):267, 269-70. Ghetti S, Alexander KW, Goodman GS. Legal involvement in child sexual abuse cases. Consequences and Gervaise S. [Seeds of violence]. Soins Pediatr Pueric 2001; interventions. Int J Law Psychiatry 2002; 25(3):235-51. 516
- 525. Ghosh AK, SinhaP. An economised craniofacial housing, financial, and health-related issues. A survey identification system. Forensic Sci Int 2001; 117(1- composed of demographic questions and the 10-item 2):109-19. social/health scale was administered to a stratified Abstract: It has been attempted to develop an random sample of inhabitants of the five towns. economised craniofacial identification system, as a RESULTS: the invasion caused extensive destruction, special automated version of photo/video food and cash shortages, internal displacement of superimposition technique, that can deal with common civilians, psychological distress, and serious cases of personal identification with the aid of a skull interruptions of basic services, including crucial health and a nearly front view face photograph of the services. Overall, Jenin experienced the most suspected victim.The proposed method is economic in deleterious effects. Using the subscales, Jenin respect of (i) cost of hardware configuration, (ii) experienced the highest overall housing damage, processing time as well as (iii) manual labour involved. Bethlehem the most financial difficulties, and Over and above, it has got a capability to take care of Ramallah the most health-related hardships. ambiguities due to soft tissue thickness during the CONCLUSIONS: civilians inevitably suffer during selection of facial features, which is a part of the conflict and war from destruction of the community procedure.In order to reconstruct a 2-D cranial image, infrastructure and from personal stress due to superimposable over the facial one, the new method disruption of services and the non-fulfilment of basic does not need any reconstruction of a digitised 3-D human needs. In contradistinction to standard damage cranial image. It works simply by a suitable segment- assessments that focus on collective physical damage, wise processing of a 2-D cranial image with the aid of this scale provides richer information on the needs of the symmetry perceiving adaptive neuronet (SPAN), civilians in conflict-torn areas, and can assist aid that has recently been introduced in connection with workers in the efficient deployment of resources. nearly front view facial image recognition. The final comparison of the facial and the superimposable Giancola PR, Parker AM. A six-year prospective study of cranial images is as versatile as the same for facial pathways toward drug use in adolescent boys with and image recognition by SPAN.A practical application of without a family history of a substance use disorder. J this extended version of SPAN has been demonstrated Stud Alcohol 2001; 62(2):166-78. in the present paper. Abstract: OBJECTIVE: The purpose of this study was to test a developmental model of drug use in male Ghuman SJ. Women's autonomy and child survival: a adolescents. The model postulates that low executive comparison of Muslims and non-Muslims in four Asian functioning and a difficult temperament are related to countries. Demography 2003; 40(3):419-36. aggression and affiliations with delinquent peers Abstract: In this article, I evaluate the hypothesis that which, in turn, are related to elevated drug use. higher infant and child mortality among Muslim METHOD: Boys (N = 187) with and without a family populations is related to the lower autonomy of Muslim history of a substance use disorder (SUD) were women using data from 15 pairs of Muslim and non- followed over a 6-year period. Executive functioning Muslim communities in India, Malaysia, the and temperament were measured at age 10-12, Philippines, and Thailand. Women's autonomy in aggression and affiliations with delinquent peers were various spheres is not consistently lower in Muslim assessed at age 12-14 and drug use was measured at than in non-Muslim settings. Both across and within age 16. RESULTS: Low executive functioning and a communities, the association between women's difficult temperament were related to increased autonomy and mortality is weak, and measures of aggression and affiliations with delinquent peers. These autonomy or socioeconomic status are generally of latter variables were related to increased drug use. limited import for understanding the Muslim Furthermore, the relation between difficult disadvantage in children's survival. temperament and drug use was fully mediated by aggression and affiliations with delinquent peers. Giacaman R, Husseini A, Gordon NH, Awartani F. Imprints CONCLUSIONS: Drug abuse prevention efforts may on the consciousness: the impact on Palestinian benefit from clinical interventions aimed at civilians of the Israeli Army invasion of West Bank strengthening executive functioning, regulating towns. Eur J Public Health 2004; 14(3):286-90. temperament and improving socialization strategies in Abstract: BACKGROUND: The dehumanizing aspects antisocial children. of conflict and war are increasingly recognized as serious health and human rights concerns. This paper Giarelli E, Souders M, Pinto-Martin J, Bloch J, Levy SE. examines the impact on civilians of the 29 March 2002 Intervention pilot for parents of children with autistic Israeli Army invasion and subsequent curfews lasting spectrum disorder. Pediatr Nurs 2005; 31(5):389-99. up to 45 consecutive days, of five West Bank towns. Abstract: Parents of children who receive the diagnosis METHODS: Using focus groups, a 10-item scale was of autistic spectrum disorder (ASD) experience a devised to measure the effects of the invasion's impact situational crisis related to receiving the diagnosis, on the social and health-related quality of life. The which causes feelings of distress and urgency to access scale is an aggregate of three constructs measuring services for the affected child. This paper describes a 517
- 526. randomized trial (n= 31) that was conducted at a Law 2003; 31(3):336-44. regional diagnostic center of a large metropolitan Abstract: To assess whether a robust typology of sex children's hospital to (a) refine a nursing intervention offenders could be established based on the patterns of designed for parents of children with ASD and (b) to denial displayed, a previously developed identify methodological revisions for a larger study. A semistructured interview method was used to assess secondary purpose was to test the effects of a post- denial in a mixed group of convicted rapists and child diagnosis nursing intervention on parents' reports of molesters. Cluster analysis was used to establish stress, impact of event (diagnosis), and use of services homogeneous groups of sex offenders based on the after a child is newly diagnosed with ASD. The pattern of denial in each case, with a three-cluster intervention consisted of usual care plus 3 hours solution emerging as the most appropriate, confirming contact with a pediatric nurse practitioner (PNP) for previous research. The denial groups were compared in counseling, instruction, and assistance with relation to objective offense characteristics to assess implementation of the recommended treatment plan. whether a consistent typology of offenders emerged. The control group received only the usual care post- Each of the four groups of offenders identified (three diagnosis, which consisted of a 1-hour consultation groups emerging from the cluster analysis and an session to receive the results of diagnostic tests and a "absolute denier" group) corresponded closely with the written copy of the recommended treatment plan previously identified typology. However, the authors provided by a developmental pediatrician and/or PNP. failed to replicate previously identified differences Between group differences in measures of "impact of between the denial groups in relation to independent event" and "perceived stress" were not statistically variables such as offense type. Each group contained significant. This was attributed to a small sample size. both rapists and child molesters and was found to differ A larger study is feasible and recommended with an quantitatively rather than qualitatively in the pattern of expanded nursing intervention and a significantly the denial expressed, with attributional style being the larger sample recruited from an additional recruitment most consistent form of denial present in all groups. site. Nurses working with this special population must The authors conclude that denial consists of at least recognize that parents have information and counseling two continuous dimensions, rather than being a needs that begin after they receive the diagnosis of dichotomous phenomenon. Differences in the patterns ASD for their child and can address these needs with a of denial displayed by rapists and child molesters were standardized nursing intervention. found to be primarily quantitative rather than qualitative. Gibb BE, Butler AC, Beck JS. Childhood abuse, depression, and anxiety in adult psychiatric outpatients. Depress Gibbs JL, Monro JL, Cunningham D, Rickards A. Survival Anxiety 2003; 17(4):226-8. after surgery or therapeutic catheterisation for congenital heart disease in children in the United Gibb BE, Wheeler R, Alloy LB, Abramson LY. Emotional, Kingdom: analysis of the central cardiac audit database physical, and sexual maltreatment in childhood versus for 2000-1. BMJ 2004; 328(7440):611. adolescence and personality dysfunction in young Notes: CORPORATE NAME: Society of adulthood. J Personal Disord 2001; 15(6):505-11. Cardiothoracic Surgeons of Great Britain and Northern Abstract: The current study examined the unique Ireland relations of childhood and adolescent maltreatment CORPORATE NAME: Paediatric Cardiac Association (emotional, physical, and sexual) with DSM-III-R CORPORATE NAME: Alder Hey Hospital personality disorder (PD) dimensions in a sample of Abstract: OBJECTIVES: To analyse simple national undergraduates. The results suggested that reported statistics and survival data collected in the central levels of childhood sexual maltreatment were uniquely cardiac audit database after treatment for congenital related to six of the 11 PD dimensions examined. In heart disease and to provide long term comparative contrast, reported levels of adolescent emotional statistics for each contributing centre. DESIGN: maltreatment were uniquely related to only three PD Prospective, longitudinal, observational, national dimensions and reported levels of adolescent physical cohort survival study. SETTING: UK central cardiac maltreatment were uniquely related to only one PD audit database. MAIN OUTCOME MEASURES: dimension. Thus, whereas reported levels of adolescent Survival at 30 days and one year after treatment in the emotional and physical maltreatment demonstrated year April 2000-March 2001, assessed by using both some specificity to the various kinds of personality volunteered life status and independently validated life dysfunction, reported levels of childhood sexual status through the Office for National Statistics, using maltreatment appeared to be related to more the patient's unique NHS number, or the general generalized personality dysfunction in young register offices of Scotland and Northern Ireland. adulthood. Institutional results following a group of six benchmark operations and three benchmark catheterisation Gibbons P, de Volder J, Casey P. Patterns of denial in sex procedures. RESULTS: Since April 2000 data have offenders: a replication study. J Am Acad Psychiatry been received from all 13 UK tertiary centres performing cardiac surgery or therapeutic cardiac 518
- 527. catheterisation in childrenwith congenital heart income, inner-city neighborhoods. PARTICIPANTS: disease. Altogether 3666 surgical procedures and 1828 First- and second-year pediatric residents and their therapeutic catheterisations were performed. Central patient-parent dyads. INTERVENTIONS: Parents in tracking of mortality identified 469 deaths, 194 the standard-intervention group received safety occurring within 30 days and 275 later. Forty two of counseling and referral to the children's safety center the 194 deaths within 30 days were detected by central from their pediatrician. Parents in the enhanced- tracking but not by volunteered data. For surgery intervention group received the standard services plus a overall, survival at 30 days was 94.9%, falling to home-safety visit by a community health worker. 91.2% at one year; this effect was most marked for OUTCOMES: Home observers assessed the following infants. For therapeutic catheterisation survival at 30 safety practices: reduction of hot-water temperature, days was 99.1%, falling to 98.1% at one year. Survival poison storage, and presence of smoke alarms, safety of individual centres or individual operators did not gates for stairs, and ipecac syrup. RESULTS: The differ from the national average after benchmark prevalence of safety practices ranged from 11% of procedures. CONCLUSIONS: Independent data parents who stored poisons safely to 82% who had a validation is essential for accurate survival analysis. working smoke alarm. No significant differences in One year survival gives a more realistic view of safety practices were found between study groups. outcome than traditional perioperative mortality. However, families who visited the children's safety Currently no detectable difference exists in survival center compared with those who did not had a between any of the 13 UK tertiary congenital heart significantly greater number of safety practices (34% disease centres, but confidence intervals for small vs 17% had > or 3). CONCLUSIONS: Home visiting centres are wide, limiting our power to detect was not effective in improving parents' safety practices. underperformance from analysis of a single year's data. Counseling coupled with convenient access to reduced- Appropriately resourced, focused national audit is cost products appears to be an effective strategy for capable of accurate data collection on which promoting children's home safety. nationwide, long term quality control can be based. Gigantesco A, Camuffo M, Mirabella F, Morosini P. Giedd JN. The anatomy of mentalization: a view from [Parental evaluation of child and adolescent mental developmental neuroimaging. Bull Menninger Clin health services: a multicentric study]. Ann Ist Super 2003; 67(2):132-42. Sanita 2005; 41(4):501-13. Abstract: The capacity for mentalization emerges from Abstract: A self-completed questionnaire for routinely developmental changes in the physical structure of the assessing parents' opinions on the quality of care in brain. Although pediatric imaging studies have not child and adolescent mental health services was directly addressed the process of mentalizing, general developed. A reliability study was performed, and the principles of brain development may shed light on the questionnaire was then introduced in the practice of 5 neurobiology of mentalization. Increases in white services. Parents' opinions were evaluated, and specific matter, which speeds communication between brain aspects of services more associated with the overall cells, growing complexity of neuronal networks opinion were investigated. Very good results were suggested by gray matter changes, and environmentally observed in the reliability study. Parents had critical sensitive plasticity are all essential aspects in a child's opinions about the availability of the rehabilitative ability to mentalize and maintain the adaptive equipment, emergency management, and linkage flexibility necessary for healthy transition into among different types of services. The judgement adulthood. about health outcomes was the most important predictor of the overall opinion on the quality of Gielen AC, McDonald EM, Wilson ME et al. Effects of services. Because of its user-friendliness, the improved access to safety counseling, products, and questionnaire may be particularly suitable for routine home visits on parents' safety practices: results of a use. randomized trial. Arch Pediatr Adolesc Med 2002; 156(1):33-40. Gilgoff D. A settlement in Boston. US News World Rep Abstract: OBJECTIVE: To present the results of an 2003; 135(9):28. intervention trial to enhance parents' home-safety practices through pediatric safety counseling, home Gill D. Ethical principles and operational guidelines for visits, and an on-site children's safety center where good clinical practice in paediatric research. parents receive personalized education and can Recommendations of the Ethics Working Group of the purchase reduced-cost products. DESIGN: Confederation of European Specialists in Paediatrics Pediatricians were randomized to a standard- or an (CESP). Eur J Pediatr 2004; 163(2):53-7. enhanced-intervention group. Parents of their patients Notes: CORPORATE NAME: Ethics Working Group were enrolled when the patient was 6 months or of the Confederation of European Specialists in younger and observed until 12 to 18 months of age. Paediatrics SETTING: A hospital-based pediatric resident Abstract: A child has the full right of protection of continuity clinic that serves families living in low- 519
- 528. his/her life byprovision of optional medical care. Girolami A, Luzzatto G, Varvarikis C, Pellati D, Sartori R, There is a need in paediatrics for better evidence based Girolami B. Main clinical manifestations of a bleeding practice founded on quality research into efficacy and diathesis: an often disregarded aspect of medical and safety of children's medications. To protect the best surgical history taking. Haemophilia 2005; 11(3):193- interests of the child one must balance the ethical 202. demand to do clinical studies with the necessity to Abstract: A suitable clinical evaluation of a bleeding avoid doing harm. To achieve this end good clinical diathesis is often forgone. The young doctor is often practice in paediatric research demands that studies unprepared to describe in an accurate way the different comply with the Declaration of Helsinki, ICH topic types of bleeding. An adequate classification and E11, EU Directives and other relevant international adequate clinical information about a bleeding guidelines. Evident differences in physiology, diathesis are instead of paramount importance. pharmacology, pharmacokinetics and Bleeding may be cutaneous, mucous, articular, pharmacodynamics between children of differing ages muscular, parenchymal, intracavitary, orificial. Each of and between children and adults demand properly these sites and forms may have diagnostic implications. constructed and conducted studies that respect the An accurate description of the several forms of special somatic, emotional and mental needs of cutaneous bleeding (petechiae, purpuric spots, children. To justify any research project one must ecchymosis, haematomas, etc.) is needed for referrals balance the benefit/risk ratio, provide experienced, and for controls. The correct evaluation of cutaneous competent personnel and infracture, obtain adequate bleeding manifestations of children (battered child informed consent/assent, and have the study evaluated syndrome) is absolutely important for clinical and and approved by an ethics committee containing medico-legal purposes. The same is true for the expertise on the rights and needs of children. battering syndrome seen in women abused by their spouses. The grading of haemarthrosis in haemophilia Gilman SE, Kawachi I, Fitzmaurice GM, Buka SL. Family patients is important for the follow-up. A proper disruption in childhood and risk of adult depression. description of haematuria is essential in suggesting the Am J Psychiatry 2003; 160(5):939-46. probable site of bleeding (kidney or bladder or urethra). Abstract: OBJECTIVE: The authors examined the risk A proper evaluation of bleeding may give also useful that family disruption and low socioeconomic status in information on the general health status of the patients early childhood confer on the onset of major (presence of anaemia, poor nutrition, renal depression in adulthood. METHOD: Participants were insufficiency, etc.). The combination of bleeding and 1,104 offspring of mothers enrolled during pregnancy thrombosis in the same patient is also a clinical in the Providence, R.I., site of the National challenge. The relationship between haemorrhage and Collaborative Perinatal Project. Measures of childhood thrombosis may be sequential or concomitant. family disruption and socioeconomic status were Sequential thrombosis may occur in a patient confined obtained before birth and at age 7. Structured in bed for a brain haemorrhage. Concomitant diagnostic interviews were used to assess respondents' thrombosis and bleeding occur in DIC and in patients lifetime history of major depressive episode between with thrombosis being treated with anticoagulants. the ages of 18 and 39. Survival analysis was used to Finally, it should be kept in mind that a proper identify childhood risks for depression onset. evaluation of the bleeding diathesis of a given patient RESULTS: Parental divorce in early childhood was may help the caring doctor in ordering appropriate associated with a higher lifetime risk of depression laboratory tests (e.g. a platelet count for petechiae, a among subjects whose mothers did not remarry as well PTT for a patient with haemarthrosis, etc.). as among subjects whose mothers remarried. These effects were more pronounced when accompanied by Gismondi RC, Almeida RM, Infantosi AF. Artificial neural high levels of parental conflict. Independent of the networks for infant mortality modelling. Comput respondents' adult socioeconomic status, low Methods Programs Biomed 2002; 69(3):237-47. socioeconomic status in childhood predicted an Abstract: This work aims to investigate a simple to use elevated risk of depression. CONCLUSIONS: Family and easy to interpret methodology for assessing the disruption and low socioeconomic status in early relative importance of input variables in artificial childhood increase the long-term risk for major neural networks (ANNs) applied to epidemiological depression. Reducing childhood disadvantages may be modelling. The independent variables were 43 one avenue for prevention of depression. Identification variables of the social, economic, environmental and of modifiable pathways linking aspects of the early health sector of 59 Brazilian municipalities, and the childhood environment to adult mental health is needed outcomes were infant mortality rates from these to mitigate the long-term consequences of childhood municipalities. Two assays were developed for the disadvantage. ANN modelling. On the first, all 43 variables were taken as input; and on the second, input variables were Girardin BW, Steveson S. Millipedes--health consequences. chosen with the help of factor analysis (FA). The J Emerg Nurs 2002; 28(2):107-10. relative importance of the input variables was investigated by means of bootstrap replications of the 520
- 529. ANN model onthe second assay. Further, multiple depression improves with antidepressant drug therapy, linear regression models (LRMs) were developed with estrogen, individual psychotherapy, nurse home visits, the same data set and compared to the ANN models. and possibly group therapy. Of the more frequently The FA analysis allowed the selection of eight studied antidepressant drugs in breastfeeding women, variables for the second assay. The percent of paroxetine, sertraline, and nortriptyline have not been explained variance R(2) on the ANNs was in the range found to have adverse effects on infants. Fluoxetine, 0.74-0.80, while linear models had R(2)=0.4-0.5. These however, should be avoided in breastfeeding women. findings were validated by the bootstrap replications, in By administering effective treatment to women with which the ANN models remained with higher R(2) and postpartum depression, we can positively impact the lower mean square error than the LRMs. The analysis lives of mothers, their infants, and other family of the best (second) ANN model indicated the highest members. ranking of importance for the variables literacy, agricultural and livestock sector jobs, number of Gladsjo JA, Breding J, Sine D et al. Termination of life commercial establishments and telephones. The support after severe child abuse: the role of a guardian approach presented here successfully integrated a data- ad litem. Pediatrics 2004; 113(2):e141-5. oriented model with expert knowledge, indicating the Abstract: Discontinuation of life-sustaining potentiality of ANN modelling in the prediction, interventions often raises ethical concerns. In cases of planning and assessment of public health actions. severe child abuse with poor prognosis for recovery, accused parents may have a conflict of interest Gjelsvik A, Verhoek-Oftedahl W, Pearlman DN. Domestic regarding medical decision-making for their child, violence incidents with children witnesses: findings because the outcome of such decisions may impact from Rhode Island surveillance data. Womens Health legal charges filed against them. The recently issued Issues 2003; 13(2):68-73. American Academy of Pediatrics guidelines for Abstract: In this study we analyze factors associated addressing such cases recommended the appointment with children witnessing police-reported domestic of a guardian ad litem for medical decision-making. violence (DV) and determine the age distribution of We present the case of an 8-month-old infant who was children witnessing. Rhode Island Department of abused severely by her father, resulting in a persistent Health surveillance data (1996-1998) from police vegetative state. We describe our experience with forms were used to assess demographic characteristics appointing a guardian ad litem and the ethical issues of victims, characteristics of incidents, whether involved. children were present, and children's ages. Victim gender, age, race/ethnicity, relationship to suspect, and Glancy GD, Spiers EM, Pitt SE, Dvoskin JA. Commentary: whether the victim was assaulted were all strong Models and correlates of firesetting behavior. J Am predictors of children witnessing a DV incident. Acad Psychiatry Law 2003; 31(1):53-7. Almost half (48%) of the children who witnessed DV incidents were less than 6 years old. To reach these Glantz JC. Clearing up meconium: clinical management and young children, prevention and intervention programs research ethics. Birth 2002; 29(2):137-40. will need to target parents and caretakers of young Notes: GENERAL NOTE: KIE: 19 refs. children and/or pediatricians. GENERAL NOTE: KIE: KIE Bib: human experimentation/minors; human Gjerdingen D. The effectiveness of various postpartum experimentation/research design depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract 2003; Glantz MD. Introduction to the special issue on the impact 16(5):372-82. of childhood psychopathology interventions on Abstract: BACKGROUND: Postpartum depression is subsequent substance abuse: pieces of the puzzle. J seen in approximately 13% of women who have Consult Clin Psychol 2002; 70(6):1203-6. recently given birth; unfortunately, it often remains Abstract: Studies of adolescents and adults have untreated. Important causes for undertreatment of this reported high levels of co-occurrence of substance disorder are providers' and patients' lack of information abuse with other psychiatric disorders, suggesting about the effectiveness of various treatments, and their influence between the conditions. The comorbidity concerns about the impact of treatment on nursing seems complex and variable, indicating that there may infants. This article presents research-based evidence be more than I type of association between the on the benefits of various treatments for postpartum comorbid disorders. When occurring in childhood. depression and their potential risks to nursing infants. some of the frequently comorbid psychopathologies METHODS: The medical literature on postpartum typically precede later drug and alcohol abuse and may depression treatment was reviewed by searching have implications for substance abuse prevention as MEDLINE and Current Contents using such key terms early risk indicators and as targets for intervention. as "postpartum depression," "treatment," "therapy," Research discussed in this article and in this special "psychotherapy," and "breastfeeding." Results and issue provides a foundation for investigating the CONCLUSIONS: There is evidence that postpartum 521
- 530. question of whethereffective treatment of childhood the extent and quality of effectiveness studies utilising psychopathologies can prevent or at least mitigate psychological interventions for CF and whether these substance abuse for some adolescents. Clinical, interventions provide significant psychosocial and research, and policy implications are discussed. physical benefits in addition to standard care. SEARCH STRATEGY: Relevant trials were identified Glasper EA. Will they listen? Paediatr Nurs 2003; 15(2):3. from searches of Ovid MEDLINE, the Cochrane trial registers for CF and Depression, Anxiety and Neurosis Glass JO, Ji Q, Glas LS, Reddick WE. Prediction of total Groups and PsychINFO; unpublished trials were cerebral tissue volumes in normal appearing brain from located through professional networks and sub-sampled segmentation volumes. Magn Reson Listserves.Most recent search: April 2003. Imaging 2003; 21(9):977-82. SELECTION CRITERIA: This review included RCTs Abstract: The need for anatomical coverage and multi- and quasi-randomised trials. Study participants were spectral information must be balanced against children and adults diagnosed with CF, and their examination and processing time to ensure high- immediate family members. Psychological quality, feasible imaging protocols for clinical research interventions were from a broad range of modalities of cerebral development in normal-appearing brains. and outcomes were primarily psychosocial, although The focus of this study was to create and assess models physical outcomes and cost effectiveness were also to estimate total cerebral volumes of gray matter, white considered. DATA COLLECTION AND ANALYSIS: matter, and cerebrospinal fluid (CSF) from Two reviewers independently selected relevant trials anatomically defined sub-samples of full clinical and assessed their methodological quality. For binary examinations. Pediatric patients (18F, 11M; aged 1.7 to and continuous outcomes a pooled estimate of 18.7, median 5.2 years) underwent a clinical imaging treatment effect was calculated for each outcome. protocol consisting of 3 mm contiguous T1-, T2-, PD-, MAIN RESULTS: This review is based on the findings and FLAIR-weighted images after obtaining informed of eight studies, representing data from a total of 358 consent. Magnetic resonance imaging (MRI) sets were participants. Studies fell into four conceptually similar registered, RF-corrected, and then analyzed with a groups: (1) gene pre-test education counselling for hybrid neural network segmentation and classification relatives of those with CF (one study); (2) biofeedback, algorithm to identify normal brain parenchyma. The massage and music therapy to assist physiotherapy correlation between the image subsets and the total (three studies); (3) behavioural intervention to improve cerebral volumes of gray matter, white matter and CSF dietary intake in children up to 12 years (three studies); were examined through linear regression analyses. Five and (4) self-administration of treatments to improve sub-sampled sets were defined and assessed in each quality of life in adults (one study). Interventions were patient to produce estimation models which were all largely educational or behavioural, targeted at specific significantly correlated (p < 0.001) with the total treatment concerns during the chronic phase. No cerebral volumes of gray matter, white matter, and completed studies concentrating on complex treatment CSF. Volumes were estimated from as little as a single approaches were found. There is some evidence that representative slice requiring minimal processing time, behavioural interventions can improve emotional 27 min, but with an average estimation error of outcomes in people with CF and their carers. There approximately 6%. Larger sub-samples of was no consistent effect on lung function although one approximately three-quarters of the full cerebral small study showed that biofeedback assisted breathing volume required much more processing time, 2 h and 4 re-training was associated with improvement in some min, but produced estimates with an average error less measures of spirometric lung function. Insufficient than 2%. This study demonstrated that investigators evidence is available at this point for interventions can choose the amount of cerebrum sampled to aimed at other aspects of the disease process. optimize the acquisition and processing time against REVIEWER'S CONCLUSIONS: Multicentre the degree of accuracy needed in the total cerebral approaches are required to increase the sample sizes of volume estimates. studies in the psychosocial field and to enhance the power and precision of the findings. This has Glasscoe CA, Quittner AL. Psychological interventions for consequent implications for funding. cystic fibrosis. Cochrane Database Syst Rev 2003; (3):CD003148. Gleason TR. Social provisions of real and imaginary Abstract: BACKGROUND: As survival estimates for relationships in early childhood. Dev Psychol 2002; cystic fibrosis (CF) steadily increase long-term 38(6):979-92. management has become an important focus for Abstract: Preschool-aged children's perceptions of their intervention. Psychological interventions are largely social relationships were examined, including those concerned with emotional and social adjustments, with parents, best friends, siblings, and imaginary adherence to treatment and quality of life, however no companions. Sixty 4-year-old children participated in systematic review of such interventions has been an interview designed to measure perceptions of the undertaken for this disease. OBJECTIVES: To describe degree of conflict, nurturance, instrumental help, and power available in their relationships. Three groups 522
- 531. were compared: childrenwith (a) invisible friends, (b) Glick S. [Child abuse--undiagnosed]. Harefuah 2002; companions who were personified objects (e.g., dolls), 141(10):879-82, 931, 930. and (c) no imaginary companion. Results indicated that Abstract: We present the case of a 2 1/2 year old child children differentiated the relationships in their social brought to the emergency room by his mother, a nurse networks according to provisions. Parent-child at that hospital, and her companion, because of a relationships afforded instrumental help and siblings fractured clavicle. Over the next 14 days the child was were associated with conflict. Provisions of real and seen by a variety of physicians in different sites (3 imaginary friendships were similar, although imaginary different emergency rooms, pediatricians' offices, friends were preferred as objects of nurturance. Results orthopedic clinics) for various injuries. Each individual imply that 4-year-old children have developed injury was treated separately, and the diagnosis of a differentiated relationship schemas and that those of battered child syndrome was not entertained. The child children with invisible friends may be particularly was not undressed completely and numerous clues to distinct. the diagnosis went undetected. A greater sensitivity to the diagnosis of child abuse is essential. More careful Glew GM, Fan MY, Katon W, Rivara FP, Kernic MA. history-taking, more thorough physical examination Bullying, psychosocial adjustment, and academic and better interinstitutional communication are performance in elementary school. Arch Pediatr essential if child abuse is to be detected in its earliest Adolesc Med 2005; 159(11):1026-31. phases. Abstract: BACKGROUND: Over the past decade, concerns about bullying and its role in school violence, Glowinski AL, Bucholz KK, Nelson EC et al. Suicide depression, and health concerns have grown. However, attempts in an adolescent female twin sample. J Am no large studies in the United States have examined the Acad Child Adolesc Psychiatry 2001; 40(11):1300-7. prevalence of bullying during elementary school or its Abstract: OBJECTIVE: To examine suicide attempts in association with objective measures of school an epidemiologically and genetically informative youth attendance and achievement. OBJECTIVE: To sample. METHOD: 3,416 Missouri female adolescent determine the prevalence of bullying during elementary twins (85% participation rate) were interviewed from school and its association with school attendance, 1995 to 2000 with a telephone version of the Child academic achievement, disciplinary actions, and self- Semi-Structured Assessment for the Genetics of reported feelings of sadness, safety, and belonging. Alcoholism, which includes a detailed suicidal DESIGN: Cross-sectional study using 2001-2002 behavior section. Mean age was 15.5 years at school data. SETTING: Urban, West Coast public assessment. RESULTS: At least one suicide attempt school district. PARTICIPANTS: Three thousand five was reported by 4.2% of the subjects. First suicide hundred thirty (91.4%) third, fourth, and fifth grade attempts were all made before age 18 (and at a mean students. MAIN OUTCOME MEASURE: Self- age of 13.6). Major depressive disorder, alcohol reported involvement in bullying. RESULTS: Twenty- dependence, childhood physical abuse, social phobia, two percent of children surveyed were involved in conduct disorder, and African-American ethnicity were bullying either as a victim, bully, or both. Victims and the factors most associated with a suicide attempt bully-victims were more likely to have low history. Suicide attempt liability was familial, with achievement than bystanders (odds ratios [ORs], 0.8 genetic and shared environmental influences together [95% confidence interval (CI), 0.7-0.9] and 0.8 [95% accounting for 35% to 75% of the variance in risk. The CI, 0.6-1.0], respectively). All 3 bullying-involved twin/cotwin suicide attempt odds ratio was 5.6 (95% groups were significantly more likely than bystanders confidence interval [CI] 1.75-17.8) for monozygotic to feel unsafe at school (victims, OR, 2.1 [95% CI, 1.1- twins and 4.0 (95% CI 1.1 -14.7) for dizygotic twins 4.2]; bullies, OR, 2.5 [95% CI, 1.5-4.1]; bully-victims, after controlling for other psychiatric risk factors. OR, 5.0 [95% CI, 1.9-13.6]). Victims and bully-victims CONCLUSIONS: In women, the predisposition to were more likely to report feeling that they don't attempt suicide seems usually to manifest itself first belong at school (ORs, 4.1 [95% CI, 2.6-6.5] and 3.1 during adolescence. The data show that youth suicide [95% CI, 1.3-7.2], respectively). Bullies and victims attempts are familial and possibly influenced by were more likely than bystanders to feel sad most days genetic factors, even when controlling for other (ORs 1.5 [95% CI, 1.2-1.9] and 1.8 [95% CI, 1.2-2.8], psychopathology. respectively). Bullies and bully-victims were more likely to be male (ORs, 1.5 [95% CI, 1.2-1.9] and 3.0 Glowinski AL, Jacob T, Bucholz KK, Scherrer JF, True W, [95% CI, 1.3-7.0], respectively). CONCLUSIONS: Heath AC. Paternal alcohol dependence and offspring The prevalence of frequent bullying among elementary suicidal behaviors in a children-of-twins study. Drug school children is substantial. Associations between Alcohol Depend 2004; 76 Suppl:S69-77. bullying involvement and school problems indicate this Abstract: INTRODUCTION: In substance abusing is a serious issue for elementary schools. The research families, sources of familial comorbidity are potentially presented herein demonstrates the need for evidence- confounded by genetic-environmental (GE) interplays. based antibullying curricula in the elementary grades. The children-of-twins (COT) design can be used to elucidate the association of a parental trait and an 523
- 532. offspring outcome suchas the association of parental treatment for cannabis abuse or dependence. Psychol alcoholism and offspring suicidality. METHODS: We Addict Behav 2005; 19(1):62-70. examined the association of paternal alcoholism and Abstract: Because alcohol or other drug use following offspring suicidal behaviors in an adolescent and young adolescent substance abuse treatment is common, adult COT sample of 'Vietnam Era Twins' offspring understanding mediators of posttreatment outcome who had completed an interview including a could help improve treatment interventions. The comprehensive assessment of lifetime suicidal authors conducted path analyses based on data from behaviors. We stratified the COT sample into four 552 adolescents (aged 12-18; 82% male) with cannabis groups contingent upon paternal zygosity, MZ versus abuse or dependence who participated in outpatient DZ, and lifetime paternal alcohol dependence history treatment. The analysis used the Family Conflict and (AD), positive versus negative. We examined whether Cohesion subscales, from the Family Environment the relationship of paternal alcoholism and offspring Scale, and several scales and indices from the Global suicidality was best explained by genetic Appraisal of Individual Needs. Family conflict, family predispositions common to alcoholism and suicidality cohesion, and social support indirectly predicted or by GE interplay--environmental influences substance use and substance-related problems as correlated with parental alcoholism or the interaction of mediated by recovery environment and social risk. This genetic and environmental factors. RESULTS: Our model replicated across 4 follow-up waves (3, 6, 9, and results suggest a main effect of paternal alcoholism on 12 months postintake). These results support the idea offspring suicide attempt; COT analyses do not support of targeting environmental factors during continuing a purely genetic explanation for this association. care as a way to improve treatment outcomes for DISCUSSION: Suicide attempts probably result from adolescents with cannabis disorders. GE interplays and must be studied in genetically informative samples of offspring of substance abusing Godsall RE, Jurkovic GJ, Emshoff J, Anderson L, Stanwyck parents. D. Why some kids do well in bad situations: relation of parental alcohol misuse and parentification to Go M, Kojima T, Takano K et al. Expression and function children's self-concept. Subst Use Misuse 2004; of tight junctions in the crypt epithelium of human 39(5):789-809. palatine tonsils. J Histochem Cytochem 2004; Abstract: Between 1991 and 1994 a sample of high- 52(12):1627-38. and low-functioning 10-18-year-old children of alcohol Abstract: The human palatine tonsils have surface and misusing and nonalcohol misusing parents were crypt stratified epithelium and may be initiated via the assessed on degree of problematic parental role epithelium to mount immune responses to various functioning (parentification) and global self-concept. presenting antigens. Here we investigated the The high functioning children had been chosen by their expression and function of tight junctions in the teachers to receive training as peer counselors, whereas epithelium of human palatine tonsils from patients with the low functioning children were in either psychiatric tonsillar hypertrophy or recurrent tonsillitis. Occludin, facilities or the custody of family and children services. ZO-1, JAM-1, and claudin-1, -3, -4, -7, -8, and -14 The parentification scores of the latter significantly mRNAs were detected in tonsillar hypertrophy. exceeded those of the former. Children of alcoholic Occludin and claudin-14 were expressed in the parents also scored higher on the parentification uppermost layer of the tonsil surface epithelium, measure than did those with nonalcoholic parents. whereas ZO-1, JAM-1, and claudin-1, -4, and -7 were Within the high functioning group hierarchical found throughout the epithelium. In the crypt regression analysis revealed that while parental alcohol epithelium, claudin-4 was preferentially expressed in misuse status accounted for a small but significant the upper layers. In freeze-fracture replicas, short amount of the variance in self-concept, the effect of fragments of continuous tight junction strands were this variable was substantially reduced after entering observed but never formed networks. In the crypt level of parentification into the equation. By contrast, epithelium of recurrent tonsillitis, the tracer was leaked within the low functioning group parental alcohol from the surface regions where occludin and claudin-4 misuse status was not significantly related to self- disappeared. Occludin, ZO-1, JAM-1, and claudin-1, - concept whereas level of parentification was. The 3, -4, and -14, but not claudin-7, mRNAs were results are discussed within a family systems decreased in recurrent tonsillitis compared with those framework. of tonsillar hypertrophy. These studies suggest unique expression of tight junctions in human palatine tonsillar Gogou G, Maglaveras N, Ambrosiadou BV, Goulis D, epithelium, and the crypt epithelium may possess an Pappas C. A neural network approach in diabetes epithelial barrier different from that of the surface management by insulin administration. J Med Syst epithelium. 2001; 25(2):119-31. Abstract: Diabetes management by insulin Godley MD, Kahn JH, Dennis ML, Godley SH, Funk RR. administration is based on medical experts' experience, The stability and impact of environmental factors on intuition, and expertise. As there is very little substance use and problems after adolescent outpatient information in medical literature concerning practical 524
- 533. aspects of thisissue, medical experts adopt their own on youth victimization, crime and delinquency in rules for insulin regimen specification and dose Alberta conducted by the Canadian Research Institute adjustment. This paper investigates the application of a for Law and the Family in collaboration with neural network approach for the development of a researchers from the University of Alberta. The survey prototype system for knowledge classification in this included 2,001 youth attending Grades 7 to 12 in domain. The system will further facilitate decision public and Catholic schools in selected urban and rural making for diabetic patient management by insulin areas in the province. Analyses focus on self-reported administration. In particular, a generating algorithm for past-year delinquency. Statistically significant results learning arbitrary classification is employed. The were found for relationships between extent of factors participating in the decision making were delinquency and gender, grade level, psychosocial among other diabetes type, patient age, current problems (as measured by conduct, hyperactivity, and treatment, glucose profile, physical activity, food emotional problems), and extent of past-year intake, and desirable blood glucose control. The victimization. For low/moderate delinquency, females resulting system was trained with 100 cases and tested were comparable to males, and even reported slightly on 100 patient cases. The system proved to be higher rates for low/moderate violence-related applicable to this particular problem, classifying delinquency. Younger students were more likely to correctly 92% of the testing cases. indicate engaging in violence-related delinquency, while older students were more likely to report Gold J, Bugg G. Alberta law confining child prostitutes property-related delinquent acts. Overall, Grade 9 upheld. Can HIV AIDS Policy Law Rev 2001; 6(1- students had the highest rates of delinquency. For 2):34-5. personal characteristics, a high score on conduct Abstract: The Alberta Court of Queen's Bench has problems was most strongly correlated with determined that the Alberta Protection of Children moderate/high delinquency. The relationship between Involved in Prostitution Act is not in violation of the high levels of delinquency and victimization was Constitution. This decision overturns the ruling of the stronger for violence-related delinquency than for Provincial Court, which held that the Act infringes the property-related delinquency. rights articulated in sections 7, 8, and 9 of the Charter. Gomez-Dantes O, Gomez-Jauregui J, Inclan C. [Equity and Golombok S, MacCallum F, Goodman E, Rutter M. fairness in the Mexican health system reform]. Salud Families with children conceived by donor Publica Mex 2004; 46(5):399-416. insemination: a follow-up at age twelve. Child Dev Abstract: OBJECTIVE: To assess the equity and 2002; 73(3):952-68. fairness of the Mexican health system reform that Abstract: Growing public awareness of the use of occurred in the late 1990's. MATERIAL AND donor insemination (DI) to enable infertile couples to METHODS: The Mexican reform process was become parents has been accompanied by increasing evaluated using the benchmark-system designed by concern regarding the potentially negative Daniels et al. This benchmark system was adapted to consequences for family relationships and child the Mexican setting by adding specific indicators. A development. Findings are presented from a documentary review of the Mexican reform process prospective study of the quality of parenting and was conducted to score its performance for each psychological adjustment of DI children at age 12. benchmark. RESULTS: Except for housing and Thirty-seven DI families, 49 adoptive families, and 91 nutrition components, the reform included few actions families with a naturally conceived child were related to health determinants. For health care, the compared on standardized interview and questionnaire main reform initiatives were those related to extending measures administered to mothers, fathers, children, the coverage of essential health services and and teachers. The differences between DI families and decentralizing health care provision to the states. the other family types reflected greater expressive Reform initiatives included few activities related to fair warmth of DI mothers toward their children and less financing, tiering, emphasis on second and third level involvement in the discipline of their children by DI care, accountability, and transparency. fathers. The DI children were well adjusted in terms of CONCLUSIONS: The late nineties reform of the their social and emotional development. The findings Mexican health system had some positive effect on are discussed with respect to the secrecy surrounding access of the poor to health care and administrative DI and the imbalance in genetic relatedness between efficiency, but little impact on fair financing, quality of the parents and the child. care, and democratic governance. The English version of this paper is available at: Gomes JT, Bertrand LD, Paetsch JJ, Hornick JP. Self- http://www.insp.mx/salud/index.html. reported delinquency among Alberta's youth: findings from a survey of 2,001 junior and senior high school Gonzalez de Dios J. [Neonatal neurology decision-making students. Adolescence 2003; 38(149):75-91. starting from systematic reviews of Cochrane Abstract: This article draws on data from a 1999 survey Collaboration]. Rev Neurol 2005; 40(8):453-9. Abstract: INTRODUCTION: Cochrane Collaboration 525
- 534. (CC) provides growingand readily accessible resource patients' illness. This study looked at survival of to help that decision-making care is based on detailed, patients after enrollment in an Australian integrated critical, and current reviews of the best available palliative care service that consists of inpatient beds evidence. There are many clinical questions for which (hospice), community care and consultation services. there is no good evidence on which to base clinical We analyzed the survival of 1138 patients enrolled practice. AIM: To analyse the bibliometric over a 30-month period. The mean age was 70.1 years characteristics of the systematic reviews (SR) about and 55% of the patients were male. The most common neonatal neurology published in Neonatal CC. cancers were lung (19.1%), colorectal (13.4%) and MATERIALS AND METHODS: Bibliometric analysis prostate (5.8%), with nonmalignant disease accounting of The Cochrane Database Systematic Reviews in for 5.6% of all patients. The median length of survival Neonatal CC, Issue 1, 2004 (n = 169 SR). The was 54 days, with 9.3% of the patients dying within 7 dependent variable registered in each SR was subject days and 16.96% of patients living longer than six area of study (mainly neurology subject area) and the months. Perhaps more importantly than median rest of variables were considered independent: authors survival is the time spent on a palliative care program (number and country), dates (late review and update), in the overall context of diagnosis till death. The characteristics of included clinical trials (number and median percentage of time since diagnosis spent on the type), characteristics of the newborns included (number program was 17%. Timing of referral should be and gestational age), reviewer's conclusions and dependent on the need for intervention for physical or potential conflicts of interest. RESULTS: Neurology psychological symptoms. This can be meaningful was the third most important subject area in Neonatal whether the number of days till death is small or large. CC (13 SR), after the subject area of respiratory (73 SR) and gastroenterology-nutrition (26 RS). We Goodman GS. Wailing babies in her wake. Am Psychol identified three selective clusters of secondary 2005; 60(8):872-81. investigation in neonatal neurology SR: intraventricular Abstract: The scientific study of child witnesses has haemorrhage (4 SR), perinatal asphyxia (4 SR) and influenced both developmental science and opiate withdrawal syndrome (2 SR). The number of jurisprudence concerning children. Focusing on the clinical trials (median 4), patients (median 193), update author's own studies, 4 categories of research are (46%), sufficient conclusion (54%) and potential briefly reviewed: (a) children's eyewitness memory and conflicts of interest (8 %) in each SR is similar to the suggestibility; (b) memory for traumatic events in rest of SR in Neonatal CC; the only difference we childhood; (c) disclosure of child sexual abuse; and (d) found is less preterm infants (15%) in this SR. All the experiences of child victim/witnesses within the legal SR are about interventions for the treatment or system. Implications for psychology and for legal prevention of diseases, and we don't found any review practice are discussed. about diagnostic tests. CONCLUSIONS: At the moment, the neonatal neurology SR published in Goodman R, Slobodskaya H, Knyazev G. Russian child Neonatal CC are infrequent and almost half of them the mental health--a cross-sectional study of prevalence reviewer's conclusions are insufficient for inferring and risk factors. Eur Child Adolesc Psychiatry 2005; probable effects in clinical practice. Many therapies in 14(1):28-33. neonatal neurology persist without supportive Abstract: BACKGROUND: The fall of communism evidence, and some common therapies may actually be and subsequent economic crises have been followed by harmful, and these are the conclusions found in SR major social and health problems. High rates of child about intraventricular haemorrhage. We detected no SR mental health problems are frequently cited by the about important neuropediatric themes in neonatal Russian media, though there is little relevant evidence. period: hypoxic-ischemic encephalopathy, AIMS: The aim of this study was to investigate the periventricular leukomalacia, neonatal seizures, prevalence and associations of child mental health hypotonia, etc. problems in Russia using internationally recognised measures and diagnostic systems. METHOD: A two- Good C, Petersen C. SSRI and mirtazapine in PTSD. J Am stage, two-phase cross-sectional survey of the mental Acad Child Adolesc Psychiatry 2001; 40(3):263-4. health of 7- to 14-year-olds involved random sampling of schools, followed by random sampling of pupils Good PD, Cavenagh J, Ravenscroft PJ. Survival after from school lists. A sample of 448 children was enrollment in an Australian palliative care program. J obtained, representing an 83% participation rate. In the Pain Symptom Manage 2004; 27(4):310-5. first phase, screening measures of psychopathology and Abstract: Palliative care services aim to achieve the risk were administered to parents, teachers and 11- to best quality of life for patients by controlling pain and 14-year-olds. In the second phase, more detailed other physical symptoms and attending to their psychiatric assessments were carried out for subgroups psychospiritual needs. There have been many studies of screen-positive and screen-negative children across different countries looking at timing of referral (N=172). RESULTS: The prevalence of psychiatric to palliative care services. Almost universally, timing disorder was about 70% higher than that recently found of referral to palliative care is 'late' in the course of the in Britain with comparable measures, but there were 526
- 535. few differences betweenBritain and Russia in type of 2001; 50(6):340-5. disorder or key risk factors. CONCLUSION: There is a Abstract: BACKGROUND: Preterm births in the pressing need for evidence-based mental health United States increased from 11.0% to 11.4% between treatments to be made widely available to Russian 1996 and 1997; they continue to be a complex children and adolescents. healthcare problem in the United States. OBJECTIVE: The objective of this research was to compare Goodway JD, Smith DW. Keeping all children healthy: traditional statistical methods with emerging new challenges to leading an active lifestyle for preschool methods called data mining or knowledge discovery in children qualifying for at-risk programs. Fam databases in identifying accurate predictors of preterm Community Health 2005; 28(2):142-55. births. METHOD: An ethnically diverse sample (N = Abstract: This study examined contextual factors 19,970) of pregnant women provided data (1,622 associated with physical activity of urban African variables) for new methods of analysis. Preterm birth American preschoolers (N = 59). Qualitative research predictors were evaluated using traditional statistical methodologies utilized data from home visits, caregiver and newer data mining analyses. RESULTS: Seven and child interviews, field notes, and document demographic variables (maternal age and binary coding collection. The primary finding suggested, "In for county of residence, education, marital status, payer underserved communities fundamental barriers exist source, race, and religion) yielded a .72 area under the that obstruct young children's ability to be physically curve using Receiving Operating Characteristic curves active." Four themes were developed revealing that to test predictive accuracy. The addition of hundreds of outside environments limited opportunities for physical other variables added only a .03 to the area under the activity, home environments resulted in sedentary curve. CONCLUSION: Similar results across data behaviors, and communities had limited physical mining methods suggest that results are data-driven and activity role models. Despite this, young children not method-dependent, and that demographic variables enjoyed being physically active. offer a small set of parsimonious variables with reasonable accuracy in predicting preterm birth Goodwin E. About a boy. Carter Lee's story put a face on outcomes in a racially diverse population. one of the medical profession's biggest issues: access. J Ark Med Soc 2005; 101(9):265-7. Goodwin MD, Otake LR, Persing JA, Shin JH. A preliminary report of the virtual craniofacial center: Goodwin E. Prenatal exposure to illegal drugs. J Ark Med development of Internet-/Intranet-based care Soc 2005; 101(8):240-2. coordination of pediatric craniofacial patients. Ann Plast Surg 2001; 46(5):511-5; discussion 516. Goodwin L, VanDyne M, Lin S, Talbert S. Data mining Abstract: The authors present preliminary information issues and opportunities for building nursing regarding the development of an Internet-based Virtual knowledge. J Biomed Inform 2003; 36(4-5):379-88. Craniofacial Center that provides access to a patient Abstract: Health care information systems tend to database with visual and textual data. Patients are capture data for nursing tasks, and have little basis in photographed by digital camera with standardized nursing knowledge. Opportunity lies in an important images. Through a Web site linked to a remote issue where the knowledge used by expert nurses database, patient demographics, management data, (nursing knowledge workers) in caring for patients is reports, and acquired digital photographic images are undervalued in the health care system. The complexity stored and retrieved. The database can be used to sort of nursing's knowledge base remains poorly articulated and to present data as desired by multiple specialists. and inadequately represented in contemporary Confidentiality is maintained by unique identification information systems. There is opportunity for data numbers and password access to the server for mining methods to assist with discovering important craniofacial team members. The current system uses linkages between clinical data, nursing interventions, economical equipment (i.e., digital camera, personal and patient outcomes. Following a brief overview of computer with modem, and access to a remote relevant data mining techniques, a preterm risk Windows NT-based server), using data that can be prediction case study illustrates the opportunities and entered in a variety of cross-platform personal describes typical data mining issues in the nontrivial computer systems and transmitted on a wide range of task of building knowledge. Building knowledge in bandwidths-from a relatively low-bandwidth (28.8 KB nursing, using data mining or any other method, will per second) modem to a high-speed T-3 line make progress only if important data that capture connection. Long-term goals include archival data expert nurses' contributions are available in clinical storage and analysis, as well as the development of information systems configurations. multicenter telemedicine links for active craniofacial centers. Goodwin LK, Iannacchione MA, Hammond WE, Crockett P, Maher S, Schlitz K. Data mining methods find Goodwin RD, Weisberg SP. Childhood abuse and diabetes demographic predictors of preterm birth. Nurs Res in the community. Diabetes Care 2002; 25(4):801-2. 527
- 536. Gordon M. Rootsof Empathy: responsive parenting, caring years. The eight cases were due to their own accidental societies. Keio J Med 2003; 52(4):236-43. shootings, and the remaining 20 cases were shot by Abstract: What is common in aggression and in others. Our findings show that the contributing factors abusive/neglectful parenting is low levels of empathy. for increasing death by firearm are terrorists' activities, Fostering empathy--the ability to identify with another traditional habits of obtaining and using guns and person's feelings--can serve as an antidote to blood feuds. aggression and is crucial to good parenting. Poor parenting and aggression cut across all socioeconomic Gorey KM, Richter NL, Snider E. Guilt, isolation and levels of the community and, as such, empathy needs to hopelessness among female survivors of childhood be fostered in all children. During the period of rapid sexual abuse: effectiveness of group work intervention. brain development, adversity has a devastating impact Child Abuse Negl 2001; 25(3):347-55. on the baby's developing brain. Repeated experiences Abstract: OBJECTIVE: This study explores the effects of stress are hardwired into the brain, creating of group work intervention on female survivors' senses damaging pathways. Risk factors such as domestic of guiltlessness, affiliation and hopefulness. violence, child abuse and neglect, maternal depression, METHOD: Secondary comparative analyses of a large maternal addictions, and poverty are not just additive to quasi-experiment-based clinical data base were the vulnerable developing brain; they are multiplicative accomplished (Richter, Snider, & Gorey): group work in their impact. The parent is the baby's lifeline, intervention (N = 78) and a waiting-list condition (N = mitigating stress for them and helping them to learn to 80). RESULTS: Group work was found to have regulate their emotions. The impact of poor parenting beneficial effects on adult female survivors' appropriate on a child's life is profound, resulting in insecure sense of guiltlessness for their childhood sexual abuse, attachments which lead to a spectrum of inadequate as well as on their sense of affiliation and hopefulness. coping mechanisms, poor emotional regulation, Consistent across the three outcome measures of diminished learning potential and low competence. guilt/guiltlessness, isolation/affiliation and Responsive and nurturing parenting is the key to hopelessness/hopefulness, 16 to 18 of every 20 such optimal early childhood development; it allows the women who participated in group work did better than young brain to develop in a way that is less aggressive the average woman in the waiting-list comparison and more emotionally stable, social and empathic. group. Moreover, these apparent clinical benefits were Good early childhood development leads to good maintained for 6 months (all p < .01). CONCLUSION: human development. We must match our investment Such effects may be characterized as very large, and where the opportunity is most ripe--building parenting are generally larger than those previously observed in capacity. The 'Roots of Empathy' program offers real this field of practice that have typically been based on hope in breaking the intergenerational transference of more general measures of depression, self-esteem or poor parenting and violence. global symptoms. Goren S, Subasi M, Tirasci Y, Kemaloglu S. Firearm-related Gorincour G, Dubus JC, Petit P, Bourliere-Najean B, Devred mortality: a review of four hundred-forty four deaths in P. Rib periosteal reaction: did you think about chest Diyarbakir, Turkey between 1996 and 2001. Tohoku J physical therapy? Arch Dis Child 2004; 89(11):1078-9. Exp Med 2003; 201(3):139-45. Abstract: The current study is based on a retrospective Gorissen WH, Schulpen TW, Kerkhoff AH, van Heffen O. investigation of firearm deaths in Diyarbakir, which Bridging the gap between doctors and policymakers: were autopsied by the Diyarbakir Branch of the the use of scientific knowledge in local school health Council of Forensic Medicine during the 6- year care policy in The Netherlands. Eur J Public Health period. Four hundred-forty four deaths were 2005; 15(2):133-9. investigated from January 1996 through December Abstract: BACKGROUND: The decentralization of 2001, including homicide (296 cases, 66.7%), suicide school health care policy in The Netherlands was (120 cases, 27%) and accidental shootings (28 cases, followed by an increase in diversity, which was most 6.3%). The age range of all firearm deaths in the study often not evidence-based. This study aims to clarify the period was 5 to 75 years with a median age of 29.8 use of scientific knowledge in school health care years. The majority were in the groups aged 16-25 policy-making processes: multi-actor processes in years (38.7%). In the homicide group, 248 subjects networks, trying to solve certain problems. (83.8%) were male, and 48 (16.2%) were female. The METHODS: Case-study design in four Municipal 31.1% of the homicide victims were in the group aged Health Service regions, using documents and half- at 20-30 years. Of the 120 suicide victims, 56 (46.7%) structured interviews as data sources. RESULTS: were in the group aged 16-20 years. The head was by Scientific knowledge is used by only 42% of the actors far the favoured site, accounting for 82 (68.3%) deaths: in 58% of decision-making rounds in policy-making entry wounds in the right temple accounted for 72 of processes. 'Recent' regional data on health indicators these. Twenty-eight cases were accidental shootings are used more often than 'established' (inter)national and 18 of them were male (64.3%). Twelve of the 28 knowledge of theoretical models. Mainly school health accidental victims (42.9%) were in the group aged 0-10 528
- 537. professionals use knowledgeas a resource to influence strategies to work on the prevention of infant the policy process. Other actors (e.g. managers and psychopathological disorders as well as the parenting municipalities) use formal power, money or 'initiative' process. The aspects on early development on children as their main resources. Powerful actors put forward are specially emphasized describing the interventions less scientific knowledge than actors in dependent to promote the development and the care of the positions. Individual actors with a combined scientific protective factors, the resilience, as well as to approach and political frame of reference put forward knowledge the risk factors. This is illustrated threw a clinical case. most frequently, especially in complex networks with many actors, more than one powerful actor, more than Gostin LO. AIDS in Africa among women and infants: a one arena, more than one dominant resource and more human rights framework. Hastings Cent Rep 2002; than one dominant frame of reference. CONCLUSION: 32(5):9-10. The use of scientific knowledge in school health care Notes: GENERAL NOTE: KIE: 16 refs. policy-making processes can and must be improved. GENERAL NOTE: KIE: KIE Bib: AIDS Liaison officers can bridge the gap between doctors and policymakers, especially in complex policy Gottdiener WH. Psychoanalysis and schizophrenia: three networks. They combine a scientific and a political responses to Martin Willick. J Am Psychoanal Assoc frame of reference and act upon scientific knowledge 2002; 50(1):314-6; author reply 316-9. as a resource in their efforts to influence the policy- making process. Gottlieb G, Halpern CT. A relational view of causality in normal and abnormal development. Dev Psychopathol Gormally L. The Maltese conjoined twins. Second Opin 2002; 14(3):421-35. (Chic) 2001; (8):36-52. Abstract: An understanding of developmental Notes: GENERAL NOTE: KIE: Gormally, Luke phenomena demands a relational or coactive concept of GENERAL NOTE: KIE: 21 fn. causality, as opposed to a conceptualization that GENERAL NOTE: KIE: KIE Bib: patient care/minors assumes that singular causes can act in isolation. In this article we present a developmental psychobiological Gorman-Smith D, Tolan PH, Henry DB et al. Predictors of systems view of relational (bidirectional, coactional) participation in a family-focused preventive causality, in which it is proposed that developmental intervention for substance use. Psychol Addict Behav outcomes are a consequence of at least two specific 2002; 16(4 Suppl):S55-64. components of coaction from the same or different Abstract: This study reports patterns of involvement in levels of a developmental system. The levels are a family-focused preventive intervention, Schools and genetic, neural, behavioral, and environmental; the Families Educating (SAFE) Children, targeting early latter level includes the cultural, social, and physical predictors of risk for delinquency and drug use among aspects of an organism's environment. We show the 175 African American and Latino first-grade children applicability of this view to the understanding of the living in economically disadvantaged inner-city development of normal and abnormal behavioral and neighborhoods. Three empirically derived patterns psychological phenotypes through illustrations from emerged: joiners, responders, and minimal responders. the existing animal and human literature. Finally, we Joiners were immediately responsive and enthusiastic discuss future possibilities and potential stumbling and participated fully. Responders attended fully only blocks in the implementation of a more fully realized after extensive effort was made to recruit and retain bidirectional, coactional perspective in developmental them. However, once engaged, they attended fully and psychopathological research. participated with enthusiasm. Minimal responders attended a few sessions sporadically even with Gou Z, Fyfe C. A canonical correlation neural network for extensive, ongoing effort to engage them. Ethnicity, multicollinearity and functional data. Neural Netw marital status, parental antisocial behavior, economic 2004; 17(2):285-93. and loss stressors, monitoring, and child's depression Abstract: We review a recent neural implementation of and hyperactivity were significant discriminators of Canonical Correlation Analysis and show, using ideas group membership. suggested by Ridge Regression, how to make the algorithm robust. The network is shown to operate on Gorodisch R. [Endemic social exclusion and early data sets which exhibit multicollinearity. We develop a development: "made in Chacarita"]. Vertex 2004; second model which not only performs as well on 15(56):115-20. multicollinear data but also on general data sets. This Abstract: My aim is to introduce in this article a project model allows us to vary a single parameter so that the that two foundations are developing in Chacarita, a network is capable of performing Partial Least Squares neighborhood in Buenos Aires City, heading to provide regression (at one extreme) to Canonical Correlation help and support to adolescent parents under social Analysis (at the other)and every intermediate operation deprivation conditions and/or undergoing emotional between the two. On multicollinear data, the parameter problems. It is an action project embracing different setting is shown to be important but on more general 529
- 538. data no particularparameter setting is required. Finally, SUMMARY: Inpatient descriptive studies and we develop a second penalty term which acts on such uncontrolled outcome studies predominate in the data as a smoother in that the resulting weight vectors literature. Although many children and adolescents are much smoother and more interpretable than the benefit from admission to mental health inpatient weights without the robustification term. We illustrate facilities, the specific advantages of admission over our algorithms on both artificial and real data. intensive community management are uncertain. Gough D. Child protection for abused children: levels of Grabenstein JD. Overcoming immunization disparities based response assessment, attachment relationships and on ethnicity. Pharm Pract Manag Q 2001; 20(3):23-30. systematic research synthesis. Pediatr Int 2002; 44(5):561-9. Gracey K. A parent's guide for advocacy and involvement. Adv Neonatal Care 2002; 2(3):170-1. Gould M. Protection bracket. Health Serv J 2003; 113(5865):14-5. Graham-Bermann SA, Hughes HM. Intervention for children exposed tointerparental violence (IPV): Gover AR. The effects of child maltreatment on violent assessment of needs and restearch priorities. Clin Child offending among institutionalized youth. Violence Vict Fam Psychol Rev 2003; 6(3):189-204. 2002; 17(6):655-68. Abstract: In this paper we review the development of Abstract: While prior literature generally supports the interventions for children who have been exposed to connection between child maltreatment and violent interparental violence (IPV), assess current needs in the offending in adolescence and early adulthood for evaluation of interventions, and provide suggestions for general population samples, less is known about the research priorities in this area. Interventions for relationship between child maltreatment and the negative outcomes associated with exposure to IPV frequency of violent offending among serious juvenile only recently have been carefully designed and offenders. As a result, few studies have examined evaluated, thus knowledge regarding program whether the effects of child maltreatment on the effectiveness is minimal. Three of the most frequency of violent offending are mediated by other comprehensive interventions that have been evaluated social processes, as developmental models of are presented. Each has demonstrated effectiveness, aggression and violence would suggest. To examine and focuses on children with different levels of this issue, self-report data on child maltreatment, symptoms and distress. However, many questions general delinquency risk factors, and violent offending remain regarding which interventions are beneficial for were collected from 3,694 juveniles confined to 48 diverse children with different kinds and intensities of correctional institutions. Results from a series of problems. A number of research priorities and negative binomial regression models indicated that the suggestions for further improvements in the evaluation relationship between child maltreatment and the of effectiveness of interventions are identified. frequency of violent offending was mediated by social risk factors. The implications of these findings for Graham K. The yin and yang of alcohol intoxication: theory and practice are discussed. implications for research on the social consequences of drinking. Addiction 2003; 98(8):1021-3. Gowers SG, Rowlands L. Inpatient services. Curr Opin Psychiatry 2005; 18(4):445-8. Gramling L, Hickman K, Bennett S. What makes a good Abstract: PURPOSE OF REVIEW: Inpatient services family-centered partnership between women and their constitute the most highly specialized child and practitioners? A qualitative study. Birth 2004; adolescent mental health provision and cater for the 31(1):43-8. most severe disorders in this age group. In view of a Abstract: BACKGROUND: Family-centered maternity number of mapping and audit initiatives in the UK in care is an approach based on mutually beneficial recent years and changing influences on admission partnerships between health care providers and policies worldwide, it is timely to review their function families. It offers new ways of thinking about the and effectiveness. RECENT FINDINGS: Recent relationship among childbearing women, their families, attention has focused on describing service and health caregivers. This study was designed to configurations and auditing against standards. National identify health care practices that promoted or limited a surveys of cost, referral processes and patient family-centered philosophy. METHODS: A qualitative satisfaction are in progress in the UK. There seems to design, using reflexive interviews and focus groups, be an international trend toward a more severe, investigated the perspectives of 34, primarily African comorbid and aggressive patient group being admitted American women who used maternity services at a to inpatient services. There is a shortage of quality large urban hospital; some women traveled from rural research into clinical outcomes of inpatient treatment, areas for delivery. Inductive data analysis was but controlled trials comparing hospital treatment with conducted on the transcribed audiotapes of the intensive community management are emerging. interviews and groups. RESULTS: Barriers to family- 530
- 539. centered maternity carewere categorized as issues in and malnutrition among the displaced population in coordination of services among health caregivers, South Darfur and reinforces the need to mount patient-health caregiver relationships and systems, and appropriate and timely humanitarian responses. access to services. Facilitators of family-centered maternity care were identified as perceived response to Grandi C, Cernadas JC. [Neonatal networks]. J Pediatr (Rio high-risk patients, health-related support outside the J) 2004; 80(5):431; author reply 431-2. hospital, and special resources. Narratives, or personal stories told by the women, were used to illustrate Grant B, Wallace JG, Hobson RA, Craig BG, Mulholland barriers and facilitators. CONCLUSIONS: Education HC, Casey FA. Telemedicine applications for the about family-centered maternity care is vitally regional paediatric cardiology service in Northern important for health caregivers. In clinical situations, Ireland. J Telemed Telecare 2002; 8 Suppl 2:31-3. each childbearing woman and her family should be Abstract: The regional paediatric cardiology centre in treated as if they are extraordinary. In this way, Northern Ireland has a telemedicine network linking practitioners can alter routines that cause the woman the neonatal units of three district general hospitals and her family to lose individualized care. using ISDN and IP-compliant equipment. We have previously reported the use of ISDN transmission at Grandesso F, Sanderson F, Kruijt J, Koene T, Brown V. 128 kbit/s for remote echocardiography. In a series of Mortality and malnutrition among populations living in 61 patients, a total of 59 transmitted scans were of South Darfur, Sudan: results of 3 surveys, September sufficient diagnostic quality to confirm or exclude the 2004. JAMA 2005; 293(12):1490-4. presence of major congenital heart disease (CHD). Abstract: CONTEXT: Mass violence against civilians There were three diagnostic errors (7%). Subsequently, in the west of Sudan has resulted in the displacement of we have examined the use of ISDN transmission at 384 more than 1.5 million people (25% of the population of kbit/s. Echocardiographic studies were carried out on the Darfur region). Most of these people are camped in 21 patients and all were followed up. Fourteen patients 142 settlements. There has been increasing (67%) had CHD confirmed. There were two diagnostic international concern about the health status of the errors (10%). Our experience of transmitting live displaced population. OBJECTIVE: To perform rapid echocardiographic images suggests that ISDN at 384 epidemiological assessments of mortality and kbit/s provides the optimum balance between the nutritional status at 3 sites in South Darfur for relief clarity of the transmitted images and costs. We expect efforts. DESIGN, SETTING, AND PARTICIPANTS: that IP videoconferencing will offer similar quality but In August and September 2004, mortality surveys were at a lower running cost, and are currently assessing it in conducted among 137,000 internally displaced persons a pilot study. All sites within our network will remain (IDPs) in 3 sites in South Darfur (Kass [n = 900 capable of ISDN transmission until the efficacy and households], Kalma [n = 893 households], and reliability of IP transmission has been demonstrated in Muhajiria [n = 900 households]). A nutritional survey a controlled trial. The clinical telemedicine service has was performed concomitantly among children aged 6 led to the earlier diagnosis of and instigation of to 59 months using weight for height as an index of appropriate treatment for CHD. acute malnutrition (Kass [n = 894], Kalma [n = 888], and Muhajiria [n = 896]). A questionnaire detailing Gray C. Pediatricians taking new look at corporal- access to food and basic services was administered to a punishment issue. CMAJ 2002; 166(6):793. subset of households (n = 210 in each site). MAIN OUTCOME MEASURES: Crude and under 5-year Gray DE. Gender and coping: the parents of children with mortality rates and nutritional status of IDPs in Kass, high functioning autism. Soc Sci Med 2003; 56(3):631- Kalma, and Muhajiria, South Darfur. RESULTS: 42. Crude mortality rates, expressed as deaths per 10,000 Abstract: Gender is a concept that is frequently per day, were 3.2 (95% confidence interval [CI], 2.2- discussed in the literature on stress, coping and illness. 4.1) in Kass, 2.0 (95% CI, 1.3-2.7) in Kalma, and 2.3 Research has reported that women are more vulnerable (95% CI, 1.2-3.4) in Muhajiria. Under 5-year mortality than men are to stressful events and use different rates were 5.9 (95% CI, 3.8-8.0) in Kass, 3.5 (95% CI, strategies to cope with them. Furthermore, it is often 1.5-5.7) in Kalma, and 1.0 (95% CI, 0.03-1.9) in asserted that these gender-based differences in coping Muhajiria. During the period of displacement covered may partially explain the differential impact of stressful by our survey in Muhajiria, violence was reported to be events on men and women. Unfortunately, much of this responsible for 72% of deaths, mainly among young research has equated gender with sex and failed to men. Diarrheal disease was reported to cause between contextualise the experience of illness and coping. This 25% and 47% of deaths in camp residents and mainly paper presents a qualitative analysis of the role of affected the youngest and oldest age groups. Acute gender and coping among parents of children with high malnutrition was common, affecting 14.1% of the functioning autism or Asperger's syndrome in an target population in Kass, 23.6% in Kalma, and 10.7% Australian sample. It attempts to analyse the different in Muhajiria. CONCLUSION: This study provides meanings of the disability for mothers and fathers and epidemiological evidence of the high rates of mortality 531
- 540. describes the variousstrategies that parents use to cope users to create hypertext markup language. with their child's disability. Green A, Gerein N. Exclusion, inequity and health system Grazzi L, Andrasik F, D'Amico D, Usai S, Kass S, Bussone development: the critical emphases for maternal, G. Disability in chronic migraine patients with neonatal and child health. Bull World Health Organ medication overuse: treatment effects at 1-year follow- 2005; 83(6):402. up. Headache 2004; 44(7):678-83. Abstract: OBJECTIVE: To determine (1) the clinical Green B. Special care baby charter: an exercise in the course of a sample of chronic migraine patients with obvious? RCM Midwives 2005; 8(11):436. drug overuse 6 and 12 months following in-patient treatment and (2) whether functional impairment, Green LA, Fryer GE Jr, Froom P, Culpepper L, Froom J. assessed by the Migraine Disability Assessment Opportunities, challenges, and lessons of international (MIDAS) questionnaire, improved upon treatment. research in practice-based research networks: the case BACKGROUND: Patients with chronic migraine and of an international study of acute otitis media. Ann medication overuse are particularly difficult to treat Fam Med 2004; 2(5):429-33. (prophylactic medications that otherwise are effective Abstract: The requirements of research become more become ineffective; discontinuation of the offending complex and demanding in international medication can lead to withdrawal headache; physical collaborations. The opportunity to study naturally and emotional dependence can be present, as well as occurring variation in treatment prompted networking increased psychological involvement; initial treatment primary care research networks in the United gains can be difficult to maintain). METHODS: Of the Kingdom, The Netherlands, and North America to 106 patients meeting criteria for chronic migraine with study acute otitis media. Additional challenges faced medication overuse, 84 went on to complete a and addressed in this study included (1) differing structured in-patient treatment, consisting of national requirements for protecting human subjects; medication withdrawal and then prophylactic (2) variation in data collection processes in primary treatment. RESULTS: As a group, the patients were care practices; (3) data transmission among improved at both 6- and 12-month follow-up, with participants; (4) duties and tariffs on necessary respect to two headache parameters (frequency and instruments; (5) fluctuation in currency exchange rates; medication use) and three measures of functional (6) incapacitation of coinvestigators; (7) complex impact extracted from the MIDAS questionnaire (Total administration of funds; (8) financing the additional, Score, Headache Frequency, and Headache Intensity). legitimate costs of collaboration; (9) sustaining strong CONCLUSION: Chronic migraine accompanied with personal relationships among coinvestigators; and (10) medication overuse led to the considerable disability accepting longer time frames than would otherwise be prior to treatment. However, notable improvement expected. Overall, international practice-based research occurred coincident with the treatment. This suggests can be productive, affect millions of people, and be that successful treatment has more wide-ranging extremely rewarding to investigators. It is not, positive benefits beyond mere symptom reduction. To however, for the faint-hearted. our knowledge, this is the first investigation where the MIDAS questionnaire has been used prospectively as Green TM, Ramelli A, Mizumoto M. Patterns among sexual an outcome measure in patients with chronic migraine assault victims seeking treatment services. J Child Sex and medication overuse to assess disability subsequent Abus 2001; 10(1):89-108. to a semi-standardized treatment program. Abstract: The validity and reliability of research on the nature and extent of sexual assault tends to be affected Grech VE. Country-wide availability of paediatric medical by different definitions, methodologies, and protocols via the local hospital intranet site. J Audiov measurements. As a result, two important aspects of Media Med 2003; 26(3):115-7. sexual assault associated with patterns of symptom Abstract: In paediatrics, a wide variety of procedures expression and therapeutic interventions are not often and interventions (protocols) are standardized. The reflected in the research; the severity of the assault, entire hard-copy collection of paediatric protocols used including the duration of the abuse, and the age at the in Malta (47 to date) was put together as a website, and time of the assault and the gender of the victim. This is hosted on the hospital intranet. Some protocols research is based on intake forms from Hawai;i's only consist of Excel spreadsheets that are used for the statewide provider of services to the victims of sexual calculation of fluids and drugs. This archive has proved assault. The analyses reveal that significant differences very useful for medical and paramedical staff in the exist between male and female victims, by age and by Department of Paediatrics, both in the hospital and in assault characteristics, including the type of sexual peripheral health centres and hospitals. Changes or new assault, use of force and injury, length of assault, and protocols may be uploaded at any time, with the relationship between victim and offender. instantaneous updating of the archive. The website was created, and is maintained and updated by the author, Greenberg MT, Speltz ML, DeKlyen M, Jones K. Correlates thanks to the ease with which modern software allows 532
- 541. of clinic referralfor early conduct problems: variable- from US census data. 2) A prospective cohort of 88 and person-oriented approaches. Dev Psychopathol infants < or = 90 days of age who had been treated for 2001; 13(2):255-76. unintentional head trauma in an urban pediatric Abstract: The current study utilized both variable- and emergency department (ED) was studied. person-oriented analyses to examine correlates of early Circumstances of injury and gender-related differences disruptive behavior problems. Participants included 80 in these circumstances were assessed. RESULTS: In preschool boys referred to a child psychiatry clinic and the NPTR database, 600 of 1072 (56%) (95% diagnosed with oppositional defiant disorder (with or confidence interval [CI] 0.53, 0.59) infants < or = 90 without attention-deficit hyperactivity disorder) and 80 days of age were boys (P =.001). In the ED cohort, 54 case-matched normal comparison boys. The study of 88 (62%) (95% CI 0.50, 0.72) subjects were boys (P examined four domains of correlates: vulnerable child =.06). In virtually all of the cases described, subjects characteristics, poor parenting practices, insecure appeared to be passive participants in the injury. The attachment, and adverse family ecology. Results most commonly reported circumstances of injury were indicated that the combination of these factors provided the following: "child left alone on furniture and fell" (n relatively high sensitivity (81%) and specificity (85%), = 39) or "parent dropped child" (n = 27). Boys clearly differentiating referred from comparison boys. accounted for 20 (74%) of the subjects in the "parent A dramatic increase in clinic status occurred when dropped child" group (P =.04). CONCLUSIONS: Boys three or more factors were present, and specific outnumber girls among infants less than 3 months of combinations of factors were differentially predictive age with unintentional head trauma. These young of conduct problems. However, no correlates were infants appear to be passive participants in their found to be either necessary or sufficient for clinic injuries, which indicates that differences in parenting status. By maintaining the integrity of individual cases, practices may account for the observed gender person-oriented analyses were able to answer different differences. questions than more traditional variable-oriented analyses. Discussion focuses on the value of person- Greenham SL, Stelmack RM. Event-related potentials and oriented analyses for understanding heterogeneous picture-word naming: effects of attention and semantic clinical groups. relation for children and adults. Dev Neuropsychol 2001; 20(3):619-38. Greene K, Bogo M. The different faces of intimate violence: Abstract: Event-related potentials (ERPs) were implications for assessment and treatment. J Marital recorded from children, 9 to 13 years of age, while they Fam Ther 2002; 28(4):455-66. named words and pictures. The words and pictures Abstract: Current research about violence in intimate were presented individually and in superimposed relationships suggests that at least two qualitatively picture-word pairs in which the meaning of the words distinct types of violence exist. This new knowledge and pictures was either congruent, semantically challenges the dominant conceptualization of intimate associated, or incongruent. Both words and pictures violence as solely a manifestation of patriarchal male elicited large amplitude negative waves (N450) at dominance. Following a review of the research and anterior electrode sites. The amplitude of this N450 analysis of illustrative clinical examples, a conceptual wave was larger for individually presented pictures framework is presented that assists couple therapists in than for words. N450 amplitude was also larger when answering three salient questions: What type of naming pictures than when naming words in the violence am I most likely to be working with? How can superimposed arrays, an effect that is attributed to I assess the differences between types of violence? And differences in attentional demand required to name how might I proceed with treatment for different types pictures rather than to exogenous stimulus of violence? characteristics. No significant effects of semantic incongruity were observed. These ERP waveforms for Greenes DS, Wigotsky M, Schutzman SA. Gender children differ from those observed for adults who differences in rates of unintentional head injury in the exhibited positive amplitude waves to individually first 3 months of life. Ambul Pediatr 2001; 1(3):178- presented pictures and who also exhibited semantic 80. incongruity effects. Abstract: OBJECTIVES: To assess for gender differences in rates of unintentional head injury in Gregory W. Reviving truth and trust. Time 2002; infants less than 3 months of age, to assess the 159(24):58-60. circumstances of injury in these patients, and to look for gender-related differences in these circumstances. Gregory W. "There will be guidance." Interview by David METHODS: Two separate databases were analyzed. 1) France. Newsweek 2002; 139(17):39. The National Pediatric Trauma Registry (NPTR) was queried for all patients < or = 90 days of age who had Greicius MD. Neuroimaging in developmental disorders. been diagnosed with unintentional head trauma Curr Opin Neurol 2003; 16(2):143-6. between 1990 and 1999. The proportion of males was Abstract: PURPOSE OF REVIEW: This review compared to the expected proportion of 51%, derived 533
- 542. considers the roleof neuroimaging in developmental before and after the 2002 ceasefire. Malnutrition deaths disorders by highlighting recent studies in two distinct, reflect the extent of the food crisis affecting this but overlapping, developmental disorders: autism and population. Timely humanitarian assistance must be fragile X syndrome. RECENT FINDINGS: After a made available to all populations in such conflicts. decade of conflicting results in neuroimaging studies of autism, recent studies have provided some convergent Greiner T, Sachs M, Morrison P. The choice by HIV- data. One well-replicated finding is that autistic positive women to exclusively breastfeed should be subjects have larger brains. Further, this enlargement, supported. Arch Pediatr Adolesc Med 2002; 156(1):87- present as early as 3 years of age, appears to represent 8. accelerated growth in infancy and may be followed by slowed growth in late childhood. Other findings are Grekin ER, Brennan PA, Hammen C. Parental alcohol use discussed but considered preliminary in the absence of disorders and child delinquency: the mediating effects converging evidence or replication studies. Recent of executive functioning and chronic family stress. J work in fragile X syndrome suggests aberrant fronto- Stud Alcohol 2005; 66(1):14-22. striatal and fronto-parietal networks and relates these Abstract: OBJECTIVE: This study examines the abnormalities "forward" to behavior and "backward" to relationship between parental alcohol use disorders decreased protein expression. SUMMARY: As the (AUDs) and child violent and nonviolent delinquency. field of neuroimaging has matured, it has revealed its It also explores the mediating effects of executive promise as a safe, reliable, in-vivo tool in the study of functioning and chronic family stress on the parental developmental disorders. By insisting on larger, more AUD/child delinquency relationship. METHOD: homogeneous patient groups and longitudinal rather Participants were 816 families with children (414 boys than cross-sectional studies, the field is poised to fulfill and 402 girls) born between 1981 and 1984 at Mater its ultimate role of linking defects in molecular biology Misericordiae Mother's Hospital in Brisbane, Australia. to aberrant behavior. Parents and children completed semistructured interviews, questionnaires and neuropsychological tests Grein T, Checchi F, Escriba JM et al. Mortality among that assessed parental alcohol use, family psychiatric displaced former UNITA members and their families in history, chronic family stress, child delinquency and Angola: a retrospective cluster survey. BMJ 2003; child executive functioning. RESULTS: Paternal (but 327(7416):650. not maternal) AUDs predicted child violent and Abstract: OBJECTIVE: To measure retrospectively nonviolent delinquency. Executive functioning mortality among a previously inaccessible population mediated the relationship between paternal AUDs and of former UNITA members and their families violent delinquency, whereas family stress mediated displaced within Angola, before and after their arrival the relationship between paternal AUDs and both in resettlement camps after ceasefire of 4 April 2002. violent and nonviolent delinquency. DESIGN: Three stage cluster sampling for interviews. CCONCLUSIONS: Results support a biosocial Recall period for mortality assessment was from 21 conceptualization of the paternal AUD/delinquency June 2001 to 15-31 August 2002. SETTING: Eleven relationship. They suggest that paternal AUDs may be resettlement camps over four provinces of Angola (Bie, associated with child executive functioning and family Cuando Cubango, Huila, and Malange) housing 149 stress, which may in turn lead to child delinquency. 000 former UNITA members and their families. PARTICIPANTS: 900 consenting family heads of Greydanus DE, Pratt HD, Richard Spates C, Blake-Dreher households, or most senior household members, AE, Greydanus-Gearhart MA, Patel DR. Corporal corresponding to an intended sample size of 4500 punishment in schools: position paper of the Society individuals. MAIN OUTCOME MEASURES: Crude for Adolescent Medicine. J Adolesc Health 2003; mortality and proportional mortality, overall and by 32(5):385-93. period (monthly, and before and after arrival in camps). Notes: CORPORATE NAME: SAM 2002-2003 Ad RESULTS: Final sample included 6599 people. The Hoc Corporal Punishment Committee 390 deaths reported during the recall period corresponded to an average crude mortality of 1.5/10 Gribomont AC. [Traumatic vitreous-retinal hemorrhage in 000/day (95% confidence interval 1.3 to 1.8), and, infants]. Bull Soc Belge Ophtalmol 2001; (281):5-11. among children under 5 years old, to 4.1/10 000/day Abstract: After a short review of the non-traumatic, and (3.3 to 5.2). Monthly crude mortality rose gradually to rare, causes of vitreoretinal hemorrhages in infants, we a peak in March 2002 and remained above emergency analyze the 4 situations where a traumatic hemorrhage thresholds thereafter. Malnutrition was the leading can be found: accidental head trauma, which has to be cause of death (34%), followed by fever or malaria very severe and is then an unfrequent etiology, head (24%) and war or violence (18%). Most war victims trauma in child abuse or the so-called "shaken baby and people who had disappeared were women and syndrome", which is the most frequent cause, and children. CONCLUSIONS: This population of where we point out the key role of the ophthalmologist displaced Angolans experienced global and child in the diagnosis and the prognostic evaluation, the mortality greatly in excess of normal levels, both 534
- 543. perinatal trauma, whichis a frequent, benign, and Munchausen syndrome by proxy (MSBP). ephemeral cause, and finally, cardiopulmonary resuscitation, which is a controversial and unlikely Griffiths M. Betting your life on it. BMJ 2004; cause. 329(7474):1055-6. Griffin ML, Amodeo M, Fassler I, Ellis MA, Clay C. Griffiths P, Hindet A, Matthews Z. Infant and child Mediating factors for the long-term effects of parental mortality in three culturally contrasting states of India. alcoholism in women: the contribution of other J Biosoc Sci 2001; 33(4):603-22. childhood stresses and resources. Am J Addict 2005; Abstract: Using cross-sectional, individual-level survey 14(1):18-34. data from Maharashtra, Tamil Nadu and Uttar Pradesh Abstract: The primary aim of this study was to identify collected under the Indian National Family Health the stresses and resources in childhood that mediate the Survey programme of 1992-93, statistical modelling relationship between parental alcoholism and adult was used to analyse the impact of a range of variables outcomes in women. Adult outcomes included alcohol on the survival status of children during their first 2 problems and measures of psychosocial adjustment. years of life. Attention was focused on the potential Standardized measures and a face-to-face interview impact of the mother's autonomy. The strongest were used to collect data on 290 community-dwelling predictors of mortality were demographic and women, with siblings as collateral informants. biological factors, breast-feeding behaviour, and use Mediation analysis showed that the effect of parental and knowledge of health services. Variables that can be alcoholism on several adult outcomes was indirect, interpreted as being related to maternal autonomy, such mediated by the other stresses and resources examined. as the presence of a mother-in-law in the household, Contextual models such as those presented here are did not have a significant direct effect on child survival helpful in understanding the long-term effects of at the individual level, and their indirect effects were childhood environment on women. very limited. Griffith R. Court appearance 1: the English and Welsh court Grinberg I, Dawkins M, Dawkins MP, Fullilove C. system. Br J Community Nurs 2003; 8(12):554-6. Adolescents at risk for violence: an initial validation of the life challenges questionnaire and risk assessment Griffith R. Health protection and age-related legislation. Br J index. Adolescence 2005; 40(159):573-99. Community Nurs 2005; 10(4):187-91. Abstract: Initial validation was sought for the Life- Abstract: Community children's nurse Debbie James Challenges Questionnaire-Teen Form, a 120-item has developed an innovative scheme to allow youth-risk assessment tool. The questionnaire was secondary school children to obtain health advice by administered to 99 students enrolled in an adolescent texting her service using mobile phones. As well as detention facility and a comparison group of 305 general advice about spots and rubella immunization, students attending high school. The survey items Sister James is also receiving inquiries about children's included correlates of youth violence and categorized legal rights that also have a health protection purpose, risk level in a Risk Assessment Index (RAI) based on such how old a child has to be before owning a pet or 53 critical items most strongly correlated with youth have an alcoholic drink. This article looks at how the violence. Higher RAI scores were expected for the law seeks to protect children by incrementally giving detention sample, males, minorities, and 15- to 18- them legal rights as they develop to mature adults and year-olds. Differences between adolescents in how legal awareness can help inform community detention and high school in terms of risk for violence health practitioners' advice to their child clients. were assessed by means of analysis of variance, and multiple regression analysis was used to examine the Griffith R. The issue of consent and children: who decides? relative effect of detention status, race/ethnicity, Br J Community Nurs 2004; 9(7):298-301. gender, and other factors on risk behavior as measured Notes: GENERAL NOTE: KIE: 16 refs. by the RAI. Findings revealed that the detention group GENERAL NOTE: KIE: KIE Bib: informed endorsed correlates of youth violence more often than consent/minors the non-detention group and received significantly higher RAI scores. In addition, being in detention, Griffiths H, Cuddihy PJ, Marnane C. Bleeding ears: a case male, and a racial/ethnic minority were significant of Munchausen syndrome by proxy. Int J Pediatr predictors of risk behavior. The authors conclude that Otorhinolaryngol 2001; 57(3):245-7. The Life-Challenges Questionnaire (and Risk Abstract: A case is presented of a child who initially Assessment Index) effectively differentiated between presented with genuine aural symptoms and pathology. the detention and student samples, thus, providing Over a period of time it became apparent that the initial support for its validity as a risk-assessment persistent aural bleeding, which is an uncommon measure. feature of Chronic Suppurative Otitis Media, was the result of trauma inflicted by its mother; a case of Grisso T, Vincent GM. The empirical limits of forensic 535
- 544. mental health assessment.Law Hum Behav 2005; from the National Longitudinal Survey of Youth. 29(1):1-5. MAIN OUTCOME MEASURE: Internalizing and Abstract: This article introduces a special issue of Law externalizing behavior problem scales of the Behavior and Human Behavior, including five articles describing Problems Index. RESULTS AND CONCLUSIONS: the limits of forensic mental health assessments of (a) Parental use of corporal punishment was associated risk of violence in female adolescents, (b) sexually with a 0.71 increase (P<.05) in children's externalizing violent predators, (c) dangerousness in capital murder behavior problems even when several parenting cases, (d) child sexual abuse, and (e) PTSD litigants. behaviors, neighborhood quality, and all time-invariant Knowing the limits of forensic mental health variables were accounted for. The association of assessment methods is essential in order to recognize corporal punishment and children's externalizing their strengths, increase the credibility of forensic behavior problems was not dependent on neighborhood mental health assessment, and drive research that will context. The research found no discernible relationship enhance the value of assessments for the courts. between corporal punishment and internalizing behavior problems. Gritz ER, Tripp MK, James AS et al. An intervention for parents to promote preschool children's sun protection: Grogan-Kaylor A, Otis MD. The effect of childhood effects of Sun Protection is Fun! Prev Med 2005; maltreatment on adult criminality: a tobit regression 41(2):357-66. analysis. Child Maltreat 2003; 8(2):129-37. Abstract: BACKGROUND: Young children are an Abstract: This article reports on the results of an important focus of sun-protection efforts, but there has analysis of a data set containing information on 667 been relatively little study of sun-protection nonmaltreated and 908 maltreated children. The data interventions developed for preschool-aged children also contain information on whether the study subjects and their parents. This paper reports on the evaluation were arrested in early adulthood. Because adult arrests of Sun Protection is Fun! (S.P.F.), designed to improve are an imperfect and censored measure of antisocial parents' practices and psychosocial outcomes related to behavior, tobit regression analysis was used to examine protecting preschool children from sun exposure. the effect of the subjects' experiences of child METHODS: A group-randomized trial was conducted maltreatment on later arrests while controlling for those in 20 preschools to evaluate the S.P.F. parent subjects' demographic characteristics. The analysis intervention that included a video, newsletters, and finds that children's age, race, and sex and experiences handbooks. A separate, on-site intervention for of child neglect all have an impact on subsequent adult preschool staff aimed to create a preschool climate that arrests. However, physical abuse and sexual abuse do encouraged parents' sun protection for their children. not emerge as statistically significant predictors of Cross-sectional samples of parents completed surveys arrests in this model. The study also illustrates a at baseline (n = 384), 12 months (n = 640), and 24 method for the decomposition of tobit coefficients to months (n = 694). RESULTS: S.P.F. demonstrated extract more information from them. significant effects on parents' sun-avoidance strategies at 12 months (P < .05) and sunscreen use at 24 months Groote AD, Groswasser J, Bersini H, Mathys P, Kahn A. (P < .05). There were significant intervention effects on Detection of obstructive apnea events in sleeping parents' sun-protection knowledge (P < .001), infants from thoracoabdominal movements. J Sleep perceived norms of teachers' sunscreen use (P < .001), Res 2002; 11(2):161-8. sunscreen impediments (P < .05), and sunscreen Abstract: The aim of the study was to determine expectancies (P < .05) at 12 months. Parents' perceived whether in infants, the evaluation of thoracoabdominal norms of teacher sunscreen use were significantly movements alone, with no measurement of airflow, improved at 24 months (P < .001). CONCLUSIONS: could be used to identify obstructive sleep apnea events More intense intervention strategies may need to (OA). Two different methods were used: first, we complement take-home materials to result in greater initially quantified thoracoabdominal asynchrony. effects on parents' sun protection for their children. Although 79.3% of OAs showed a significant increase of thoracoabdominal asynchrony, only 10.9% of the Grogan-Kaylor A. Relationship of corporal punishment and events scored by the identification of phase opposition antisocial behavior by neighborhood. Arch Pediatr were true OAs. Next, we developed two artificial Adolesc Med 2005; 159(10):938-42. neural networks (ANNs) as classifiers for the study of Abstract: OBJECTIVES: To examine the relationship the thoracoabdominal signals. The first network was of corporal punishment with children's behavior trained to locate obstructive and central apnea events. It problems while accounting for neighborhood context correctly detected 75% of the OAs; however, only and while using stronger statistical methods than 6.2% of the detected events were true OAs. When a previous literature in this area, and to examine whether second network was used, OAs could not be different levels of corporal punishment have different discriminated from other portions of the signals effects in different neighborhood contexts. DESIGN: showing similar phase characteristics. It was concluded Longitudinal cohort study. SETTING: General that the information available in uncalibrated signals of community. PARTICIPANTS: 1943 mother-child pairs thoracic and abdominal respiratory movements was 536
- 545. insufficient to unambiguouslydetect OA events in the current parent-child relationship. In addition, the sleeping infants. domestic and international adoptees' behavior is more similar than it is different. The study highlights the Gross E, Burr CK. HIV counseling and testing in pregnancy. importance of helping families understand how early N J Med 2003; 100(9 Suppl):21-6; quiz 67-8. negative experiences are associated with behavior difficulties. Results suggest that families may have Grossman DC. Computer simulation: a powerful tool for similar need for social and medical services, regardless injury control. Arch Pediatr Adolesc Med 2001; of the country of origin of adoption. 155(9):992-3. Gruber KJ, Fleetwood TW. In-home continuing care Grote A. [Traction retinal detachment, optic atrophy, apallic services for substance use affected families. Subst Use syndrome after shaking trauma in an infant]. Misuse 2004; 39(9):1379-403. Ophthalmologe 2002; 99(4):295-8. Abstract: The role of in-home work with substance use Abstract: INTRODUCTION: Ophthalmological affected family members has great potential for examinations are important in children with suspected addressing family and personal issues that are often not shaken baby and/or battered child syndrome. Retinal well addressed by continuing care interventions that and epiretinal haemorrhages can indicate non- involve limited contact with the family and the impact accidental injuries. We observed a case of extensive alcohol and other drug "abuse" has on the family retinal hemorrhages, edema of the optic disc followed environment. This article reviews the importance of by development of optic atrophy, neovascularisation involving the family in the recovery process and offers and tractional retinal detachment over the course of comparative advantages of an in-home visitation months. CASE REPORT: A 6-week-old infant with no approach for assisting the substance user with history of systemic disease or trauma was admitted to maintaining substance use avoidance, reintegrating the children's hospital because of a disorder of with the family, and addressing unresolved family consciousness, respiratory insufficiency, taut fontanel issues affecting children and spousal relationships. and dilated pupils with sluggish reaction to light. A subdural haematoma was diagnosed. Ophthalmological Gruber KJ, Fleetwood TW, Herring MW. In-home examination showed no signs of trauma in the anterior continuing care services for substance-affected segment. Ophthalmoscopy revealed extensive retinal families: the bridges program. Soc Work 2001; haemorrhages and swollen optic nerve heads. During 46(3):267-77. the next months optic atrophy, subretinal fibrosis at the Abstract: Addressing substance abuse in families is an posterior pole, neovascularisation at the optic disc and important concern for the social work field. This article non-rhegmatogenous retinal detachment developed. presents a preliminary view of a continuing care The child is in a persistent vegetative state. substance abuse recovery services program designed to DISCUSSION: Non-accidental injuries can cause assist the substance-affected family. The intervention direct trauma and indirect traumatic sequelae. Retinal approach is a blended model of substance abuse haemorrhages, especially in conjunction with recovery work and family preservation. Services are unexplained trauma or changes of consciousness directed at helping substance-abusing parents with should arouse suspicion of shaken baby syndrome. The "recovering" their role with their families, developing ophthalmologist should emphasize this and strongly support for their recovery work, and helping them gain recommend further investigation if not previously the education and skills they need for effective undertaken. parenting, supportive family involvement, and avoidance of drugs and alcohol. The program focuses Groza V, Ryan SD. Pre-adoption stress and its association on helping substance abusers and their families achieve with child behavior in domestic special needs and relapse prevention by addressing functioning in four international adoptions. Psychoneuroendocrinology domains: individual actions and cognitions, individual 2002; 27(1-2):181-97. recovery actions, family actions and cognitions, and Abstract: This article presents data from studies of family recovery actions. The article presents two case children adopted through the United States public child examples to highlight the efficacy of the intervention welfare system and children adopted internationally model and the general positive effect continuing care from Romania. The article summarizes the data on: a). services are having on substance-affected families. behavior problems as they relate to Romanian adoptees from a cross-sectional study, b). behavior problems for Grundell E. Tissue typing for bone marrow transplantation: a sample of children adopted through the United States an ethical examination of some arguments concerning public child welfare system from a cross-sectional harm to the child. Monash Bioeth Rev 2003; 22(4):45- study, and c). a comparison of children's behavior for 55. these two groups. Results indicate that the most Notes: GENERAL NOTE: KIE: 48 fn. significant predictor of children's behavior is a negative GENERAL NOTE: KIE: KIE Bib: organ and tissue pre-adoptive history of abuse or institutionalization and donation; prenatal diagnosis; reproduction 537
- 546. Abstract: Tissue typing(TT) is a recent and comments on "Childhood victimization and pain in controversial scientific advance. Whilst its current adulthood" K.G. Raphael et al., Pain 2001; 92:283-293. applications can easily be described as pro-therapeutic Pain 2002; 98(1-2):231-3; author reply 233-4. and within the realms of preventative medicine, its specificity and potential are often characterized as the Guevara AL. In re K.I.: an urgent need for a uniform system tip of the eugenic iceberg: undermining the very basis in the treatment of the critically ill infant--recognizing of individual autonomy and identity in an inevitable the sanctity of life of the child. Univ San Francisco march towards the perfect society. In addition to Law Rev 2001; 36(1):237-60. arguments concerning societal harms flowing from TT, Notes: GENERAL NOTE: KIE: Guevara, Angie L significant concerns have also been raised concerning GENERAL NOTE: KIE: 203 fn. harms to the future child born as a result. In the context GENERAL NOTE: KIE: KIE Bib: allowing to of current legislation and policy, this article examines die/infants two aspects of arguments concerning harm to the future child: those relating to psychological harms, and those Guha-Sapir D, van Panhuis WG, Degomme O, Teran V. arguing that TT is contrary to the future child's best Civil conflicts in four african countries: a five-year interests. The article examines the moral basis for review of trends in nutrition and mortality. Epidemiol arguments concerning harm to the future child. It Rev 2005; 27:67-77. proposes that arguments concerning psychological harm may overlook or minimise the potential benefits Guilamo-Ramos V, Turrisi R, Jaccard J, Wood E, Gonzalez flowing from the broader social, familial context into B. Progressing from light experimentation to heavy which the child is born. These arguments may be episodic drinking in early and middle adolescence. J countered, or at least balanced, by considering the Stud Alcohol 2004; 65(4):494-500. future child in this context. In relation to arguments Abstract: OBJECTIVE: Few studies have examined that TT is contrary to the future child's best interests, psychological variables related to changes in drinking the paper examines a non-standard consideration of patterns from light experimentation with alcohol to best interests. It argues that this standard should be heavy episodic drinking in early and middle used in considering whether or not TT for bone marrow adolescence. The present study examined parental and transplant is harmful to the future child, thereby peer influences, gender and grade level as predictors of extending moral consideration of interests to intra- such changes in adolescent alcohol consumption. familial interests and outcomes. On this basis, it can be METHOD: Approximately 1420 light drinkers were argued that TT is not contrary to the interests of the analyzed from Wave 1 of the National Longitudinal future child. The paper concludes by noting a potential Study of Adolescent Health (Add Health). Heavy tension between the first guiding principle of the episodic drinking activity was assessed 1 year later. Infertility Treatment Act 1995 (Vic) and the current RESULTS: Gender differences in transitions to heavy Victorian policy on TT. episodic drinking were observed, with males being more likely than females to make a transition. Parent Grupp-Phelan J, Zatzick D. Post-traumatic stress and its parameter setting and communication variables, as well effect on health outcomes in children. J Pediatr 2005; as peer variables at different grade levels, buffered 146(3):309-10. these gender differences. CONCLUSIONS: Adolescents who are light experimenters represent a Gruson LM, Chang MW. Berloque dermatitis mimicking high-risk group as a consequence of their initial child abuse. Arch Pediatr Adolesc Med 2002; consumption tendencies. Some of these adolescents 156(11):1091-3. graduated beyond simple experimentation and moved Abstract: Berloque dermatitis is a type of photocontact into patterns of consumption that could be considered dermatitis. It occurs after perfumed products containing dangerous. Our analyses implicated an array of bergamot (or a psoralen) are applied to the skin parental-based buffers: parent involvement in the followed by exposure to sunlight. Striking linear adolescent's life, development of good communication patterns of hyperpigmentation are characteristic, patterns and expressions of warmth and affection. corresponding to local application of the scented Minimizing associations with peers who consume product. In the acute phase, erythema and even alcohol may also have a buffering effect. There was blistering can be seen. We report a case of berloque evidence that these buffers may dampen gender dermatitis in a 9-year-old girl that was initially reported differences not so much by affecting female drinking as child abuse. To our knowledge, this is the first report tendencies as by keeping males at reduced levels of of berloque dermatitis mimicking child abuse. alcohol consumption comparable to those of females. Questioning to elicit a history of perfume application coupled with sunlight exposure should help to prevent Guler NF, Kocer S. Classification of EMG signals using this misdiagnosis in children. PCA and FFT. J Med Syst 2005; 29(3):241-50. Abstract: In this study, the fast Fourier transform (FFT) Grzesiak RC. "Psychogenic pain" and pain-proneness: analysis was applied to EMG signals recorded from 538
- 547. ulnar nerves of59 patients to interpret data. The data of decrease in the number of children hospitalised for the patients were diagnosed by the neurologists as 19 injuries sustained in the home environment, it is not patients were normal, 20 patients had neuropathy and possible to determine if this is a 'real' change or a result 20 patients had myopathy. The amount of FFT of other factors affecting the data. While children coefficients had been reduced by using principal continue to be killed and injured as a result of components analysis (PCA). This would facilitate preventable incidents in the home environment, injury calculation and storage of EMG data. PCA coefficients prevention strategies should be continued and were applied to multilayer perceptron (MLP) and strengthened. support vector machine (SVM) and both classified systems of performance values were computed. Gumpert CH. [Assessment of children's reliability in Consequently, the results show that SVM has high connection with sexual abuse. A complex interplay anticipation level in the diagnosis of neuromuscular between the judicial system and expert witnesses]. disorders. It is proved that its test performance is high Lakartidningen 2002; 99(24):2734-8. compared with MLP. Gunn VL, Hickson GB, Cooper WO. Factors affecting Guler NF, Kocer S. Use of support vector machines and pediatricians' reporting of suspected child neural network in diagnosis of neuromuscular maltreatment. Ambul Pediatr 2005; 5(2):96-101. disorders. J Med Syst 2005; 29(3):271-84. Abstract: OBJECTIVE: To identify factors associated Abstract: In this study the performance of support with pediatricians' decision not to report suspected vector machine (SVM)and back-propagation neural child maltreatment. DESIGN: A survey was distributed network were applied to analyze the classification of to a random sample of pediatricians in a single state. the electromyogram (EMG) signals obtained from Participants were asked if they had ever suspected normal, neuropathy and myopathy subjects. By using child abuse or neglect but did not report. In addition, autoregressive (AR) modeling, AR coefficients were all were asked to list all the considerations that obtained from EMG signals. Moreover, the support pediatricians incorporate into their decisions not to vector machine and artificial neural network (ANN) report. RESULTS: One hundred ninety-five were used as base classifiers. The AR coefficients were pediatricians completed the survey (56% of those benefited as inputs for SVM and ANN. Besides, these eligible). Twenty-eight percent of respondents stated coefficients were tested both in ANN and SVM. The that they had considered reporting an incident of results show that SVM has high anticipation level in suspected child maltreatment but had chosen not to. the diagnosis of neuromuscular disorders. It is proved Providers who had chosen not to report were more that its test performance is high compared with ANN. likely to be men (P = .006), to have been in practice longer (P = .001), to have reported more cases (P = Gulliver P, Dow N, Simpson J. The epidemiology of home .001), to have been deposed (P = .001) or to have injuries to children under five years in New Zealand. testified (P = .01) in child maltreatment cases, and to Aust N Z J Public Health 2005; 29(1):29-34. have been threatened with lawsuit (P = .02) than were Abstract: OBJECTIVE: This paper describes the pediatricians who had never declined to report. epidemiology of injuries sustained by children under Multivariate logistic regression demonstrated that male five in the home. METHODS: Cases were selected gender (odds ratio [OR] 2.18; 95% confidence interval from the New Zealand Health Information Service [CI] 1.05-4.49), years in practice (OR 1.23; 95% CI public hospital morbidity and mortality data, and 1.05-1.44), and experience reporting (OR 1.28; 95% CI included all 0-4 year olds where the place of injury 1.02-1.60) were all independently associated with occurrence was classified as 'home'. The circumstances decisions not to report. Respondents who had declined of injury were coded according to the Supplementary to report were more likely to cite lack of knowledge Classifications of External Causes of Injury and about reporting laws and process (P = .05) and poor Poisoning (E-codes) of the International Classifications experiences with child service agencies (P = .03) as of Diseases. Age-specific rates of death or reasons for not reporting than were their counterparts hospitalisation due to injury were calculated using the who had never declined to report suspected population of 0-4 year olds in New Zealand for each maltreatment. CONCLUSIONS: Many barriers exist to year as the denominator. RESULTS: The rate of death reporting suspected maltreatment. Specific educational from an injury sustained at home between 1989 and interventions may be helpful in eliminating barriers to 1998 was 13 per 100,000 population per year. The reporting. main causes of death were suffocation, submersion, homicide and fire. The rate of hospitalisation in Gupta A, Rani M, Mittal AK, Dikshit PC. A study of children aged 0-4 years from an injury sustained in the homicidal deaths in Delhi. Med Sci Law 2004; home between 1989 and 2000 was 737 per 100,000 44(2):127-32. population per year. The most frequently recorded Abstract: A meticulous post-mortem review was causes of hospitalisation were falls, scalds, poisonings undertaken in the department of forensic medicine at and cut/piercing incidents. CONCLUSION AND the Maulana Azad Medical College (MAMC) to find IMPLICATIONS: Although there has been an apparent 539
- 548. out trends inhomicides during the period 1992-1996. terms of the children's involvement with peers, Standard procedures for autopsies and a review of the maternal arranging and monitoring of peer play, and inquest papers were carried out. Out of 3,886 medico- maternal beliefs about inclusion. RESULTS: Despite legal autopsies performed in the department during the aetiology-specific expectations for children with DS, said period, only 232 cases (5.9%) were homicidal no differences were found for a variety of measures of deaths. The commonest age group of the victims was peer involvement focusing on the frequency of contacts 21-30 years (38%). Males were victimized three times and the characteristics of children's peer social more often than females. The incidence of crime was networks. Maternal arranging of activities with peers slightly more at night than in the daytime, though was similarly related to peer involvement for both evenly distributed during the winter and summer groups of children. Higher ratings of the benefits of seasons. In our series, sharp weapon injuries were the inclusion were obtained from mothers of children with most common type (34.9%) followed by blunt force DS, but these maternal beliefs were unrelated to injuries (15.9%). Defence wounds were present in 35 maternal arranging or peer involvement. cases (15%). Violent rage/quarrel was the motive in 61 CONCLUSIONS: Parental adaptations to the cases (29%). aetiology-specific behavioural patterns of children and the general influence of children's experiences within a Gupta S, Berg D, de Lott F, Kellner P, Driver C. Directly developmental framework are discussed in the context observed therapy for tuberculosis in New York City: of interpreting aetiology-specific findings. factors associated with refusal. Int J Tuberc Lung Dis 2004; 8(4):480-5. Gureje O, Alem A. Hidden science? A glimpse at some Abstract: OBJECTIVES: To describe patients who work in Africa. World Psychiatry 2004; 3(3):178-81. utilize hospital-based directly observed therapy (DOT) Abstract: Even though Africa contributes a programs and to describe factors that influence refusal disproportionately small quantity to the world scientific of DOT. METHODS: Retrospective analysis of information pool, much of what it produces may be patients diagnosed with tuberculosis through hospital unavailable to the scientific community. A number of admission in 1997 at 12 hospital sites with out-patient scientific journals published on the continent but not DOT programs. Data were obtained from hospital listed in international indexes often report studies in patient records and from the New York City mental health and related fields. An analysis of some of Tuberculosis Case Registry. RESULTS: Of 443 these publications revealed that, over the period 1999- patients diagnosed with tuberculosis in 1997 at the 12 2003, research issues addressed include substance hospital sites and available and/or eligible for DOT, 52 abuse, neuroscience and neuropsychiatry, health (12%) refused DOT. The two main reasons for DOT services, and child mental health. Most of the studies refusal were that the patients felt they could self- are descriptive and based on convenient or clinical medicate (21%) and that their work schedule interfered samples. Community-based epidemiological studies with a DOT program (19%). White non-Hispanic and those examining the cost-effectiveness of different race/ethnicity was associated with refusal of DOT (P = forms of intervention are rare. Even though the strength 0.001). Conversely, interview for DOT while in the of the studies reported varied considerably, they hospital (P < 0.001) and enrollment in drug treatment nevertheless suggest that a considerable amount of were associated with acceptance of DOT (P = 0.05). research activities is taking place on the continent. The The five hospitals with tuberculosis clinics on site had number and types of studies reported highlight the poor the lowest percentages (0-9%) of patients refusing investment in research in Africa. DOT. CONCLUSION: To increase patient acceptance of DOT, programs need flexible hours that Guterman NB. Advancing prevention research on child accommodate patients in the workforce. Patient abuse, youth violence, and domestic violence: education should focus on the difficulty of completing emerging strategies and issues. J Interpers Violence tuberculosis treatment on a self-administered regimen 2004; 19(3):299-321. and the importance of the support offered through Abstract: Prevention research on the related problems DOT. of child abuse, youth violence, and domestic violence has grown at an accelerating pace in recent years. In Guralnick MJ. Involvement with peers: comparisons this context, a set of shared methodological issues has between young children with and without Down's emerged as investigators seek to advance the syndrome. J Intellect Disabil Res 2002; 46(Pt 5):379- interpersonal violence prevention knowledge base. 93. This article considers some of the persistent Abstract: BACKGROUND: It has been well methodological issues in these areas and points out established that heterogeneous groups of young emerging research strategies that are forging advances children with mild intellectual disability are at in garnering valid, rigorous, and useful knowledge to considerable risk of becoming socially isolated from prevent interpersonal violence. Research issues and their peers in school, home and community settings. emerging strategies in three key domains of prevention METHOD: Matched groups of young children with research are considered, including complexities in and without Down's syndrome (DS) were compared in validly conceptualizing and measuring varying forms 540
- 549. of violence asspecific targets for preventive Children's Attitudes and Behaviors Towards Animals intervention, research issues and strategies designed to (CABTA) was designed and piloted on 360 elementary reliably predict and identify future violence risk to be school children, enabling community norms and a targeted by preventive intervention, and research issues factor structure for the instrument to be derived. In the and emerging strategies in the application of empirical second phase, the questionnaire was completed by the methods to forge specific advances in preventive parents of a small sample of children (N = 17) to intervention strategies themselves. establish its test-retest reliability. In the third phase of the study, the CABTA was completed by the parents of Guthrie BJ, Young AM, Boyd CJ, Kintner EK. Dealing with 19 children who had been diagnosed with either a daily hassles: smoking and African-American Disruptive Behavioral Disorder or Attention Deficit adolescent girls. J Adolesc Health 2001; 29(2):109-15. Hyperactivity Disorder, and the results were compared Abstract: PURPOSE: To examine cigarette use and its with the outcome of a semistructured interview with relationship to daily life hassles in an urban sample of parents regarding their child's behavior toward animals. African-American adolescent girls. METHODS: A The results of the various phases of the study indicated sample of 105 African-American adolescent girls that the CABTA consists of two factors. Typical and (mean age of 15.45 years) derived from a larger cross- Malicious Cruelty to animals, and is a reliable and sectional research project titled "Female Adolescent valid tool for detecting childhood cruelty to animals. Substance Experience Study" funded by the National Possible use and adaptations of the CABTA as a Institute of Drug Abuse comprised the sample. The screening instrument in clinical and community sample was divided into adolescents who had ever samples are discussed. smoked in their lifetime and adolescents who had never smoked before. Student's t-tests were conducted to Gwadz MV, Clatts MC, Leonard NR, Goldsamt L. determine whether there were differences between Attachment style, childhood adversity, and behavioral these groups on demographic characteristics and the risk among young men who have sex with men. J number of daily life hassles. Pearson product moment Adolesc Health 2004; 34(5):402-13. correlations were also conducted to examine the Abstract: PURPOSE: To examine relationships among association between age of smoking initiation and childhood adversity, attachment style (one's core number of hassles. RESULTS: Less than 50% of the beliefs regarding the self and others), and the following teenagers had ever smoked cigarettes in their lifetime, risk behaviors and contexts among young men who and of those who had ever smoked, the average age of have sex with men (YMSM): homelessness, daily initiation was 12.55 years (SD = 2.63). Furthermore, substance use, participation in sex work, involvement girls who had ever smoked, in contrast to girls who had in the criminal justice system, and being out of school never smoked, had a significantly greater number of or work. METHODS: Using a targeted sampling daily life hassles, in general, and within the approach, we recruited 569 YMSM aged 17-28 years school/academic and family/economic domains in from natural venues in New York City including bars, particular. Age of smoking initiation was negatively clubs, parks, and bus stations. Youth completed a related to the number of hassles, indicating that girls structured interview assessing lifetime and current risk who started to smoke at a younger age reported more and protective contexts and behavior. Data were hassles. CONCLUSIONS: These findings are analyzed using univariate and multivariate statistical discussed in terms of developing an understanding of methods, including hierarchical logistic regression. gender and ethnic-specific correlates of smoking that RESULTS: After controlling for demographic can be used to better delineate the developmental characteristics and childhood adversity, YMSM with a smoking trajectory of African-American girls. fearful attachment style were more likely to have been homeless (OR 2.93, 95% CI 1.65-5.18), to have Guyer B. Challenges facing MCH leadership: Martha May participated in sex work (OR 2.35, 95% CI 1.44-3.85), Eliot Award Commentary, 2003. Matern Child Health J to use substances daily (OR 2.79, 95% CI 1.29-6.03), 2004; 8(1):43-4. to have been involved in the criminal justice system (OR 2.04, 95% CI 1.38-3.01), and to be out of Guymer EC, Mellor D, Luk ES, Pearse V. The development school/work (OR 2.47, 95% CI 1.47-4.15). Three of a screening questionnaire for childhood cruelty to subgroups were particularly vulnerable: YMSM who animals. J Child Psychol Psychiatry 2001; 42(8):1057- identified as heterosexual, or bisexual, and/or 63. transgender. CONCLUSIONS: A fearful attachment Abstract: Childhood cruelty to animals may be a style contributes to some YMSM remaining outside of marker of poor prognosis amongst conduct disordered the protective systems of family, school, and work, and children. However, other than semistructured is associated with risky contexts where they are less interviews with parents or children, there are no likely to encounter prosocial peers and adults. Further, screening instruments for this behavior. The aim of this it is associated with risk behavior. Although gay- study was to develop such an instrument. In the first identified youth are generally found to have poor phase of the study, a parent-report questionnaire, outcomes when compared with the general population of adolescents, in the present report, YMSM who 541
- 550. identified as heterosexualwere at particular risk. Abstract: We described a case of shaken-baby Attachment theory can guide interventions by syndrome with multiple chronic subdural hematomas. informing how individuals experience relationships and A 10-month-old male baby was admitted to our manage developmental transitions. hospital because of loss of consciousness and convulsions. CT scan revealed an acute subarachnoid Haas F. Bereavement care: seeing the body. Nurs Stand hemorrhage extending into the interhemispheric fissure 2003; 17(28):33-7. and supracerebellar space. The patient was treated Abstract: BACKGROUND: Generally, it is now conservatively, and discharged from the hospitaL Two accepted that the long-term outcomes are better for months after ictus, a baby was admitted to our hospital those who are able to see the body of a loved one as it with general fatigue. CT scan demonstrated multiple helps people who are grieving to come to terms with chronic subdural hematomas. Burr hole irrigation and the death. CONCLUSION: While the evidence drainage brought about complete disappearance of indicates that seeing the body of a loved one helps the these lesions. Retrospectively, it was found that these grieving process, a recent study into bereavement multiple subdural hematomas were due to shaken-baby reactions following neonatal deaths gives disturbing syndrome. Shaken-baby syndrome is a form of child evidence to the contrary, so while it may usually be abuse that can cause significant head injury, and good practice to encourage viewing, this may be subdural hematoma is the most common manifestation. potentially damaging to new parents who have lost a It is well known that the outcome of shaken-baby baby. syndrome is generally not good. It is important to suspect shaken-baby syndrome when a chronic Haddad HM. Munchausen syndrome by proxy. subdural hematoma is seen in a baby. Ophthalmology 2004; 111(2):407; author reply 407. Hagele DM. The impact of maltreatment on the developing Hadders-Algra M. Early brain damage and the development child. N C Med J 2005; 66(5):356-9. of motor behavior in children: clues for therapeutic intervention? Neural Plast 2001; 8(1-2):31-49. Haggerty RJ. Index of suspicion. Pediatr Rev 2003; Abstract: The Neuronal Group Selection Theory 24(8):276-83. (NGST) could offer new insights into the mechanisms directing motor disorders, such as cerebral palsy and Haggman-Laitila A. Early support needs of Finnish families developmental coordination disorder. According to with small children. J Adv Nurs 2003; 41(6):595-606. NGST, normal motor development is characterized by Abstract: AIMS: This study describes the early needs two phases of variability. Variation is not at random for support that families with small children have in the but determined by criteria set by genetic information. context of their own life situations. The study Development starts with the phase of primary population consisted of Finnish families (n = 551) who variability, during which variation in motor behavior is participated in a project titled 'Families with Children' not geared to external conditions. At function-specific (1996-2001). The project supplemented the existing ages secondary variability starts, during which motor public services. The information provided by the study performance can be adapted to specific situations. In was utilized in supporting families and developing both forms, of variability, selection on the basis of family work in seven experimental areas. METHODS: afferent information plays a significant role. From the The data were collected between 1997 and 2000 using NGST point of view, children with pre- or perinatally family service plans and client reports. The data were acquired brain damage, such as children with cerebral analysed with inductive content analysis and using the palsy and part of the children with developmental SPSS software (version 7.5). FINDINGS: The families coordination disorder, suffer from stereotyped motor needed support in the areas of parenthood, upbringing behavior, produced by a limited repertoire or primary and child care, marital problems and social support (sub)cortical neuronal networks. These children also networks. The need for early support was also have problems in selecting the most efficient neuronal connected to health problems of the children or the activity, due to deficits in the processing of sensory parents, problems with work or studies, unemployment, information. Therefore, NGST suggests that problems in economic or living conditions, or family intervention in these children at early age should aim at crises. In addition to support, the families searched for an enlargement of the primary neuronal networks. With help from family workers in disputes over child increasing age, the emphasis of intervention could shift custody and visitation rights, intoxicant abuse and to the provision of ample opportunities for active violence, and problems in adjusting to society. Each practice, which might form a compensation for the family had 4-5 needs for early support. impaired selection. CONCLUSIONS: The results demonstrate that families with small children have many needs for which they Haga S, Ishido K, Inada N, Sakata S. [Multiple chronic seek help when there are available services subdural hematoma in shaken-baby syndrome]. No supplementing the existing public services. The Shinkei Geka 2004; 32(8):845-8. information provided by the study can be utilized in 542
- 551. maternity and childwelfare clinics, in social services adults with SUD had psychopathology that began in and in family work provided by civic organizations to childhood, frequently preceding the onset of their SUD. define the early needs of families for support and to These findings further highlight the importance of develop services. targeting antecedent disorders for preventive and early intervention programs aimed at reducing the risk for Haggstrom-Nordin E, Hanson U, Tyden T. Associations SUD. between pornography consumption and sexual practices among adolescents in Sweden. Int J STD Hahn ME, Farley AM, Lin V, Chou LS. Neural network AIDS 2005; 16(2):102-7. estimation of balance control during locomotion. J Abstract: Pornography consumption and sexual Biomech 2005; 38(4):717-24. behaviour were studied, with an aim to investigate any Abstract: Gait patterns of the elderly are often adjusted associations. Participants were 718 students from 47 to accommodate for reduced function in the balance high school classes, mean age 18 years, in a medium- control system and a general reduction in skeletal sized Swedish city. More men (98%) than women muscle strength. Recent studies have demonstrated that (72%) had ever consumed pornography. More male measures related to motion of whole body center of high consumers than low consumers or women got mass (COM) can distinguish elderly individuals with sexually aroused by, fantasized about, or tried to balance impairment from healthy peers. Accurate COM perform acts seen in a pornographic film (P<0.001). estimation requires a multiple-segment anthropometric Three-quarters of the sample had had sexual model, which may restrict its broad application in intercourse, of which 71% reported contraceptive use assessment of dynamic instability. Although temporal- at first intercourse. Anal intercourse was reported by distance measures and electromyography have been 16%, with infrequent condom use (39%). Intercourse used in evaluation of overall gait function and with a friend (adjusted odds ratio (adj. OR) 2.29; 95% determination of gait dysfunction, no studies have confidence interval (CI) 1.27-4.12) was significantly examined the use of gait measurements in predicting associated with high consumption of pornography COM motion during gait. The purpose of this study among men, while anal intercourse (adj. OR 1.99; 95% was to demonstrate the effectiveness of an artificial CI 0.95-4.16) and group sex (adj. OR 1.95; 95% CI neural network (ANN) model in mapping gait 0.70-5.47) tended to be associated. A significant measurements onto COM motion in the frontal plane. confounder was early age of sexual debut (adj. OR Data from 40 subjects of varied age and balance 1.49; 95% CI 1.18-1.88). impairment were entered into a 3-layer feed-forward model with back-propagated error correction. Hagman J, Hyytinen P, Tuulonen A. A pilot experiment Bootstrap re-sampling was used to enhance the using a network camera in ophthalmic teleconsultation. generalization accuracy of the model, using 20 re- Acta Ophthalmol Scand 2004; 82(3 Pt 1):311-2. sampling trials. The ANN model required minimal processing time (5 epochs, with 20 hidden units) and Hahesy AL, Wilens TE, Biederman J, Van Patten SL, accurately mapped COM motion (R-values up to 0.89). Spencer T. Temporal association between childhood As training proportion and number of hidden units psychopathology and substance use disorders: findings increased, so did model accuracy. Overall, this model from a sample of adults with opioid or alcohol appears to be effective as a mapping tool for estimating dependency. Psychiatry Res 2002; 109(3):245-53. balance control during locomotion. With easily Abstract: Adults with substance use disorders (SUD; obtained gait measures as input and a simple, alcohol or drug abuse or dependence) were evaluated computationally efficient architecture, the model may to determine if childhood-onset psychopathology prove useful in clinical scenarios where preceded the onset of SUD. Using structured electromyography equipment exists. psychiatric interviews, we assessed 47 clinically referred adults with SUD (27 with opioid dependence Hahn RA, Bilukha O, Lowy J et al. The effectiveness of and 20 with alcohol dependence), with attention to therapeutic foster care for the prevention of violence: a childhood-onset psychopathology. A sequence of systematic review. Am J Prev Med 2005; 28(2 Suppl psychopathology and SUD was reconstructed using 1):72-90. mean diagnosis onset data. Sixty-two percent of the 47 Notes: CORPORATE NAME: Task Force on SUD adults (mean age 39.3+/-6.6 years) had early- Community Preventive Services onset SUD (defined as < or = 18 years) and 38% had late-onset SUD (> or = 19 years at onset). Hahn RA, Lowy J, Bilukha O et al. Therapeutic foster care Psychopathology preceded the onset of SUD in 56% of for the prevention of violence: a report on adults. Attention deficit/hyperactivity disorder, recommendations of the Task Force on Community multiple anxiety, and disruptive disorders typically Preventive Services. MMWR Recomm Rep 2004; preceded the onset of SUD; in contrast, mood disorders 53(RR-10):1-8. (specifically depressive and bipolar disorders) followed Notes: CORPORATE NAME: CDC Task Force on the onset of SUD. The majority of clinically referred Community Preventive Services 543
- 552. Abstract: In therapeuticfoster care programs, youths RESULTS: The majority of parents intended who cannot live at home are placed in homes with disclosure. Dominant themes among disclosing parents foster parents who have been trained to provide a included the belief that a child has a right to know and structured environment that supports their learning concerns about the harmful effects of family secrets. social and emotional skills. To assess the effectiveness Among nondisclosing parents, common themes were of such programs in preventing violent behavior among knowing of no compelling reason to tell and perceiving participating youths, the Task Force on Community potential harm in telling. Undecided parents reported Preventive Services conducted a systematic review of concerns about how and when to tell and the child's the scientific literature regarding these programs. possible reaction. Parents in all groups expressed Reported and observed violence, including violent concern about their disclosure decisions. crime, were direct measures. Proxy measures were CONCLUSIONS: Dominant decisional influences externalizing behavior (i.e., behavior in which were beliefs and values and concerns about possible psychological problems are acted out), conduct harm. Longitudinal study is needed to determine the disorder, and arrests, convictions, or delinquency, as impact of disclosure decisions on children, families, ascertained from official records, for acts that might and society. have included violence. Reviewed studies assessed two similar interventions, distinguished by the ages and Haider AH, Risucci DA, Omer SB et al. Injury prevention underlying problems of the target populations. priority score: a new method for trauma centers to Therapeutic foster care for reduction of violence by prioritize injury prevention initiatives. J Am Coll Surg children with severe emotional disturbance (hereafter 2004; 198(6):906-13. referred to as cluster therapeutic foster care) involved Abstract: BACKGROUND: Trauma centers are programs (average duration: 18 months) in which expected to develop injury prevention programs that clusters of foster-parent families cooperated in the care address needs of the local population. A relatively of children (aged 5-13 years) with severe emotional simple, objective, and quantitative method is needed disturbance. The Task Force found insufficient for prioritizing local injury prevention initiatives based evidence to determine the effectiveness of this on both injury frequency and severity. STUDY intervention in preventing violence. Therapeutic foster DESIGN: Pediatric trauma patients (16 years or care for the reduction of violence by chronically younger; n= 7,958) admitted to two Level I regional delinquent adolescents (hereafter referred to as trauma centers (Johns Hopkins Children Center and program-intensive therapeutic foster care) involved Westchester Medical Center) from 1993 to 1999 were short-term programs (average duration: 6-7 months) in grouped by injury causal mechanism according to ICD- which program personnel collaborated closely and 9 external cause codes. An Injury Prevention Priority daily with foster families caring for adolescents (aged Score (IPPS), balancing the influences of severity 12-18 years) with a history of chronic delinquency. On (based on the Injury Severity Score) and frequency, the basis of sufficient evidence of effectiveness, the was calculated for each mechanism and mechanisms Task Force recommends this intervention for were ranked accordingly. RESULTS: IPPS-based rank prevention of violence among adolescents with a lists differed across centers. The highest ranked history of chronic delinquency. This report briefly mechanism of injury among children presenting to describes how the reviews were conducted, provides Johns Hopkins Children Center was "pedestrian struck additional information about the findings, and provides by motor vehicle," and at Westchester Medical Center information that might help communities in applying it was "motor vehicle crash." Different age groups also the intervention locally. had specific injury prevention priorities, eg, "child abuse" was ranked second highest among infants at Hahn SJ, Craft-Rosenberg M. The disclosure decisions of both centers. IPPS was found to be stable (r = 0.82 to parents who conceive children using donor eggs. J 0.93, p < 0.05) across alternate measures of injury Obstet Gynecol Neonatal Nurs 2002; 31(3):283-93. severity. CONCLUSIONS: IPPS is a relatively simple Abstract: STUDY OBJECTIVE: To identify variables and objective tool that uses data available in trauma that influence the disclosure decisions of parents who center registries to rank injury causes according to both conceive children using donor eggs and to compare frequency and severity. Differences between two such variables among disclosing, nondisclosing, and centers and across age groups suggest IPPS may be undecided families. DESIGN: Exploratory, useful in tailoring injury prevention programs to local comparative, descriptive. SETTING: A university population needs. hospital-assisted reproductive technology program in the Midwest. PARTICIPANTS: Thirty-one couples Hall D. Protecting children, supporting professionals. Arch with children conceived with anonymously donated Dis Child 2003; 88(7):557-9. eggs. METHODS: Audiotaped telephone interviews, measures of social support and family environment, Hall I, Strydom A, Richards M, Hardy R, Bernal J, and a demographic survey. MAIN OUTCOME Wadsworth M. Social outcomes in adulthood of MEASURES: Content analysis of interview transcripts children with intellectual impairment: evidence from a and comparison of recurring themes among groups. 544
- 553. birth cohort. JIntellect Disabil Res 2005; 49(Pt 3):171- METHOD: The scale has 33 items representing five 82. domains: Verbal Aggression, Aggression Against Abstract: BACKGROUND: Social Policy for people Objects and Animals, Provoked Physical Aggression, with intellectual disabilities (ID) continues to evolve, Unprovoked Physical Aggression, and Use of but little is known about the lives to which such Weapons. The CAS-P was completed for 73 clinically policies are applied. We aimed to use a prospective referred children. Validity was evaluated dimensionally follow-up of a British birth cohort to identify children by examining the relationship of CAS-P scores to other with mild and more severe intellectual impairment, and parent and teacher rating scales, and categorically by compare a range of social outcomes in adulthood with comparing scores of children with attention-deficit people in the rest of the cohort. METHOD: We used hyperactivity disorder (ADHD) alone, oppositional data from the MRC National Survey for Health and defiant disorder, and conduct disorder. RESULTS: The Development. Intellectual impairment was identified scale as a whole had excellent internal consistency by intelligence tests and educational history. Adult (alpha = .93). Children with conduct disorder were outcome measures included employment and social rated significantly higher than those with oppositional class, education, marriage and children, home defiant disorder, who were rated significantly higher ownership, social networks and community use. than those with ADHD alone. The CAS-P did not RESULTS: We identified 111 people with mild distinguish clinical control children from those with intellectual impairment (2.7%) and 23 with severe ADHD only. Correlations with other rating scales intellectual impairment (0.6%) at age 15/16. By the age provide further support for the validity of the CAS-P. of 43, there were 52 people remaining in the mild CONCLUSIONS: The CAS-P assesses distinct impairment group and 14 in the severe impairment components of aggressive behavior and may fill a gap group. In adulthood those with intellectual impairment in that it distinguishes among various types and enjoyed contact with friends and family, and joined in severity of aggressive behaviors, and the settings in informal social activities. Although the mild which they take place. intellectual impairment group were less likely to attain the following social outcomes than people with normal Halpern CT, Hallfors D, Bauer DJ, Iritani B, Waller MW, intellectual functioning, 67% had jobs, 73% were Cho H. Implications of racial and gender differences in married, 62% had children and 54% owned their own patterns of adolescent risk behavior for HIV and other homes. 12% participated in adult education. People sexually transmitted diseases. Perspect Sex Reprod with more severe intellectual impairment were less Health 2004; 36(6):239-47. likely to attain these outcomes. CONCLUSIONS: Abstract: CONTEXT: Sexual and substance use These outcomes highlight issues in current social behaviors covary in adolescence. Prevalence of HIV policy and suggest efforts should be directed and other sexually transmitted diseases (STDs) differs particularly towards promoting educational according to race and gender, yet few studies have opportunities and developing social inclusion for systematically investigated risk behavior patterns by people with ID. subgroup, particularly with nationally representative data. METHODS: A priori considerations and K-means Hall P. Doctors and the war on terrorism. BMJ 2004; cluster analysis were used to group 13,998 non- 329(7457):66. Hispanic black and white participants in the National Notes: GENERAL NOTE: KIE: 10 refs. Longitudinal Study of Adolescent Health, Wave 1, GENERAL NOTE: KIE: KIE Bib: torture according to self-reported substance use and sexual behavior. Multinomial logit analyses examined racial Hallman M, Buchmann L, Omstead L. NICU managers and gender differences by cluster. RESULTS: Among make their mark on practice. To advance neonatal 16 clusters, the two defined by the lowest risk nursing, a dynamic group of managers forged an idea- behaviors (sexual abstinence and little or no substance exchange program. Nurs Manage 2004; 35(7):41-3. use) comprised 47% of adolescents; fewer than 1% in Abstract: Detroit-area neonatal intensive care unit these groups reported ever having received an STD nurses merge in a spirit of cooperation and support to diagnosis. The next largest cluster-characterized by further the interests of their specialty. sexual activity (on average, with one lifetime partner) and infrequent substance use-contained 15% of Halperin JM, McKay KE, Newcorn JH. Development, participants but nearly one-third of adolescent with reliability, and validity of the children's aggression STDs. Blacks were more likely than whites to be in this scale-parent version. J Am Acad Child Adolesc group. Black males also were more likely than white Psychiatry 2002; 41(3):245-52. males to be in three small clusters characterized by Abstract: OBJECTIVE: To provide preliminary high-risk sexual behaviors (i.e., having had sex with a psychometric data on the Children's Aggression Scale- male or with at least 14 partners, or for drugs or Parent Version (CAS-P), which assesses severity, money). Black females generally were the least likely frequency, pervasiveness, and diversity of aggressive, to be in high-risk behavior clusters but the most likely as distinct from nonaggressive, disruptive behaviors. to report STDs. CONCLUSIONS: Adolescents' risk behavior patterns vary by race and gender, and do not 545
- 554. necessarily correlate withtheir STD prevalence. report "any violence." Of six other sociodemographic Further investigation of adolescents' partners and characteristics examined, importance of religion (OR = sexual networks is needed. .27, CI = 0.07-1.07) and school size (OR = .32, CI = 0.09-1.11) were associated with victimization at the p < Halpern CT, Oslak SG, Young ML, Martin SL, Kupper LL. .10 level. Adolescents who reported that religion was Partner violence among adolescents in opposite-sex important to them and adolescents who attended larger romantic relationships: findings from the National schools were at lower risk of "any violence." Longitudinal Study of Adolescent Health. Am J Public CONCLUSIONS: As with opposite-sex relationships, Health 2001; 91(10):1679-85. psychological and minor physical violence Abstract: OBJECTIVES: This report examines (1) the victimization is common among adolescents involved prevalence of psychological and minor physical in same-sex intimate relationships. Males reporting violence victimization in a nationally representative exclusively same-sex relationships were less likely sample of adolescents and (2) associations between than females to report experiencing the violence sociodemographic factors and victimization. behaviors examined. METHODS: Analyses are based on 7500 adolescents who reported exclusively heterosexual romantic Halsted S, Elder D. Delays in the investigation of allegations relationships in the National Longitudinal Study of of child sexual abuse in the Wellington city district Adolescent Health. Items from the Conflict Tactics 1995-1996: a retrospective study. N Z Med J 2001; Scale were used to measure victimization. Associations 114(1125):33-5. between victimization patterns and sociodemographic Abstract: AIMS: To determine the duration of the characteristics were assessed with polytomous logistic statutory investigation process after referral of alleged regression. RESULTS: One third of adolescents chid sexual abuse and to assess which components of reported some type of victimization, and 12% reported this process are most prone to delay. METHODS: physical violence victimization. Although most Retrospective review of police, Child Youth and sociodemographic characteristics were significantly Family (CYF) and medical records for 123 young associated with victimization, patterns varied by sex persons <17 years old for whom a referral regarding and type of victimization. CONCLUSIONS: alleged sexual abuse was made to the Wellington Psychological and minor physical violence Serious Abuse Team from January 1995 to December victimization is common in opposite-sex romantic 1996. RESULTS: There were 82 (66.7%) females and relationships during adolescence. The sex-specific 41 (33.3%) males referred. Maori and Pacific Island associations between sociodemographic characteristics children were over-represented in the sample. The and patterns of partner violence victimization median time from referral to evidential interview or underscore the importance of pursuing longitudinal, diagnostic interview was 47 days. This period was theory-driven investigations of the characteristics and longer for children <5 years of age (66 days) compared developmental histories of both partners in a couple to with children > or =5 years of age (45.5 days), advance understanding of this public health problem. although this difference was not statistically significant. Although 53.3% of children alleged genital Halpern CT, Young ML, Waller MW, Martin SL, Kupper contact, only 26% were referred for a medical LL. Prevalence of partner violence in same-sex assessment. The time from initiation of investigation to romantic and sexual relationships in a national sample completion was a median of 141 days. Reasons for of adolescents. J Adolesc Health 2004; 35(2):124-31. delay were difficult to delineate but appeared to relate Abstract: PURPOSE: To present the first national to inadequate staffing. CONCLUSIONS: There is an prevalence estimates of psychological and physical unreasonable delay in the investigation of alleged child intimate partner violence between adolescents in same- sexual abuse. This is particularly concerning in sex relationships. METHODS: Analyses focus on 117 younger children. adolescents aged 12-21 years (50% female) from Wave II of the National Longitudinal Study of Adolescent Halvorsen I, Andersen A, Heyerdahl S. Girls with anorexia Health who reported exclusively same-sex romantic or nervosa as young adults. Self-reported and parent- sexual relationships in the 18 months before interview. reported emotional and behavioural problems Items from the Conflict Tactics Scale were used to compared with siblings. Eur Child Adolesc Psychiatry measure partner violence victimization. Data analysis 2005; 14(7):397-406. included computation of prevalence estimates and a Abstract: This follow-up study had three objectives: 1) logistic regression analysis to assess associations to investigate emotional and behavioural problems, between sociodemographic characteristics and violence adaptive functioning and substance use in former victimization. RESULTS: Almost one-quarter of anorexia nervosa (AN) patients compared with adolescents with same-sex romantic or sexual partners siblings, 2) to compare information obtained from reported some type of partner violence victimization; different informants, and 3) to compare questionnaire about 1 in 10 reported physical victimization. results with interview results. Fifty (of 55) female AN Significant sex differences were found (OR = .29, CI = patients, representative for AN patients under 18 years 0.08, 1.00), with males being less likely than females to referred to county health services, were assessed at a 546
- 555. mean of 8.8years after treatment start with the Young maternal smoking on birthweight. Health Econ 2001; Adult Self-Report and the Young Adult Behaviour 10(5):399-410. Checklist (mean age 23.1 years). In all, 48 patients, 25 Abstract: This paper assesses the causal impact of late- siblings, 33 mothers and 27 fathers participated in the term (8th month) maternal smoking on birthweight questionnaire study. Although 41/50 (82 %) had using data from a randomized clinical trial, in which recovered from their eating disorder, the former AN some women were encouraged not to smoke, while patients had substantially more self-reported and others were not. The estimation of treatment effects in parent-reported problems than their siblings, this case is made difficult as a result of the presence of particularly with regard to Internalising Problems and non-compliers, women who would not change their on the Anxious/Depressed syndrome scale. Cross- smoking status, regardless of the receipt of informant agreement between the parents and between encouragement. Because these women are not at risk of parents and patients was high, but low between parents changing treatment status, treatment effect distributions and siblings. The patients with psychiatric diagnoses at may be difficult to construct for them. Consequently, follow-up had substantially higher problem scores than the paper focuses on obtaining the distribution of those without diagnoses both on the self-report and the treatment impacts for the sub-set of compliers found in parent-report, supporting the validity of the the data. Because compliance status is not observed for questionnaires. In conclusion, the self- and parent- all subjects in the sample, a Bayesian finite mixture reports showed a high level of Internalising Problems model is estimated that recovers the treatment effect and were useful instruments in the assessment of parameters of interest. The complier average treatment former AN patients. effect implies that smokers give birth to infants weighing 348 g less than those of non-smokers, on Hamada A, Zakupbekova M, Sagandikova S et al. Iodine average, although the 95% posterior density interval prophylaxis around the Semipalatinsk Nuclear Testing contains zero. The treatment effect is stronger for Site, Republic of Kazakstan. Public Health Nutr 2003; women who were moderate smokers prior to 6(8):785-9. pregnancy, implying a birthweight difference of 430 g. Abstract: OBJECTIVE: This study aimed to clarify the However, the model predicts that only about 22% of iodine deficiency status in the Semipalatinsk region the women in the sample were at risk of changing their that has been contaminated by radioactive fallout from smoking behaviour in response to encouragement to nuclear testing during the period of the former USSR. quit. DESIGN: Based on the Japan-Kazakstan joint project of adult cancer screening around the Semipalatinsk Hamilton CE, Falshaw L, Browne KD. The link between Nuclear Testing Site (SNTS), from May to October recurrent maltreatment and offending behaviour. Int J 2002 spot urine specimens were collected at random in Offender Ther Comp Criminol 2002; 46(1):75-94. each village. Separately, children aged 5-15 years from Abstract: This article considers recurrent maltreatment around the SNTS were chosen at random and spot and offending behaviour. The sample was 60 males and urine specimens were collected from them. SETTING: 19 females (11 to 18 years) resident within a secure Area contaminated by radioactive fallout around the institution in England and considered a risk to SNTS, Republic of Kazakstan. SUBJECTS: A total of themselves and/or others. Overall, 20.8% had not 2609 adults aged >40 years from 16 settlements in experienced maltreatment, 6.5% had experienced a three regions and one city, and 298 children aged 5-15 single incident, 11.7% were repeat victims (same years from two regions and one city. RESULTS: perpetrator), 6.5% were revictimised (different Median urinary iodine concentrations of adults and perpetrators), and more than half (54.5%) had suffered children in all regions were in the range of 116.0-381.7 both repeat and revictimisation. Of those who had and 127.7-183.0 microg l(-1), respectively. The highest committed a violent and/or sexual crime, 74% had prevalence of values <50 microg l(-1) (14.1%) did not experienced some form of revictimisation, compared to exceed 20%. Distributions within each group, adults 33% of those who committed nonviolent offences. and children, showed almost the same pattern, except Those young people most likely to have committed for one region where more than 50% of adults had violent and/or sexual crimes were those who had been urinary iodine concentration >100 microg l(-1). victims of recurrent extrafamilial maltreatment (many CONCLUSIONS: In agreement with our previous of whom had also experienced recurrent intrafamilial studies, the urinary iodine concentration data showed maltreatment). Thus, in this sample, revictimisation no clear evidence of iodine deficiency around the was associated with serious crimes. However, these SNTS. Kazakstan is geographically and nutritionally at findings are preliminary, and prospective research with moderate risk of iodine deficiency disorders without a larger sample is needed. fortification or iodine replacement by iodised salt. The socio-medical prophylaxis against iodine deficiency Hamilton M, Corwin P, Gower S, Rogers S. Why do parents has been successfully maintained in East Kazakstan. choose not to immunise their children? N Z Med J 2004; 117(1189):U768. Hamilton BH. Estimating treatment effects in randomized Abstract: AIMS: To ascertain the reasons why some clinical trials with non-compliance: the impact of parents choose not to immunise their children and 547
- 556. where these parentsobtained their immunisation Hammerschlag MR. Use of nucleic acid amplification tests information. METHODS: Seventy general practitioners in investigating child sexual abuse. Sex Transm Infect (GPs) in Christchurch who kept a record of children 2001; 77(3):153-4. whose parents declined immunisation were asked to recruit these parents. Half of the GPs were able to Hammond P, Hutton TJ, Allanson JE et al. 3D analysis of invite the 76 parents of children declining facial morphology. Am J Med Genet A 2004; immunisation to take part in this study. Twenty one 126(4):339-48. (28%) of these parents agreed to completing a Abstract: Dense surface models can be used to analyze structured questionnaire. RESULTS: Parents in this 3D facial morphology by establishing a sample were highly educated and had used information correspondence of thousands of points across each 3D from a variety of sources in making their decision not face image. The models provide dramatic to immunise. Almost half of the parents had not visualizations of 3D face-shape variation with potential discussed immunisation with their lead maternity carer. for training physicians to recognize the key They viewed information from the Ministry of Health components of particular syndromes. We demonstrate as biased. They were concerned about vaccine safety their use to visualize and recognize shape differences and efficacy and the effects of immunisation on their in a collection of 3D face images that includes 280 child's immune system. CONCLUSIONS: Parents who controls (2 weeks to 56 years of age), 90 individuals choose not to immunise their children are distrustful of with Noonan syndrome (NS) (7 months to 56 years), information provided by the Ministry of Health. and 60 individuals with velo-cardio-facial syndrome General practitioners are the main source of (VCFS; 3 to 17 years of age). Ten-fold cross-validation immunisation information for these parents and they testing of discrimination between the three groups was must be able to provide accurate, unbiased information carried out on unseen test examples using five pattern regarding the risks and benefits of immunisation. recognition algorithms (nearest mean, C5.0 decision trees, neural networks, logistic regression, and support Hammack PL, Richards MH, Luo Z, Edlynn ES, Roy K. vector machines). For discriminating between Social support factors as moderators of community individuals with NS and controls, the best average violence exposure among inner-city African American sensitivity and specificity levels were 92 and 93% for young adolescents. J Clin Child Adolesc Psychol 2004; children, 83 and 94% for adults, and 88 and 94% for 33(3):450-62. the children and adults combined. For individuals with Abstract: Using both surveys and the experience VCFS and controls, the best results were 83 and 92%. sampling method (ESM), community violence In a comparison of individuals with NS and individuals exposure, social support factors, and depressive and with VCFS, a correct identification rate of 95% was anxiety symptoms were assessed longitudinally among achieved for both syndromes. This article contains inner-city African American adolescents. Moderator supplementary material, which may be viewed at the models were tested to determine protective factors for American Journal of Medical Genetics website at youth exposed to community violence. Several social http://www.interscience.wiley.com/jpages/0148- support factors emerged as protective-stabilizing forces 7299/suppmat/index.html. for witnesses of violence both cross-sectionally and longitudinally, including maternal closeness, time spent Hampers LC, Faries SG, Poole SR. Regional after-hours with family, social support, and daily support (ESM). urgent care provided by a tertiary children's hospital. Contrary to hypotheses, several social support factors Pediatrics 2002; 110(6):1117-24. demonstrated a promotive-reactive effect such that, in Abstract: BACKGROUND: Ambulatory presentation conditions of high victimization, they failed to protect to a tertiary pediatric emergency department (ED) is youth from developing symptoms. Effects did not not convenient for many families. Yet many primary differ by outcome or sex, though sex differences in care pediatricians (PCPs) desire after-hours urgent care findings emerged. Protective-stabilizing effects for their patients as an alternative to extended office occurred more for witnessing violence, whereas hours or care by general emergency medicine providers promotive-reactive patterns occurred more for at community hospitals. OBJECTIVE: To describe a victimization. Results affirm social support factors as regional, community-based pediatric urgent care protective from the adverse effects of violence network (PUCN). METHODS: The PUCN consists of exposure, but they also suggest that some factors 4 models: 1) pediatric emergency medicine faculty in a typically conceived as contributing to resilience might community hospital ED; 2) general pediatricians in a at times fail to protect youth in conditions of extreme community hospital ED; 3) general pediatricians in a risk. freestanding urgent care center; and 4) general pediatricians in a community hospital-based urgent Hammerschlag MR. Nucleic acid amplification tests care center. Physician staffing at all 4 sites is managed (polymerase chain reaction, ligase chain reaction) for by our tertiary children's hospital. Billing records were the diagnosis of Chlamydia trachomatis and Neisseria reviewed and a questionnaire was mailed to 55 PCP gonorrhoeae in pediatric emergency medicine. Pediatr practices in our metro area. RESULTS: Year 2001 Emerg Care 2005; 21(10):705. visits totaled 37 143. Minor trauma, ear complaints, 548
- 557. and viral illnessesaccounted for 70% of visits. Current preceding 3 months. METHODS: In total, 24,776 Procedural Terminology codes for visits, reflecting people living in rural communities in the Bavi District, complexity levels 1, 2, 3, 4, and 5 were billed at the Northern Vietnam, were surveyed in home visits following frequency: 1%, 35%, 44%, 17% and 3%, during 2000. In the home visits, injuries that needed respectively. A total of 2.2% of visits required care or disrupted normal activities were recorded, admission or transfer. Mean collection rates ranged together with their circumstances. RESULTS: Overall, from 37% to 68% across the 4 sites. Break-even 2079 new non-fatal injuries were recorded over 23,338 average hourly patient volumes ranged from 1.1 (site 4) person-years, a rate of 89/1000 person-years-at-risk. to 1.9 (sites 1 and 3). A total of 110 PCPs, representing Males had a significantly higher injury rate than all 55 practices, responded to the questionnaire: 81% females for all age groups except for those aged 35-59 reported their patients used the PUCN often, 85% felt years and the elderly (P<0.05). The elderly were at that communication between the PUCN and their highest risk of injury (P<0.05), particularly females. practice was good, and 99% reported overall Home injuries occurred at the highest overall rate, satisfaction with the network. CONCLUSIONS: The particularly among the elderly. Road traffic injuries PUCN effectively addresses the needs of regional were most common among children. Most injuries PCPs; however, the cost-effectiveness of such a involved contact with another object. Less than one- program depends on billing practices, local collection quarter of injury victims sought care at a health facility. rates, and site-specific staffing patterns. CONCLUSIONS: Community-based household surveys revealed the hidden part of the injury iceberg, Hanani M. Multiple myenteric networks in the human as well as showing high incidence rates, indicating that appendix. Auton Neurosci 2004; 110(1):49-54. injury is an important public health problem which Abstract: The general histological organization of the should be a priority for intervention in rural Vietnam, appendix, including its innervation, is believed to be and probably elsewhere. This comprehensive study is generally similar to that of the large intestine. intended to contribute evidence and methods to the However, several authors described an unusual Ministry of Health's national programme for injury arrangement of the myenteric ganglia within the prevention, and to a wider audience. appendiceal muscle, but conflicting reports do not allow clear conclusions on this matter. The aim of this Hanna BA, Edgecombe G, Jackson CA, Newman S. The work was to examine the appendiceal innervation in importance of first-time parent groups for new parents. detail. The myenteric plexus of the human appendix Nurs Health Sci 2002; 4(4):209-14. was examined using sections and whole mount Abstract: First-time parent groups are offered to all preparations. Human small and large intestines were new parents in Victoria, Australia through the Maternal used for comparison. The nerves were stained using and Child Health Service, which is funded by state and immunohistochemistry, enzyme histochemistry for local governments. Parents who join a group attend a NADPH-diaphorase, and vital staining with 4-(4- series of eight sessions that emphasize parenting skills, diethylaminostyryl)-methylpyridinium iodide. relationship development and social support in order to Appendices from rabbits were also studied. In most increase confidence and skills in parenting. The present cases, the innervation of the external muscle of the paper highlights the importance of first-time parent appendix consisted of three concentric networks of groups, claiming that these groups serve an important ganglia. These networks were located both between the social support and health function amid a climate of circular and longitudinal muscle layers and within early discharge policies and changing family structures. them. The middle network made connections with the Although there are a number of challenges to the other two. Such arrangement was not observed in the successful running of groups, it is argued that first-time human small and large intestines. The myenteric plexus parents benefit from participating in these groups in a in the rabbit appendix displayed a much smaller degree number of ways: by developing social networks, of three-dimensional distribution compared with that of gaining self confidence, and through access to relevant the human appendix. It is concluded that the myenteric information on child health and parenting. Research plexus in the human appendix consists of several indicates that first-time parent groups provide lasting distinct networks, and appears to be unique in benefits not only for families, but also for society as a comparison with the other parts of the intestine. whole. Maternal and child health nurses play a key role in facilitating groups for first-time parents. Hang HM, Bach TT, Byass P. Unintentional injuries over a 1-year period in a rural Vietnamese community: Hanna EZ, Yi HY, Dufour MC, Whitmore CC. The describing an iceberg. Public Health 2005; 119(6):466- relationship of early-onset regular smoking to alcohol 73. use, depression, illicit drug use, and other risky Abstract: OBJECTIVES: To document unintentional behaviors during early adolescence: results from the injuries in a rural community over a 1-year period as a youth supplement to the third national health and basis for prioritizing preventive activities. STUDY nutrition examination survey. J Subst Abuse 2001; DESIGN: Quarterly home visits over 1 year to elicit 13(3):265-82. experience of injury among household members in the Abstract: PURPOSE: Recently we found that the early 549
- 558. onset of regulartobacco use is as predictive of lifetime Abstract: Toys placed in the bed or microenvironment drug use and depressive disorders as it is of alcohol use of infants in the neonatal intensive care unit (NICU) disorders [Alcohol.: Clin. Exp. Res. 23 (1999) 513.]. demonstrate high rates of colonization (92%). As with This finding, which paralleled findings regarding early other fomites, toys may be one potential source of onset of alcohol use [J. Subst. Abuse 10 (1998) 59.], nosocomial infection (NI). This project critically suggested that early regular use of any drug might evaluated the practice of placing toys in the simply be an indicator of risk for a constellation of microenvironment of critically ill infants by using the problem behaviors. The purpose of the present study is Iowa Model of Evidence-Based Practice to Promote to test this hypothesis as well as to study the strength Quality Care. With the model as a guide for decision and patterns of associations among these problem making, the existing evidence was explored using a behaviors already present among youth. The results systematic review of the literature, case studies, will permit description of more precise profiles to scientific principles, theory, and expert opinion. A identify groups of children at risk. METHODS: Using comprehensive review of the literature did not clearly data for respondents aged 12-16 from the Third identify a causal relationship between toys in the NICU National Health and Nutrition Examination Survey microenvironment and NI. Levels of evidence (NHANES III), descriptive statistics were calculated suggesting an association between toys and NI were and logistic regression models were estimated. determined to be moderately strong and consistent. A RESULTS: Descriptive analyses indicated that in plausible relationship between the practice of placing comparison with those who never smoked, or who toys in the beds of NICU patients and risk for infection simply experimented, early-onset regular smokers, both was found. These findings prompted a pilot practice those who began at age 13 or younger and those who change, eliminating toys in the NICU, to test the did so between 14 and 16, were those most likely to potential impact of this intervention. Pre- and use alcohol and other drugs as well as have school postintervention infection rates were compared. NI problems and early sexual experiences culminating in rates decreased from 4.6 to 1.99 per 1,000 patient days pregnancy. Multivariate logistic regression analyses over a 6-month evaluation period. Although this were conducted to assess the associations among these decrease was not statistically significant, it was the high-risk behaviors. IMPLICATIONS: These results lowest rate recorded in 5 years. Ongoing evaluation of support the hypothesis that early onset of smoking is NI rates is in progress. Individual NICUs must but an indicator of a syndrome of problem behaviors determine if the evidence warrants a practice change in already in place during childhood. They also suggest their setting. that the significance of an age onset variable may differ depending on the age of the sample used. As follow-up Hanrahan LP, Anderson HA, Busby B et al. Wisconsin's data are collected, we expect to learn much about the environmental public health tracking network: natural course of the distinct risk groups identified in information systems design for childhood cancer the analyses by studying longitudinally this nationally surveillance. Environ Health Perspect 2004; representative group of early adolescents. 112(14):1434-9. Abstract: In this article we describe the development of Hanna JN, Symons DJ, Lyon MJ. A measles outbreak in the an information system for environmental childhood Whitsundays, Queensland: the shape of things to cancer surveillance. The Wisconsin Cancer Registry come? Commun Dis Intell 2002; 26(4):589-92. annually receives more than 25,000 incident case Abstract: This report describes a small outbreak of reports. Approximately 269 cases per year involve measles that occurred in the Whitsunday region, north children. Over time, there has been considerable Queensland, in July to August 2002. With one community interest in understanding the role the exception, all the cases were deliberately unvaccinated environment plays as a cause of these cancer cases. because their parents were conscientious objectors to Wisconsin's Public Health Information Network (WI- vaccination. It is suggested that this pattern of measles PHIN) is a robust web portal integrating both Health outbreaks, with most cases being not preventable Alert Network and National Electronic Disease because of conscientious objection, will become Surveillance System components. WI-PHIN is the increasingly recognised in the future. information technology platform for all public health surveillance programs. Functions include the secure, Hannesdottir H. [Early prevention and Mental Health automated exchange of cancer case data between Service for children and adolescents. Laeknabladid public health-based and hospital-based cancer 2003; 89(4):295. registrars; web-based supplemental data entry for Notes: .] environmental exposure confirmation and hypothesis testing; automated data analysis, visualization, and Hanrahan KS, Lofgren M. Evidence-based practice: exposure-outcome record linkage; directories of public examining the risk of toys in the microenvironment of health and clinical personnel for role-based access infants in the neonatal intensive care unit. Adv control of sensitive surveillance information; public Neonatal Care 2004; 4(4):184-201, quiz 202-5. health information dissemination and alerting; and information technology security and critical 550
- 559. infrastructure protection. Forhypothesis generation, processes, possibly due to involvement of frontal cancer case data are sent electronically to WI-PHIN neural networks. and populate the integrated data repository. Environmental data are linked and the exposure- Harding B, Risdon RA, Krous HF. Shaken baby syndrome. disease relationships are explored using statistical tools BMJ 2004; 328(7442):720-1. for ecologic exposure risk assessment. For hypothesis testing, case-control interviews collect exposure Hargreaves KM, Stewart RJ, Oliver SR. Informed choice histories, including parental employment and and public health screening for children: the case of residential histories. This information technology blood spot screening. Health Expect 2005; 8(2):161-71. approach can thus serve as the basis for building a Abstract: OBJECTIVE: To examine parents' and health comprehensive system to assess environmental cancer professionals' views on informed choice in newborn etiology. blood spot screening, and assess information and communication needs. DESIGN AND Hansen L, Bollhorn M. [The reality is--unfortunately--"on PARTICIPANTS: A qualitative study involving semi- the other side"]. Ugeskr Laeger 2002; 164(10):1370-1. structured telephone interviews and focus groups with 47 parents of children who were either found to be Hanson S. Engelhardt and children: the failure of libertarian affected or unaffected by the screened conditions, and bioethics in pediatric interactions. Kennedy Inst Ethics 35 health professionals with differing roles in newborn J 2005; 15(2):179-98. blood spot screening programmes across the UK. Notes: GENERAL NOTE: KIE: 6 refs. RESULTS AND CONCLUSIONS: Parents and health GENERAL NOTE: KIE: KIE Bib: personhood; professionals recognize a tension between informed treatment refusal/minors choice in newborn blood spot screening and public Abstract: In Engelhardt's secular bioethics, moral health screening for children. Some propose resolving obligations derive from contracts and agreements this tension with more information and better between rational persons, and no infants or children communication, and some with rigorous dissent and few adolescents meet Engelhardt's requirements procedures. This paper argues that neither extensive for being a rational person. This is a problem, as one parent information, nor a signed dissent model cannot have any direct secular moral obligations adequately address this tension. Instead, clear, brief toward nonpersons such as infants and adolescents. and accurate parent information and effective The Engelhardtian concepts of ownership, indenture, communication between health professionals and and social personhood, which are meant to allow the parents, which take into account parents' information theory to accommodate children and adolescents needs, are required, if informed choice and public adequately, fail to give an Engelhardtian any actual health screening for children are to coexist means of determining the right action to take in successfully. difficult cases, even on his or her own terms. Thus, the theory is incapable of determining the morally correct Harkavy I. University-assisted community school program action to take in cases involving children and therefore of West Philadelphia: democratic partnerships that is unhelpful in dealing with moral questions involving make a difference. New Dir Youth Dev 2005; children. (107):35-43, table of contents. Abstract: The university-assisted community school Hanten G, Chapman SB, Gamino JF et al. Verbal selective model is showing results for children and youth in learning after traumatic brain injury in children. Ann West Philadelphia. The University of Pennsylvania's Neurol 2004; 56(6):847-53. (Penn's) Center for Community Partnerships has Abstract: Selective learning (SL), the ability to select coordinated universitywide efforts, in partnership with items to learn from among other items, engages the community, in order to create and develop cognitive control, which is purportedly mediated by the community school programs. The Sayre program aims frontal cortex and its circuitry. Using incentive-based to become a university-assisted community school, auditory word recall and expository discourse tasks, we with a comprehensive community problem-solving studied the efficiency of SL in children ages 6 to 16 curriculum and communitywide program that is fully years who had sustained severe traumatic brain injury integrated across both the Sayre curriculum and the (TBI) at least 1 year earlier. We hypothesized that SL curriculum of a number of Penn's schools. The Penn- would be compromised by severe TBI. Results Sayre project demonstrates that higher education can indicated that children with severe TBI performed be a permanent anchor for revitalizing schools and significantly worse than age-matched typically communities if the vast resources it possesses, developing children on word- and discourse-level particularly its faculty, students, and staff, are brought measures of SL efficiency with no significant group to bear in a coordinated fashion. differences in number of items recalled from auditory word lists or declarative facts. We conclude that severe Harkema JR, Keeler G, Wagner J et al. Effects of TBI disrupts incentive-based cognitive control concentrated ambient particles on normal and 551
- 560. hypersecretory airways inrats. Res Rep Health Eff Inst concentrator effectively concentrated the fine ambient 2004; (120):1-68; discussion 69-79. particles from this urban atmosphere (10-30 times) Abstract: Epidemiological studies have reported that without significantly changing the major elevated levels of particulate air pollution in urban physicochemical features of the atmospheric particles. communities are associated with increases in attacks of Daily CAPs mass concentrations during the 10-hour asthma based on evidence from hospital admissions exposure period (0800-1800) in July ranged from 16 to and emergency department visits. Principal pathologic 895 microg/m3 and in September ranged from 81 to features of chronic airway diseases, like asthma, are 755 microg/m3. In general, chemical characteristics of airway inflammation and mucous hypersecretion with ambient particles were conserved through the excessive amounts of luminal mucus and increased concentrator into the exposure chamber. Single or numbers of mucus-secreting cells in regions of the repeated exposures to CAPs did not cause adverse respiratory tract that normally have few or no mucous effects in the nasal or pulmonary airways of healthy cells (ie, mucous cell metaplasia). The overall goal of F344 or BN rats. In addition, CAPs-related toxicity the present project was to understand the adverse was not observed in F344 rats pretreated with bacterial effects of urban air fine particulate matter (PM2.5; < or endotoxin. Variable airway responses to CAPs = 2.5 pm in aerodynamic diameter)* on normal airways exposure were observed in BN rats with preexisting and airways compromised with airway inflammation allergic airway disease induced by OVA sensitization and excess mucus. Our project was specifically and challenge. Only OVA-challenged BN rats exposed designed to (1) examine the chemical and physical to CAPs for 5 consecutive days in September 2000 had characteristics of PM2.5 and other airborne pollutants significant increases in airway mucosubstances and in the outdoor air of a local Detroit community with a pulmonary inflammation compared to saline- high incidence of childhood asthma; (2) determine the challenged/air-exposed control rats. OVA-challenged effects of this community-based PM2.5 on the airway BN rats that were repeatedly exposed to CAPs in July epithelium in normal rats and rats compromised with 2000 had only minor CAPs-related effects. In only the preexisting hypersecretory airway diseases (ie, animal September 5-day exposure protocol, PM2.5 trace models of human allergic airway disease--asthma and elements of anthropogenic origin (La, V, and S) were chronic bronchitis); and (3) identify the chemical or recovered from the lung tissues of CAPs-exposed rats. physical components of PM2.5 that are responsible for Recovery of these specific trace elements was greatest PM2.5 -induced airway inflammation and epithelial in rats with OVA-induced allergic airway disease. alterations in these animal models. Two animal models Additional laboratory experiments using intratracheal of airway disease were used to examine the effects of instillations of ambient PM2.5 samples were performed PM2.5 exposure on preexisting hypersecretory to identify bioactive agents in the CAPs to which rats airways: neutrophilic airway inflammation induced by had been exposed in the inhalation exposure endotoxin challenge in F344 rats and eosinophilic component. Because the most pronounced effects of airway inflammation induced by ovalbumin (OVA) CAPs inhalation were found in BN rats with OVA- challenge in BN rats. A mobile air monitoring and induced allergic airways exposed in September, we exposure laboratory equipped with inhalation exposure used ambient PM2.5 samples that were collected on 2 chambers for animal toxicology studies, air pollution days during the September CAPs inhalation exposures monitors, and particulate collection devices was used to use for instillation. Ambient PM2.5 samples were in this investigation. The mobile laboratory was parked collected, fractionated into soluble and insoluble in a community in southwestern Detroit during the species, and then compared with each other and with summer months when particulate air pollution is total PM2.5 for their effects in healthy BN rats and usually high (July and September 2000). We monitored those with OVA-induced allergic airway disease. the outdoor air pollution in this community daily, and Intratracheal instillation of the insoluble fraction of exposed normal and compromised rats to concentrated PM2.5 caused mild neutrophilic inflammation in the PM2.5 from this local urban atmosphere. Rats in the lungs of healthy rats. However, total PM2.5 or the inhalation studies were exposed for 1 day or for 4 or 5 soluble or insoluble fractions instilled in rats with consecutive days (10 hours/day) to either filtered air OVA-induced airway inflammation did not enhance (controls) or concentrated ambient particles (CAPs) the inflammation or the airway epithelial remodeling delivered by a Harvard ambient fine particle that was evident in some of the BN rats exposed to concentrator. Rats were killed 24 hours after the end of CAPs by inhalation. Therefore, the results from this the exposure. Biochemical, morphometric, and instillation component did not suggest what fractions of molecular techniques were used to identify airway the CAPs may have been responsible for enhancing epithelial and inflammatory responses to CAPs. Lung OVA-induced airway mucosubstances and pulmonary lobes were also either intratracheally lavaged with inflammation observed in the inhalation exposure saline to determine cellular composition and protein in component. In summary, inhaled CAPs-related bronchoalveolar lavage fluid (BALF) or removed for pulmonary alterations in the affected OVA-challenged analysis by inductively coupled plasma-mass rats appeared to be related to the chemical composition, spectrometry (ICPMS) to detect retention of ambient rather than the mass concentration, to which the PM2.5--derived trace elements. The Harvard animals were exposed. Results of the trace element 552
- 561. analysis in thelungs of CAPs-exposed BN rats exposed the Department of Transportation-National Highway in September suggested that air particles derived from Traffic Safety Administration ([DOT-NHTSA], the identified local combustion sources were preferentially funding agency) and the development and launch of a retained in allergic airways. These results demonstrate pilot program: "Buckle-Up and Smile for Life". that short-term exposures to CAPs from this Sections of the paper include: background information southwestern Detroit community caused variable on the problems of disparity and access; the impact of responses in laboratory rats and suggest that adverse community education and the benefits of collaboration; biological responses to ambient PM2.5 may be evolution of the unique partnership, including associated more closely with local sources of particles background information on disparities in seat belt and weather patterns than with particle mass. usage among African Americans; a description on how the pilot program was structured and implemented; and Harner HM. Childhood sexual abuse, teenage pregnancy, future plans. The objective of this article is to and partnering with adult men: exploring the encourage other oral health organizations to form relationship. J Psychosoc Nurs Ment Health Serv 2005; alliances with the NDA (and other organizations 43(8):20-8. committed to public health) to go into underserved Abstract: Although the mechanism by which early communities to deliver the oral health message. victimization, specifically sexual abuse, increases the Involvement and participation on all levels, with risk of adolescent pregnancy is unclear, a relationship diverse and non-traditional partners will make a between previous victimization and adolescent difference. The National Dental Association applauds pregnancy has been demonstrated. While partnering the commitment of the American Dental Assistants with an older man may initially offer the means Association to form alliances that address the issues of necessary to escape a neglectful or violent family of access and disparities. Groups working together for a origin, this protection be accompanied by an imbalance common good are linked together by one common of power and control. Both adolescent mothers notion: Caring Counts. partnered with adult men and adolescent mothers partnered with male peers reported sexual abuse Harper K, Steadman J. Therapeutic boundary issues in perpetrated by family members, family friends, working with childhood sexual-abuse survivors. Am J strangers, and peers. Policies developed to protect Psychother 2003; 57(1):64-79. young people from victimization, including mandatory Abstract: The article describes a study of therapists reporting and statutory rape laws, should be evaluated involved in treating survivors of childhood sexual for their consistent application to all children, abuse. The authors focus on what induces participants regardless of age, race, gender, or pregnancy status. to change their usual therapeutic boundaries. Through qualitative research utilizing extensive interviews, Harper HJ. Buckle-up and smile for life: uncommon partners written questionnaires, and a focus-group discussion, find common ground to collaborate and eliminate the authors gathered information from therapists disparities. Part 1. Dent Assist 2003; 72(3):8-12. related to situations that influence them to change their Abstract: Disparities in health and lack of access to oral own boundaries. Emergent themes are discussed and health are well-documented common concerns. Health the information is integrated with the authors' education and health promotion increase awareness experience of supervision and psychotherapy. Concern about the importance of prevention and the relationship for client safety is the commonly recurrent issue that of oral health to overall health. The benefits of pushes therapists to change their boundaries. Other collaboration and coalition building to enhance intense feelings, such as resentment of the client, worry community outreach are well established. In order to about the client's feelings, a wish to connect and imbue combat and correct the problems of disparities and hope are also strong influences. Self-disclosure access, many more collaborative efforts must be put in boundaries of the therapist are challenged by the wish place. Meaningful impact on the health of a community to balance power within the relationship. Supervision can be made by collaborations of both traditional and provides an opportunity to examine what influences non-traditional partners. Grassroots efforts that therapists to make subtle boundary shifts before they mobilize coalitions around a specific cause and target become harmful boundary crossings. specific populations can achieve far greater results than any one entity acting alone. Well-coordinated Harris J. Human beings, persons and conjoined twins: an community projects that represent a collaboration of ethical analysis of the judgement in Re A. Med Law efforts can galvanize the resources, mobilize volunteers Rev 2001; 9(3):221-36. and engender public support that will achieve a Notes: GENERAL NOTE: KIE: Harris, John positive outcome for a common good. The integration GENERAL NOTE: KIE: 43 fn. of oral health messages with other public health GENERAL NOTE: KIE: KIE Bib: patient care/minors; messages and partnership with a very non-traditional personhood entity was an approach that was adopted by the National Dental Association (NDA). This paper Harris M, Fallot RD. Envisioning a trauma-informed service describes the unique partnership between the NDA and 553
- 562. system: a vitalparadigm shift. New Dir Ment Health adolescence, and can create unique problems for the Serv 2001; (89):3-22. homosexual adolescents. Homosexuality can place Abstract: With the recognition that large numbers of them at risk for social stigmatization, isolation, men and women receiving services in the mental health depression, suicide, abuse, and rejection by their and addictions systems are the survivors of sexual and families and friends. During this exceptionally stressful physical abuse, practitioners need to become informed time, both adolescent students and their families need about the dynamics and the aftermath of trauma. anticipatory guidance and support. In providing anticipatory guidance, this article discusses critical Harrison H. Preemies on steroids: a new iatrogenic disaster? roles played by professionals who work with Birth 2001; 28(1):57-9. adolescents in community or school settings. Included are insights into development of this normal variant of Harrison RL, Li J, Pearce K, Wyman T. The Community sexual attraction and orientation, risks that homosexual Dental Facilitator Project: reducing barriers to dental adolescent students may face as well as their disclosure care. J Public Health Dent 2003; 63(2):126-8. concerns, and possible reactions families may have Abstract: OBJECTIVES: This report describes an following disclosure. Supporting homosexual initiative developed and implemented by a low-income, adolescents and their families is emphasized with urban, Canadian community to respond to their regard to sensitively providing information, disclosure children's dental problems. METHODS: The first decisions, coping with stigmatization, and resiliency strategy pursued by the community was the factors. development of the Community Dental Facilitator Project. This project facilitated children's access to Harsanyi A, Mott S, Kendall S, Blight A. The impact of a existing government funding for dental treatment, and history of child sexual assault on women's decisions subsequently facilitated access to treatment at local and experiences of cervical screening. Aust Fam dental offices. Children in need of treatment were Physician 2003; 32(9):761-2. identified by a school dental screening. The facilitation work was done by three lay workers hired from within Hart A, Saunders A, Thomas H. Attuned practice: a service the community who represented the community's user study of specialist child and adolescent mental predominant ethnic groups. RESULTS: Parents health, UK. Epidemiol Psichiatr Soc 2005; 14(1):22- revealed that barriers to dental care in local dental 31. offices were lack of information about funding Abstract: AIMS: Best practice emphasises user programs, language, inflexible work situation, and involvement. This exploratory study addresses the mistrust of bureaucracy. By the project's end, with the views of teenage clients and their parents on service assistance of the facilitators, a significantly increased delivery in a specialist Child and Adolescent Mental number of children had been enrolled for government Health Service (CAMHS) serving a population of dental benefits (P<.001). In addition to the 123 children 250,000. It aims to explore some of the complexities identified at the screening as needing treatment, inherent in children's services when parents are integral another 30 children "self-referred" to the program. At to modes of treatment. METHODS: Twenty-seven the end of the project's original funding period, dental teenage clients from specialist CAMHS were recruited appointments had been made for 68 children: 60 with their parents (n=30). All were white British, 11 (48.8%) of the "screened" group, 8 (26.7%) of the boys and 16 girls, from a range of socioeconomic "self-referred" group. One-year telephone follow-up to backgrounds. Focus groups were employed using a parents of the screened children revealed that 42 of 59 series of structured interactive technique to elicit (71.1%) had completed treatment. CONCLUSIONS: information, preceded by home visits. Analysis of Barriers to dental care for low-income children go interview data followed standard approaches to beyond economics. A community facilitation model qualitative data analysis. Descriptive statistics were can improve low-income children's access to existing generated from both home interview data and focus dental services and may reduce the barriers to care for groups. RESULTS: Three themes emerged: the core some children requiring treatment. values implicated in establishing a therapeutic alliance; the style of therapy and mode of practice (i.e. its Harrison TW. Adolescent homosexuality and concerns inclusiveness of different family members). regarding disclosure. J Sch Health 2003; 73(3):107-12. PRACTICE IMPLICATIONS: Core therapeutic skills Abstract: Development of sexual identity in middle are of fundamental importance. Our paper supplements childhood and early adolescence is a natural process. a model of organisational user involvement with a However, it is more stressful for homosexual model of therapeutic user involvement for use in adolescents. Society continues to stigmatize and negotiating mode of practice. CONCLUSIONS: This marginalize homosexuality. To avoid rejection and exploratory study was a collaboration between service hostility, homosexual adolescents are pressured to hide users, researchers and health professionals exploring their sexual identities. This fact compounds the three important themes of therapy and the complexities anticipated normal developmental concerns of inherent in children's services. The process of eliciting views was therapeutic in itself leading to the formation 554
- 563. of a parent-ledself-help group. The design can be restriction subscale of the Child Feeding Questionnaire replicated in other specialist CAMHS to achieve decreased significantly in the OPPS condition (-0.22+/- attuned practice. 0.42 vs. 0.08+/- 0.63, p < 0.05), indicating that mothers in the OPPS group were engaging in less restrictive Harvey AR, Hill RB. Africentric youth and family rites of child feeding practices over time. DISCUSSION: A passage program: promoting resilience among at-risk home-visiting program focused on changing lifestyle African American youths. Soc Work 2004; 49(1):65- behaviors and improving parenting skills showed 74. promise for obesity prevention in high-risk Native- Abstract: This article examines the effects of an American children. Africentric youth and family rites of passage program on at-risk African American youths and their parents. Harvey SA, Ayabaca P, Bucagu M et al. Skilled birth Data were obtained from a three-year evaluation of a attendant competence: an initial assessment in four youth rites of passage demonstration project using countries, and implications for the Safe Motherhood therapeutic interventions based on Africentric movement. Int J Gynaecol Obstet 2004; 87(2):203-10. principles. At-risk African American boys between Abstract: OBJECTIVES: Percentage of deliveries ages 11.5 and 14.5 years with no history of substance assisted by a skilled birth attendant (SBA) has become abuse were referred from the criminal justice system, a proxy indicator for reducing maternal mortality in diversion programs, and local schools. The evaluation developing countries, but there is little data on SBA revealed that participating youths exhibited gains in competence. Our objective was to evaluate the self-esteem and accurate knowledge of the dangers of competence of health professionals who typically drug abuse. Although the differences were not attend hospital and clinic-based births in Benin, statistically significant, parents demonstrated Ecuador, Jamaica, and Rwanda. Methods: We improvements in parenting skills, racial identity, measured competence against World Health cultural awareness, and community involvement. Organization's (WHO) Integrated Management of Evidence from interviews and focus groups suggests Pregnancy and Childbirth guidelines. To evaluate that the program's holistic, family-oriented, Africentric, knowledge, we used a 49-question multiple-choice test strengths-based approach and indigenous staff covering seven clinical areas. To evaluate skill, we had contributed to its success. participants perform five different procedures on anatomical models. The 166 participants came from Harvey-Berino J, Rourke J. Obesity prevention in preschool facilities at all levels of care in their respective native-american children: a pilot study using home countries. Results: On average, providers answered visiting. Obes Res 2003; 11(5):606-11. 55.8% of the knowledge questions correctly and Abstract: OBJECTIVE: To determine whether performed 48.2% of the skills steps correctly. Scores maternal participation in an obesity prevention plus differed somewhat by country, provider type, and parenting support (OPPS) intervention would reduce subtopic. Conclusion: A wide gap exists between the prevalence of obesity in high-risk Native-American current evidence-based standards and current levels of children when compared with a parenting support (PS)- provider competence. only intervention. RESEARCH METHODS AND PROCEDURES: Forty-three mother/child pairs were Hashemi RR, Young JF. The prediction of methylmercury recruited to participate. Mothers were 26.5 +/- 5 years elimination half-life in humans using animal data: a old with a mean BMI of 29.9 +/- 3 kg/m(2). Children neural network/rough sets analysis. J Toxicol Environ (23 males) were 22 +/- 8 months old with mean Health A 2003; 66(23):2227-52. weight-for-height z (WHZ) scores of 0.73 +/- 1.4. Abstract: Artificial neural networks and Rough Sets Mothers were randomly assigned to a 16-week OPPS methodology have been utilized to predict human intervention or PS alone. The intervention was pharmacokinetic elimination half-life data based on delivered one-on-one in homes by an indigenous peer animal data training sets. Methylmercury (Hg) educator. Baseline and week 16 assessments included pharmacokinetic data was obtained from 37 literature weight and height (WHZ score and weight-for-height references, which provided data on species, gender, percentile for children), dietary intake (3-day food age, weight, route of administration, dose, dose records), physical activity (measured by frequency, and elimination half-life based on either accelerometers), parental feeding style (Child Feeding whole-body Hg analysis or blood Hg analysis. Data Questionnaire), and maternal outcome expectations, were categorized into various formats for analysis self-efficacy, and intention to change diet and exercise comparisons. Rough Sets methodology was utilized to behaviors. RESULTS: Changes in WHZ scores showed identify and remove redundant independent variables. a trend toward significance, with WHZ scores Artificial neural networks were used to produce models decreasing in the PS condition and increasing among based on the animal data, which were in turn used to the OPPS group (-0.27 +/- 1.1 vs. 0.31 +/- 1.1, p = predict and compare to the human elimination half-life 0.06). Children in the OPPS condition also values. These neural network predictions were significantly decreased energy intake (-316 +/- 835 compared to allometric graphical plots of the same kcal/d vs. 197 +/- 608 kcal/d, p < 0.05). Scores on the data. The best artificial neural network prediction was 555
- 564. based on a"thermometer" categorical representation of for the reduction of stress in mothers. Some data also the data. indicate the potential value of parent-led support networks. CONCLUSIONS: More research and Hashimoto T, Noguchi T, Nagai K, Uchida Y, Shimada T. clinical development are needed to establish a firmer The organization of the communication routes between evidence base for stress interventions with parents of the epithelium and lamina propria mucosae in the children with intellectual disabilities. There are also a human esophagus. Arch Histol Cytol 2002; 65(4):323- number of potential practical implications of reducing 35. parental stress for maximising the efficacy of general Abstract: Morphological studies examined parent training interventions and also behavioural communication routes between the epithelium and programmes for children's challenging behaviours. lamina propria mucosae in the human esophagus, using a series of techniques including silver staining, Hatherall P. Law. On duty. Health Serv J 2003; immunohistochemistry, transmission electron 113(5874):37. microscopy, and scanning electron microscopy (SEM). For SEM, tissue blocks were treated with either Haugen K, Slungard A, Schei B. [Sexual assault against osmium/ultrasonication or NaOH. Observations women-- injury pattern and victim-perpetrator showed the esophageal papillae to be arranged relationship]. Tidsskr Nor Laegeforen 2005; regularly in a mostly longitudinal row. The reticular 125(24):3424-7. fibers, consisting of fibrils approximately 40 nm in Abstract: BACKGROUND: Women who have been diameter, were situated just beneath the epithelial basal exposed to sexual assault have the opportunity to lamina. They showed a positive reaction with a type III consult specialised health service. The Centre for collagen antibody, and formed a continuous sheet 2-3 victims of sexual assault at St. Olav University microm thick with dense networks. This sheet as well Hospital, Trondheim, Norway, offers emergency as the epithelial basal lamina had numerous foramina medical treatment, psychosocial follow-up and collects of diameters of 3-5 microm. Immune cells such as evidence in case the victim wants to file a complaint. lymphocytes and Langerhans cells were situated The aim of this study was to examine whether injury around these foramina. The foramina were situated pattern and assault characteristics differed according to both around papillae and the duct orifice of the the victim's relationship to the perpetrator. esophageal gland. In addition, lymphoid follicles MATERIAL AND METHODS: Information about the surrounded the duct of the esophageal gland. The assaults was collected retrospectively from medical structural characteristics around the duct appear to be journals of 162 female clients who presented at the those of duct-associated lymphoid tissue (DALT). centre over the period 1 June 2000 through 31 May Thus, these foramina in the epithelial basal lamina and 2003. Depending on their relationship with the reticular fiber sheet may represent important perpetrator, the victims were categorised into four communication routes between the epithelium and groups: stranger, accidental acquaintance, lamina propria mucosae. In addition, they may play an acquaintance, or partner. Assault characteristics and important role in the mucosal immune response in the injury patterns were compared among these groups. human esophagus. RESULTS: 69 % (111/162) of the victims knew their offender. Accidental acquaintances were reported as Hassall I. Response to Chaffin (2004). Child Abuse Negl perpetrator in 32 (20 %) of the assaults, acquaintances 2005; 29(3):235; author reply 241-9. in 68 (42 %), partners in 11 (7 %) and unknown offenders in 29 (18 %). Type and severity of the sexual Hastings RP, Beck A. Practitioner review: stress intervention assaults did not differ significantly according to victim- for parents of children with intellectual disabilities. J perpetrator relationship. The most life-threatening Child Psychol Psychiatry 2004; 45(8):1338-49. violence and use of a weapon were reported used by Abstract: BACKGROUND: Parents of children with known offenders only. INTERPRETATION: In intellectual disabilities are at increased risk for stress emergency medical response to victims of sexual and other mental health problems. The purpose of the assaults, it should be made sure that victims, present review is to consider the evidence base for independently of their relationship with perpetrator, are psychological intervention to remediate stress in these met and treated equally. parents. METHODS: A selective review of interventions designed to reduce stress in parents of Haugland BS. Paternal alcohol abuse: relationship between children with intellectual disabilities, with a focus on child adjustment, parental characteristics, and family group interventions that incorporate various cognitive functioning. Child Psychiatry Hum Dev 2003; behavioural techniques. RESULTS: Research evidence 34(2):127-46. suggests that standard service models (e.g., respite Abstract: This study examines possible risk factors care, case management) probably help to reduce associated with child adjustment in a sample of parental stress. The strongest evidence base is for children with alcohol abusing fathers in Norway (N = cognitive behavioural group interventions, especially 37). Factors included are socio-economic status, 556
- 565. severity of thefathers' alcohol abuse, parental skills. Parent assets, measured as social support and psychological problems, and family functioning. problem-focused coping, predicted change in maternal Children of alcohol abusing fathers were found to have and paternal parent-related stress respectively. The more adjustment problems assessed by CBCL implications of these findings for both the science of compared to a general population sample. The findings child development and the policies and practices of further suggest that child adjustment in families with developmental intervention are discussed. paternal alcohol abuse is the result of an accumulation of risk factors rather than the effects of the paternal Hauser R, Gos T, Lipowski P, Kuczkowski J. [Retinal alcohol abuse alone. Both general environmental risk hemorrhages as a case for shaking trauma. Case factors (psychological problems in the fathers, family report]. Arch Med Sadowej Kryminol 2003; 53(4):363- climate, family health and conflicts) and environmental 8. factors related to the parental alcohol abuse (severity of Abstract: An interesting shaking trauma case was the alcohol abuse, the child's level of exposure to the reported. A detailed analysis of the pattern of injuries alcohol abuse, changes in routines and rituals due to and their progress allowed to reconstruct the drinking) were related to child adjustment. The results mechanism and time point of cerebral lesions in a 6 indicate the need to obtain both parents' assessments of week old infant who survived the impact. The necessity child adjustment, as the fathers' assessment was of postmortem investigation of the fundus and cranial associated with different risk factors compared to the nerves in fatal cases of shaking trauma is stressed. mothers'. Hawkins JD, Kosterman R, Catalano RF, Hill KG, Abbott Hauser-Cram P, Warfield ME, Shonkoff JP, Krauss MW, RD. Promoting positive adult functioning through Sayer A, Upshur CC. Children with disabilities: a social development intervention in childhood: long- longitudinal study of child development and parent term effects from the Seattle Social Development well-being. Monogr Soc Res Child Dev 2001; 66(3):i- Project. Arch Pediatr Adolesc Med 2005; 159(1):25- viii, 1-114; discussion 115-26. 31. Abstract: This Monograph presents the results of the Abstract: OBJECTIVE: To examine the long-term Early Intervention Collaborative Study, a longitudinal effects of the Seattle Social Development Project investigation of the cognitive and adaptive behavior intervention in promoting positive adult functioning development of children with developmental and preventing mental health problems, crime, and disabilities and the adaptation of their parents, substance use (including tobacco, alcohol, and other extending from infancy through middle childhood. The drugs) at 21 years of age. DESIGN: This study was designed to generate and test conceptual nonrandomized controlled trial followed up models of child and family development and contribute participants to 21 years of age, 9 years after the to the knowledge base that informs social policy and intervention ended. We compared the following 3 practice. The sample for the investigation reported here intervention conditions: a full 6-year intervention consists of 183 children with Down syndrome, motor (grades 1 through 6); a late 2-year intervention (grades impairment, developmental delay and their families 5 and 6 only); and a no-treatment control condition. who were recruited at the time of their enrollment in an SETTING: Eighteen public elementary schools serving early intervention program in Massachusetts or New diverse neighborhoods, including high-crime Hampshire. Data were collected at five time points neighborhoods, of Seattle, Wash. PARTICIPANTS: A between entry to early intervention and the child's 10th sex-balanced, multiethnic sample of 605 participants birthday. Home visits were conducted at each time across the 3 conditions who completed interviews at 21 point and included child assessments, maternal years of age (94% of the original sample in these interview, and questionnaires completed independently conditions). INTERVENTIONS: Teacher training in by both parents. Trajectories in children's development classroom instruction and management, child social and parental well-being were analyzed using and emotional skill development, and parent training. hierarchical linear modeling. Predictor variables were MAIN OUTCOME MEASURES: Self-reports of measured at age 3 years when children were exiting functioning in school and work, emotional and mental early intervention programs. Children's type of health, and crime and substance use at 21 years of age disability predicted trajectories of development in and official court records. RESULTS: Broad cognition, social skills, and daily living skills. significant effects on functioning in school and work Children's type of disability also predicted changes in and on emotional and mental health were found. Fewer maternal (but not paternal) child-related and parent- significant effects on crime and substance use were related stress. Beyond type of disability, child self- found at 21 years of age. Most outcomes had a regulatory processes (notably behavior problems and consistent dose effect, with the strongest effects in mastery motivation) and one aspect of the family subjects in the full-intervention group and effects in the climate (notably mother-child interaction) were key late-intervention group between those in the full- predictors of change in both child outcomes and parent intervention and control groups. CONCLUSIONS: A well-being. A different aspect of the family climate-- theory-guided preventive intervention that strengthened family relations--also predicted change in child social teaching and parenting practices and taught children 557
- 566. interpersonal skills duringthe elementary grades had mortality widened, irrespective of socio-economic wide-ranging beneficial effects on functioning in early status indicator used, whereas for females it widened adulthood. only when certain socio-economic indicators were used: occupation (unemployment measure) and Hawkins SS, Law C. Patterns of research activity related to income, but was not significant for the other single government policy: a UK web based survey. Arch Dis indicators or for the composite indicator. Child 2005; 90(11):1107-11. CONCLUSIONS: Sydney trends of widening Abstract: AIMS: To describe the patterns of child and inequalities are generally similar to those reported for family health and wellbeing research activity in the Britain and for other industrialised countries, fiscal year (FY) 2002/2003 in relation to UK suggesting that this is a common phenomenon and that government policies. METHODS: Projects policies to reduce health inequalities over the past investigating the health and wellbeing of children and quarter of a century have not been effective. families were located through a web based survey of major research funders, including UK government Hayez JY. [Confrontation of children and adolescents with departments and non-departmental public bodies, pornography]. Arch Pediatr 2002; 9(11):1183-8. research councils, and medical charities. A budget was Abstract: The author describes the influence of estimated for each project for the FY 2002/2003, and pornography on children, focusing on pornographical each project coded according to a framework which material on the web. Most children escape almost reflected government priorities and research uninjured from visualization of pornography. However methodologies. RESULTS: There was a substantial some are either traumatized, or precipitated in a strict amount of project information posted on the websites perversion. The consequences on adolescents are of the funding organisations, but the level of detail similar, though more complex. The hypersexualization varied. For the FY 2002/2003, 31 organisations were of teenagers may become complicated by addiction (so identified that commissioned 567 projects investigating called internet addiction disorder: IAD), isolation, and the health and wellbeing of children and families. perversion. Recommendations for the parents are Based on information from organisations' websites, this presented. represented approximately 3% of their research budgets. Within this funding area, low proportions of Hayman RM, Taylor BJ, Peart NS, Galland BC, Sayers RM. research activity related to health inequalities (9% of Participation in research: informed consent, motivation total expenditure on child and family health research), and influence. J Paediatr Child Health 2001; 37(1):51- health economic analysis (8%), primary and secondary 4. prevention (12%), and children and adolescents at high Abstract: OBJECTIVE: To investigate the process and risk of ill health (14%). CONCLUSIONS: A limited quality of informed consent, motivation and influence amount of research activity on children and families in parents who were invited to enroll their baby in a health funded in the FY 2002/2003 is addressing UK research project. METHODOLOGY: A mixed government policy priorities. This suggests the need to quantitative/qualitative questionnaire was sent to a commission further research to fill gaps in the cohort invited to participate in a physiological research evidence. project on sudden infant death syndrome (SIDS) at the Dunedin Public Hospital, Dunedin, New Zealand. Hayes LJ, Quine S, Taylor R, Berry G. Socio-economic Separate questionnaires were used for parents who mortality differentials in Sydney over a quarter of a participated (94) and those who declined to participate century, 1970-94. Aust N Z J Public Health 2002; (103). Response rates were 69% and 47%, respectively. 26(4):311-7. RESULTS: All consenting parents felt they understood Abstract: OBJECTIVE: To examine trends in socio- the purpose and procedure of the study. The majority economic differentials in all-cause mortality in Sydney (90%) thought the information about the study was over a 25-year period (1970-94). METHODS: Five very good; 6.5% felt more detail was required. Eighty- measures of single indicators (two for occupation, two five per cent found the verbal explanation the most for education and one for income) and a composite useful source of information. All participated for measure of socio-economic disadvantage based on altruistic reasons such as to aid SIDS research. Census data (the Australian Bureau of Statistics' Index Although 27% had concerns about safety of the tests, of Relative Socio-Economic Disadvantage) were used after the tests all responders felt happy with the safety as indicators of socio-economic status by local of the tests. Inconvenience was the main reason (53%) govemment area. The relationship between mortality for declining to participate. Twenty-eight per cent of and socio-economic status was examined using declining parents were concerned about the safety of quintiles based on these six measures of socio- the tests. CONCLUSION: Of those who responded to economic status. RESULTS: Socio-economic the questionnaire, the process for obtaining informed differentials in mortality were evident for males and consent in the SIDS studies was satisfactory. Parents' females for all periods, and over the 25-year period the motives for participating were mostly altruistic. The relative socio-economic differentials did not decline. role of recall bias and selection bias may make the For males, the socio-economic status differential in implications of this study unclear. 558
- 567. Hayslip B Jr,Kaminski PL. Grandparents raising their community service needs of families resident in the grandchildren: a review of the literature and Hunter region who care for a child manifesting suggestions for practice. Gerontologist 2005; disruptive behaviour. METHODOLOGY: Families 45(2):262-9. were eligible to participate in the survey if they had at Abstract: An increasingly prevalent family least one child known to have one of the DSM-IV constellation is a home headed by a grandparent who is disruptive behaviour disorders, autistic spectrum raising grandchildren. We explore the state of our disorders, behaviour problems associated with rarer knowledge about such grandparents with particular forms of brain disease, brain injury or mild intellectual attention to its implications for service providers and disability or were identified by school personnel as researchers. In our review we address several key having significant behaviour problems. Families were areas: (a) the costs and benefits of raising a grandchild; recruited to the survey via schools, early education (b) the heterogeneity of custodial grandparent centres and clinical services. Parents completed a caregivers; (c) the critical need for social support questionnaire, mailed to them by educational and/or among custodial grandparents; (d) parenting practices clinical services. Parents were asked to prioritize and attitudes among grandparents raising options for improving or expanding clinical services grandchildren; and (e) helping efforts at multiple levels and for reducing their treatment costs. RESULTS: A with custodial grandparents. We also discuss directions total of 1412 families responded to the survey. The for research and practice concerning custodial highest-ranked clinical service options involved the grandparents. expansion of mainstream community treatment services for children with disruptive behaviour Hazell PL, Stuart JE. A randomized controlled trial of problems and their families, with a particular emphasis clonidine added to psychostimulant medication for on counselling services. Respite care and in-patient hyperactive and aggressive children. J Am Acad Child services were given relatively low priority. Subgroup Adolesc Psychiatry 2003; 42(8):886-94. analyses showed that disadvantaged and stressed Abstract: OBJECTIVE: To compare clonidine with families gave higher rankings to out of home options, placebo added to ongoing psychostimulant therapy for such as respite care, in-patient care and subsidised the treatment of attention-deficit/hyperactivity disorder holiday camps, than the aggregate sample. with comorbid oppositional defiant disorder or conduct CONCLUSIONS: Enhancement of community based disorder. METHOD: Children 6 to 14 years of age counselling services would meet the needs of the recruited through 2000 to 2001 were randomized to greatest number of participating families. Resource- receive clonidine syrup 0.10 to 0.20 mg/day (n = 38) or intense residential services are required by a small but placebo (n = 29) for 6 weeks. Primary outcome important group of families who experience measures were the Conduct and Hyperactive Index disadvantage and high levels of stress. subscales of the parent-report Conners Behavior Checklist. Side effects were monitored using Heap J. Nurses' role in protecting children. Nurs N Z 2001; physiological measures and the Barkley Side Effect 7(3):19-21. Rating Scale. RESULTS: Evaluable patient analysis showed that significantly more clonidine-treated Heath I. Treating violence as a public health problem. BMJ children than controls were responders on the Conduct 2002; 325(7367):726-7. scale (21 of 37 versus 6 of 29; chi2(1) = 8.75, p <.01) Notes: GENERAL NOTE: KIE: 6 refs. but not the Hyperactive Index (13 of 37 versus 5 of GENERAL NOTE: KIE: KIE Bib: public health 29). Compared with placebo, clonidine was associated with a greater reduction in systolic blood pressure Hechtman L, Abikoff H, Klein RG et al. Children with measured standing and with transient sedation and ADHD treated with long-term methylphenidate and dizziness. Clonidine-treated individuals had a greater multimodal psychosocial treatment: impact on parental reduction in a number of unwanted effects associated practices. J Am Acad Child Adolesc Psychiatry 2004; with psychostimulant treatment compared with 43(7):830-8. placebo. CONCLUSIONS: The findings support the Abstract: OBJECTIVE: To test the hypothesis that continued use of clonidine in combination with multimodal psychosocial intervention, which includes psychostimulant medication to reduce conduct parent training, combined with methylphenidate symptoms associated with attention- significantly enhances the behavior of parents of deficit/hyperactivity disorder. Treatment is well children with attention-deficit/hyperactivity disorder tolerated and unwanted effects are transient. (ADHD), compared with methylphenidate alone and compared with methylphenidate and nonspecific Hazell PL, Tarren-Sweeney M, Vimpani GV, Keatinge D, psychosocial treatment (attention control). METHOD: Callan K. Children with disruptive behaviours II: One hundred three children with ADHD (ages 7-9), clinical and community service needs. J Paediatr Child free of conduct and learning disorders, who responded Health 2002; 38(1):32-40. to short-term methylphenidate therapy were Abstract: OBJECTIVE: To assist in health service randomized for 2 years to receive either (1) planning by determining the perceived clinical and 559
- 568. methylphenidate treatment alone;(2) methylphenidate ROC area 0.819), and inversions of genetic material plus psychosocial treatment that included parent during recombination (training ROC area 0.812), training and counseling, social skills training, academic evolved less accurate ANN. CONCLUSION: ANN assistance, and psychotherapy; or (3) methylphenidate optimized by genetic algorithms accurately plus attention control treatment. Parents rated their discriminated pneumonia within a training cohort, and knowledge of parenting principles and negative and within a testing cohort consisting of cases on which the positive parenting behavior. Children rated their networks had not been trained. Genetic algorithms can parents' behavior. RESULTS: Psychosocial treatment be used to implement efficient search strategies for led to significantly better knowledge of parenting optimal ANN to predict pneumonia. principles but did not enhance parenting practices, as rated by parents and children. Significant improvement Heermann JA, Wilson ME, Wilhelm PA. Mothers in the in mothers' negative parenting occurred across all NICU: outsider to partner. Pediatr Nurs 2005; treatments and was maintained. CONCLUSIONS: In 31(3):176-81, 200. nonconduct-disordered, stimulant-treated children with Abstract: The emerging care delivery model for ADHD, parent training does not improve self-rated Neonatal Intensive Care Units (NICU) is family- parental behavior. The benefits of brief stimulant focused, developmentally supportive care. The purpose treatment for negative parental behavior are sustained of this study was to explore and describe mothers' with extended treatment. experience of becoming a mother while their infants were receiving care in the NICU. A qualitative research Heckerling PS, Gerber BS, Tape TG, Wigton RS. Use of design was used. Interviews with 15 mothers whose genetic algorithms for neural networks to predict infants were in a Level III NICU were analyzed using community-acquired pneumonia. Artif Intell Med Spradley's domain analysis approach. Mothers 2004; 30(1):71-84. developed from outsider to engaged parent along four Abstract: BACKGROUND: Genetic algorithms have continua: (1) focus: from NICU to baby; (2) been used to solve optimization problems for artificial ownership: from their baby to my baby; (3) caregiving: neural networks (ANN) in several domains. We used from passive to active; and (4) voice: from silence to genetic algorithms to search for optimal hidden-layer advocacy. Mothers entered the continua at different architectures, connectivity, and training parameters for points and moved at different rates toward "engaged ANN for predicting community-acquired pneumonia parenting." The final stage, partnering, required active among patients with respiratory complaints. participation of nurses. Mothers' development evolved METHODS: Feed-forward back-propagation ANN in predictable patterns. The results of this study can be were trained on sociodemographic, symptom, sign, considered in implementation and evaluation plans for comorbidity, and radiographic outcome data among NICUs moving to family-focused developmental care. 1044 patients from the University of Illinois (the training cohort), and were applied to 116 patients from Hegarty K. The health consequences of child sexual abuse the University of Nebraska (the testing cohort). Binary and partner abuse for women attending general chromosomes with genes representing network practice. Aust Fam Physician 2003; 32(9):760. attributes, including the number of nodes in the hidden layers, learning rate and momentum parameters, and Hegna K, Mossige S, Wichstrom L. Older adolescents' the presence or absence of implicit within-layer positive attitudes toward younger adolescents as sexual connectivity using a competition algorithm, were partners. Adolescence 2004; 39(156):627-51. operated on by various combinations of crossover, Abstract: The prevalence of older adolescents' positive mutation, and probabilistic selection based on network attitudes toward younger sexual partners was mean-square error (MSE), and separately on average investigated through three measures of self-reported cross entropy (ENT). Predictive accuracy was hypothetical likelihood of having sex with measured as the area under a receiver-operating preadolescents and younger adolescents (LSA), using a characteristic (ROC) curve. RESULTS: Over 50 school-based cluster sample of 710 Norwegian 18- to generations, the baseline genetic algorithm evolved an 19-year-olds attending nonvocational high schools in optimized ANN with nine nodes in the first hidden Oslo. Some likelihood of having sex with a layer, zero nodes in the second hidden layer, learning preadolescent (less than 12 years of age) was reported rate and momentum parameters of 0.5, and no within- by 5.9% of the males. The 19.1% of the males who layer competition connectivity. This ANN had an ROC indicated some likelihood of having sex with a 13- to area in the training cohort of 0.872 and in the testing 14-year old, compared to those who did not, reported cohort of 0.934 (P-value for difference, 0.181). more high-frequency drinking, more alcohol-related Algorithms based on cross-generational selection, Gray problems, earlier sexual initiation, more conduct coding of genes prior to mutation, and crossover problems, and poorer psychosocial adjustment. This recombination at different genetic levels, evolved subgroup also reported more high-frequency use of optimized ANN identical to the baseline genetic pornography, having more friends with an interest in strategy. Algorithms based on other strategies, child pornography and violent pornography, and including elite selection within generations (training 560
- 569. greater use ofcoercion to obtain sexual favors. neurobiological effects of early life stress should be addressed. Findings from such studies may ultimately Hehir B. Nurses should not collude with spying on parents. help to prevent the deleterious neurobiological and Nurs Times 2001; 97(5):21. psychopathological consequences in the unacceptably high number of children exposed to early life stress in Heikkinen A, Puura K, Mattila K. Improving health centre modern society. physicians' child-psychiatric networks. Scand J Prim Health Care 2005; 23(1):26-7. Heim C, Newport DJ, Wagner D, Wilcox MM, Miller AH, Abstract: OBJECTIVE: To study changes in Finnish Nemeroff CB. The role of early adverse experience and GPs' child-psychiatric networks over a one-year period. adulthood stress in the prediction of neuroendocrine DESIGN: Postal questionnaire. SETTING: Health stress reactivity in women: a multiple regression centres in the area of Tampere University Hospital with analysis. Depress Anxiety 2002; 15(3):117-25. a catchment population of one million. Abstract: Sensitization of stress-responsive INTERVENTION: A one-off course in the field of neurobiological systems as a possible consequence of child psychiatry was held 56 times in different health early adverse experience has been implicated in the centres. SUBJECTS: GPs (n = 761) working in the area pathophysiology of mood and anxiety disorders. In received a questionnaire in 2000 and 2001. Those addition to early adversities, adulthood stressors are responding in both years were included in the analysis also known to precipitate the manifestation of these (n = 371). MAIN OUTCOME MEASURES: A fill-in disorders. The present study sought to evaluate the picture was used to identify professionals in the relative role of early adverse experience vs. stress network of each GP. Three levels were analysed: (1) experiences in adulthood in the prediction of health centre, (2) municipality, and (3) secondary neuroendocrine stress reactivity in women. A total of healthcare. RESULTS: The number of collaborators 49 women (normal volunteers, depressed patients, and increased significantly only in the training group at women with a history of early abuse) underwent a municipality level. No statistically significant battery of interviews and completed dimensional rating differences were found in proportions of GPs naming scales on stress experiences and psychopathology, and cooperating persons. CONCLUSION: The impact of a were subsequently exposed to a standardized one-off training programme on the scope of GPs' child- psychosocial laboratory stressor. Outcome measures psychiatric networks was not very strong but was in were plasma adrenocorticotropin (ACTH) and cortisol accordance with the aims of the programme. responses to the stress test. Multiple linear regression analyses were performed to identify the impact of Heim C, Nemeroff CB. Neurobiology of early life stress: demographic variables, childhood abuse, adulthood clinical studies. Semin Clin Neuropsychiatry 2002; trauma, major life events in the past year, and daily 7(2):147-59. hassles in the past month, as well as psychopathology Abstract: A burgeoning number of clinical studies have on hormonal stress responsiveness. Peak ACTH evaluated the immediate and long-term neurobiological responses to psychosocial stress were predicted by a effects of early developmental stress, eg, child abuse history of childhood abuse, the number of separate and neglect or parental loss, in the past years. This abuse events, the number of adulthood traumas, and the review summarizes and discusses the available findings severity of depression. Similar predictors were from neuroendocrine (hypothalamic-pituitary-adrenal identified for peak cortisol responses. Although abused axis, other neuroendocrine axes), neurochemical women reported more severe negative life events in (catecholamines, serotonin, other neurotransmitters), adulthood than controls, life events did not affect psychophysiological (autonomic function, startle neuroendocrine reactivity. The regression model reactivity, brain electrical activity) and neuroimaging explained 35% of the variance of ACTH responses. studies (brain structure, function) conducted in children The interaction of childhood abuse and adulthood or adults with a history of early life stress, with or trauma was the most powerful predictor of ACTH without psychiatric disorders. Early developmental responsiveness. Our findings suggest that a history of stress in humans appears to be associated with childhood abuse per se is related to increased neurobiological alterations that are similar to many neuroendocrine stress reactivity, which is further findings in animal models of early life stress, and likely enhanced when additional trauma is experienced in represent the biological basis of an enhanced risk for adulthood. psychopathology. Clinical studies are now beginning to explore potentially differential neurobiological effects Heinemann U. Basic mechanisms of partial epilepsies. Curr of different types of early life stress and the existence Opin Neurol 2004; 17(2):155-9. of critical developmental periods, which may be Abstract: PURPOSE OF REVIEW: Partial epilepsies sensitive to the neurobiological effects of specific are characterized by cell loss with consequences for stressors. In addition, the role of a multitude of neuronal organization, excitability, mnestic and moderating and mediating factors in the determination cognitive functions and present with pharmaco- of individual vulnerability or resilience to the resistance and difficulties in clinical management. While mesial temporal lobe epilepsies present 561
- 570. frequently with cellloss and neuronal reorganization, Heiss JE, Held CM, Estevez PA, Perez CA, Holzmann CA, neocortical epilepsies frequently involve Perez JP. Classification of sleep stages in infants: a developmental alterations. RECENT FINDINGS: neuro fuzzy approach. IEEE Eng Med Biol Mag 2002; There is increasing evidence that nerve cells in 21(5):147-51. epileptic tissue become more vulnerable to excitotoxic cell death due to impairment of mitochondrial Helveston EM, Orge FH, Naranjo R, Hernandez L. functions and that free radical formation is critically Telemedicine: Strabismus e-consultation. J AAPOS involved in these processes. Whether and to what 2001; 5(5):291-6. extent such alterations contribute to pharmaco- Abstract: BACKGROUND: Volunteer resistance is unclear. However, at least three ophthalmologists can achieve success with teaching mechanisms may contribute to pharmaco-resistance: and service programs working with high intensity over changes in target molecules for antiepileptic drugs, a short term. Continuation of initially successful upregulation of drug transporters, and potentially programs may be limited by lack of timely, effective reorganization processes in inhibitory networks. communication and follow-up. In an attempt to Upregulation of drug transporters also seems to be overcome these limitations, a total of 6 telemedicine involved in pharmaco-resistance of developmental programs were established after a successful trial alterations underlying focal epilepsies. Recent data program at the Ramon Pando Ferrer Hospital in from the literature suggest that transgenic models for Havana, Cuba. METHODS: Two pediatric disturbances of cortical development may be useful ophthalmology-strabismus clinics, one in Cuba and one models for the study of these variable forms of partial in Romania, were provided a digital camera and a epilepsies. SUMMARY: The data suggest that computer in order to obtain and then transmit by e-mail improvement of therapy could result from free radical patient images obtained according to a prescribed scavenging and from manipulation of drug transport format. Ophthalmologists in both of these programs into the affected tissue. New models of developmental were instructed personally during an orientation period epilepsies may help us to understand mechanisms in their clinics. Training included use of a digital underlying increased vulnerability to seizures as well camera and computer, patient examination, and as improving strategies for treatment. surgical technique in the operating room. Four additional programs referred patients via digital images Heinrich H, Moll GH, Dickhaus H, Kolev V, Yordanova J, after receiving only written and oral instruction. Rothenberger A. Time-on-task analysis using wavelet RESULTS: The diagnosis and treatment plan networks in an event-related potential study on determined by one of us (E.M.H.) for each of the first attention-deficit hyperactivity disorder. Clin 15 Cuban patients after study of digital images sent by Neurophysiol 2001; 112(7):1280-7. e-mail was the same as the diagnosis and treatment Abstract: OBJECTIVE: The aim of this event-related plan determined by the same observer after in-person potential (ERP) study was to test time-on-task analysis examination of the patients. On the basis of the level of at the level of single sweeps in a clinical trial. Since confidence attained in these patients, 35 additional inattentiveness is one of the main symptoms of patients from a total of 6 clinics were seen by digital attention-deficit hyperactivity disorder (ADHD), this consultation only. CONCLUSION: A store-and- child psychiatric disorder was chosen as an exemplary forward telemedicine consultation technique that uses application. METHODS: Twenty-four healthy and 24 digital images and e-mail holds promise to be an ADHD boys, aged 9--15 years, performed an auditory effective means for carrying out consultation for selective attention task for about 5 min. ERP single patients with strabismus. trials were analyzed using wavelet networks. Time-on- task analysis was applied to omission errors, reaction Hendrickson SG. Reaching an underserved population with time and slow ERP components (frontal negativity, a randomly assigned home safety intervention. Inj Prev parietal positivity), represented by a low-frequency 2005; 11(5):313-7. wavelet component. RESULTS: Both performance and Abstract: OBJECTIVE: To access an underserved, ERP measures showed distinct temporal dynamics. mobile segment of a monolingual Spanish speaking Time-on-task effects were not only linear, but also of population and to improve maternal self efficacy for higher order and started after less than 1 min. For home safety behaviors using a culturally appropriate ADHD children, earlier time-on-task effects, i.e. an intervention. DESIGN: A pre- and post-test earlier increase of omission errors and frontal experimental design tested differences in maternal negativity, resulted. Healthy children could allocate childhood injury health beliefs (MCIHB) and more attentional resources during the course of the controllable safety hazards (CHS). Participants were experiment. CONCLUSION: Time-on-task analysis at randomly assigned to experimental and control groups. the level of single trials revealed phenomena probably Baseline data assessed demographic and study reflecting ADHD children's attentional deficits. Thus, a variables comparability. The intervention included more differentiated ERP analysis may provide a better counseling, assessment of maternal safety practices, understanding of the pathophysiological background in and provision of safety items. SETTING: A non-urban neuropsychiatric disorders. area in Texas where low income, largely migrant 562
- 571. Hispanics represent themajority of residents. immunohistochemistry. Neurones labelled from the PARTICIPANTS: Eighty two mothers of 1--4 year old mucosa were located in all ganglionated nerve children. RESULTS: The 95% retention rate of an networks, including the myenteric plexus. In all itinerant, hard to reach population suggests that plexuses, at least five neurochemical types of neurones minority participants may be receptive to culturally could be observed, i.e. SOM-IR neurones, SP-IR appropriate home visits. The intervention group neurones, SOM/SP-IR neurones, VIP-IR neurones and demonstrated improved self efficacy for home safety neurones lacking immunoreactivity for any of these behaviors (F (2, 77)=7.50, p=0.01). Mothers with markers. Most of the DiI-labelled neurones were stronger self efficacy and fewer perceived barriers had multidendritic; a minority of neurones could be fewer accessible in-home hazards. Observed home identified as Dogiel type II cells, suggesting the hazard predictors were: (a) never being married; (b) existence of a subgroup of primary afferent neurones in poor home repair, (c) lower self efficacy for safety the DiI-filled cell population. The ratio of labelled behaviors; and (d) control group status. multidendritic neurones (assumed to be secretomotor) CONCLUSIONS: Safety items coupled with a home to labelled Dogiel type II neurones (assumed to be visit tailored to child age and maternal culture was an primary afferent) in the myenteric plexus is higher in effective intervention in a hard to reach population. large mammals (pig and human) than in small This study contributes to designing research for a mammals (guinea pig). This might point to the monolingual population with limited local language existence of a different topographical distribution of proficiency and community residency. Injuries subsets of primary afferent neurones and/or represent a major source of health disparities in these topographically distinct intrinsic mucosal reflex neglected populations. circuits in large mammals, including humans. Henry JK. Eliminating health inequities: national goals and Henthorn JS, Almeida AM, Davies SC. Neonatal screening developing programs. J Obstet Gynecol Neonatal Nurs for sickle cell disorders. Br J Haematol 2004; 2001; 30(5):523-8. 124(3):259-63. Abstract: In the 20th century, infant and maternal mortality declined dramatically and the life span and Herbert MA, Beveridge CJ, Saunders NJ. Bacterial virulence quality of life for women and infants increased. At the factors in neonatal sepsis: group B streptococcus. Curr end of the century, the rate of decline slowed and Opin Infect Dis 2004; 17(3):225-9. policy makers began to look for new ways to address Abstract: PURPOSE OF REVIEW: Group B the problem. A significant challenge now is to streptococcus is a leading cause of neonatal eliminate the persistent disparities in maternal and pneumonia, septicaemia and meningitis. Up to one infant health among various racial and ethnic groups, quarter of women in labour are now given intravenous particularly between black and white women and antibiotics to prevent early-onset disease by the infants. To improve perinatal outcomes, programs are organism, a situation that will remain constant until a needed that focus on community-based interventions successful vaccine is available. From a molecular that reduce infant mortality across all racial and ethnic understanding of the pathogenicity of group B groups. Two promising programs that are expected to streptococcus we may be able to devise novel means receive additional federal funding through the for controlling disease, such as identifying inhibitors of Children's Health Act are the Fetal and Infant Mortality key metabolic pathways or regulatory networks. This Review Program and home visiting programs. review summarizes our post-genomic knowledge of the Expansion of these programs may provide the vehicle regulation, metabolism and virulence of group B to reduce disparities in maternal and infant mortality streptococcus. RECENT FINDINGS: Although and morbidity. New programs are needed to meet the advances have been made in the understanding of ambitious goals of Healthy People 2010. classic group B streptococcus virulence traits, such as capsular polysaccharide, beta-haemolysin, C5a Hens J, Vanderwinden JM, De Laet MH, Scheuermann DW, peptidase, adhesins and immunogenic surface proteins, Timmermans JP. Morphological and neurochemical the major recent contribution to group B streptococcus identification of enteric neurones with mucosal pathogenesis has been the whole genome sequencing of projections in the human small intestine. J Neurochem three group B streptococcus strains, representing 2001; 76(2):464-71. serotypes Ia, III and V. From these genomes, we not Abstract: Data on the axonal projections of enteric only see where the classic virulence genes map, but we neurones in the human intestine are still scarce. The can also gain insights into the metabolism and present study aimed to identify the morphology and regulation of the organism and how these affect its neurochemical coding of enteric neurones in the human virulence. SUMMARY: Knowledge of virulence small intestine, which are involved in the innervation factors and the organism's metabolism and gene of the mucosa. The lipophilic neuronal tracer DiI was regulation offers opportunities to find novel means of applied to one mucosal villus of small intestinal preventing group B streptococcus infection in babies. resection specimens. The tissue was kept in organotypic culture and subsequently processed for 563
- 572. Hermer L. Paradigmsrevised: intersex children, bioethics & relationship to 5 indicators of adolescent deviant the law. Ann Health Law 2002; 11:195-236, table of behavior. While maltreatment in childhood poses a risk contents. for later deviance in adolescence, the risk can be even Notes: GENERAL NOTE: KIE: 210 fn. greater for those who have experienced more GENERAL NOTE: KIE: KIE Bib: informed consent; transitions while growing up. patient care/minors Abstract: Ms. Hermer explores the controversy Herrera VM, McCloskey LA. Gender differences in the risk surrounding the management of intersex infants and for delinquency among youth exposed to family children in America. Her focus on the areas of medical violence. Child Abuse Negl 2001; 25(8):1037-51. malpractice and informed consent leads her to the Abstract: OBJECTIVE: The purpose of this research conclusion that contrary to some recommendations, a was to illuminate gender differences in adolescent moratorium on cosmetic genital and sex assignment delinquency against a backdrop of childhood exposure surgeries for infants and children is not warranted. to both marital violence and physical child abuse. Rather, providers should focus on offering parents with Specifically, analyses were performed to trace the complete information, referrals to support groups and unique effects of exposure to either form of family forthright discussions on the dearth of information violence (marital or child) on the violent and available. nonviolent delinquency of boys and girls. METHOD: This is a prospective study of 299 children who were Hernandez Robles M, Ramirez Enriquez C, Gonzalez Diaz interviewed with their mothers in 1991 about forms of SN, Canseco Gonzalez C, Arias Cruz A, del Castillo O. abuse in the family. Approximately 5 years later a [Psychological profile of the pediatric asthma patient]. search of juvenile court records was performed for Rev Alerg Mex 2002; 49(1):11-5. these same children. Details on the nature of the crimes Abstract: BACKGROUND: When a child develops were collected. Outcome variables included: (1) asthma symptoms, several changes in his/her behavior, whether there was ever an arrest; and (2) whether there in his/her family and in his/her social environment was ever an arrest for a violent crime. RESULTS: begin. OBJECTIVE: To identify the most frequent Preliminary analyses indicated no gender differences in personality traits and psychological disturbances in overall referral rates to juvenile court, although boys asthmatic children and adolescents. MATERIAL AND were more likely than girls to be referred for property, METHODS: A transversal, observational and felony, and violent offenses. Exposure to marital descriptive study was performed on 85 asthmatic violence in childhood predicted referral to juvenile children and adolescents ages from 5 to 18 years old court. Girls with a history of physical child abuse were that attended a questionnaire, and a graphic test on 77 arrested for violent offenses more than boys with of those children, which consisted on drawing two similar histories, but the context of violent offenses pictures. Such pictures were analyzed by a differed dramatically by gender: Nearly all referrals for psychotherapist to determine the personality traits and a violent offense for girls were for domestic violence. the psychological disturbance present in these CONCLUSIONS: Although boys and girls share individuals. RESULTS: All the children answered similar family risk factors for delinquency, girls are positively at least one of the questions which detect more likely than boys to be arrested for violent data related to depression in the questionnaire, being offenses in the aftermath of child physical abuse. These the more frequent: easy anger (40%), insomnia (29%), findings suggest that it takes more severe abuse to sadness (15%), auto-aggression or suicide ideas (11%) prompt violence in girls than is necessary to explain and loss of appetite (6%). According to graphic test boys' violent offending. interpretation, 39% of children showed a depression disturbance, 29% adaptation disturbance with Herskovits EH, Gerring JP. Application of a data-mining depression symptoms, and 12% an adaptation method based on Bayesian networks to lesion-deficit disturbance. In addition, we found that 2 children were analysis. Neuroimage 2003; 19(4):1664-73. victim of abuse and negligence into their families. Abstract: Although lesion-deficit analysis (LDA) has CONCLUSION: The 100% of the evaluated asthmatic provided extensive information about structure- children and adolescents, showed data related to function associations in the human brain, LDA has depression presence. suffered from the difficulties inherent to the analysis of spatial data, i.e., there are many more variables than Herrenkohl EC, Herrenkohl RC, Egolf BP. The psychosocial subjects, and data may be difficult to model using consequences of living environment instability on standard distributions, such as the normal distribution. maltreated children. Am J Orthopsychiatry 2003; We herein describe a Bayesian method for LDA; this 73(4):367-80. method is based on data-mining techniques that employ Abstract: The relationship between stability of living Bayesian networks to represent structure-function arrangements and adolescent deviance was examined associations. These methods are computationally for 212 adolescents in a longitudinal study of tractable, and can represent complex, nonlinear maltreated and non maltreated children. Transitions in structure-function associations. When applied to the caretakers and residences have a statistically significant evaluation of data obtained from a study of the 564
- 573. psychiatric sequelae oftraumatic brain injury in Hertz-Pannier L, Chiron C, Vera P et al. Functional imaging children, this method generates a Bayesian network in the work-up of childhood epilepsy. Childs Nerv Syst that demonstrates complex, nonlinear associations 2001; 17(4-5):223-8. among lesions in the left caudate, right globus pallidus, Abstract: In children with medically intractable right side of the corpus callosum, right caudate, and left lesional epilepsy, surgery is deemed successful if the thalamus, and subsequent development of attention- epileptogenic focus can be removed while major deficit hyperactivity disorder, confirming and neurological functions are spared. Current techniques extending our previous statistical analysis of these data. rely on invasive intracranial recordings. The new Furthermore, analysis of simulated data indicates that developments in functional imaging offer the methods based on Bayesian networks may be more possibility of localizing the epileptogenic focus sensitive and specific for detecting associations among noninvasively (PET/SPECT) and mapping cognitive categorical variables than methods based on chi-square functions (fMRI). Ictal SPECT shows hyperperfusion and Fisher exact statistics. in the focus and has proved to have better localizing value than interictal PET or SPECT, which show focal Hertz-Pannier L, Chiron C, Jambaque I et al. Late plasticity hypometabolism or hypoperfusion. Ictal SPECT is for language in a child's non-dominant hemisphere: a useful for deciding on the placement of intracranial pre- and post-surgery fMRI study. Brain 2002; 125(Pt electrodes in extratemporal epilepsies, particularly in 2):361-72. young children. Functional MRI has proved highly Abstract: The ability of the right hemisphere to sustain accurate for localizing motor and language networks, the acquisition or the recovery of language after thus offering the possibilities of replacing the Wada extensive damage to the left hemisphere has been test (language hemispheric lateralization) and studying essentially related to the age at the time of injury. postlesional brain plasticity. Despite the difficulties of Better language abilities are acquired when the insult functional imaging in children owing to the limited occurs in early childhood (perinatal insults) compared cooperation that can be expected, ethical constraints, with later occurrence. However, while previous studies and poor normative data, SPECT/PET and fMRI have described the neuropsychological pattern of provide clinically useful information for presurgical language development in typical cases, the neural bases work-up of childhood epilepsies. of such plasticity remain unexplored. Non-invasive functional MRI (fMRI) is a unique tool to assess the Hess CR, Papas MA, Black MM. Use of the Bayley Infant neural correlates of brain plasticity through repeated Neurodevelopmental Screener with an environmental studies, but the technique has not been widely used in risk group. J Pediatr Psychol 2004; 29(5):321-30. children because of methodological limitations. Abstract: OBJECTIVE: To determine predictive Plasticity of language was studied in a boy who validity of the Bayley Infant Neurodevelopmental developed intractable epilepsy related to Rasmussen's Screener (BINS) during the first 2 years of life with a syndrome of the left hemisphere at age 5 years 6 group of children at risk for developmental delay due months, after normal language acquisition. The first to environmental risk factors. METHOD: The setting fMRI study at age 6 years 10 months showed left consisted of home visits to participants. The BINS was lateralization of language networks during a word administered to 106 children, ages 6 and 13 months, of fluency task. After left hemispherotomy at age 9 years, low-income, African American, adolescent mothers. the child experienced profound aphasia and alexia, Three risk groups were identified: low, moderate, and with rapid recovery of receptive language but slower high. The Bayley Scales of Infant Development, and incomplete recovery of expressive language and second edition (BSID-II), were administered at 24 reading. Postoperative fMRI at age 10 years 6 months months and served as the criterion standard. A cut showed a shift of language-related networks to the score of 85 (1.00 SD below mean) represented a right during expressive and receptive tasks. Right clinically meaningful indicator of delayed development activation was seen mainly in regions that could not be on the mental and psychomotor developmental indices, detected preoperatively, but mirrored those previously as well as a composite of these indices. Two other cut found in the left hemisphere (inferior frontal, temporal scores on the BSID-II were also included for and parietal cortex), suggesting reorganization in a pre- comparison: 90 (0.75 SD below mean) and 77 (1.50 SD existing bilateral network. In addition, below mean). RESULTS: Using BSID-II scores at 24 neuropsychological data of this case support the months as the criterion measure, 6- and 13-month hypothesis of innately more bilateral distribution of BINS scores yielded low sensitivity values but high receptive than expressive language. This first serial specificity values, regardless of how BINS risk groups fMRI study illustrates the great plasticity of the child's were defined and which cut points on the BSID-II were brain and the ability of the right hemisphere to take used. Positive predictive value was higher when the cut over some expressive language functions, even at a score was set below 90 than when it was set below 85. relatively late age. It also suggests a limit for removal CONCLUSIONS: Low predictive validity of the BINS of the dominant hemisphere beyond the age of 6 years, with an environmental risk group highlights the a classical limit for the critical period of language difficulties inherent in developmental screening among acquisition. infants who have environmental, but not biological, 565
- 574. risk factors. Becauseinfants at environmental risk tend Higgins LP, Hawkins JW. Screening for abuse during to experience developmental declines after infancy, it pregnancy: implementing a multisite program. MCN may be beneficial for primary care providers to use Am J Matern Child Nurs 2005; 30(2):109-14. psychosocial screening tools to identify which children Abstract: Screening for abuse at every healthcare visit need closer monitoring and referral to enrichment is a standard of practice promulgated by many programs to prevent developmental declines during healthcare professional organizations. The need for toddlerhood. such screening is underscored by reports of homicide as a leading cause of maternal mortality during Hester JD. Intersex(es) and informed consent: how pregnancy and the first year of the baby's life in physicians' rhetoric constrains choice. Theor Med Massachusetts and Maryland, and by the calculation of Bioeth 2004; 25(1):21-49. the costs of intimate partner violence in the United Notes: GENERAL NOTE: KIE: KIE Bib: informed States. This article discusses how we addressed consent; patient care/minors problems that arose in implementing screening for Abstract: When a child is born with ambiguous abuse in 13 different sites as a part of a clinical nursing genitalia it is declared a psychosocial emergency, and research project. Engaging in clinical nursing research the policy first proposed by John Money (Johns necessitates close relationships with clinical agencies Hopkins University) and adapted by the American and their staff members. This often means establishing Academy of Pediatrics (and more broadly accepted in and maintaining relationships with all nurses caring for Canada, the U.K., and Europe) requires determination patients in each clinical unit serving as a study site. For of underlying condition(s), selection of gender, surgical research on abuse during pregnancy, our study team intervention, and a commitment by all parties to accept members were engaged in interactions with prenatal the "real sex" of the patient, all no later than 18-24 care providers at 13 different study sites. Central to the months, preferably earlier. Ethicists have recently study was implementing use of a standardized abuse questioned this protocol on several grounds: lack of screening tool, the Abuse Assessment Screen, at each medical necessity, violation of informed consent, study site. This article also describes the lessons we uncertainty of standards of success, among others. This learned in attempting to implement such a large scale suggests that the faults in the protocol can be addressed change in clinical practice. and improved. Through a rhetorical approach informed by Perelman/Olbrechts-Tyteca, the disciplinary Higgins SS. Parental role in decision making about pediatric pathologization and reconstruction of the body are cardiac transplantation: familial and ethical explored as incidents of constraining rhetoric that enact considerations. J Pediatr Nurs 2001; 16(5):332-7. their persuasion upon the body of intersexed children. Abstract: Parents of children with complex or terminal This essay shows that the presumptions, judgments, heart conditions often face agonizing decisions about values, and presuppositions brought by the physician to cardiac transplantation. There are differences in the the identification, diagnosis, and curative procedures level of involvement that parents prefer when making create a network of constraints that exclude alternative such decisions. The purpose of this study was to possibilities. The result is a situation wherein parents, identify and describe parents' preferences for their roles physicians, and intersexed patients have "no choice" in decisions related to cardiac transplantation. A but to accept the medical treatment guidelines. prospective ethnographic method was used to study 24 parents of 15 children prior to their decision of Hewson B. Killing off Mary: was the Court of Appeal right? accepting or rejecting the transplant option for their Med Law Rev 2001; 9(3):281-98. children. Findings revealed that the style of parent Notes: GENERAL NOTE: KIE: Hewson, Barbara decision making ranged from a desire to make an GENERAL NOTE: KIE: 74 fn. independent, autonomous choice to a wish for an GENERAL NOTE: KIE: KIE Bib: patient care/minors authoritarian, paternalistic choice. Nurses and physicians can best support families in this situation, Hewson B. Must HIV-positive women give birth in hospital? showing sensitivity to the steps that parents use to Pract Midwife 2002; 5(10):4-5. make their decisions. An ethical model of decision making is proposed that includes respect for Hey E. Suspected child abuse: the potential for justice to differences in beliefs and values of all persons involved miscarry. BMJ 2003; 327(7410):299-300. in the transplantation discussion. Hey E, Fleming P, Sibert J. Learning from the sad, sorry Hilal A, Cekin N, Gulmen MK, Ozdemir MH, Karanfil R. saga at Stoke. Arch Dis Child 2002; 86(1):1-3. Homicide in Adana, Turkey: a 5-year review. Am J Forensic Med Pathol 2005; 26(2):141-5. Hicks R. Relating to methodological shortcomings and the Abstract: Violence is a significant public health concept of temporary brittle bone disease. Calcif problem. Thus, so as to prevent this problem, Tissue Int 2001; 68(5):316-9. homicide, the severest form of violence depriving a human being of his right to live, deserves a detailed examination. This study is a retrospective research 566
- 575. examining the 2951cases of medicolegal autopsies in conduct disorders. J Child Psychol Psychiatry 2002; Adana during a period of 5 years (1997-2001). Among 43(1):133-64. these cases, 620, which were determined to be Abstract: BACKGROUND: This paper reviews recent homicidal, were taken into the scope of this study. The evidence on the causes and maintenance of aggressive cases were examined with respect to sex, age groups, and disruptive behaviours in childhood and the method used during the act of homicide, the adolescence. It considers the relative merits of several number and the localization of the wounds on the body. different ways of conceptualising such problems, in A total of 620 (21%) of the medicolegal autopsies relation to the contribution of biological, psychological conducted within this period were homicides. Of these and social factors. METHOD: It focuses on conduct cases, 515 (83.06%) were male and 105 (16.94%) problems appearing in young childhood, which greatly female, and the rate of the males to females was 4.9; increase the likelihood of persistent antisocial 72.74% of the victims were between the ages of 21 and behaviours in adolescence and adult life in association 50. It was seen that 54.83% of the homicides involved with wider interpersonal and social role impairments. It firearms, while 35.16% of the victims were stabbed to considers the contribution of individual factors, death with a cutting object. It was also determined that including impaired verbal skills, deficits in executive the victims suffered a single wound in 47.35% of functions, and an imbalance between behavioural firearm-related murders and 29.35% of stabbings activation and inhibition systems. These are viewed in resulted in death. Alcohol was found in the blood of interaction with commonly associated environmental 7.58% of the homicide victims, while none had any disadvantages such as hostile or intrusive parenting. illicit drugs. The roles of attributional biases, unrealistic self- evaluations, and insecure attachment are considered in Hildebrand P. Prospero's paper. Int J Psychoanal 2001; 82(Pt relation to affect regulation, and effective social action. 6):1235-46. The contributions of the wider social environments of Abstract: The writer proposes that the interplay peers, neighbourhood and socio-economic conditions between the hermeneutics of psychoanalysis and are evaluated. CONCLUSIONS: The paper concludes literature can illuminate understanding of the that, although considerable progress has been made transference and countertransference at large in an over the past ten years, there is a need to further refine analytic treatment. Writing about the work with a our conceptualisation of the behaviours to be young woman who had been persistently sexually explained, to develop a coherent theory of the causal abused as a child and who developed anorexia in her and maintaining processes, and to carry out prospective adolescence so severe that her life was endangered studies with adequate numbers of high risk children. both by the illness and by attempts at suicide, the author finds his reading of Shakespeare's The Tempest Hill NE, Bush KR, Roosa MW. Parenting and family a powerful informant to the work. Interpreting the socialization strategies and children's mental health: object relations represented by Prospero and Miranda low-income Mexican-American and Euro-American and the process of their integration into new mental mothers and children. Child Dev 2003; 74(1):189-204. structures lends the analytic work an additional level of Abstract: The extent to which current theories on understanding, in particular in relation to the oedipal family-related factors associated with children's bond between patient and analyst. When the analyst is depression and conduct problems are applicable to confronted by the imminence of his own death towards Mexican American children was examined among the end of the analysis, his reading of Prospero's demographically comparable samples of low-income relinquishment of his magical powers and his release of Mexican American (English and Spanish speaking) and his daughter into sexual maturity and independence Euro-American mothers and children. There were helps the patient to replace her destructive inner objects ethnic differences in mean levels of children's with more reparative and benign ones as she develops a depression, maternal inconsistent discipline, and hostile capacity for concern and mourning. control. In addition, there were differences across language within the Mexican American sample on Hill DJ. The morality of the separation of the conjoined levels of reported maternal inconsistent discipline and attard twins of Manchester. Health Care Anal 2005; hostile control. The vast majority of relations between 13(3):163-76. parenting and mental health were similar between Notes: GENERAL NOTE: KIE: 7 refs. Mexican Americans and Euro-Americans, suggesting GENERAL NOTE: KIE: KIE Bib: patient care/minors that current theories do apply across ethnic groups. Abstract: I argue that the separation of the conjoined However, analyses across language within the Mexican Attard twins of Manchester was not morally justified as American sample showed that language preference it involved intentionally internally affecting moderated the relation between maternal acceptance ("invading") the body of the weaker twin without and children's conduct problems. Moreover, the permission and without any advantage to her. relation between acceptance and hostile control differed across groups. These results are discussed in Hill J. Biological, psychological and social processes in the light of the relative influence of ethnicity and other contextual variables on parenting and children's mental 567
- 576. health. annual assessments of ERPs to determine if multiple P3b growth patterns exist. The P3b amplitude patterns Hill NE, Herman-Stahl MA. Neighborhood safety and social obtained were related to risk status, concurrent involvement: associations with parenting behaviors and presence of childhood psychopathology (internalizing depressive symptoms among African American and or externalizing), and age of onset to develop a Euro-American mothers. J Fam Psychol 2002; diagnosis. RESULTS: A pattern characterized by lower 16(2):209-19. P3b amplitude at study entry and a slower rate of Abstract: The relation between neighborhood change during child and adolescent development characteristics and parenting and the mediating role of (pattern 3) was most often associated with high-risk maternal depressive symptoms was examined among status in boys and high-risk status in combination with African American and Euro-American mothers of the presence of a childhood diagnosis in girls. Pattern 3 kindergarten children. Mothers' ratings of was significantly related to the overall presence of neighborhood safety were related to disciplinary childhood psychopathology (internalizing or strategies for both African American and Euro- externalizing) and to the presence of an Axis I American mothers but not to expressions of affection. diagnosis at young adult follow-up. CONCLUSIONS: Interviewers' ratings of safety were related to mothers' The developmental pattern previously described for use of hostile socialization strategies. Both mothers' offspring at high risk for developing alcoholism and interviewers' reports of safety were linked with because of their familial/genetic background was maternal depressive symptoms. Depressive symptoms confirmed. Admixture analysis has refined this mediated the relation between neighborhood safety and observation and suggests that among all children and inconsistent discipline, suggesting that the influence of adolescents tested, three developmental patterns can be safety on inconsistent discipline was due to its impact identified, one of which is most often seen in on maternal depression. Although there were association with male high-risk children and similarities across ethnic groups, the relation between adolescents. social involvement and mothers' withdrawal of interactions with their children differed across groups. Hill TD, Angel RJ. Neighborhood disorder, psychological distress, and heavy drinking. Soc Sci Med 2005; Hill S, Hill A, Hampton D. Videoconferencing in a hospital 61(5):965-75. school: removing barriers. J Audiov Media Med 2004; Abstract: Studies show that residents of disadvantaged 27(2):58-61. neighborhoods drink more heavily than residents of Abstract: Videoconferencing has enhanced the learning more affluent neighborhoods. However, explanations experiences of children who, as a result of medical for this association are not well developed. Using data difficulties, have attended James Brindley School. The collected from a sample of low-income women with School is based in thirteen hospitals and specialist units children from Boston, Chicago, and San Antonio, we across Birmingham, and provides educational explore the possibility that perceptions of opportunities for children from 3 to 19 years of age. At neighborhood disorder encourage heavy drinking. one of these sites, the Diana, Princess of Wales, Drawing on Conger's (Q. J. Stud. Alcohol 17 (1956) Children's Hospital, the use of videoconferencing has 296) tension reduction hypothesis, we propose that the been extremely effective in practice, and experiences stress of living in a neighborhood characterized by suggest that it should be adopted as a fundamental tool problems with drugs, crime, teen pregnancy, by those who wish to develop and enhance the unemployment, idle youth, abandoned houses, and educational process in similar environments. unresponsive police can be psychologically distressing and lead some people to consume alcohol as a means Hill SY, Shen S. Neurodevelopmental patterns of visual P3b of palliative escape, to regulate feelings of anxiety and in association with familial risk for alcohol dependence depression. In support of the tension reduction and childhood diagnosis. Biol Psychiatry 2002; hypothesis, we find that the positive association 51(8):621-31. between neighborhood disorder and heavy drinking is Abstract: BACKGROUND: The P3b component of the largely mediated by anxiety and depression. event-related potential (ERP) has frequently been reported to be reduced in children and adolescents at Hinden BR, Biebel K, Nicholson J, Mehnert L. The Invisible high risk for developing alcoholism relative to control Children's Project: key ingredients of an intervention children and adolescents without familial loading for for parents with mental illness. J Behav Health Serv alcohol dependence. P300 amplitude changes during Res 2005; 32(4):393-408. development for all children. Previously it has been Abstract: This study used a collective case study design shown that high-risk offspring display a pattern in to identify key ingredients of the Invisible Children's which the amplitude is lower at age 8 with a smaller Project, an intervention program for families in which a rate of change during adolescence. METHODS: parent has a mental illness. Data were obtained from Admixture analysis was applied to data obtained for interviews with parents and service providers, and from those children and adolescents having five or more family file records. Qualitative analyses were used to generate hypotheses regarding key ingredients and 568
- 577. targeted outcomes, andto develop a testable Hipwell AE, Loeber R, Stouthamer-Loeber M, Keenan K, intervention model. Key ingredients were defined as White HR, Kroneman L. Characteristics of girls with core processes, essential services, and mediators. early onset disruptive and antisocial behaviour. Crim Strong convergence across parents and providers Behav Ment Health 2002; 12(1):99-118. suggested core processes defined by family-centered, Abstract: BACKGROUND: Crime, particularly among strengths-based, emotionally supportive, and juvenile females, has increased in recent years. Little is comprehensive approaches; essential services including known, however, about the development and family case management, 24-hour crisis services, precursors in childhood of female delinquent access to flexible funds, liaison and advocacy, and behaviour. This is primarily due to a lack of consensus mediators reflecting parent-provider trust and on how to define and assess female antisocial communication/cooperation, provider-provider trust, behaviour, and a lack of studies using sufficiently large adoption of strengths-based approaches, development samples. METHOD: A community sample of 2451 of appropriate treatment plans, parent engagement, and girls between the ages of five and eight years were parent self-esteem/self-efficacy. A model of the recruited into a longitudinal study following the intervention is presented, and results are discussed with enumeration of 103,238 households in the city of respect to research and policy implications. Pittsburgh. Data on disruptive and antisocial behaviours were collected from parents, teachers and Hinman AR. Immunization, equity, and human rights. Am J children during the first wave of the study. RESULTS: Prev Med 2004; 26(1):84-8. Prevalence rates of disruptive disorders varied by Notes: GENERAL NOTE: KIE: 24 refs. choice of informants and measurement thresholds. The GENERAL NOTE: KIE: KIE Bib: immunization prevalence of most disruptive behaviours was similar Abstract: There is much to be proud of with respect to across the four age cohorts. Where there were progress in childhood immunization in the United differences, parents of younger girls tended to report States and around the world. However, the good fewer problematic behaviours compared with parents fortune is not yet shared by all. There is more to be of older girls. Teachers reported more disruptive done in the United States, and much more to be done behaviours than parents and, by their reports, older around the world to ensure that all children of the girls were more likely to show oppositional/defiant world enjoy the right to immunization. behaviour and relational aggression than younger girls. Girls scoring highly on several domains relative to Hinshaw SP. Process, mechanism, and explanation related to their peers were over-represented in disadvantaged externalizing behavior in developmental neighbourhoods. CONCLUSIONS: A range of psychopathology. J Abnorm Child Psychol 2002; disruptive disorders are present among a subgroup of 30(5):431-46. females at an early age, particularly among girls in the Abstract: Advances in conceptualization and statistical most disadvantaged neighbourhoods. Longitudinal modeling, on the one hand, and enhanced appreciation follow-up is required to examine the developmental of transactional pathways, gene-environment trajectories and predictive utility of these behaviours. correlations and interactions, and moderator and The implications for clinical interventions are mediator variables, on the other, have heightened discussed. awareness of the need to consider factors and processes that explain the development and maintenance of Hirsch BJ, Mickus M, Boerger R. Ties to influential adults psychopathology. With a focus on attentional among black and white adolescents: culture, social problems, impulsivity, and disruptive behavior class, and family networks. Am J Community Psychol patterns, I address the kinds of conceptual approaches 2002; 30(2):289-303. most likely to lead to advances regarding explanatory Abstract: Although prior research suggests the models in the field. Findings from my own research importance of nonparental adults to adolescents, the program on processes and mechanisms reveal both ecological context of those relationships has received promise and limitations. Progress will emanate from little attention. This study examined ties to influential use of genetically informative designs, blends of adults among 122 adolescents who varied by race, variable and person-centered research, explicit testing family structure, and gender The strongest effects were of developmental processes, systematic approaches to for race. Blacks reported stronger ties than Whites to moderation and mediation, exploitation of "natural the maternal grandmother as well as more supportive experiments," and the conduct of prevention and interactions with adult males. While race differences in intervention trials designed to accentuate explanation grandparental ties were robust across social class as well as outcome. In all, breakthroughs will occur (SES), ties to an influential adult male became only with advances in translational research-linking nonsignificant upon controlling for SES. African basic and applied science-and with the further American girls from divorced families consistently development of transactional, systemic approaches to reported the strongest ties. Discussion considers the explanation. role of culture versus SES in explaining race differences. Implications for mentoring interventions are proposed, with special attention to the role of 569
- 578. actualizing latent tiesto already existing network definition of treatment effectiveness. In randomised members. placebo-controlled antidepressant clinical trials (RCT), the assessment of treatment effectiveness is commonly Hiscock H, Wake M. Randomised controlled trial of made with the CDRS-R (improvement of 20% or 30% behavioural infant sleep intervention to improve infant or 40%) and CGI. SSRI demonstrated significantly, but sleep and maternal mood. BMJ 2002; 324(7345):1062- modest, improvement compared with placebo in CGI 5. score of 1 or 2: 10% more for sertraline, 16.8% more Abstract: OBJECTIVE: To compare the effect of a for paroxetine and between 16 to 24% more for behavioural sleep intervention with written information fluoxetine. In adults, RCT studies have shown placebo about normal sleep on infant sleep problems and response rates of 30% to 50%, drug response rates of maternal depression. DESIGN: Randomised controlled 45% to 50% and drug-placebo differences of 18% to trial. SETTING: Well child clinics, Melbourne, 25%. The highest placebo response rates, in young Australia. PARTICIPANTS: 156 mothers of infants people, may be related to the highly selected group not aged 6-12 months with severe sleep problems representative of the general population of depressed according to the parents. MAIN OUTCOME patients and/or to the high youths' sensibility of MEASURES: Maternal report of infant sleep problem; psychotherapy. Patients participating in antidepressant scores on Edinburgh postnatal depression scale at two clinical trials have a low BDI and CDI in Emslie's and four months. INTERVENTION: Discussion on study for example (2002). In adults, previous reports behavioural infant sleep intervention (controlled suggest that SSRI use is associated with increased crying) delivered over three consultations. RESULTS: suicidal risk. But the analyse of 48 277 depressed At two months more sleep problems had resolved in patients participating in RCT for nine FDA approved the intervention group than in the control group (53/76 antidepressants fail to support an overall difference in v 36/76, P=0.005). Overall depression scores fell suicide risk between antidepressants (SSRI) and further in the intervention group than in the control placebo treated subjects. An inverse relationship group (mean change -3.7, 95% confidence interval -4.7 between regional change in use of antidepressants to -2.7, v -2.5, -1.7 to -3.4, P=0.06). For the subgroup (increased) and suicide (decreased) is found in young - of mothers with depression scores of 10 and over more people in United States from 1990 and 2000. We can sleep problems had resolved in the intervention group not draw a conclusion from few studies with few - than in the control group (26/33 v 13/33, P=0.001). In participants. None suicide have been reported in this subgroup depression scores also fell further for pharmacological studies. And the link between intervention mothers than control mothers at two "suicidality" and MDD can not be excluded. The months (-6.0, -7.5 to -4.0, v -3.7, -4.9 to -2.6, P=0.01) instruments of assessment in depressed young patients and at four months (-6.5, -7.9 to 5.1 v -4.2, -5.9 to -2.5, are based on extensions of adult procedures. Whereas P=0.04). By four months, changes in sleep problems clinical picture of MDD in children, adolescents and and depression scores were similar. CONCLUSIONS: adults have some differences. Depressed youngsters Behavioural intervention significantly reduces infant have more pronounced mood lability. Depressed sleep problems at two but not four months. Maternal adolescents have more anhedonia than depressed report of symptoms of depression decreased children. Future investigations into the efficacy and significantly at two months, and this was sustained at safety of treatments for children and adolescents four months for mothers with high depression scores. depression should use specific instruments directly built on phenomenological and clinical picture of Hjalmarsson L, Corcos M, Jeammet P. [Selective serotonin depressed children and adolescents. Comparison reuptake inhibitors in major depressive disorder in studies of pharmacotherapy, specific psychotherapies children and adolescents (ratio of benefits/risks)]. (not only CBT) and combined therapies are necessary Encephale 2005; 31(3):309-16. to identify the adolescents who will benefit the most Abstract: Major depressive disorder in children and from specific or combined therapies. Further studies adolescents is associated with high risk of suicide and into the factors that influence treatment outcome persistent functional impairment. While psychological including clinical picture (clinical dimensions, severity, treatments are used as a first line treatment in mild and duration, co morbidity), genetic factor, age, and i-llness moderately severe depression in this age group, the course may help identify appropriate treatments for number of prescriptions for antidepressant medication children and adolescents with MDD. Studies should (SSRI) has grown in recent years. Recently, FDA and include patients more severely ill, with associated MHRA advised that most of SSRI should not be used psychiatric troubles, treatment resistance, history of to treat MDD under the age of 18 years. They may relapses... In clinical studies, the link between increase the risk of suicidal thoughts and self harm. We "suicidality" and some clinical dimensions (which take reviewed the recent literature on efficacy and suicide part in clinical picture or not) must be analysed by risks of SSRI in depressed young people. Conflicting assessing anhedonia, hopelessness feel, impulsive trait, findings of SSRI efficacy have been reported in clinical borderline personality, familial inter-action, biological studies. The discrepancies could be related to the indices. New treatment should be expand and their heterogeneous samples and the absence of a standard efficacy and safety must be study: St John's worth, 570
- 579. Bright light therapy,Trans-cranial Magnetic monitoring equipment, more babies have survived. Stimulation. In practice: suicide and MDD have a Closer cooperation between obstetricians and strongest relation and it must be investigate syste- neonatologists was a great leap forward towards matically during the course of MDD. The suicide risk perinatal medicine. Physicians should endeavour to increases in the context of past history of suicide reduce the incidence and prevalence of birth defects attempts, hopelessness, psychosis, impulsivity traits, and metabolic errors. Perinatal asphyxia should be substance abuse, familial dysfunction, life events, open promptly detected and managed effectively, including access of arms. The use of SSRI in depressed children neuroprotective strategies. There should be markers to and adolescents is also the question of the quality and predict the outcome of asphyxiated babies for decision- the support of the consultant and the mode of the making. Neonatologists should be mindful of safe prescription. introduction of new technologies and rapid diagnostic techniques for infections, including group B Hjort B. On the line. Listing reported abuse cases on the streptococcal screening and chemoprophylaxis when accounting of disclosures (AoD). J AHIMA 2004; required. Other current issues include prevention of 75(9):73, 75. major morbidities, preservation of brain function, improved neurodevelopmental outcome of premature Hladek GA. Cochlear implants, the deaf culture, and ethics: babies, use of blood substitutes, optimal nutrition, fetal a study of disability, informed surrogate consent, and surgery, evidence-based medicine, better information ethnocide. Monash Bioeth Rev 2002; 21(1):29-44. systems, avoidance of medication errors, adequate Notes: GENERAL NOTE: KIE: 23 fn. sedation and pain relief of the baby, and the use of GENERAL NOTE: KIE: KIE Bib: biomedical nitric oxide. One should bear in mind the need to technologies; patient care/minors enhance the neonatal intensive care environment, Abstract: The use of cochlear implants in born-deaf improve non-invasive monitoring and minimise infants addresses the issues of disability, proxy invasive procedures. Physicians should prioritise consent, and potential ethnocide of the Deaf culture. neonatal care for their country and utilise less costly The ethical issues explored in this paper are: 1) the neonatal care. Ethical issues in neonatology that arise disability versus trait argument of deafness, 2) parents following advancement in neonatal care deserve versus Deaf community in proxy consent, 3) attention. Advances in life sciences, such as the justification for surgical intervention in a non-life completion of the human genome project, cloning of threatening condition, and 4) justification for tissues and organs, human stem cell research and ethnocide. Decisions for non-competent individuals technology, gene therapy, deoxyribonucleic acid should be made to assure the child of an open future, vaccines and nanomedicine, should benefit with rights that need to be protected now, so that the neonatology. child can exercise them later as an adult. Cochlear implants provide the potential of an open future and are Hobbs C. The prevalence of child maltreatment in the morally justified on that basis. United Kingdom. Child Abuse Negl 2005; 29(9):949- 51. Ho NK. Neonatology in Singapore: the way we were, the way forward. Ann Acad Med Singapore 2003; Hobbs CJ. Abdominal injury due to child abuse. Lancet 32(3):311-7. 2005; 366(9481):187-8. Abstract: Singapore has a maternity hospital since 1924, but for many decades the newborns could only Hock E, Hart M, Kang MJ, Lutz WJ. Predicting children's receive basic care. Neonatal and perinatal mortality reactions to terrorist attacks: the importance of self- rates were high. Marked improvement in neonatal care reports and preexisting characteristics. Am J began from the 1980s when many neonatal Orthopsychiatry 2004; 74(3):253-62. departments were set up to provide intensive care. Abstract: Forty-eight mothers and their 11-year-old Improved socioeconomic status, better healthcare children, who were participants in a longitudinal study, facilities, effective infection control, immunisation were interviewed in their home after the terrorist programmes and availability of potent antibiotics attacks of September 11, 2001. Children's verbatim contributed to the decline of perinatal and neonatal statements were analyzed for fear, separation anxiety, mortality. Following the implementation of the denial, rationalization, anger, and empathy. In the final glucose-6-phosphate dehydrogenase (G6PD) model, preexisting child anxiety and maternal worry deficiency screening programme, severe neonatal significantly explained 33% of the variance in jaundice and kernicterus were largely reduced. children's self-reported fearful feelings. Exchange blood transfusions initiated in the 1960s and phototherapy in the 1970s had saved many babies. Hodgins S, Muller-Isberner R. Preventing crime by people Kernicterus is almost not seen now. With more with schizophrenic disorders: the role of psychiatric neonatal-trained staff, organised resuscitation teams, services. Br J Psychiatry 2004; 185:245-50. advances in respiratory management and better Abstract: BACKGROUND: Knowledge of when and 571
- 580. how to implementtreatments to prevent criminal DATA COLLECTION AND ANALYSIS: Reviewers offending among people with schizophrenia is urgently independently assessed trial quality and extracted data. needed. AIMS: To identify opportunities for Double data entry was performed. Study authors were interventions to prevent offending among men with contacted to request additional information. MAIN schizophrenic disorders by tracking their histories of RESULTS: Sixteen trials involving 13,651 women offending and admissions to hospital. METHOD: We were included. The trials were generally of good to examined 232 men with schizophrenic disorders excellent quality, although 3 used an allocation method discharged from forensic and general psychiatric likely to introduce bias. Programs offering additional hospitals. Data were collected from participants, family social support for at-risk pregnant women were not members and official records. RESULTS: More than associated with improvements in any perinatal three-quarters (77.8%) of the forensic patients had outcomes, but there was a reduction in the likelihood of previously been admitted to general psychiatric caesarean birth and an increased likelihood of elective services; 24.3% of the general psychiatric patients had termination of pregnancy. Some improvements in a criminal record. Offences had been committed by immediate maternal psychosocial outcomes were found 39.8% of the forensic patients and 10.8% of the general in individual trials. REVIEWER'S CONCLUSIONS: psychiatric patients before their first admission to Pregnant women need the support of caring family general psychiatry, and after their first admission these members, friends, and health professionals. While 59 patients committed 195 non-violent and 59 violent programs which offer additional support during offences. Subsequently, 49 of them committed serious pregnancy are unlikely to prevent the pregnancy from violent offences that led to forensic hospital admission. resulting in a low birthweight or preterm baby, they The offenders were distinguished by a pervasive and may be helpful in reducing the likelihood of caesarean stable pattern of antisocial behaviour evident from at birth. least mid-adolescence. CONCLUSIONS: General psychiatry requires resources in order to prevent Hoffman JM. A case of shaken baby syndrome after criminal offending among a subgroup of patients with discharge from the newborn intensive care unit. Adv schizophrenic disorders. Neonatal Care 2005; 5(3):135-46. Abstract: Preterm infants may be at higher risk of Hodnett ED, Fredericks S. Support during pregnancy for physical abuse after hospital discharge. Nonaccidental women at increased risk of low birthweight babies. or inflicted head neurotrauma is the most common Cochrane Database Syst Rev 2003; (3):CD000198. cause of mortality and morbidity in physical-abuse Abstract: BACKGROUND: Studies consistently show cases, and shaken baby syndrome (SBS) is the most a relationship between social disadvantage and low common form of abuse. In the majority of the cases, birthweight. Many countries have programs offering parents who shake their infant do not intend to harm special assistance to women thought to be at risk for the infant. This article presents a report of a former giving birth to a low birthweight infant. These preterm infant who presented to the pediatrician's programs may include advice and counselling (about office with a maternal report of an accidental fall. nutrition, rest, stress management, alcohol and Shaken baby syndrome was suspected based on recreational drug use), tangible assistance (eg bilateral subdural hemorrhages of varying ages, which transportation to clinic appointments, help with were inconsistent with the history provided. The household responsibilities), and emotional support. The differential diagnosis and systematic clinical evaluation programs may be delivered by multidisciplinary teams for SBS are provided, and medical and nursing of health professionals, by specially trained lay management is discussed. Patient care, advocacy, and workers, or by a combination of lay and professional mandatory reporting are reviewed. The newborn workers. OBJECTIVES: The objective of this review intensive care unit caregivers' role in preventing SBS in was to assess the effects of programs offering this high-risk population, including specific parent additional social support for pregnant women who are teaching and anticipatory guidance, is reviewed with an believed to be at risk for giving birth to preterm or low emphasis on teaching all caregivers about the dangers birthweight babies. SEARCH STRATEGY: We of shaking an infant. searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003). SELECTION Hoffman MK. Domestic violence: how you can help. Del CRITERIA: Randomized trials of additional support Med J 2003; 75(12):471-3. during at-risk pregnancy by either a professional (social worker, midwife, or nurse) or specially trained Hoffmann F, Funk M, Linde R et al. Effect of antiretroviral lay person, compared to routine care. Additional triple combinations including the protease inhibitor support was defined as some form of emotional support nelfinavir in heavily pretreated children with HIV-1 (eg counselling, reassurance, sympathetic listening) infection. Eur J Med Res 2002; 7(7):330-4. and information/advice, either in home visits or during Abstract: BACKGROUND: In this retrospective study clinic appointments, and could include tangible the effect of antiretroviral triple therapy including the assistance (eg transportation to clinic appointments, protease-inhibitor nelfinavir (NFV) on CD4-cells and assistance with the care of other children at home). 572
- 581. viral load (VL)in heavily pretreated HIV-infected of the data and analysis are discussed. children was evaluated. PATIENTS AND METHODS: 20 children (<18 years) were included. Median Hofvander Y. The world's children--the children's world. duration of antiretroviral pretreatment was 27 months The Rosen von Rosenstein award. Acta Paediatr 2004; (range, 7 65), median initial VL was 4.7 log subset 10 93(11):1414-9. (3.2 6.1) and median relative CD4-cells was 17.5% (3 Abstract: I feel very honoured to have been selected for 33). Patients were put on combinations with NFV the Nils Rosen von Rosenstein award. My thanks are because of treatment failure (increasing VL), due to the Swedish Paediatric Society. intolerance to prior therapy with PIs or adherence problems with prior indinavir. Viral load (RT-PCR, Hogan DM. Parenting beliefs and practices of opiate- detection limit 50 copies/ml) and CD4-cells were addicted parents: concealment and taboo. Eur Addict measured every 4-8 weeks. RESULTS: Median viral Res 2003; 9(3):113-9. load decreased 1.2 log(10) (-1.3 2.5), 0.9 log(10) (-0.8 - Abstract: The lifestyle associated with opiate 2.5) and 0.4 log(10) (-0.5 - 3.0) after 12, 24 and 36 dependence, including drug taking, the buying and weeks. The VL of 2 patients was below the detection selling of drugs, and contact with other drug users, limit (50 copies/ml) after 24 weeks. The relative CD4- carries potential risks for the safety and well-being of cell count increased from a median of 17.5% to 22%, children of drug-using parents. Based on a qualitative 23% and 25% after 12, 24 and 36 weeks, respectively. interview study conducted with 50 opiate-dependent Side effects of NFV were usually mild. WHO grade 1 parents in Dublin, Ireland, the parenting beliefs and or 2 diarrhea occurred in 70% and moderate elevations practices in relation to children's exposure to drugs and of triglycerides in 40% of the patients. At 48 weeks the associated lifestyle are described. Parents saw their 18/20 patients had to be switched to other lifestyle as potentially risky for their children and their combinations due to virological failure. families. The most common strategy adopted by CONCLUSIONS: In children with intensive prior parents was to conceal their drug-related activities and antiretroviral therapy combination therapy including maintain a strict family taboo about these activities. NFV lead to a modest short-term reduction of the VL Intervention programmes should be offered to support and increase in CD4-cells. However, the long-term effective family communication about parental drug antiretroviral effect was poor. dependence. Hoffmann JP, Cerbone FG. Parental substance use disorder Hoh BL, Putman CM, Budzik RF, Carter BS, Ogilvy CS. and the risk of adolescent drug abuse: an event history Combined surgical and endovascular techniques of analysis. Drug Alcohol Depend 2002; 66(3):255-64. flow alteration to treat fusiform and complex wide- Abstract: A common observation in the research necked intracranial aneurysms that are unsuitable for literature is that children of drug-dependent parents are clipping or coil embolization. J Neurosurg 2001; at significantly heightened risk of adolescent drug use, 95(1):24-35. abuse, and dependence. Recent research indicates that Abstract: OBJECT: Certain intracranial aneurysms, several psychological and interpersonal factors may because of their fusiform or complex wide-necked affect the association between parents' psychoactive structure, giant size, or involvement with critical substance use disorder (PSUD) and drug use risks perforating or branch vessels. are unamenable to direct among adolescents, yet studies have failed to examine surgical clipping or endovascular coil treatment. explicitly whether these factors moderate the Management of such lesions requires alternative or association between PSUD and adolescent substance novel treatment strategies. Proximal and distal abuse. This paper explores these potential relationships occlusion (trapping) is the most effective strategy. In using longitudinal data from a study that has followed lesions that cannot be trapped, alteration in blood flow three cohorts of adolescents and their families over a 7- to the "inflow zone," the site most vulnerable to year period. The cohorts are defined by parental aneurysm growth and rupture, is used. METHODS: diagnoses of PSUD, affective disorders, or no From 1991 to 1999 the combined neurosurgical- diagnosable disorder. The results indicate that PSUD is neuroendovascular team at the Massachusetts General positively associated with adolescent drug abuse, yet Hospital (MGH) managed 48 intracranial aneurysms this association is attenuated by strong family that could not be clipped or occluded. Intracavernous cohesion. Affective disorders among parents are internal carotid artery aneurysms were excluded from associated with a higher risk of alcohol, but not drug, this analysis. By applying a previously described abuse. The associations are stronger in the presence of aneurysm rupture risk classification system (MGH lower stress and higher self-esteem. PSUD is also Grades 0-5) based on the age of the patient, aneurysm associated more strongly with offspring drug and size, Hunt and Hess grade, Fisher grade, and whether alcohol abuse when levels of use are lower. Hence, the aneurysm was a giant lesion located in the posterior some unobserved mechanism that may involve circulation, the authors found that a significant number physiological sensitivities to drugs and alcohol appears of patients were at moderate risk (MGH Grade 2; to put children of parents with drug problems at 31.3% of patients) and at high risk (MGH Grades 3 or particular risk of drug and alcohol abuse. Limitations 573
- 582. 4; 22.9%) fortreatment-related morbidity. The lesions and neck, presenting to Alder Hey Children's Hospital, were treated using a variety of strategies--surgical, Liverpool, from June 1998 to June 2003. We identified endovascular, or a combination of modalities. 16 patients who suffered such injuries with ages Aneurysms that could not be trapped or occluded were ranging from 5 to 15 years. The majority of cases were treated using a paradigm of flow alteration, with flow violent assaults, which is not in accordance with redirected from either native collateral networks or previous published reports. All of these occurred in from a surgically performed vascular bypass. Overall public places outside the home. Most incidents clinical outcomes were determined using the Glasgow occurred through the spring and summer period. Six Outcome Scale (GOS). A GOS score of 5 or 4 was patients required overnight stay in hospital. Nine achieved in 77.1%, a GOS score of 3 or 2 in 8.3%, and patients required operative procedures to remove the death (GOS 1) occurred in 14.6% of the patients. airgun pellets. Two patients had serious eye injuries Procedure-related complications occurred in 27.1% of resulting in loss of vision. Two patients had penetrating cases; the major morbidity rate was 6.3% and the neck injuries requiring exploration of the wound. The mortality rate was 10.4%. Three patients experienced remaining group had either skin-penetrating injuries aneurysmal hemorrhage posttreatment; in two patients with lodgement of fragments in subcutaneous tissues or this event proved to be fatal. Aneurysms with MGH non-skin penetrating injuries. This study highlights Grades 0, 1, 2, 3, and 4 were associated with favorable serious injuries arising from the abuse of airguns as outcomes (GOS scores of 5 or 4) in 100%, 92.8%, weapons of assault. Airguns are readily available to 71.4%, 50%, and 0% of instances, respectively. people without license. Recent legislation has increased CONCLUSIONS: Despite a high incidence of transient the minimum age at which airguns can be carried in a complications, intracranial aneurysms that cannot be public place, but we believe that stricter legislation is clipped or occluded require alternative surgical and required to produce a reduction in the number of endovascular treatment strategies. In those aneurysms airgun-related injuries. that cannot safely be trapped or occluded, one approach is the treatment strategy of flow alteration. Holland PR, Mau MK, Yamamoto LG. Survey of parenting books for advice on the common cold, diarrhea, and Hohlfeld P. Cesarean section on request: a case for common otitis media in infants and toddlers. Clin Pediatr (Phila) sense. Gynakol Geburtshilfliche Rundsch 2002; 2004; 43(7):647-51. 42(1):19-21. Abstract: Parenting books often provide advice for Abstract: Considering the patient's right to autonomy common medical ailments of infants and toddlers. and the trend towards more involvement of the patient However, the accuracy of such advice has never been in the decision making, it is our belief that obstetricians evaluated. The purpose of this study is to survey the should consider the woman's request for cesarean informational content of a sample of parenting books. section without medical indication. The procedure can Fifty general parenting books were identified and only be carried out after obtaining proper consent of reviewed for the informational content on the following the patient with careful information including a topics: common colds, diarrhea, and otitis media. detailed description of the possible risks and benefits of When covered by the book, accurate and consistent both modes of delivery. In order to decrease the risk of information was generally provided in the following respiratory distress syndrome, cesarean section under topic areas: non-medicated nose drops for nasal these circumstances should not be performed prior to congestion, upright positioning for children with colds, 39 weeks' gestation. Debating over whether or not to breastfeeding infants with diarrhea, electrolyte charge women who request a cesarean section that is solutions for diarrhea, and feeding practices as they not medically indicated is fruitless, since rigorous cost relate to otitis media. The following topic areas studies are lacking and since any implementation of displayed significant inconsistency: the use of such a system would be extremely difficult. decongestants, antihistamines, expectorants, cough suppressants, and decongestant nose drops for colds; Holden C. Behavioral genetics. Getting the short end of the antidiarrheal medications; soft drinks and juice for allele. Science 2003; 301(5631):291-3. diarrhea; home recipes for oral hydration solutions; and the usefulness of pressure equalization tubes for Holla RG, Gupta A. Child abuse where do we stand today? refractory otitis media. Practitioners should be aware Indian Pediatr 2005; 42(12):1251. that parents may be misinformed by some parenting books and take measures to educate parents. Holland P, O'Brien DF, May PL. Should airguns be banned? Br J Neurosurg 2004; 18(2):124-9. Hollingsworth LD. International adoption among families in Abstract: In this article, we express concerns regarding the United States: considerations of social justice. Soc the availability of airguns, the injuries that they cause Work 2003; 48(2):209-17. and their abuse as weapons of assault. We wish to Abstract: The practice of international adoption of stimulate debate on this topic and report a 5-year children is critiqued, using Rawls' egalitarian concept retrospective analysis of all airgun injuries to the head of a distributive method of social justice. From this perspective, international adoption may be perceived as 574
- 583. contradictory to principlesof social justice by ignoring significant "possible infantile cataract" were identified, the social context within which it occurs. Social diagnosed between the ages of 2 and 8 years. Inclusion contexts that frequently surround international adoption of these "possible infantile cataracts" would result in an are severe poverty and the disenfranchisement of the estimate of overall birth prevalence for visually adopted child's biological family; the significant infantile cataract of 4.5 per 10,000 live disenfranchisement of certain children because of their births (95% CI: 2.5-7.5 per 10,000). CONCLUSIONS: lower social status; gender oppression and Using population-based medical record retrieval discrimination against female children; risk to methods, we estimate the birth prevalence of visually children's rights to the knowledge of their birth history significant infantile cataract to be 3.0 to 4.5 per 10,000. and parentage; risk to children's rights to identification Infantile cataracts are an important cause of visual with their ethnic, cultural, and national group; and impairment in children and these data are useful in practices that may involve abduction, deceit, and planning clinical trials and allocating health care trafficking in children. The article presents alternate resources. views, including libertarian and utilitarian perspectives. Solutions from two international conventions are Holmes SE, Slaughter JR, Kashani J. Risk factors in critiqued and implications are discussed for social work childhood that lead to the development of conduct policy advocacy, practice, and research. disorder and antisocial personality disorder. Child Psychiatry Hum Dev 2001; 31(3):183-93. Holmes A. Changes and challenges. RCM Midwives 2004; Abstract: With juvenile crime on the rise, 7(10):444-5. understanding and preventing juvenile delinquency is Abstract: Although I have discussed the challenges one of the greatest challenges facing mental health associated with establishing this role, on reflection I professionals today. Recognizing early signs of think this is possibly one of the best jobs in midwifery conduct disorder (CD) can be difficult, but identifying today. The diversity experienced through the post is risk factors is an important step in preventing a child's amazing and the ability to work clinically, while progression to CD or Antisocial Personality Disorder having a leadership role that impacts on the service, (APD). This paper focuses on various risk factors for research and education agendas, is both powerful and CD and APD, such as intrinsic individual differences, unique. I hope this has given you some insight into my psychosocial/environmental factors, genetic and post and demonstrated how innovative and exciting the neurochemical factors. Early recognition and consultant role actually is. I believe these posts have intervention may prevent the progression from real potential to influence our profession and the aggressive and maladaptive behaviors to CD and later service we provide for women and families and hope APD. this is evident. However, none of this can be achieved without networking and having the support of a range Holowka DW, King S, Saheb D, Pukall M, Brunet A. of people across a variety of organisations. Childhood abuse and dissociative symptoms in adult schizophrenia. Schizophr Res 2003; 60(1):87-90. Holmes JM, Leske DA, Burke JP, Hodge DO. Birth Abstract: Dissociative symptoms, occurring in many prevalence of visually significant infantile cataract in a psychiatric disorders including schizophrenia, are often defined U.S. population. Ophthalmic Epidemiol 2003; preceded by traumatic experience. We hypothesized 10(2):67-74. that various types of childhood trauma would correlate Abstract: PURPOSE: To determine the birth with levels of dissociative symptomatology in adult prevalence of visually significant infantile cataract, patients. Twenty-six patients completed the using population-based comprehensive medical record Dissociative Experiences Scale (DES) and the retrieval, in a defined US population. DESIGN: Childhood Trauma Questionnaire (CTQ). Dissociation Retrospective, population-based, medical record was significantly correlated with emotional abuse retrieval. METHODS: We reviewed records of all (r=0.84, one-tailed p<0.001), and physical abuse pediatric patients (0-17 years) coded as cataract during (r=0.55, p<0.01). We suggest that emotional abuse may a 20-year period (1978 to 1997) using the resources of play an important role in the etiology of dissociation in the Rochester Epidemiology Project. "Infantile schizophrenia. cataract" was defined as a cataract diagnosed within the first year of life. "Possible infantile cataract" was Holst H, Mare K, Jarund A et al. An independent evaluation defined as a cataract, diagnosed after the first year in a of a new method for automated interpretation of lung child born in Olmsted County, where there was no scintigrams using artificial neural networks. Eur J Nucl evidence of an acquired traumatic, acquired systemic, Med 2001; 28(1):33-8. or acquired ocular etiology. Visually insignificant Abstract: The purpose of this study was to evaluate a cataracts were excluded. RESULTS: Ten incident cases new automated method for the interpretation of lung of visually significant infantile cataract were identified perfusion scintigrams using patients from a hospital during the 20-year study period, yielding a birth other than that where the method was developed, and prevalence of 3.0 per 10,000 live births (95% CI: 1.5- then to compare the performance of the technique 5.6 per 10,000). Five additional cases of visually 575
- 584. against that ofexperienced physicians. A total of 1,087 the sample had actually bedshared. Parents with no scintigrams from patients with suspected pulmonary previous intention to do so slept with their babies for a embolism comprised the training group. The test group variety of reasons. One of this study's most important consisted of scintigrams from 140 patients collected in findings is that babies were being brought into bed with a hospital different to that from which the training both parents. Ninety five percent of the bedsharing group had been drawn. An artificial neural network infants slept with both mother and father. This study was trained using 18 automatically obtained features has shown that bedsharing is a relatively common from each set of perfusion scintigrams. The image parenting practice. Despite initial worries and fears, processing techniques included alignment to templates, mainly concerning overlaying, some parents found construction of quotient images based on the bedsharing an effective option yet were covert in their perfusion/template images, and finally calculation of practices, fearing the disapproval of health features describing segmental perfusion defects in the professionals and relatives. quotient images. The templates represented lungs of normal size and shape without any pathological Hootman J. Quality improvement projects related to changes. The performance of the neural network was pediculosis management. J Sch Nurs 2002; 18(2):80-6. compared with that of three experienced physicians Abstract: Concern about student absenteeism related to who read the same test scintigrams according to the repeated pediculosis infestations and the consequent modified PIOPED criteria using, in addition to risk for unsuccessful school achievement led to a perfusion images, ventilation images when available quality improvement program comprised of 6 projects. and chest radiographs for all patients. Performances The goal was to identify effective nursing interventions were measured as area under the receiver operating for children and families incurring repeated characteristic curve. The performance of the neural infestations. One project addressed the prevalence of network evaluated in the test group was 0.88 (95% infestation, frequency of school exclusion, and duration confidence limits 0.81-0.94). The performance of the of consequential lost school days. Affirmed were low three experienced experts was in the range 0.87-0.93 contagion in classrooms and multiple social and when using the perfusion images, chest radiographs emotional challenges in students having chronic and ventilation images when available. Perfusion infestations. From other projects, the importance of scintigrams can be interpreted regarding the diagnosis establishing effective relationships with parents, of pulmonary embolism by the use of an automated students, and school staff to work toward effective method also in a hospital other than that where it was management outcomes was apparent. Also identified developed. The performance of this method is similar was the need to better match hair texture with the to that of experienced physicians even though the selection of a lice comb for effective mechanical physicians, in addition to perfusion images, also had removal of lice and nits. There is a need to replicate access to ventilation images for most patients and chest these projects with larger numbers of students in radiographs for all patients. These results show the different geographic locations. It is important to have high potential for the method as a clinical decision evidence-based information about the communicability support system. and management strategies for pediculosis to contribute to sound treatment and policy formation. Holt G. Clinical benchmarking for the validation of AI medical diagnostic classifiers. Artif Intell Med 2005; Hope T, Frith P, Craze J, Mussai F, Chadha A, Noble D. 35(3):259-60. Developing guidelines for medical students about the examination of patients under 18 years old. BMJ 2005; Hong KE. Mental health care for children and adolescents: a 331(7529):1384-6. regional perspective. World Psychiatry 2005; 4(3):158- Notes: GENERAL NOTE: KIE: 8 refs. 9. GENERAL NOTE: KIE: KIE Bib: medical ethics/education; patient care/minors Hooker E, Ball HL, Kelly PJ. Sleeping like a baby: attitudes and experiences of bedsharing in northeast England. Hopper JL. The Australian Twin Registry. Twin Res 2002; Med Anthropol 2001; 19(3):203-22. 5(5):329-36. Abstract: This paper reports findings from a study that Abstract: The Australian Twin Registry (ATR), investigated infant care practices in a small population established in the late 1970s, is a volunteer registry of of Northeast England in order to determine whether over 30,000 pairs of Australian twins of all zygosity parent-infant bedsharing is common parenting types and ages unselected for their health or medical behavior. In a year-long prospective study we history. The ATR does not undertake research itself but examined the opinions and practices of parents with acts as facilitator, providing an important national and regard to their infants' nighttime sleeping strategies international resource for medical and scientific before and after the birth of their babies. Results researchers across a broad range of disciplines. Its core confirm that parents pursue a heterogeneous array of functions are the maintenance of an up-to-date database nighttime parenting strategies and that 65 percent of containing basic contact details and baseline 576
- 585. information, and themanagement of access to the 1997 to February 1998 to immunization program resource in ways that enhance research capacity within managers and/or their designees within the state health Australia while protecting the rights of twins. The ATR department of each of the 50 states and the District of has facilitated more than 200 studies using a variety of Columbia. Some of the survey items were later updated designs, including classic biometrical twin and twin through follow-up interviews and informal family studies, co-twin control studies, intervention communications. Copies of legislation, administrative studies, longitudinal studies, and studies of issues rules and regulations, and immunization registry relevant specifically to twins. These have yielded more policies were collected for review. RESULTS: As of than 300 peer-reviewed publications to date. Areas of October 2000, 24 of 51 states (47%) had laws (21) or major research include studies of behavior, rules (3) specifically authorizing an immunization musculoskeletal conditions, teeth and face patterns, registry. Nine additional states (18%) have laws cardiovascular risk factors, substance abuse, and risk specifically addressing the sharing of immunization factors for melanoma and breast cancer. Extensive information. CONCLUSIONS: Over half of the states longitudinal data are available for around 10,000 pairs. have enacted legislation or rules addressing registries DNA samples have been obtained from more than or the sharing of immunization information. Further 6000 twins. Considerable efforts are devoted to research should be conducted to assess the impact of maintaining the commitment of registry members and this legislation on immunization registries. recruitment. The ATR hopes to secure funding to expand its activities, including the systematic Horn IB, Cheng TL, Joseph J. Discipline in the African collection of DNA samples, so that it can continue to American community: the impact of socioeconomic play a major role in the development of twin research status on beliefs and practices. Pediatrics 2004; and contribute to the annotation of the human genome. 113(5):1236-41. Abstract: OBJECTIVE: To describe and compare Horan M, Stutchfield PR. Severe congenital myotonic disciplinary beliefs and practices among African dystrophy and severe anaemia of prematurity in an American parents from diverse socioeconomic infant of Jehovah's Witness parents. Dev Med Child backgrounds. METHODS: A cross-sectional survey Neurol 2001; 43(5):346-9. was conducted of self-identified African American Abstract: Severe congenital myotonic dystrophy parents of children <48 months of age at 2 ambulatory (CMD) is an autosomal dominant condition teaching clinics, 2 community health centers, and 3 characterized by hypotonia and respiratory private practices in Washington, DC, and the insufficiency at birth. Terminal outcome has been surrounding metropolitan area. Disciplinary beliefs and reported in infants requiring ventilation for longer than practices of African American parents were measured. 30 days. The case is reported of an infant born at 34 RESULTS: A total of 175 of the 189 parents who were weeks' gestation with severe CMD. Infant survived approached for the study completed the survey for a following ventilatory support from birth until day 67 of participation rate of 92.5%. Middle/upper life. Subcutaneous erythropoietin (600 units, three socioeconomic status (SES) parents in this study were times weekly) was commenced on day 6 as the more likely to be married (60.9% vs 14.7%), older Jehovah's Witness parents were strongly opposed to (31.4 years vs 25 years), and more educated (80% blood transfusions. Haemoglobin fell to 5.8 g/dL having attended at least some college vs 34.4%) than without adverse effects and then progressively rose to lower SES parents. There were no significant 15.4 g/dL. No blood transfusions were necessary. This differences between middle/upper and lower SES case illustrates that infants with severe CMD requiring parents with regard to their belief in a preferred ventilation for more than 30 days do not have a disciplinary method (teaching, spanking, removing) or universally fatal outcome. Low haemoglobin was well approach (positive, negative). Lower SES parents were tolerated which calls for re-examination of the more likely to endorse spanking a 1- to 3-year-old child indications for blood transfusions in ventilated if they were doing something that was not safe (90.5% neonates. vs 78.3%). Middle/upper SES parents were significantly more likely to reward their child for Horlick GA, Beeler SF, Linkins RW. A review of state positive behavior than lower SES parents (66.1% vs legislation related to immunization registries. Am J 47.1%). CONCLUSIONS: Lower and middle/upper Prev Med 2001; 20(3):208-13. SES parents in this study population were reasonably Abstract: BACKGROUND: Since the early 1990s, a similar with respect to disciplinary beliefs and concerted effort has been made to develop community- practices. Exceptions to this generalization were that and state-based immunization registries. A 1995 survey lower SES parents were more likely to endorse showed that nine states had laws specifically spanking as a response to an unsafe behavior on the authorizing immunization registries. This survey was part of the child, and middle/upper SES parents conducted to describe the current status of legislation reported higher levels of reward for positive behavior. and policies addressing immunization registries and the sharing of immunization information. METHODS: A Horn W, Popow C, Miksch S, Kirchner L, Seyfang A. telephone survey was administered from September Development and evaluation of VIE-PNN, a 577
- 586. knowledge-based system forcalculating the parenteral when solids were introduced. Breastfeeding duration nutrition of newborn infants. Artif Intell Med 2002; was not associated with infants' age at introduction of 24(3):217-28. solids. In infants given formula, as soon as regular Abstract: Calculating the daily changing composition formula feeds started, the breastfeeding frequency and of parenteral nutrition for small newborn infants is suckling duration declined swiftly. The younger an troublesome and time consuming routine work in infant was at the start of regular formula feeds, the neonatal intensive care. The task needs expertise and shorter the breastfeeding duration. CONCLUSIONS: experience and is prone to inherent calculation errors. Health care personnel and parents need to be aware that We designed VIE-PNN (Vienna Expert System for introduction of solids and introduction of formula can Parenteral Nutrition of Neonates), a knowledge-based have very different consequences for breastfeeding. If system (KBS) in order to reduce daily routine work and the aim is to introduce other foods to breastfed infants calculation errors. VIE-PNN was redesigned several under the protection of breast milk, it is important to times because the clinicians accepted the system only realize that formula is also another food and needs to when it saved time. The most recent version of VIE- be treated as such. PNN uses an Hypertext Markup Language (HTML)- based client-server architecture and is integrated into Hornor G. Domestic violence and children. J Pediatr Health the intranet of the local patient data management Care 2005; 19(4):206-12. system. Since more than 3 years all parenteral nutrition Abstract: Domestic violence affects the lives of many plans are calculated using VIE-PNN. Evaluating the Americans, including children. It is imperative that system's performance and the users contentedness, we primary care providers working with children, compared 50 nutrition plans calculated in parallel using including pediatric nurse practitioners, understand the VIE-PNN or a hand-held calculator, retrospectively dynamics of domestic violence, recognize domestic analyzed more than 5000 nutrition plans stored in VIE- violence, and intervene appropriately. Domestic PNNs database and evaluated a user questionnaire. violence places children at risk physically, emotionally, Nutrition plans were calculated in a mean time of 2.4 and developmentally. The effect on children who versus 7.1min using VIE-PNN or the hand-held witness domestic violence will be discussed. Primary calculator. Errors and omissions in the nutrition plans care providers have a professional responsibility to were detected in 22% versus 56% and errors in the screen for domestic violence. The primary care VIE-PNN's plans occurring only with interactively provider can play a pivotal role in breaking the cycle of changed values. Reviews of stored plans show that a family violence by timely identification of and mean of 4 out of 16 parameters were interactively appropriate intervention for domestic violence. changed. VIE-PNN was well accepted. Most important reasons for the successful operation of VIE-PNN in the Horowitz JA, Bell M, Trybulski J et al. Promoting daily routine work were time savings and robustness of responsiveness between mothers with depressive the system. symptoms and their infants. J Nurs Scholarsh 2001; 33(4):323-9. Hornell A, Hofvander Y, Kylberg E. Solids and formula: Abstract: PURPOSE: To test the efficacy of an association with pattern and duration of breastfeeding. interactive coaching intervention to promote Pediatrics 2001; 107(3):E38. responsiveness between mothers experiencing Abstract: OBJECTIVES: To study changes in pattern postpartum depressive symptoms (PPDS) and their and duration of breastfeeding associated with the infants. DESIGN: An experimental design with 117 introduction of solids and formula. STUDY DESIGN: postpartum women in the Northeastern United States. Descriptive longitudinal, prospective study. SETTING: METHODS: Participants were randomly assigned The participants were recruited from the maternity either to the treatment or control group. Both groups ward in the University Hospital in Uppsala, Sweden, had home visits at 4-8 weeks, 10-14 weeks, and 14-18 between May 1989 and December 1992. A total of 15 weeks postpartum and mother-infant interaction was 189 infants were born during the period, 1 177 mother- videotaped and coded for responsiveness. The infant pairs were found eligible for participation; 57% treatment group also received a coached behavioral declined because of the perceived high workload. intervention designed to promote maternal-infant Study Population. Five hundred six mother-infant responsiveness. Measures included the Edinburgh pairs. METHODS: Daily recordings by the mothers on Postnatal Depression Scale, the Beck Depression infant feeding, from the first week after delivery to the Inventory-II, and the Dyadic Mutuality Code. second menstruation postpartum or a new pregnancy; FINDINGS: The hypothesis, that the treatment group fortnightly home visits with structured interviews by a would show significantly higher maternal-infant research assistant. RESULTS: Introduction of solids responsiveness after the intervention, was supported. was associated with no or minor changes in No effect of the intervention on depression scores was breastfeeding frequency and suckling duration. found. A significant increase in responsiveness and a Breastfeeding frequency remained constant the first significant decrease in depression scores occurred over month after the introduction and then declined slowly, time for both treatment and control groups. No while daily suckling duration started to decline slowly interaction between group and time was detected. 578
- 587. CONCLUSIONS: The studyshowed that a coaching between sex and visual problems in the prediction of strategy had a positive effect on maternal-infant bullying. CONCLUSIONS: For those children who interaction in this sample. Future research is needed to require glasses, opticians should be aware of the risks test coaching interventions in conjunction with other of bullying, and strategies should be developed and strategies targeted to promote maternal-infant discussed that help reduce their vulnerability. responsiveness and to reduce PPDS. Hossain SM, Duffield A, Taylor A. An evaluation of the Horton R. In defence of Roy Meadow. Lancet 2005; impact of a US$60 million nutrition programme in 366(9479):3-5. Bangladesh. Health Policy Plan 2005; 20(1):35-40. Notes: GENERAL NOTE: KIE: 7 refs. Abstract: OBJECTIVE: To compare levels of GENERAL NOTE: KIE: KIE Bib: fraud and childhood malnutrition in areas where the Bangladesh misconduct; medical ethics Integrated Nutrition Project had been operational for over 5 years with matched non-project areas, with the Horwitz SM, Kerker BD. Preschool and school age children purpose of evaluating whether the project had achieved under welfare reform. Child Psychiatry Hum Dev its objective of reducing the prevalence of underweight 2001; 32(2):107-24. among children <24 months. METHODS: The study Abstract: This study compared the behavioral and involved an ex-post cross-sectional survey in six thanas school problems of young children whose mothers (a locality with a population of approximately 200,000- participated in two different income support programs, 450,000 people) in Bangladesh. Participants were Jobs First and AFDC. The analyses also included 6,820 households (4,554 in the project areas and 2,266 measures of maternal education, maternal health, in the non-project areas) including 7183 children aged maternal psychological factors, and family 6-59 months selected using a two-stage stratified environment. There were no differences in child school cluster sampling frame. Main outcome measures were or behavioral problems across the income support moderate and severe underweight, wasting and stunting programs. Children, however, were more likely to have reported using z scores, and indicators of mothers' school problems if they were older or if their mothers reported nutritional knowledge and practice. received less than a high school education, reported RESULTS: 2,388 children aged 6-23 months and 6815 child behavioral problems or made criteria for children aged 6-59 months had clean anthropometric depression on the CIDI. Behavioral problems were data. No significant difference was found between the more likely to occur if mothers reported violence in the socio-economic variables of households in the project home, many depressive symptoms on the CES-D, few and non-project areas. No significant difference was child positive qualities, or if the child had repeated a found in the prevalence of either severe or moderate grade. Several familial factors, then, must be addressed underweight (weight-for-age) in children aged 6-23 in order to ensure that children excel both academically months in the project and non-project areas: 183 and behaviorally. (11.4%, 95% confidence interval 9.9-13.2%) children in project areas and 96 (12.2%, 95% confidence Horwood J, Waylen A, Herrick D, Williams C, Wolke D. interval 9.9-14.8%) children in non-project areas. Common visual defects and peer victimization in Mothers in project areas reported significantly better children. Invest Ophthalmol Vis Sci 2005; 46(4):1177- caring practices than in non-project areas. 81. CONCLUSION: There is no evidence that the Abstract: PURPOSE: To investigate whether wearing Bangladesh Integrated Nutrition Project has achieved glasses, having manifest strabismus, or having a history its objectives to reduce severe underweight by 40% if of wearing an eye patch predisposes preadolescent project areas are compared ex-post with non-project children to being victimized more frequently at school areas. There is urgent need to review the evidence and whether the impact may be different on boys than behind investments based on growth monitoring and on girls. METHODS: Data were examined on 6536 promotion. children from the Avon Longitudinal Study of Parents and Children (ALSPAC) based in the United Kingdom. Host G. [Child abuse--from the perspective of the child]. At 7.5 years, the children undertook a detailed eye Lakartidningen 2001; 98(4):346. examination by orthoptists, including a cover test and visual acuity assessment. At 8.5 years, trained Howard DE, Feigelman S, Li X, Cross S, Rachuba L. The psychologists assessed the children's bullying relationship among violence victimization, witnessing involvement as either victim or perpetrator for overt violence, and youth distress. J Adolesc Health 2002; and relational bullying, in a standard interview. 31(6):455-62. RESULTS: Children currently wearing glasses or with Abstract: PURPOSE: To explore whether violence a history of wearing eye patches were 35% to 37% victimization and witness experiences of more likely to be victims of physical or verbal predominantly African-American, low-income, urban bullying, even after adjustment for social class and adolescents were associated with distress and whether maternal education. No interactions were found psychosocial factors contributed to symptomatology. 579
- 588. METHODS: Data forthis study were obtained from a between maltreated and nonmaltreated children were cross-sectional survey of 349 youth between the ages examined in an experiment in which middle- of 9 and 15 years who resided in any of 10 low-income socioeconomic-status (SES; N = 60), low-SES public housing communities in an East Coast city. maltreated (N = 48), and low-SES nonmaltreated (N = Survey instruments assessed exposure to violence, 51) children (ages 5-7, 8-9, and 10-12 years) studied 12 distress symptomatology, youth psychosocial Deese-Roediger-McDermott lists. Using recall and functioning, and family dynamics. Data were analyzed recognition measures, the results showed that both true by computing Pearson correlation coefficients and a and false memories increased with age and, contrary to series of multiple linear regression models. RESULTS: some speculation, these trends did not differ as a Witnessing violence was related to youth reports of function of maltreatment status. However, there were intrusive thoughts and feelings, difficulties with differences in overall memory performance as a concentration, and vigilant or avoidant behavior. function of SES. These results are discussed in the Violence victimization was correlated with feelings of broader framework of children's memory development despondency about having either a happy or long life, and the effects of the chronic stress associated with as well as feelings of being unloved, uncared for, and child maltreatment on basic memory processes. afraid. Younger youth, boys, and active problem solvers were more likely to report intrusive thoughts. Howell JC, Kelly MR, Palmer J, Mangum RL. Integrating Problematic family communication was related to child welfare, juvenile justice, and other agencies in a intrusive thoughts, distraction, feeling a lack of continuum of services. Child Welfare 2004; 83(2):143- belonging, and expressions of emotional 56. numbing.CONCLUSIONS: The act of witnessing Abstract: This article presents a comprehensive violence may be associated with a set of distinct strategy framework for integrating mental health, child symptoms. Youth who witness violence also need to be welfare, education, substance abuse, and juvenile identified so they may be aided in dealing with their justice system services. It proposes an infrastructure of distress. Family communication, particularly information exchange, cross-agency client referrals, a problematic family communication, and problem networking protocol, interagency councils, and service solving also contribute to symptomatology. integration models. This infrastructure facilitates integrated service delivery. Howard MW, Rizzuto DS, Caplan JB et al. Gamma oscillations correlate with working memory load in Howes C, Aikins JW. Peer relations in the transition to humans. Cereb Cortex 2003; 13(12):1369-74. adolescence. Adv Child Dev Behav 2002; 29:195-230. Abstract: Functional imaging of human cortex implicates a diverse network of brain regions Hoyer D, Bauer R, Conrad K et al. Specific monitoring of supporting working memory - the capacity to hold and neonatal brain function with optimized frequency manipulate information for short periods of time. bands. IEEE Eng Med Biol Mag 2001; 20(5):40-6. Although we are beginning to map out the brain networks supporting working memory, little is known Hoyle T. What information should be integrated with the about its physiological basis. We analyzed intracranial childhood immunization registry? Mich Med 2005; recordings from two epileptic patients as they 104(1):18-9. performed a working memory task. Spectral analyses revealed that, in both patients, gamma (30-60 Hz) Hoyle T, Swanson R. Assessing what child health oscillations increased approximately linearly with information systems should be integrated: the memory load, tracking closely with memory load over Michigan experience. J Public Health Manag Pract the course of the trial. This constitutes the first 2004; Suppl:S66-71. evidence that gamma oscillations, widely implicated in Abstract: This project examined which child health perceptual processes, support the maintenance of data would be appropriate and useful to integrate with multiple items in working memory. an existing real-time Michigan Department of Community Health (MDCH) application, such as the Howe EG. Unicorns, Carravaggio, and fetal surgery. J Clin Michigan Childhood Immunization Registry. A Ethics 2001; 12(4):333-45. consultant was secured to conduct data gathering Notes: GENERAL NOTE: KIE: Howe, Edmund G analysis activities. An advisory committee of MDCH GENERAL NOTE: KIE: 50 fn. Administrators convened to guide the project. GENERAL NOTE: KIE: KIE Bib: patient care/minors; Interviews were conducted with MDCH administrators, fetuses program managers and representatives from the public and private health care provider community. These Howe ML, Cicchetti D, Toth SL, Cerrito BM. True and false interviews focused on answering three main questions: memories in maltreated children. Child Dev 2004; (1) What MDCH data resources do you currently use? 75(5):1402-17. (2) How do you use and access these data? and (3) Abstract: Differences in basic memory processes What is your vision for expanding, enhancing, and 580
- 589. linking these datato meet Michigan's future health A health fair was undertaken to heighten public health goals? Acceptance of the Michigan Childhood awareness through the collaboration of these various Immunization Registry by the pediatric and family agencies. In this research, formative, process, and practice community demonstrates the utility of summative evaluations were conducted to determine providing more information electronically to the the benefits of partnerships. Elements evaluated medical community in Michigan. The MDCH has included the planning process, health fair relevancy, completed a stakeholders analysis and is moving integration of community resources, participants forward with requirements gathering sessions in order satisfaction and knowledge acquisition, and partnership to create an integrated child health data system. The satisfaction. The samples of this study included (1) 529 integrated child health data system will include data adult participants who completed the on-site evaluation from immunizations, newborn screening, newborn questionnaires; (2) 1,090 child participants who hearing, lead, the Women, Infants, and Children returned gift-reward cards; (3) 114 partners who gave program, and Medicaid. written feedback on their satisfaction; and (4) 57 third- year and 16 fourth-year undergraduate nursing student Hser YI, Grella CE, Hubbard RL et al. An evaluation of participants. Data was collected from the evidence drug treatments for adolescents in 4 US cities. Arch report of the Department of Health, the project Gen Psychiatry 2001; 58(7):689-95. proposal, activity protocols, meeting records, the Abstract: BACKGROUND: Little is known about project final report, students term papers, and outcomes of community-based treatment programs for questionnaires. The chief administrator of the County adolescents with drug problems. METHODS: We Health Bureau was very impressed with the creative studied 1167 adolescents (age range, 11-18 years; 368 exhibits in the fair and, therefore, invited a coalition to females, 799 males) from 4 US cities (Pittsburgh, Pa; continue further workshops. Seventeen educational Minneapolis, Minn; Chicago, Ill; and Portland, Ore) exhibits, two dance programs and two drama programs using a naturalistic, nonexperimental evaluation design. related to health issues were demonstrated in the fair. These adolescents were consecutive admissions during Resources from community organizations were the period from 1993 to 1995 at 23 community-based successfully integrated and allocated. Community treatment programs in the Drug Abuse Treatment participants expressed satisfaction with the fair and Outcome Studies for Adolescents. Included were 418 anticipated similar activities in the future. Participants admissions to 8 residential programs, 292 admissions revealed more than 80% accuracy in health knowledge to 9 outpatient drug-free programs, and 457 admissions quizzes. The senior nursing students highlighted their to 6 short-term inpatient programs. RESULTS: interaction with the community, community health Adolescents in treatment typically had multiple nurses, and health volunteers. Community-based health problems (eg, 58.4% of them were involved in the legal promotion and nursing education can be successfully system, and 63.0% met diagnostic criteria for a mental connected when various disciplines and sectors form disorder). Nevertheless, less than half (43.8%) of all effective partnerships. patients reported weekly marijuana use in the year following treatment (dropping from 80.4% in the year Huang MC, Lin SJ. Newborn screening: should explicit before admission). Similarly, there were decreases in parental consent be required? Acta Paediatr Taiwan heavy drinking (dropping from 33.8% to 20.3%), use 2003; 44(3):126-9. of other illicit drugs (dropping from 48.0% to 42.2%), Abstract: Newborn screening, the first population- and criminal involvement (dropping from 75.6% to based metabolic screening program has been 52.8%). Additionally, patients reported better universally conducted for several decades. With the psychological adjustment and school performance after advent of genetic technologies, many genetic/metabolic treatment. Longer stays in treatment were positively disorders can be detected pre-symptomatically but associated with several favorable outcomes, although might be untreatable. Since the benefits and risks of length of time in treatment was generally short. screening tests on newborns are not fully known, CONCLUSIONS: Substance abuse treatment for newborn screening programs confront both legal and adolescents is effective in achieving many important ethical challenges. This article aims to explore the behavioral and psychological improvements. Strategies following questions: (1) Is explicit parental consent specific to adolescents to improve their treatment required? (2) What level of consent should be sought? retention and completion are needed to maximize the and (3) Is screening in the absence of explicit consent therapeutic benefits of drug treatment. legally defensible? This article considers: (1) the introduction of newborn screening, (2) the conditions Huang CL. Health promotion and partnerships: collaboration under which it is conducted (voluntary vs. mandatory), of a community health management center, county (3) the argument over whether explicit parental consent health bureau, and university nursing program. J Nurs is required, (4) the conditions under which implied Res 2002; 10(2):93-104. consent may be assumed, and (5) the principles of Abstract: Effective partnerships were established informing parents. This article concludes that implied between a community health management center, a consent is not acceptable except for traditional routine county health bureau and a university nursing program. screening. Healthcare professionals should provide 581
- 590. information about theknown benefits and risks of higher levels of general parental control and testing and recognize the parental right of refusal. authoritarian feeding practices. Alternatively, Finally, since the absence of explicit parental consent authoritative feeding styles were associated with higher to newborn screening is not legally defensible, levels of general parental responsiveness. Among the children's advocates should lobby for legislation two permissive feeding styles, Hispanic parents were permitting it in the absence of explicit consent in more likely to be indulgent, whereas African-American specific circumstances. parents were more likely to be uninvolved. Further, differences were found among the feeding styles on an Hudziak JJ, Copeland W, Stanger C, Wadsworth M. independent measure of child's body mass index. Screening for DSM-IV externalizing disorders with the Child Behavior Checklist: a receiver-operating Huijbregts SC, de Sonneville LM, van Spronsen FJ, Licht R, characteristic analysis. J Child Psychol Psychiatry Sergeant JA. The neuropsychological profile of early 2004; 45(7):1299-307. and continuously treated phenylketonuria: orienting, Abstract: BACKGROUND: This study examines the vigilance, and maintenance versus manipulation- diagnostic accuracy of the CBCL syndrome AS scales functions of working memory. Neurosci Biobehav Rev for predicting DSM-IV Attention Deficit-Hyperactivity 2002; 26(6):697-712. Disorder (ADHD) and Oppositional Defiant Disorder Abstract: In this paper, we review neuropsychological with or without Conduct Disorder (ODD/CD). test results of early and continuously treated METHODS: The sample included 370 children (187 Phenylketonuria (PKU) patients. To increase insight probands and 183 siblings) participating in a family into the neuropsychological profile of this population, genetic study of attention and aggressive behavior we have attempted to place the results within an problems. Univariate and stepwise logistic regression attentional network model [Images of the mind, 1994], analyses were used to derive models for predicting two which proposes interacting but dissociable attentional diagnostic conditions: ADHD and ODD/CD. networks for orienting, vigilance, and executive control RESULTS: The Attention Problems syndrome of attention. Executive control of attention is discussed significantly predicted ADHD, and ODD/CD was against the background of the process-specific theory significantly predicted by the Aggressive Behavior of working memory (WM) [Handbook of syndrome. Both scales demonstrated good diagnostic neuropsychology, 1994], which postulates a distinction accuracy, as assessed through receiver operating between the 'maintenance'-function of WM and the characteristics analyses. Cut-point analyses confirmed 'manipulation and monitoring'- the utility of low T-scores, 55 on the respective function.Neuropsychological results are presented for syndromes, for efficiently discriminating cases from 67 early and continuously treated PKU patients and 73 noncases. CONCLUSIONS: CBCL syndromes display controls aged 7-14 years. Four neuropsychological good diagnostic efficiency for assessing common tasks were employed to measure orienting, mnemonic externalizing disorders in children. processing, interference suppression, and top-down control in visual search. No differences were found in Huff B. Men, meth and sex. GMHC Treat Issues 2005; 19(1- orienting and the maintenance-function of WM. In 2):7-9. addition to previously reported impairments in sustained attention/vigilance and inhibition of Hughes SO, Power TG, Orlet Fisher J, Mueller S, Nicklas prepotent responding, PKU patients exhibited deficits TA. Revisiting a neglected construct: parenting styles when top-down control was required in a visual search in a child-feeding context. Appetite 2005; 44(1):83-92. task, but showed no impairment when interference Abstract: The extent to which general parenting suppression was required. It is discussed how the represents feeding styles in ethnically diverse specific neuropsychological impairments in PKU may populations is not well documented. Existing measures be a consequence of mid-dorsolateral prefrontal cortex of child feeding have focused almost exclusively on (DLPFC) dysfunctioning due to deficiencies in specific behaviors of European-American parents. A catecholamine modulation. valid and reliable instrument was developed to identify feeding styles in parents of low-income minority Hulac P. Creation and use of You Are Not Alone, a video preschoolers. Two hundred thirty-one parents (130 for parents facing difficult decisions. J Clin Ethics Hispanic; 101 African-American) completed 2001; 12(3):251-3. questionnaires on feeding practices and parenting Notes: GENERAL NOTE: KIE: Hulac, Peter styles. Based on self-reported feeding behavior, parents GENERAL NOTE: KIE: 1 ref. were assigned to four feeding styles (authoritarian, GENERAL NOTE: KIE: KIE Bib: patient care/minors n=84; authoritative, n=34; indulgent, n=80; and uninvolved, n=33). Convergent validity was evaluated Hull B, McIntyre P. Mapping immunisation coverage and by relating feeding styles to independent measures of conscientious objectors to immunisation in NSW. N S general parenting and authoritarian feeding practices. W Public Health Bull 2003; 14(1-2):8-12. Authoritarian feeding styles were associated with Notes: GENERAL NOTE: KIE: 12 refs. 582
- 591. GENERAL NOTE: KIE:KIE Bib: immunization; the beginning. N C Med J 2005; 66(5):373-9. treatment refusal Huntington RW 3rd. Symptoms following head injury. Am J Hunt CE. Gene-environment interactions: implications for Forensic Med Pathol 2002; 23(1):105; author reply sudden unexpected deaths in infancy. Arch Dis Child 105-6. 2005; 90(1):48-53. Abstract: From the perspective of systems biology, Hurst I. Baby Doe rules. Pediatrics 2005; 116(6):1600-1; genes and proteins interact to produce complex discussion 1601-3. networks, which in turn interact with the environment to influence every aspect of our biological lives. Recent Hurst I. The legal landscape at the threshold of viability for advances in molecular genetics and the identification of extremely premature infants: a nursing perspective, gene polymorphisms in victims of sudden infant death part II. J Perinat Neonatal Nurs 2005; 19(3):253-62; syndrome (SIDS) are helping us better to understand quiz 263-4. that SIDS, like all other human conditions in health and Abstract: This is the second of a 2-part article disease, represents the confluence of specific exploring the legal landscape overlying the difficult environmental risk factors interacting in complex ways decisions that can confront a family with an extremely with specific polymorphisms to yield phenotypes premature infant at the threshold of viability. In Part I, susceptible to sudden and unexpected death in infancy. recent legal regulations and litigation were analyzed to Failure to consider both genetic and environmental risk show that the baby doe regulations are largely inert and factors will impede research progress. that recent litigation arises out of state laws and regulations. Part II takes up the analysis to show that Hunte HE, Turner TM, Pollack HA, Lewis EY. A birth the common thread through all these conflicts, and the records analysis of the Maternal Infant Health subsequent litigation, is a failure to obtain parental Advocate Service program: a paraprofessional consent for the course of treatment at issue. The author intervention aimed at addressing infant mortality in argues that the central focus of all parties seeking to African Americans. Ethn Dis 2004; 14(3 Suppl minimize legal risks in these situations must be on 1):S102-7. creating a transparent decision-making process that Abstract: Recognizing that no single intervention was includes the parents from the onset. Nurses play a likely to eliminate racial disparities, the Genesee pivotal role in that process and are supported broadly County REACH 2010 partnership, utilizing both by the professional guidelines of the American Nurses "bench" science and "trench" knowledge, developed 13 Association, the Association of Women's Health broad-based, multi-faceted interventions to eliminate Obstetric and Neonatal Nurses, the National infant mortality. This article provides highlights from a Association of Neonatal Nurses, the American recent birth records comparison analysis of the Academy of Pediatrics, and the Principles of Family- Maternal Infant Health Advocate Service (MIHAS) Centered Neonatal Care. intervention, and is solely based on the records of 111 MIHAS clients, and a random sample of 350 African- Hurst I. Response to Dr Silverman's column. 'Acceptable' American women residing in Flint, Michigan. The and 'unacceptable' risks. Paediatr Perinat Epidemiol MIHAS clients were more likely than the comparison 2002; 16(1):4-5. sample not to have graduated from high school (56% vs 35%, respectively, P<.0001). The MIHAS clients Hurt H, Malmud E, Brodsky NL, Giannetta J. Exposure to were more likely to report at least some smoking violence: psychological and academic correlates in during pregnancy (20% vs 15%, respectively, P<.05). child witnesses. Arch Pediatr Adolesc Med 2001; However, after controlling for age and education, these 155(12):1351-6. results were no longer statistically significant. In terms Abstract: BACKGROUND: Inner-city children are of birth outcomes, the comparative odds of MIHAS frequently exposed to violence; however, there are few clients delivering a low birth-weight infant are 1.124 data regarding the psychological and academic (95% CI: 0.620-2.038); the odds of their delivering an correlates of such exposure in young children at school infant at 37 weeks or earlier are 1.032 (0.609-1.749). entry. OBJECTIVES: To document exposure to Although the MIHAS clients did not have statistically violence in inner-city children aged 7 years; assess better birth outcomes than those of the general African- their feelings of distress; and evaluate the relationships American population in Flint, the MIHAS clients did of exposure to violence with school performance, not demonstrate the outcomes one would expect, given behavior, and self-esteem. SETTING: A study center in their higher level of risk. Based on this analysis, the an inner-city hospital. PARTICIPANTS: One hundred MIHAS intervention may have brought its clients "up nineteen inner-city children evaluated at age 7 years; to par" with the general community on several birth 119 caregivers (biological and foster). DESIGN: As outcomes. part of a longitudinal study, children were administered the following by a masked examiner: Things I Have Hunter WM. A new paradigm for child protection: begin at Seen and Heard (TISH) to assess exposure to violence; 583
- 592. Levonn, a cartoon-basedinterview for assessing group. RESULTS: The RR of all cancer sites combined children's distress symptoms; and the Culture-Free was significantly elevated in both men and women in Self-Esteem Inventory, Second Edition. School exposed counties. Significantly elevated RR were performance was assessed by school reports and child observed for cancers of the stomach, rectum, skin behavior by the Child Behavior Checklist (CBCL), the melanoma, soft tissue and kidney in men and for Parent Report Form, and the Teacher Report Form. cancers of the cervix and lymph nodes in women. An Caregivers for children were administered the parent increase in haematopoietic cancers was also observed report version of the Checklist of Children's Distress in the population under 10 years in the exposed Symptoms (CCDS-PRV) as well as the CBCL Parent counties in both males and females. CONCLUSION: Report Form. MAIN OUTCOME MEASURES: Study results are compatible with a relationship Exposure to violence (TISH); feelings of distress between cancer incidence and living in proximity to oil (Levonn); school performance; behavior (CBCL Parent fields. An environmental monitoring and cancer Report Form and CBCL Teacher Report Form); and surveillance system in the area is recommended. self-esteem (Culture-Free Self-Esteem Inventory). RESULTS: We found that these children were Hurtig AK, San Sebastian M. Incidence of childhood frequently exposed to violence. For example, 75% had leukemia and oil exploitation in the Amazon basin of heard gun shots, 60% had seen drug deals, 18% had Ecuador. Int J Occup Environ Health 2004; 10(3):245- seen a dead body outside, and 10% had seen a shooting 50. or stabbing in the home (TISH). Many showed signs of Abstract: To determine whether there was any depression and anxiety; eg, 61% worried some or a lot difference in childhood leukemia incidence rates of the time that they might get killed or die and 19% between populations living in the proximity to oil sometimes wished they were dead (Levonn). Higher fields and those living in areas free from oil exposure to violence (TISH Total Violence score) was exploitation in the Amazon basin of Ecuador, 91 cancer correlated with higher Levonn composite scores for cases among children (0-14 years) from the provinces depression and anxiety and with lower self-esteem (P< of Sucumbios, Orellana, Napo, and Pastaza during the or =.04), and was also associated with lower grade period 1985-2000 were studied. The relative risks for point average and more days of school absence (P< or all leukemias indicated significantly elevated levels in =.02). Caregiver assessment of child anxiety correlated the youngest age group (0-4 years), both genders poorly with child report of anxiety (P =.58). combined (RR 3.48, 95% CI 1.25-9.67), and in all age CONCLUSIONS: Young inner-city children have a groups (0-14 years) combined for females (RR 2.60, high exposure to violence by age 7 years; many show 95% CI 1.11-6.08) and both genders combined (RR signs of distress that frequently are not recognized by 2.56, 95% CI 1.35-4.86). There was no significant caregivers. Further, higher exposure to violence in difference between the two groups in all other cancer children correlates with poorer performance in school, sites combined. Study results are compatible with a symptoms of anxiety and depression, and lower self- relationship between childhood leukemia incidence and esteem. living in the proximity of oil fields in the Ecuadorian Amazon. Hurtig AK, San Sebastian M. Geographical differences in cancer incidence in the Amazon basin of Ecuador in Hussain K, Mundy H, Aynsley-Green A, Champion M. A relation to residence near oil fields. Int J Epidemiol child presenting with disordered consciousness, 2002; 31(5):1021-7. hallucinations, screaming episodes and abdominal pain. Abstract: BACKGROUND: Since 1972, oil companies Eur J Pediatr 2002; 161(2):127-9. have extracted more than 2 billion barrels of crude oil from the Ecuadorian Amazon, releasing billions of Hussein MA, Coats DK, Paysse EA. Use of the RetCam 120 gallons of untreated wastes and oil directly into the for fundus evaluation in uncooperative children. Am J environment. This study aimed to determine if there Ophthalmol 2004; 137(2):354-5. was any difference in overall and specific cancer Abstract: PURPOSE: To report our experience using incidence rates between populations living in proximity the RetCam 120 to evaluate suspected retinal pathology to oil fields and those who live in areas free from oil in children who did not cooperate for standard in-office exploitation. METHODS: Cancer cases from the examination. DESIGN: Interventional case series. provinces of Sucumbios, Orellana, Napo and Pastaza METHODS: We reviewed charts of eight consecutive during the period 1985-1998 were included in the uncooperative children with suspected fundus study. The exposed population was defined as those abnormalities that were photographed using the living in a county (n = 4) where oil exploitation had RetCam 120 as a routine part of patient care. been ongoing for a minimum of 20 years up to the date RESULTS: Three uncooperative children with of the study. Non-exposed counties were identified as suspected pathology required RetCam 120 photos those (n = 11) without oil development activities. because of inadequate fundus examination. Five had Relative risks (RR) along with 95% CI were calculated pathology or suspected pathology that required more for men and women as ratios of the age-adjusted detailed examination. In all of these children, we were incidence rates in the exposed versus non-exposed 584
- 593. able to reachor rule out a diagnosis. CONCLUSION: intraindividual change in coping over time. Evidence The Retcam 120 digital fundus camera has utility as an for both change and continuity in the development of in-office diagnostic tool for fundus examination of coping from adolescence to adulthood was found, poorly cooperative children and may be a good although adolescent coping had limited impact on alternative to examination under anesthesia or sedation stress and substance use in adulthood. Support was also in selected cases. found for complex stress-buffering and stress- exacerbating effects of coping on the relations between Hussong AM, Chassin L. Parent alcoholism and the leaving major life events and adult drug use and between stress home transition. Dev Psychopathol 2002; 14(1):139- associated with the new roles of adulthood and heavy 57. alcohol use. Implications of these findings for Abstract: Although they have received little empirical development and adjustment in the transition to attention, departures from the parental home play a adulthood are discussed. significant role in demarcating the transition from adolescence to young adulthood. The current study Hutchings J, Lane E. Parenting and the development and examined the extent to which various features of young prevention of child mental health problems. Curr Opin adults' experiences of leaving home differed for Psychiatry 2005; 18(4):386-91. children of alcoholic (COAs) versus nonalcoholic Abstract: PURPOSE OF REVIEW: The government is parents, what adolescent precursors might account for recognizing the need to deal with the growing numbers noted differences and what indicators of young adult of antisocial young people through investing in early adjustment are related to the leaving home experience. preventive parenting support. It is important that the A total of 227 young adults drawn from a high-risk, services provided are evidence-based and delivered community sample of COAs and matched controls effectively. This review briefly discusses the were interviewed at ages 18-23 years regarding their contribution of parenting to the development of child prior leaving home experiences. COAs showed greater mental health difficulties, particularly externalizing difficulties in negotiating this transition, fewer positive problems, and reviews some effective early feelings about the transition, and different reasons for intervention preventive programmes. RECENT leaving home as compared to participants without an FINDINGS: Over 30 years of research have established alcoholic parent. Moreover, adolescent risk behaviors, both that parenting behaviours influence the family conflict, and family disorganization (assessed development of childhood conduct disorders and that prior to this transition) each partly accounted for behavioural family interventions targeting specific COAs' risk for difficulty in the leaving home transition. parenting skills are the most effective way of Although certain aspects of the leaving home transition preventing or reducing child behaviour problems. Until were uniquely related to young adult adjustment, future recently, however, those children at highest risk have research is still needed to more comprehensively often had the poorest outcomes from intervention. understand the implications for young adult Recent research has identified the factors that make development associated with such individual parenting interventions effective and how to engage the differences in the leaving home transition. multi-stressed, hard-to-reach families whose children are most at risk. SUMMARY: Research has identified Hussong AM, Chassin L. Stress and coping among children risk factors that are associated with the development of of alcoholic parents through the young adult transition. conduct disorder and affect the quality of parenting. Dev Psychopathol 2004; 16(4):985-1006. This has made it possible to provide preventive Abstract: The transition to young adulthood is both a interventions, targeting families that are most at risk. time when risky health behaviors such as substance Evaluations have shown, however, that getting misuse peak and a time of opportunity for growth and effective preventive services to those most at risk is not development through the acquisition of adult roles. In straightforward and programmes need to address the this transition, coping styles include responses to the problem of recruiting parents who, by virtue of their stressors and opportunities associated with the multiple problems, have traditionally been hard to emergence of adulthood. The extent to which such engage. Emphasis is placed on the importance of using coping styles are skillfully employed in part determines evidenced-based programmes in service settings in adjustment into adulthood. The current study used a ways that are effective. high-risk, longitudinal design to examine the development of coping styles over adolescence, Huth-Bocks AC, Levendosky AA, Bogat GA. The effects of continuity in these coping styles from adolescence to domestic violence during pregnancy on maternal and adulthood, the impact of coping on adult stress and infant health. Violence Vict 2002; 17(2):169-85. substance misuse, the ability of coping to buffer effects Abstract: The present study examined the impact of of stress on substance use, and differences in coping domestic violence on maternal and infant health by between at-risk youth (i.e., children of alcoholics assessing maternal health during pregnancy and infant [COAs]) and their peers. A sample of 340 adolescents health at two months postpartum. Two hundred and completed four assessments over ages 11-23. We used two women (68 battered and 134 non-battered) were latent trajectory models to examine interindividual and recruited from the community and completed both 585
- 594. pregnancy and 2-monthpostpartum interviews. Results triggering events included an acute febrile illness in 20 revealed that domestic violence during pregnancy was patients, school change in 11 patients, trauma in 2 associated with numerous health problems for mothers patients, death of a loved one in 2 patients, and sexual and infants including more health problems during abuse in 2 patients. Before diagnosis, all patients pregnancy, more likelihood of premature labor, later underwent extensive negative evaluations. Nearly all entrance into prenatal care, lower infant birth weight, patients had mental health evaluations that ruled out greater utilization of health care resources, and more eating disorder and psychosis. Medical management prenatal substance use. After income was controlled, had failed, and surgeries worsened symptoms. In a the relationship between violence and timing of majority of patients, we identified a comorbid prenatal care and infant birth weight became psychiatric disorder. CONCLUSIONS: Evaluation of nonsignificant. Maternal social support was found to preteens and teens unable to go to school or eat protect against the effects of violence for several health because of unexplained incapacitating symptoms outcomes. The current findings suggest the need for should include queries about factors associated with domestic violence screening during pregnancy, as well PADS. To treat PADS, medical and mental health as clinical interventions for battered, pregnant women clinicians must recognize pain as having both in order to prevent serious physical and emotional nociceptive and affective components and address problems for both mothers and their infants. treatment collaboratively. Invasive procedures and surgery reinforce the cycle of arousal and pain and are Hyder AA. Evaluating education as an intervention for to be avoided. Age for the onset of PADS in the injury control. Am J Public Health 2004; 94(12):2047; preteen and early teen years suggests that author reply 2047-8. developmental issues play a role. Hylton C, Goldberg MF. Images in clinical medicine. Hynes HP, Brugge D, Osgood ND, Snell J, Vallarino J, Circumpapillary retinal ridge in the shaken-baby Spengler J. "Where does the damp come from?" syndrome. N Engl J Med 2004; 351(2):170. Investigations into the indoor environment and respiratory health in Boston public housing. J Public Hyman PE, Bursch B, Sood M, Schwankovsky L, Cocjin J, Health Policy 2003; 24(3-4):401-26. Zeltzer LK. Visceral pain-associated disability Abstract: The self-reported prevalence of asthma syndrome: a descriptive analysis. J Pediatr increased by 75% from 1980 to 1994, a trend found to Gastroenterol Nutr 2002; 35(5):663-8. be significant and evident in every region of the Abstract: OBJECTIVE: Pain-associated disability country. The increase has been most marked in syndrome (PADS) is a recently defined term that children 0-14 years of age, and there is evidence that, describes patients with chronic pain whose restriction as with lead poisoning, inner-city and urban in daily activities appears disproportionately severe for populations are most at risk. Attention has turned to the the observable pathology. The aim of this study is to role of indoor environment risk factors, especially in describe the features of a group of pediatric patients homes and schools. Such factors include moisture and with abdominal symptoms fitting this diagnosis. mold growth, pest infestation, dust mites, the building METHODS: To identify factors associated with envelope, heating systems, inadequate ventilation, visceral PADS, we reviewed the records of 40 patients NO2, and environmental tobacco smoke. The Healthy (18 males; age range, 7-21 years) with gastrointestinal Public Housing Initiative (HPHI) is a Boston-based symptoms severe enough to prevent school attendance community-centered research and intervention project or eating for 2 months or more. These patients, in designed to engage Boston Housing Authority whom pain was neither feigned nor self-induced, met residents in a collaborative process to improve the diagnostic criteria for visceral PADS, including respiratory health, quality of life, building conditions, failure of usual treatments and lack of a satisfactory and building maintenance in public housing. This organic explanation for the severity of the pain. article summarizes the significant research findings RESULTS: The dominant symptom was abdominal from four pilot studies in housing developments that pain in 30 patients, regurgitation in 5 patients, nausea lay the foundation for the larger HPHI asthma-related in 3 patients, and chest pain in 2 patients. All patients environmental intervention study. The research design complained of pain or discomfort, and all met for the pilot projects is informed by principles of symptom-based criteria for one or more functional community-collaborative research. The strengths of gastrointestinal disorder. Disordered sleep was a this model of research to our work are also discussed. problem for 39 patients. Factors associated with PADS included learning disabilities, unrealistic goals in a Hynes J, McCune N. Follow-up of childhood depression: perfectionist, high-achieving child, early pain historical factors. Br J Psychiatry 2002; 181:166-7; experiences, passive or dependent coping style, marital author reply 167. problems in the home, and chronic illness in a parent. All patients had at least two associated factors, and a Hyun MS, Kools S, Kim SA. A model of recovery from majority had four or more associated factors. Possible substance abuse and dependence for Korean 586
- 595. adolescents. J ChildAdolesc Psychiatr Nurs 2003; protein diet and special supplemental formula) for 16(1):25-34. children and adolescents with phenylketonuria (PKU) Abstract: PROBLEM: There is a need for a model that and their caregivers. A semistructured interview was illuminates the recovery process from substance abuse administered to 19 caregivers and 11 children with and dependence for Korean adolescents, identifies the PKU to describe formula and dietary problems and stages and strategies of recovery, and directs their frequency, difficulty, and affective intensity. interventions to specific stages. METHODS: The Information was also gathered on attempted solutions model was developed from content analysis focused on to problems and their perceived effectiveness. the experiences during the recovery process of 8 Caregivers who rated dietary problems as less frequent, Korean adolescents with substance abuse and difficult, and emotionally upsetting and strategies as dependence. CONCLUSIONS: The stages in recovery more effective for solving problems had children with include retracing, accepting, surrendering, and turning significantly lower phenylalanine (Phe) levels, a to change. The strategies of recovery involve a variety biological indicator of adherence (i.e., better of activities and multidimensional domains. The model adherence; all p values <.05). Caregivers who reported integrates the stages and strategies of recovery, and using strategies coded as representing an authoritarian suggests nursing interventions to promote recovery of parenting style to solve dietary problems were adolescents with a substance-related disorder. significantly more likely to have lower household incomes and older children with higher Phe levels than Iacono WG, Malone SM, McGue M. Substance use were those who did not report such strategies (all p disorders, externalizing psychopathology, and P300 values <.05). event-related potential amplitude. Int J Psychophysiol 2003; 48(2):147-78. Iglesias-Rozas JR, Hopf N. Histological heterogeneity of Abstract: We hypothesize the existence of an inherited human glioblastomas investigated with an predisposition for a spectrum of behaviors and traits unsupervised neural network (SOM). Histol characterized by behavioral disinhibition. This Histopathol 2005; 20(2):351-6. externalizing spectrum includes childhood disruptive Abstract: The histological variability of Glioblastomas disorders, antisocial behavior, substance use disorders, (GB) precludes the modern assimilation of theses personality traits related to behavioral undercontrol, tumors into a single histological tumor group. As an and the precocious expression of problem behavior. alternative to statistical histological evaluation, we We further hypothesize that a genetically influenced investigated 1489 human GB in order to discover central nervous system diathesis underlies this whether they could be correctly classified using Self- spectrum and is reflected in reduced P300 amplitude in Organizing Maps (SOM). In all tumors 50 histological a visual oddball event-related potential task. A review features, as well as the age and sex of the patients, were of evidence bearing on the model is derived from examined. Four clusters of GB with a significance of findings from the Minnesota Twin Family Study, a 52 (maximal significance 60) were found. Cluster C1 population-based, longitudinal investigation of twin contained 37.47% of all GB and 41.09% of all youth. These findings indicate that the collection of polymorphic glioblastomas (PG). Cluster C2 included attributes related to behavioral disinhibition is familial, 35.06% of all GB and 44.96% of all giant cell heritable, and interrelated. Evidence supporting P3 glioblastomas (GCG). Cluster C3 contained 16.45% of amplitude reduction (P3-AR) as an index of genetic all GB with a significant component of astroblasts, vulnerability for this externalizing spectrum includes glioblasts and oligodendroglia. Cluster C4 included its association with (a) familial risk for substance use 11.01% of all GB, 87.80% of the gliosarcomas (GS) and antisocial personality disorders, (b) diagnoses of and 36.72% of all GCG. Placing a series of component childhood disruptive disorders and substance use windows with their maps side by side allows the disorders, (c) early onset of undersocialized behavior, immediate recognition of the dependencies on and (d) quantitative phenotypes related to externalizing variables and the determination of variables necessary problems. In addition, the development of substance to build the specific clusters. The SOM allow a realistic use disorders over a 3-year period is associated with histological classification, comparable to the actual P3-AR measured prior to their expression. These classification by the WHO. In addition, we found new, findings suggest that P3-AR indexes one aspect of the small subclusters of human GB which may have a genetic diathesis for a spectrum of externalizing clinical significance. With SOM one can learn to problem behavior. discriminate, discard and delete data, select histological and clinical or genetic variables that are meaningful, Ievers-Landis CE, Hoff AL, Brez C, Cancilliere MK, and consequently influence the result of patient McConnell J, Kerr D. Situational analysis of dietary management. challenges of the treatment regimen for children and adolescents with phenylketonuria and their primary Im SB, Kim JL, Ju SJ et al . Development of child and caregivers. J Dev Behav Pediatr 2005; 26(3):186-93. adolescent psychiatric nursing practice in Korea, 1980- Abstract: A situational analysis was conducted to 2000. J Child Adolesc Psychiatr Nurs 2004; 17(2):56- evaluate challenges with the treatment regimen (a low 65. 587
- 596. Abstract: PROBLEM: Althoughthe need for mental Because the corticosteroid could not be discontinued, health services for children and youth is on the rise in promethazine, a phenothiazine derivative, was used to Korea, there are no data available regarding the current treat the psychotic symptoms. Symptoms resolved with status of psychiatric nurses working with children and use of promethazine. DISCUSSION: A number of adolescents. METHODS: Descriptive statistics were published reports describe the appearance of used to analyze questionnaires from 324 respondents. psychological symptoms with corticosteroid use. While FINDINGS: Only 5% of psychiatric nurses in Korea the mechanism is unclear, the reaction is usually are working at child and adolescent-specific programs. reversible with dose reduction or discontinuation of the The level of nurses' roles and functions vary from corticosteroid. In cases where this cannot be done, simple to specialized. CONCLUSIONS: More effort typical treatment involves an antipsychotic medication. should be put into networking among nurses to Most antipsychotic medications, such as the exchange updated information and to share nursing phenothiazine class, have not been evaluated in very strategies and strengthen college education for further young children. Promethazine is a phenothiazine specialization and expansion of nursing roles in the derivative that has been used in children for a number various settings. of nonpsychiatric indications. CONCLUSIONS: Promethazine may be effective in treating steroid- Inbar Z, Meibar R, Shehada S, Irena V, Rubin L, Rishpon S. induced psychosis in pediatric patients. "Back to sleep": parents compliance with the recommendation on the most appropriate sleeping Intromasso C. Reproductive self-determination in the Third position of infants, Haifa District, Israel, 2001. Prev Circuit: the statutory proscription of wrongful birth and Med 2005; 40(6):765-8. wrongful life claims as an unconstitutional violation of Abstract: BACKGROUND: In 1993, the Israel Planned Parenthood v. Casey's undue burden standard. Ministry of Health issued a formal recommendation to Women's Rights Law Report 2003; 24(2):101-20. avoid placing healthy infants to sleep in the prone Notes: GENERAL NOTE: KIE: 249 fn. position in order to prevent sudden infant death. The GENERAL NOTE: KIE: KIE Bib: abortion/legal objective of the study was to study parents' compliance aspects; wrongful life with this recommendation and to identify characteristics of noncompliant parents of infants aged Iribarren JA, Ramos JT, Guerra L et al. [Prevention of less than 6 months old. METHODS: The study vertical transmission and treatment of infection caused population consisted of 1912 parents of infants aged 0- by the human immunodeficiency virus in the pregnant 12 months who visited the Haifa District primary woman. Recommendations of the Study Group for preventive health centers during the study week and AIDS, Infectious Diseases, and Clinical Microbiology, answered the self-administered questionnaire. the Spanish Pediatric Association, the National AIDS RESULTS: 15.6% of infants younger than 1 year were Plan and the Spanish Gynecology and Obstetrics placed to sleep in the prone position: 12.4% among Society]. Enferm Infecc Microbiol Clin 2001; infants younger than 3 months, and 17.6% among 19(7):314-35. infants 3-6 months old. Surprisingly, multiple logistic regression analysis demonstrated that Israeli-born Irwin HJ. The relationship between dissociative tendencies Jewish mothers were more likely to place their babies and schizotypy: an artifact of childhood trauma? J Clin prone than Israeli-born Arab mothers or mothers born Psychol 2001; 57(3):331-42. in the former Soviet Union who had immigrated to Abstract: Previous research has suggested a Israel after 1990. CONCLUSIONS: At-risk behaviors relationship between dissociative tendencies and are usually associated with minority and immigrant schizotypy. This study sought to extend the previous populations. Culture specific and other possible reasons work in two fundamental respects. First, explicit for our unusual findings are discussed. cognizance was taken of the multidimensionality of both dissociative tendencies and schizotypy. Second, Ingram DG, Hagemann TM. Promethazine treatment of the study examined the possibility that the observed steroid-induced psychosis in a child. Ann correlation between dissociative tendencies and Pharmacother 2003; 37(7-8):1036-9. schizotypy is an artifact of the association between Abstract: OBJECTIVE: To report a case of steroid- each of these personality domains and a history of induced psychosis in a child that resolved with the childhood trauma. Australian adults (N = 116) were treatment of promethazine, a phenothiazine derivative. administered the Dissociative Experiences Scale, the CASE SUMMARY: A 2-year-old white boy with a Schizotypal Personality Questionnaire-Brief, and the history of relapsed acute lymphoblastic leukemia Childhood Trauma Questionnaire. Hierarchical underwent a bone marrow transplant and developed regression analysis revealed that both pathological and graft-versus-host disease, which was treated with nonpathological dissociative tendencies were predicted methylprednisolone. Within 24 hours of initiation of by the dimensions of schizotypy, even after the the methylprednisolone, the patient developed contribution of childhood trauma had been removed. It symptoms associated with steroid-induced psychosis is concluded that the relationship between dissociative including mania, head-banging, and excessive crying. 588
- 597. tendencies and schizotypyis not an artifact of of the Handbook would greatly contribute to improving childhood abuse, but the clinical significance of this the management of children with psychosomatic and relationship remains to be established. psychosocial disorders, together with the construction of the basic network model for management of these Isaacs D. To kill or to let die? J Paediatr Child Health 2003; children. 39(2):135-6. Notes: GENERAL NOTE: KIE: 5 refs. Islam MN, Islam MN. Retrospective study of alleged rape GENERAL NOTE: KIE: KIE Bib: allowing to die; victims attended at Forensic Medicine Department of euthanasia Dhaka Medical College, Bangladesh. Leg Med (Tokyo) 2003; 5 Suppl 1:S351-3. Isaksen CR, Lund EB. [Shaken baby syndrome--shaking Abstract: Sexual assault is one of the fast growing violence against infants]. Ugeskr Laeger 2002; violent crimes in Bangladesh. We carried out a 164(48):5662-3. retrospective study of 675 alleged rape victims out of Abstract: We describe two cases of shaken baby total examined 1665 cases during 1994-2000. In the syndrome. Both children were about three months of last seven years, 441 victims refused examination and a age. It is important to recognise the characteristic final report is pending in 2.4% cases due to non- features of this form of child abuse in order to prevent availability of ancillary investigation reports. We found further damage and to ensure removal of the children that 48.9% cases were sexually abused based on from the abusive environment. history, physical evidence and opinion of the examining doctor although high vaginal swab for Ishizaki Y, Kobayashi Y, Yamagata Z et al. Research on spermatozoa was found to be negative in all cases. Out promotion of management of children with of 675 cases studied in this paper, 33.5% was in the 12- psychosomatic and psychosocial disorders in Japan. 15 year age group, in 511 cases the assailant was Pediatr Int 2005; 47(3):352-7. known to the victims, 23.7% was reported and was Abstract: BACKGROUND: The number of children examined within 72 h of occurrence, unmarried with psychosomatic and psychosocial disorders has persons constituted 56.6% cases and 69.9% was been increasing in Japan. There are, however, few literate. In 45.8% of the cases the victims were abused trained pediatricians who have adequate knowledge of during the daytime. Non-genital violence was observed the treatment needed. The Research Group on the in 91 cases, 2.9% was admitted to the hospital, 2% Promotion of Management of Children with reported with pregnancy, 0.4% reported with abortion Psychosomatic and Psychosocial Disorders carried out and four cases had a history of previous abuse. Genital the present study to (i) disseminate knowledge about findings included hymenal rupture in 38.9% and 9.6% psychosomatic and psychosocial disorders of children; cases of forchette were found with recent tears. In 248 and (ii) establish a community-based network model to cases, opinion was negative due to delayed attendance, ensure effective communication among relevant false charge and time-consuming procedures. institutions. METHODS: To disseminate knowledge of the psychosocial and psychosomatic disorders, the Ismail AI. Determinants of health in children and the Research Group compiled the Handbook for problem of early childhood caries. Pediatr Dent 2003; Psychosomatic Disorders of Children and distributed it 25(4):328-33. to pediatricians throughout Japan. A follow-up Abstract: Early childhood caries (ECC) is a significant questionnaire survey was then carried out. Also, in dental problem for many low-income and minority order to examine the current status of the children in the United States. The diagnosis, communication network between pediatricians and the prevention, and management of ECC have been based related institutions, the Research Group conducted a upon both experiential knowledge and scientific questionnaire survey on general pediatricians. evidence. In the prevention and management of ECC, RESULTS: Sixty-five percent of the respondents the focus has been on modifying the dental, infectious, indicated that they were actually using the Handbook. and behavioral determinants of the disease. The The topics in the Handbook that were most frequently purpose of this concept paper is to expand the referred to by the respondents were attention deficit paradigm used to understand the etiology of ECC and hyperactivity disorders, school refusal, eating design programs to prevent and manage this condition. disorders, and orthostatic dysregulation. Thirty-seven percent of the participants indicated changes in their Israel BA, Parker EA, Rowe Z et al. Community-based behavior towards psychosomatic and psychosocial participatory research: lessons learned from the Centers problems. The results of the survey on communication for Children's Environmental Health and Disease networks found that the pediatricians generally Prevention Research. Environ Health Perspect 2005; collaborated with different institutions depending on 113(10):1463-71. the nature of the problems, such as school refusal and Abstract: Over the past several decades there has been bullying, developmental disorders, child abuse and growing evidence of the increase in incidence rates, maltreatment, and others. CONCLUSION: Promotion morbidity, and mortality for a number of health 589
- 598. problems experienced bychildren. The causation and vulnerability to the effects of stressful life events aggravation of these problems are complex and several years after the program was completed. Data multifactorial. The burden of these health problems and from a randomized trial of the NFP were examined for environmental exposures is borne disproportionately by mothers (N = 324) who were generally low-income, children from low-income communities and young, and unmarried at the time of the birth of their communities of color. Researchers and funding first child. Structured interviews were done with institutions have called for increased attention to the mothers about 15 years after the program began. complex issues that affect the health of children living Results showed that experiencing uncontrollable in marginalized communities--and communities more stressful life events, such as the death of a loved one, broadly--and have suggested greater community led to fewer negative outcomes (fewer mental health involvement in processes that shape research and problems, less binge drinking, and better parenting intervention approaches, for example, through practices) among nurse-visited mothers than among community-based participatory research (CBPR) mothers receiving no visitation. Furthermore, the partnerships among academic, health services, public program's effect on reducing vulnerability to the health, and community-based organizations. Centers negative impact of life events was particularly evident for Children's Environmental Health and Disease among parents who were younger or had a lower sense Prevention Research (Children's Centers) funded by the of personal control at intake. These findings suggest National Institute of Environmental Health Sciences that, in addition to preventing the occurrence of and U.S. Environmental Protection Agency were negative outcomes that were direct targets of the required to include a CBPR project. The purpose of intervention, the NFP more generally enhanced this article is to provide a definition and set of CBPR mothers' ability to cope with future stressful life events. principles, to describe the rationale for and major benefits of using this approach, to draw on the Jaatinen PT, Erkolahti R, Asikainen P. Networking family experiences of six of the Children's Centers in using counselling services. Developing psychosocial support CBPR, and to provide lessons learned and for school children. J Interprof Care 2005; 19(3):294-5. recommendations for how to successfully establish and maintain CBPR partnerships aimed at enhancing our Jack SM, DiCenso A, Lohfeld L. A theory of maternal understanding and addressing the multiple engagement with public health nurses and family determinants of children's health. visitors. J Adv Nurs 2005; 49(2):182-90. Abstract: BACKGROUND: Home visiting by public Iton A, Oliver MM, Torgensen K. Preventing sexual health nurses and family visitors is promoted as an exploitation of children and teens. J Law Med Ethics important intervention for enhancing parent and child 2005; 33(4 Suppl):38-9. development. Mothers of children at-risk for developmental delays tend to be the most difficult to Iverson D. Schools uniting neighborhoods: the SUN access and engage, and commonly drop out of home initiative in Portland, Oregon. New Dir Youth Dev visiting programmes prematurely. PURPOSE: This 2005; (107):81-7, table of contents. paper reports a study developing a theory that describes Abstract: The SUN Community Schools Initiative is a the process by which mothers of children at-risk community-driven model that allows each school engage with public health nurses and family visitors in community to design the programs that fit a blended home visiting programme. METHODS: neighborhood needs in Portland, Oregon. County and Grounded theory was used to guide the collection, city governments, local school districts, and recording, organization and analysis of the data. A community agencies have jointly leveraged resources purposeful sample of 20 mothers receiving public to support fifty-one community schools. The program health nurse and family visitor home visits were is managed by the Multnomah County Department of recruited from a public health unit in Canada. Data School and Community Partnerships. The City Parks were collected through client record reviews and 29 in- and Recreation Bureau oversees twelve sites staffed by depth interviews that explored participants' city employees. Strong support across political systems experiences, beliefs and expectations about aligns funding and reduces the fragmentation in engagement. Data collection and analysis continued existing funding patterns. until all categories were saturated. FINDINGS: Mothers felt vulnerable and frequently powerless when Izzo CV, Eckenrode JJ, Smith EG et al. Reducing the impact they allowed the service providers into their home. of uncontrollable stressful life events through a Mothers with children at-risk engage with public health program of nurse home visitation for new parents. Prev nurses and family visitors through a basic social Sci 2005; 6(4):269-74. process of limiting family vulnerability, which has Abstract: The current study examined whether the three phases: (1) overcoming fear; (2) building trust; Nurse Family Partnership (NFP), an intervention in and (3) seeking mutuality. The personal characteristics, which mothers received home visitation by registered values, experiences and actions of the public health nurses pre- and postnatally, reduced mothers' nurse, family visitor and mother influence the speed at which each phase is successfully negotiated and the 590
- 599. ability to developa connected relationship. nursing practice. The purpose of this article is to CONCLUSION: Public health nurses working with describe bioethical principles and common ethical families at risk need to identify client fears and dilemmas faced by nurses in pediatric end-of-life care perceptions related to home visiting, and to explain the and suggest nursing interventions to promote a role of public health nurses and family visitors to all peaceful end-of-life experience for the child and family members. Given the importance that mothers family. place on the development of an interpersonal relationship, it is important for home visitors Jacobs J, Jonas WB, Jimenez-Perez M, Crothers D. continually to assess the quality of their relationships Homeopathy for childhood diarrhea: combined results with clients. and metaanalysis from three randomized, controlled clinical trials. Pediatr Infect Dis J 2003; 22(3):229-34. Jackson JK, Vellucci J, Johnson P, Kilbride HW. Evidence- Abstract: BACKGROUND: Previous studies have based approach to change in clinical practice: shown a positive treatment effect of individualized introduction of expanded nasal continuous positive homeopathic treatment for acute childhood diarrhea, airway pressure use in an intensive care nursery. but sample sizes were small and results were just at or Pediatrics 2003; 111(4 Pt 2):e542-7. near the level of statistical significance. Because all Abstract: OBJECTIVE: Recent studies provide three studies followed the same basic study design, the evidence that nasal intermittent positive pressure combined data from these three studies were analyzed ventilation (NIPPV) may stabilize the airway of to obtain greater statistical power. METHODS: Three extremely low birth weight infants after endotracheal double blind clinical trials of diarrhea in 242 children extubation. The objective of this project was to ages 6 months to 5 years were analyzed as 1 group. introduce the use of NIPPV into a busy level 3 Children were randomized to receive either an intensive care nursery. METHODS: This report individualized homeopathic medicine or placebo to be describes the process of NIPPV introduction using a taken as a single dose after each unformed stool for 5 series of rapid-cycle improvement projects, as days. Parents recorded daily stools on diary cards, and proposed by the Vermont Oxford Network. RESULTS: health workers made home visits daily to monitor In the first cycle, 7 (88%) of 8 infants were children. The duration of diarrhea was defined as the successfully extubated with NIPPV after meeting time until there were less than 3 unformed stools per criteria for reintubation on nasal continuous positive day for 2 consecutive days. A metaanalysis of the airway pressure alone. Proper positioning of the prongs effect-size difference of the three studies was also in the nasopharynx was found to be an important conducted. RESULTS: Combined analysis shows a determinant of success. In a second cycle, shorter 2.5- duration of diarrhea of 3.3 days in the homeopathy cm nasopharyngeal prongs were more effective than group compared with 4.1 in the placebo group (P = standard 4-cm prongs in 12 recently extubated infants 0.008). The metaanalysis shows a consistent effect-size as assessed by objective measurements and subjective difference of approximately 0.66 day (P = 0.008). nursing reports. A third cycle confirmed the acceptance CONCLUSIONS: The results from these studies of this technique in our unit and demonstrated an confirm that individualized homeopathic treatment associated decrease in markers of chronic lung disease decreases the duration of acute childhood diarrhea and in extremely low birth weight infants during the 22 suggest that larger sample sizes be used in future months after its introduction. CONCLUSION: This homeopathic research to ensure adequate statistical experience supports the role for the rapid-cycle change power. Homeopathy should be considered for use as an model in achieving effective evidence-based medical adjunct to oral rehydration for this illness. practices in a neonatal intensive care setting. Jacobson JL, Jacobson SW. Effects of prenatal alcohol Jacobs AJ. Liberty, equality, and genetic selection. Pharos exposure on child development. Alcohol Res Health Alpha Omega Alpha Honor Med Soc 2001; 64(1):15- 2002; 26(4):282-6. 20; discussion 20-3. Notes: GENERAL NOTE: KIE: 25 refs. Jacquemin Le Vern H. [Adolescence and pornography]. GENERAL NOTE: KIE: KIE Bib: genetic Gynecol Obstet Fertil 2004; 32(5):416-9. intervention; genetic screening; prenatal diagnosis Abstract: It is difficult to define pornography; it always proceeds from censure. Any representation of sexual Jacobs HH. Ethics in pediatric end-of-life care: a nursing relations forbidden by the law is considered as perspective. J Pediatr Nurs 2005; 20(5):360-9. pornography. How can we evaluate its impact on Abstract: Care of children at the end of life frequently teenagers? What are the possible consequences? Which involves ethical dilemmas and difficult decisions. image of woman is carried through pornography? These ethical dilemmas often complicate the already challenging circumstances surrounding the death of a Jaffe ME, Sharma KK. Cybersex with minors: forensic child; therefore, the knowledge and application of implications. J Forensic Sci 2001; 46(6):1397-402. ethical principles becomes an essential component of Abstract: This paper is designed to assist forensic 591
- 600. psychiatrists/psychologists who evaluateadults who Abstract: BACKGROUND: Childhood asthma commit sexual crimes against children on the Internet. continues to be a growing medical concern in the The typical offender is an adult male who logs onto the United States, affecting > 17 million children in 1998. Internet and enters a chat room in which children The mortality rate from asthma in children aged 5 to 14 congregate. Unbeknownst to the offender, undercover years has nearly doubled, from 1.7 deaths per million police officers are posing as minors in the chat rooms. to 3.2 deaths per million between 1980 and 1993. The undercover officer (pretend kid) and offender OBJECTIVE: To evaluate the use of artificial neural engage in increasingly explicit, sexual conversation; networks (ANNs) to rate problem-based strategies for the offender may transmit erotic photographs to the asthma management in a defined population of undercover officer and/or arrange to meet at a motel in children. METHODS: The participants in our study order to have sexual intercourse. The authors will were recruited from a local inner-city medical facility discuss the relevant legal, clinical, and ethical aspects in Los Angeles. The majority of participants had of examining these offenders, and describe specific received the diagnosis of mild-to-moderate-persistent cases that the author (2) evaluated. asthma. Each participant was given 10 asthma-based problems and asked to manage them. Each Jaffe PG, Crooks CV, Wolfe DA. Legal and policy management decision and its order were entered into a responses to children exposed to domestic violence: the database. This database was used to train an artificial need to evaluate intended and unintended neural network (ANN). The trained ANN was then consequences. Clin Child Fam Psychol Rev 2003; used to cluster the various performances, and outputs 6(3):205-13. were evaluated graphically. RESULTS: Three hundred Abstract: Greater training and specialization in five performances were analyzed through our trained working with children exposed to domestic violence neural network. Our ANN classified five major clusters has resulted in new policies, interagency protocols, and representing different approaches to solving an acute legislation in many states. This paper examines court- asthma case. CONCLUSIONS: ANNs can build rich related responses in criminal, child protection, and models of complex phenomena through a training and family court custody proceedings, which highlight pattern-recognition process. Such networks can solve legislative changes and resulting systemic change. classification problems with ill-defined categories in Although this legislation originated with the best of which the patterns are deeply hidden within the data, intentions to assist and protect children, some of the and models of behavior are not well defined. In our most striking outcomes have been negative and pilot study, we have shown that ANNs can be useful in unintended. Laws that mandate reporting of children automating evaluation and improving our exposed to domestic violence can clash with understanding of how children manage their asthma. inadequate training and resources, or inadvertently revictimize abused women. Similarly, child custody Jakobsen MS, Sodemann M, Molbak K, Alvarenga IJ, legislation that raises a rebuttable presumption that a Nielsen J, Aaby P. Termination of breastfeeding after violent spouse will not receive custody or joint custody 12 months of age due to a new pregnancy and other of children after parental separation has resulted in causes is associated with increased mortality in greater skepticism about abuse allegations We propose Guinea-Bissau. Int J Epidemiol 2003; 32(1):92-6. that efforts at law reform can be enhanced by a more Abstract: BACKGROUND: As part of an assessment thoughtful analysis of potential intended and of breastfeeding and child health in Guinea-Bissau, we unintended consequences, and should be accompanied investigated the impact of mother's reason for weaning by a comprehensive evaluation plan to monitor on subsequent child mortality. METHODS: Children implementation effects. were identified and followed by the demographic health surveillance system of the Bandim Health Jain V, Ray M, Singhi S. Strangulation injury, a fatal form Project in Guinea-Bissau. Breastfeeding status and of child abuse. Indian J Pediatr 2001; 68(6):571-2. survival were ascertained by 3-monthly follow-up Abstract: Strangulation is a common method of home visits. At termination of breastfeeding mothers committing murder, though underreported in Indian were interviewed about her reasons for weaning. In all, literature. We managed a girl child, victim of child 1423 children who terminated breastfeeding after 12 abuse who later succumbed to its neurological months of age were followed to 3 years of age. complications. This case report describes the clinical RESULTS: Median length of breastfeeding was 22 features associated with such injuries and months. Following termination of breastfeeding, 66 complications which should be anticipated in such children died before 36 months of age. In all, 62% cases. (879/1423) were weaned because they were 'healthy'. Compared with the 'healthy' children, all other causes Jaing JT, Sepulveda JA, Casillas AM. Novel computer- of weaning were associated with a higher mortality based assessment of asthma strategies in inner-city (mortality ratio [MR] = 2.97, 95% CI: 1.54-5.73). For children. Ann Allergy Asthma Immunol 2001; 237 children weaned due to a new pregnancy the MR 87(3):230-7. was 3.25 (95% CI: 1.45-7.30). Seventy-five children weaned because of illness had a 2.98 (95% CI: 0.95- 592
- 601. 9.39) fold excessmortality compared with children associated with many negative social and considered healthy. Excess deaths in the 'non-healthy' psychological ramifications such as peer aggression. group accounted for 44% (29/66) of post-weaning However, the relationship between overweight and deaths. Median length of spacing between an index obesity status with different forms of bullying child and a new sibling was 28 months irrespective of behaviors remains unclear. The purpose of this article whether the index child survived or died before 3 years is to examine these relationships. METHODS: We of age. The majority of the deaths occurred before birth examined associations between bullying behaviors of the new sibling. CONCLUSION: Popular (physical, verbal, relational, and sexual harassment) rationalizations of abstinence during breastfeeding with overweight and obesity status in a representative emphasizes, as we observed, that weaning due to new sample of 5749 boys and girls (11-16 years old). The pregnancy of the mother is associated with higher results were based on the Canadian records from the mortality. This was not due to a shorter breastfeeding 2001/2002 World Health Organization Health period of the child weaned due to a new pregnancy. Behaviour in School-Aged Children Survey. Body Generally children weaned for other reasons than mass index (BMI) and bullying behaviors were 'being healthy' had higher mortality. The mother's determined from self-reports. RESULTS: With the reason for weaning could potentially be used as exception of 15- to 16-year-old boys, relationships screening criteria in child monitoring programmes in were observed between BMI category and peer areas with high mortality. victimization, such that overweight and obese youth were at greater relative odds of being victims of Jamner LD, Whalen CK, Loughlin SE et al. Tobacco use aggression than normal-weight youth. Strong and across the formative years: a road map to significant associations were seen for relational (eg, developmental vulnerabilities. Nicotine Tob Res 2003; withdrawing friendship or spreading rumors or lies) 5 Suppl 1:S71-87. and overt (eg, name-calling or teasing or hitting, Abstract: Different vulnerabilities are launched or play kicking, or pushing) victimization but not for sexual a more active role at different developmental stages harassment. Independent of gender, there were no and different ages. Furthermore, the interplay between associations between BMI category and bully- developmental and biological, psychosocial, and perpetrating in 11- to 14-year-olds. However, there environmental vulnerabilities is expected to differ were relationships between BMI category and bully- across stages of smoking. This article focuses on the perpetrating in 15- to 16-year-old boys and girls such intersection of vulnerability associated with that the overweight and obese 15- to 16-year-olds were adolescence with tobacco-use vulnerability resulting more likely to perpetrate bullying than their normal- from biological, psychological, and environmental weight classmates. Associations were seen for characteristics of an adolescent. Recommendations relational (boys only) and overt (both genders) forms include the following: (a) Effectively treat childhood of bully-perpetrating but not for sexual harassment. and adolescent behavioral and emotional disorders that CONCLUSIONS: Overweight and obese school-aged place adolescents at risk; (b) target programs toward children are more likely to be the victims and specific high-risk subgroups; (c) incorporate training in perpetrators of bullying behaviors than their normal- self-control, affect regulation, and healthy coping weight peers. These tendencies may hinder the short- strategies into educational programs and extracurricular and long-term social and psychological development of activities; (d) encourage youth to develop healthy overweight and obese youth. sources of success and satisfaction; (e) encourage communities and states to launch environmental, Janssens HM, van der Wiel EC, Verbraak AF, de Jongste policy, and regulatory initiatives to protect youth from JC, Merkus PJ, Tiddens HA. Aerosol therapy and the tobacco; (f) consider bold initiatives that will require fighting toddler: is administration during sleep an fundamental changes in public attitudes, including alternative? J Aerosol Med 2003; 16(4):395-400. monetary rewards for nonsmoking, heightened Abstract: Insufficient cooperation during penalties for facilitating and engaging in underage administration of aerosols by pressurized metered dose smoking, and government subsidies for substitute inhaler (pMDI)/spacers is a problem in nearly 50% of pharmacological agents. treated children younger than 2 years. For these children, administration during sleep might be more Janson S. Home visitation: from sanitary control to support efficient. However, it is unknown how much aerosol of the young family. Acta Paediatr 2002; 91(5):505-6. reaches the lungs during sleep. The aim of this study was to determine in vitro the lung dose in young Janssen I, Craig WM, Boyce WF, Pickett W. Associations children from a pMDI/spacer during sleep and while between overweight and obesity with bullying being awake. Breathing patterns were recorded by a behaviors in school-aged children. Pediatrics 2004; pneumotachograph in 18 children (age 11 +/- 5.1 113(5):1187-94. months) during sleep and wakefulness. Next, breathing Abstract: OBJECTIVE: The prevalence of overweight patterns were replayed by a computer-controlled and obesity in children is rising. Childhood obesity is breathing simulator to which an anatomically correct nose-throat model of a 9-month-old child was attached. 593
- 602. One puff ofbudesonide (200 microg) was administered X-ray, by computer from a 3-D digitized model of the to the model via a metal spacer. Aerosol was trapped in vertebral body line, and by neural-network estimation a filter placed between model and breathing simulator. from indices of torso surface asymmetry. The estimates The amount of budesonide on the filter (5 lung dose) of the Cobb angle by computer and by neural network was analyzed by HPLC. For each of the 36 breathing were equally accurate in 153 records from 52 patients patterns, lung dose was measured in triplicate. The (standard deviation of 6 degrees from the Cobb angle, sleep breathing patterns had significantly lower r=0.93), showing that torso asymmetry reliably respiratory rate and peak inspiratory flows, and smaller predicted spinal deformity. Further improvements in variability in respiratory rate, tidal volume, and peak predictive accuracy may require estimation of other 3- inspiratory flows. Lung dose (mean +/- SD) was 6.5 +/- D indices of spinal deformity besides the Cobb angle 3.2 and 11.3 +/- 3.9 microg (p = 0.004) for the wake with its wide measurement variability. and sleep breathing pattern, respectively. This infant model-study shows that the lung dose of budesonide by Jaremko JL, Poncet P, Ronsky J et al. Estimation of spinal pMDI/spacer is significantly higher during sleep deformity in scoliosis from torso surface cross sections. compared to inhalation during wake breathing. Spine 2001; 26(14):1583-91. Administration of aerosols during sleep might, Abstract: STUDY DESIGN: Correlation of torso scan therefore, be an efficient alternative for uncooperative and three-dimensional radiographic data in 65 scans of toddlers. 40 subjects. OBJECTIVES: To assess whether full- torso surface laser scan images can be effectively used Jansson A, Sivberg B, Larsson BW, Uden G. First-time to estimate spinal deformity with the aid of an artificial mothers' satisfaction with early encounters with the neural network. SUMMARY OF BACKGROUND nurse in child healthcare: home visit or visit to the DATA: Quantification of torso surface asymmetry may clinic? Acta Paediatr 2002; 91(5):571-7. aid diagnosis and monitoring of scoliosis and thereby Abstract: The aim of this study was to describe first- minimize the use of radiographs. Artificial neural time mothers' views of satisfaction with their first networks are computing tools designed to relate input encounter with the nurse, in order to investigate and output data when the form of the relation is differences between home visits and clinic visits and unknown. METHODS: A three-dimensional torso scan between high/middle and low socioeconomic taken concurrently with a pair of radiographs was used classification (SEC). A nation-wide postal to generate an integrated three-dimensional model of questionnaire sent to 800 first-time mothers yielded the the spine and torso surface. Sixty-five scan-radiograph data for statistical analysis. Data were collected using a pairs were generated during 18 months in 40 patients modified version of the questionnaire "Quality of Care (Cobb angles 0-58 degrees ): 34 patients with from the Patient's Perspective", the part concerning adolescent idiopathic scoliosis and six with juvenile child healthcare. The results showed that mothers who scoliosis. Sixteen (25%) were randomly selected for had received home visits were more content with the testing and the remainder (n = 49) used to train the encounter than were mothers who had to visit the artificial neural network. Contours were cut through clinic. This particularly concerned advice on the torso model at each vertebral level, and the line breastfeeding, being able to talk to the nurse in peace joining the centroids of area of the torso contours was and quiet, and the fact that the nurse took time and was generated. Lateral deviations and angles of curvature of personal. In contrast, the mothers who had received a this line, and the relative rotations of the principal axes home visit were less content with the competence of of each contour were computed. Artificial neural the nurse when she examined the child. Mothers of low network estimations of maximal computer Cobb angle SEC were less satisfied with the first encounter than were made. RESULTS: Torso-spine correlations were were mothers of high/middle SEC with regard to generally weak (r < 0.5), although the range of torso several points. Conclusion: Home visits were shown to rotation related moderately well to the maximal Cobb have advantages over visits to the clinic. Mothers of angle (r = 0.64). Deformity of the torso centroid line low SEC were less satisfied with the first encounter was minimal despite significant spinal deformity in the with the nurse than were mothers in the high/middle patients studied. Despite these limitations and the small SEC. data set, the artificial neural network estimated the maximal Cobb angle within 6 degrees in 63% of the Jaremko JL, Poncet P, Ronsky J et al. Comparison of Cobb test data set and was able to distinguish a Cobb angle angles measured manually, calculated from 3-D spinal greater than 30 degrees with a sensitivity of 1.0 and reconstruction, and estimated from torso asymmetry. specificity of 0.75. CONCLUSIONS: Neural-network Comput Methods Biomech Biomed Engin 2002; analysis of full-torso scan imaging shows promise to 5(4):277-81. accurately estimate scoliotic spinal deformity in a Abstract: While scoliotic spinal deformity is variety of patients. traditionally measured by the Cobb angle, we seek to estimate scoliosis severity from the torso surface Jaremko JL, Poncet P, Ronsky J et al. Genetic algorithm- without X-ray radiation. Here, we measured the Cobb neural network estimation of cobb angle from torso angle in three ways: by protractor from postero-anterior asymmetry in scoliosis. J Biomech Eng 2002; 594
- 603. 124(5):496-503. Jayasena A, Niriella DA. Rupture of the tympanic Abstract: Scoliosis severity, measured by the Cobb membrane following assault: a retrospective study of angle, was estimated by artificial neural network from victims of violence who presented to the private sector. indices of torso surface asymmetry using a genetic Ceylon Med J 2001; 46(4):161-2. algorithm to select the optimal set of input torso indices. Estimates of the Cobb angle were accurate Jeal N, Salisbury C. A health needs assessment of street- within 5 degrees in two-thirds, and within 10 degrees based prostitutes: cross-sectional survey. J Public in six-sevenths, of a test set of 115 scans of 48 scoliosis Health (Oxf) 2004; 26(2):147-51. patients, showing promise for future longitudinal Abstract: BACKGROUND: Research with prostitutes studies to detect scoliosis progression without use of has tended to concentrate on sexual health rather than X-rays. wider health issues, and has failed to differentiate between street-based prostitutes and off-street workers. Jaspan T, Griffiths PD, McConachie NS, Punt JA. Little is known about the general health and Neuroimaging for non-accidental head injury in background of street-based sex workers, the group childhood: a proposed protocol. Clin Radiol 2003; likely to have the greatest needs. METHODS: An 58(1):44-53. interview-based survey amongst street-based sex Abstract: Non-accidental head injury (NAHI) is a workers in central Bristol was employed. RESULTS: major cause of neurological disability and death during Seventy-one women were interviewed. All reported infancy. Radiological imaging plays a crucial role in chronic health problems. Sexually transmitted evaluating craniospinal injury, both for guiding infections were between nine and 60 times more medical management and the forensic aspects of common than the general population. Many women (44 abusive trauma. The damage sustained is varied, per cent; n = 31) had experienced sexual abuse and 38 complex and may be accompanied by an evolving per cent (n = 27) had been in care. Women who had pattern of brain injury secondary to a cascade of experienced care left school earlier (14.1 versus 15.5 metabolic and physiological derangements. years; p < 0.0001 unpaired t-test) and were less likely Regrettably, many cases are poorly or incompletely to have their own children at home [1/18 (5.5 per cent) evaluated leading to diagnostic errors and difficulties in versus 8/25 (32 per cent); p = 0.06) The stillbirth rate executing subsequent child care or criminal was 50/1000. Most (97 per cent; n = 69) had been proceedings. It is evident, from cases referred to the offered more money for unprotected sex. Half (51 per authors, that imaging protocols for NAHI are lacking cent; n = 36) had unprotected sex in the last week. All (or only loosely adhered to, if present) in many centres had drug or alcohol dependency problems. In the last throughout the U.K. Future research in this field will week, 22 per cent (n = 9/41) of injecting drug users had also be hampered if there is a lack of consistent and shared needles and 59 per cent (n = 24/41) had shared reliable radiological data. There is no nationally agreed injecting equipment, despite most (96 per cent; n = protocol for imaging NAHI. We propose such a 39/41) knowing the risks. CONCLUSIONS: The health protocol, based upon a wide experience in the medical and social inequalities experienced by this group are management of child abuse and extensive involvement much worse than any group highlighted in the in the medicolegal aspects of NAHI. 'Tackling Health Inequalities Review 2002' and appear cross generational. In neither that report nor the Sexual Jasper J, Clark WD, Cabrera-Meza G, Berseth CL, Health and HIV Strategy report are sex workers Fernandes CJ. Whose child is it anyway? Resolving identified as a particularly high priority group. There is parent-physician conflict in the NICU setting. Am J the potential for their needs to continue to be unmet. Perinatol 2003; 20(7):373-80. Notes: GENERAL NOTE: KIE: 23 refs. Jenkins C, Rahman H. Rapidly changing conditions in the GENERAL NOTE: KIE: KIE Bib: treatment brothels of Bangladesh: impact on HIV/STD. AIDS refusal/minors Educ Prev 2002; 14(3 Suppl A):97-106. Abstract: Much has been written on parental Abstract: Bangladesh is a low HIV prevalence country involvement in decision making when dealing with with several well-documented at-risk groups, the most critically ill children, but few articles have touched prominent of which is brothel-based sex workers. upon parental refusal of treatment in noncritically ill Using two waves of HIV behavioral surveillance data children. What steps should be taken when a parent for a national sample of all operating registered refuses what is generally considered "standard of care" brothels supplemented by historical and observational medicine for their hospitalized child? Does medical accounts, this article presents a case study of the advice outweigh parental views or wishes, and what changing conditions in the brothels. Between the two does one do when our role as physician turns from waves of surveillance, several brothels were forcibly medical expert into one of medical negotiator? The closed; the number of sex workers dropped; the following case and discussion deal with parental average number of clients per woman rose; and overall refusal of conventional medical care, and how one may safety, both in terms of violence and protected sex, did find peaceful resolutions to challenging situations for not improve. Only treatment-seeking behavior for the ultimate good of the child. sexually transmitted diseases was positively changed. 595
- 604. Continued surveillance ofthe possible negative impact Jhanjee I, Saxeena D, Arora J, Gjerdingen DK. Parents' of HIV prevention programs is under way. Protective health and demographic characteristics predict policies are needed to facilitate improved HIV noncompliance with well-child visits. J Am Board Fam prevention and safety of sex workers, a key to Pract 2004; 17(5):324-31. controlling the HIV epidemic. Abstract: BACKGROUND: The purpose of this study was to investigate factors related to well-child visit Jenkins T, Moellendorf D, Schuklenk U. The distribution of noncompliance in an ethnically diverse family practice medical resources, withholding medical treatment, drug clinic population. METHODS: Participants included trials, advance directives, euthanasia and other ethical 146 parents (131 mothers and 15 fathers) of children issues: the Thandi case (II). Developing World Bioeth aged 0 to 24 months who received care at a St. Paul 2001; 1(2):163-74. residency clinic. Participants completed telephone Notes: GENERAL NOTE: KIE: Jenkins, Trefor; surveys that asked about their demographic Moellendorf, Darrel; Schuklenk, Udo characteristics, attitudes toward well-child visits, GENERAL NOTE: KIE: 13 refs. whether the most recent planned well-child visit had GENERAL NOTE: KIE: KIE Bib: bioethics; patient been kept, and their own and their child's health care/minors characteristics. RESULTS: All participants thought that well-child visits were important, with Jensen PS, Eaton Hoagwood K, Roper M et al. The services immunizations being the highest rated reason for for children and adolescents-parent interview: importance. Fourteen percent of parents said they had development and performance characteristics. J Am missed a recent well-child visit, mostly because they Acad Child Adolesc Psychiatry 2004; 43(11):1334-44. forgot. More than three fourths of parents believed visit Abstract: OBJECTIVE: To date, no instrument has reminders were helpful, and the preferred type of been developed that captures children's services use reminder was a telephone call. Noncompliance with across primary care, specialty mental health, and other well-child visits was associated with the parent's settings, including setting, treatment type, provider depressive symptoms, transportation difficulties, discipline, and length and intensity of specific working at a job, having private (vs public) health interventions over varying follow-up periods. The insurance, and being older (vs younger). authors developed a highly structured services CONCLUSIONS: These results suggest that well-child assessment measure [Services for Children and visit compliance might be enhanced by visit reminders Adolescents-Parent Interview (SCAPI)] for use in the and improved access to transportation. The relationship National Institute of Mental Health Multimodal of well-child visit noncompliance to parental Treatment Study of Children With Attention Deficit depressive symptoms, if verified in other populations, Hyperactivity Disorder (MTA). METHOD: After points to a need for greater surveillance of successfully piloting and refining the SCAPI during children/families who do not schedule or keep well- initial phases of the MTA, the authors used this child visits. measure at 24 months post-randomization to ascertain the previous 6 months of services use for all Jing H, Takigawa M, Benasich AA. Relationship of participating (516 of 579) MTA children and families nonlinear analysis, MRI and SPECT in the and 285 age- and gender-matched classroom control lateralization of temporal lobe epilepsy. Eur Neurol children. RESULTS: Findings revealed meaningful, 2002; 48(1):11-9. face-valid differences between MTA and control Abstract: OBJECTIVES: The purpose of this study was children in levels and types of services used during the to investigate the correlation of lateralization by previous 6-month period. Services use data reported by nonlinear analysis, magnetic resonance imaging (MRI) parents was substantially in accord with data and interictal single-photon emission computed independently gathered by the research data center. tomography (SPECT) in patients with temporal lobe Site variations were found in the level and use of epilepsy. METHODS: Twenty-three patients (7 males, several specific services, such as individual child 16 females) were examined by MRI, interictal SPECT psychotherapy (sites ranged from 0% to 6.8% among and EEG. Nonlinear dynamic properties of neuronal classroom controls compared with 9.7% to 46.1% networks were estimated by calculating correlation among MTA participants) and special education dimensions on interictal EEG signals and services (0% to 14.6% among classroom controls, corresponding surrogate data. Lateralization was 27.5% to 34.8% among MTA participants), consistent detected based on the criteria introduced in this study. with differences reported in other studies. Concordance rates of the results among the three CONCLUSIONS: These data support the descriptive methods were compared. RESULTS: Epileptogenic validity of SCAPI-ascertained services use data and foci were shown in the temporal areas in 21 patients indicate that the SCAPI can provide investigators and using the nonlinear method (8 left, 2 right, 11 both), policymakers a valid means of assessing services type, while 20 patients showed abnormalities in temporal intensity, onset and offset, provider type, and content. lobes on MR images (13 left, 5 right, 2 both). Low cerebral blood flows of the temporal lobes were detected in all patients (11 left, 8 right, 4 both). 596
- 605. Completely concordant lateralizationwas observed in 8 postnatal care at the hospital. The home-visiting patients (35%) for the nonlinear method and MRI, in 9 midwives use a checklist to give and gain information patients (39%) for the nonlinear method and SPECT, about the health of the child and mother and about how and in 10 patients (43%) for MRI and SPECT. There breast-feeding is going. The purpose of this study was were no significant differences among the concordance to examine the parents' need of information after early rates for these different methods. CONCLUSIONS: discharge after delivery and to compare their needs Our results revealed that correlation dimension is with the information given according to the checklist useful for differentiating dynamic properties of for home-visits. Forty-two couples completed the neuronal networks in the interictal state, and can study. They were asked to formulate five questions to provide informative data for localizing epileptogenic the midwife at the home-visit. After the questions were foci in epileptic patients. Therefore, the present gathered, a content-analysis was done. Three different nonlinear method is recommended for use with patients main groups were identified: questions concerning 1) during presurgical evaluation. the child (68%) such as hygiene, bowel movements, burping, vomiting, eating, sleeping and sneezing 2) Joanisse MF, Seidenberg MS. Phonology and syntax in breast-feeding (21%) questions were asked about specific language impairment: evidence from a position while breast-feeding, nipples and amount of connectionist model. Brain Lang 2003; 86(1):40-56. milk 3) the mother (11%) questions concerned Abstract: Difficulties in resolving pronominal anaphora afterpains, stitches, eating and drinking. The results have been taken as evidence that Specific Language show that the checklist worked sufficiently well as a Impairment (SLI) involves a grammar-specific work tool, but can be adjusted further according to the impairment. The present study explores an alternative parents' need. This study shows that they needed more view, that grammatical deficits in SLI are sequelae of information about the care of the infant, primarily impaired speech perception. This perceptual deficit concerning hygiene. specifically affects the use of phonological information in working memory, which in turn leads to poorer than Johnson A. Birth defects registries: a resource for research. expected syntactic comprehension. This hypothesis NCSL Legisbrief 2003; 11(46):1-2. was explored using a connectionist model of sentence processing that learned to map sequences of words to Johnson A. The genetic key to public health. State Legis their meanings. Anaphoric resolution was represented 2003; 29(2):28-30. in this model by recognizing the semantics of the Abstract: Strides in genetics research are making a correct antecedent when a bound pronoun was input. difference in public health. When the model was trained on distorted phonological inputs-simulating a perceptual deficit-it exhibited Johnson A. Protecting the privacy of newborns. NCSL marked difficulty resolving bound anaphors. However, Legisbrief 2003; 11(11):1-2. many other aspects of sentence comprehension were intact; most importantly, the model could still resolve Johnson AK. Social work is standing on the legacy of Jane pronouns using gender information. In addition, the Addams: but are we sitting on the sidelines? Soc Work model's deficit was graded rather than categorical, as it 2004; 49(2):319-22. was able to resolve pronouns in some sentences, but not in others. These results are consistent with Johnson AL, Morrow CE, Accornero VH, Xue L, Anthony behavioral data concerning syntactic deficits in SLI. JC, Bandstra ES. Maternal cocaine use: estimated The model provides a causal demonstration of how a effects on mother-child play interactions in the perceptual deficit could give rise to grammatical preschool period. J Dev Behav Pediatr 2002; deficits in SLI. 23(4):191-202. Abstract: The study objective was to evaluate the Johansson A, Hermansson G, Ludvigsson J. When does quality of parent-child interactions in preschool-aged exposure of children to tobacco smoke become child children exposed prenatally to cocaine. African- abuse? Lancet 2003; 361(9371):1828. American mothers and their full-term newborns (n = 343) were enrolled prospectively at birth and classified Johansson K, Darj E. What type of information do parents as either prenatally cocaine-exposed (n = 157) or non- need after being discharged directly from the delivery cocaine-exposed (n = 186) on the basis of maternal ward? Ups J Med Sci 2004; 109(3):229-38. self-report and bioassays. Follow-up evaluations at 3 Abstract: Early discharge normally means that mother years of age (mean age, 40 mo) included a videotaped and infant are discharged from the hospital between six dyadic play session and maternal interviews to assess hours and three days after delivery. Early discharge ongoing drug use and maternal psychological distress. with home-visits after normal delivery was introduced Play interactions were coded using a modified version at Uppsala University Hospital in 1990. Seventeen of Egeland et al's Teaching Task coding scheme. percent of the women who gave birth in 2003 in Regression analyses indicated cocaine-associated Uppsala used the home-care option as an alternative to deficits in mother-child interaction, even with 597
- 606. statistical adjustment formultiple suspected influences advocacy roles for pediatric nurses. J Spec Pediatr Nurs on interaction dynamics. Mother-child interactions 2002; 7(4):171-4. were most impaired in cocaine-exposed dyads when the mother continued to report cocaine use at the 3-year Johnson RJ, Greenhoot AF, Glisky E, McCloskey LA. The follow-up. Multivariate profile analysis of the Egeland relations among abuse, depression, and adolescents' interaction subscales indicated greater maternal autobiographical memory. J Clin Child Adolesc intrusiveness and hostility, poorer quality of Psychol 2005; 34(2):235-47. instruction, lower maternal confidence, and diminished Abstract: This study examined the relations among child persistence in the cocaine-exposed dyads. early and recent experiences with abuse, depression, and adolescents' autobiographical memory in a Johnson DM, Pike JL, Chard KM. Factors predicting PTSD, longitudinal study of family violence. Participants' (N depression, and dissociative severity in female = 134) exposure to violence was documented when treatment-seeking childhood sexual abuse survivors. they were 6 to 12 years old and again when they were Child Abuse Negl 2001; 25(1):179-98. 12 to 18 years old. The second assessment included Abstract: OBJECTIVE: Two main questions were measures of depression and autobiographical memory asked: (1) what abuse characteristics relate to PTSD, for childhood experiences. Memory problems were depressive, and dissociative severity in adult survivors more consistently related to current circumstances than of child sexual abuse (CSA); and (2) what abuse childhood abuse history. For instance, depressive characteristics influence the severity of dissociation symptoms were associated with increased rates of during CSA. METHOD: 89 female CSA survivors' "overgeneral" childhood memories. Recent exposure to current symptoms of PTSD, depression, and family violence predicted more overgeneral memories, dissociation were assessed with standardized measures. shorter memories, and lower rates of negative Additionally, abuse characteristics (e.g., age of onset, memories. The patterns suggest that adolescents peritraumatic dissociation) were assessed with a currently stressed by depression or family violence structured interview. RESULTS: Correlational analyses might strategically avoid the details of past experiences indicated that peritraumatic dissociation was most to regulate affect. strongly related to all three types of symptom severity. Additional posthoc correlational analyses revealed that Johnson SA, Fisher K. School violence: an insider view. women who experienced penile penetration, believed MCN Am J Matern Child Nurs 2003; 28(2):86-92. someone/thing else would be killed, and/or were Abstract: PURPOSE: To discover what teachers injured as a result of the abuse exhibited more severe perceive to be contributing factors to violence in peritraumatic dissociation. Regression analyses schools. STUDY DESIGN AND METHODS: Open- indicated that peritraumatic dissociation was the only ended questions were asked of a convenience sample variable to significantly predict symptom severity of teachers ( = 396) during an in-service education across symptom type or disorder. Furthermore, program on school violence. The teachers were in a different abuse characteristics predicted adult symptom semi-rural school district in a Mid-Atlantic state. severity and peritraumatic dissociation. Answers were analyzed using content analysis; all CONCLUSIONS: The relation between peritraumatic responses were reviewed and important themes were dissociation and adult symptomatology was most extracted. Identified themes were then placed into intriguing and has two main clinical implications: (1) suitable categories and studied to determine teaching engagement strategies to some CSA survivors relationships. RESULTS: Of the surveys analyzed ( = in hopes of containing dissociative symptoms 239), 13 themes were identified. The three categories immediately following the abuse and (2) the inclusion which then identified probable causes of school of exposure-based interventions in the treatment of violence were (1) lack of knowledge, (2) lack of some adult CSA survivors where indicated. support, and (3) inadequate safety measures. CLINICAL IMPLICATIONS: Nurses can use the Johnson MH, Mareschal D. Cognitive and perceptual results of this study in multiple ways. One is to help development during infancy. Curr Opin Neurobiol parents understand their role in preventing school 2001; 11(2):213-8. violence. Because violence in the home and violence in Abstract: Over the past seven years, the main advances the media seem to foster violent acting-out behavior, in our understanding of infant development have nurses can teach parents about these correlations and involved the application of cognitive neuroscience seek solutions such as the elimination of family methods such as neuroimaging and computer violence, and monitoring television viewing and video modelling. Results obtained using these methods have games. Nursing assessments of school-aged children illuminated further the complex interactions between and their families can include these elements. School nature and nurture that underlie early postnatal nurses in particular can use these study results as an development. opportunity to develop interventions for students, teachers, and families that stress knowledge building Johnson MO, O'Sullivan AL. Children and the courts: about impulse control, anger management, appropriate parenting, and early intervention for at-risk children. 598
- 607. Johnson SE. Physicallyrestraining children at home or well as change in parental monitoring over time. school. Psychiatr Serv 2002; 53(2):125. Monitoring increased over the 15-month interval more in urban areas than rural areas and among mothers with Johnston I. Conjoined twins. Lancet 2001; 357(9250):149. lower levels of depressive symptoms. Clinical Notes: GENERAL NOTE: KIE: Johnston, Ian implications and directions for future research are GENERAL NOTE: KIE: 2 refs. discussed. GENERAL NOTE: KIE: KIE Bib: parental consent Jones DP. Editorial: Dissociation in pre-school children. Johnston MV. Excitotoxicity in neonatal hypoxia. Ment Child Abuse Negl 2001; 25(9):1249-51. Retard Dev Disabil Res Rev 2001; 7(4):229-34. Abstract: Hypoxic-ischemic encephalopathy (HIE) in Jones DP. Interviewing children about individual incidents neonates is a disorder of excessive neuronal excitation of sexual abuse. Child Abuse Negl 2001; 25(12):1641- that includes seizures, abnormal EEG activity, and 2. delayed failure of oxidative metabolism with elevated levels of lactic acid in the brain. Evidence from Jones JK, Kommu S. A survey of cutlass ("Collins") injuries experimental models and clinical investigation seen in the emergency department of the Queen indicates that HIE is triggered by a profound disruption Elizabeth Hospital in Barbados. West Indian Med J in the function of glutamate synapses so that re-uptake 2002; 51(3):157-9. of glutamate from the synapse is impaired and post- Abstract: For the period March to November 1998 synaptic membranes containing glutamate receptors are inclusive, a prospective survey was conducted of all depolarized. Severe hypoxemia preferentially patients who sustained injuries with a cutlass or depolarizes neuronal membranes, while ischemia machete and were admitted to the Accident and probably has greater impact on the activity of glial Emergency Department of the Queen Elizabeth glutamate re-uptake. Together, severe hypoxia and Hospital. Of the 77 patient admissions, 81% (62/77) ischemia trigger a delayed cascade of events that may were male. The average age was 28.8 years (range 8 to result in cell death by necrosis and/or apoptosis. 73 years; standard deviation 13.1). Twenty-two per Apoptosis is far more prominent in the neonate than in cent of the patients were less than 20 years old. The the adult and activation of cysteine proteases such as most common locations of the lacerations were upper caspase-3 is a very important pathway in excitotoxic extremity (59 lacerations) and scalp (16 lacerations). neonatal injury. Understanding the complex molecular Thirty-four per cent of the patients (26/77) sustained networks triggered by an excitotoxic insult in the lacerations to two or more anatomical locations. There neonate provides insight into patterns of selective were 23 fractures in 21 patients; skull fractures were neuronal vulnerability and potential therapeutic the most common fractures (11). Of the 63 patients strategies. who responded to the question on whether they knew the identity of their assailants, 51 reported that they Jones B, Litzelfelner P, Ford J. The value and role of Citizen were attacked by someone known to them; eight were Review Panels in child welfare: perceptions of citizens assaulted by a spouse or known family member. review panel members and child protection workers. Eighty-six per cent of patients (66/77) were treated in Child Abuse Negl 2003; 27(6):699-704. the emergency room and discharged. Of the 11 patients admitted, eight required treatment in the operating Jones DJ, Forehand R, Brody G, Armistead L. Parental theatre. The average length of stay was 3.6 days. There monitoring in African American, single mother-headed were no amputations or deaths. One patient sustained families. An Ecological approach to the identification loss of vision in one eye. In Barbados, most victims of of predictors. Behav Modif 2003; 27(4):435-57. cutlass injuries are males who know their assailants Abstract: Parental monitoring is considered an essential and the morbidity is most often related to head injuries parenting skill. Despite its relevance to a range of child and to short-term physical disability due especially to and adolescent outcomes, including the prevention of lacerations of the hand and forearm. conduct problems and substance use, there has been little empirical attention devoted to examining the Jones LM, Finkelhor D. Putting together evidence on antecedents of parental monitoring. Building on declining trends in sexual abuse: a complex puzzle. Brofenbrenner's ecological model, this study examined Child Abuse Negl 2003; 27(2):133-5. the association between the ecological context in which families reside and parental monitoring across two Jones RA. Randomized, controlled trial of dexamethasone in waves of data separated by 15 months. Findings were neonatal chronic lung disease: 13- to 17-year follow-up consistent across increasingly conservative sets of study: I. Neurologic, psychological, and educational hierarchical multiple regression analyses. Whether the outcomes. Pediatrics 2005; 116(2):370-8. neighborhood was rural or urban and the level of Notes: CORPORATE NAME: Collaborative maternal depressive symptoms predicted parental- Dexamethasone Trial Follow-up Group monitoring behavior concurrently and longitudinally as Abstract: OBJECTIVES: To study neurologic, 599
- 608. educational, and psychologicalstatus in adolescence of practitioners, and autopsy records were obtained. The neonates enrolled in a double-blind, randomized, information was assessed with particular reference to: controlled trial of dexamethasone therapy for chronic features and duration of asthma before death; severity lung disease. PARTICIPANTS: A total of 287 infants of asthma; time and place of death; long-term and who were chronically dependent on supplementary ongoing medical treatment; quality of medical care; oxygen and were 2 to 12 weeks of age were recruited circumstances of final illness; and medical treatment from 31 centers in 6 countries to a randomized, during the final episode of asthma. Age groups of 1-4 controlled trial of dexamethasone base (0.5 mg/kg per years, 5-14 years, and 15-19 years were analyzed day for 1 week); 95% of survivors were reviewed at 3 separately and in aggregate. Death occurred years. Survivors from the 25 British and Irish centers predominantly in the 15-19-year age group. Generally, were retraced at 13 to 17 years of age. OUTCOME significantly more patients died in the summer. These MEASURES: Nonverbal reasoning, British Picture patients were more atopic, had fewer asthma Vocabulary Scale, Goodman Strengths and Difficulties symptoms, and did not have regular asthma Questionnaire behavior scores, school national test consultations. Nearly all patients had early-onset results, teacher ability ratings, and parental and general asthma. The 1-4-year age group was characterized by practitioner questionnaires. RESULTS: A total of 195 severe asthma. Major risk factors (all age groups) were: children were eligible for the follow-up study. gradual deterioration during the last month; length of Information was available for 150 children (77%), with final attack (>3 hr); and delay in seeking medical help 142 (73%) being assessed in home visits. No baseline during the final attack. None of the children died differences were detected between the children during their first attack. Nonadherence was most included in the follow-up study and those not included. frequent among the 15-19-year-olds. All asthmatic There was a slight excess of cerebral palsy in the children and young adults should regularly receive steroid group, which was not statistically significant medical care and assessment, even if they suffer only a (relative risk: 1.58; 95% confidence interval: 0.81- few symptoms. This study underlines the need for 3.07). Overall disability rates in both groups were high ongoing education of the patient's family, the patient, (21% moderate and 14% severe), but with no and doctors on long-term management and difference between the 2 groups (for severe disability, management of acute attacks. Copies of clearly written relative risk: 0.84; 95% confidence interval: 0.37-1.86). individual plans for periods with increasing symptoms CONCLUSIONS: Information was obtained for 150 should be supplied to the patient/family and, where adolescents randomized to receive dexamethasone or appropriate, to their general practitioners. The object of placebo for neonatal chronic lung disease. Rates of these measures is that the patient and parents/family disabilities and educational difficulties were high, but learn to recognize the signs of deterioration and to act with no significant differences between the 2 groups. on them. Some use of open-label steroids in the placebo group plus losses to long-term follow-up monitoring reduced Jose N. Child poverty: is it child abuse? Paediatr Nurs 2005; the power of this study to detect clinically important 17(8):20-3. differences, and this study cannot rule out a real increase in cerebral palsy, as reported by others. Joseph J, Noble K, Eden G. The neurobiological basis of reading. J Learn Disabil 2001; 34(6):566-79. Jones S. Human cloning--ever closer. RCM Midwives 2005; Abstract: The results from studies using positron 8(9):374-5. emission tomography (PET) and functional magnetic resonance imaging (fMRI) in adults have largely Jonsson U. From needs-based to rights-based approaches to revealed the involvement of left-hemisphere child nutrition: lessons learnt from the 1990s. Forum perisylvian areas in the reading process, including Nutr 2003; 56:118-20. extrastriate visual cortex, inferior parietal regions, superior temporal gyrus, and inferior frontal cortex. Jorgensen IM, Jensen VB, Bulow S, Dahm TL, Prahl P, Juel Although the recruitment of these regions varies with K. Asthma mortality in the Danish child population: the particular reading-related task, general networks of risk factors and causes of asthma death. Pediatr regions seem to be uniquely associated with different Pulmonol 2003; 36(2):142-7. components of the reading process. For example, visual Abstract: Child death due to asthma is a rare and word form processing is associated with occipital and potentially preventable event. We investigated possible occipitotemporal sites, whereas reading-relevant risk factors for death due to asthma in children and phonological processing has been associated with adolescents, as a step towards preventing or superior temporal, occipitotemporal and inferior frontal minimizing asthma death in this age group, and sites of the left hemisphere. Such findings are improving asthma management and care. We reviewed evaluated in light of the technical and experimental all 108 cases of asthma death in 1-19-year-olds in limitations encountered in functional brain imaging Denmark, 1973-1994. Copies of death certificates, studies, and the implications for pediatric studies are hospital records, information from general discussed. 600
- 609. Joseph MM. Thehuman side of medicine: don't be scared to and terrorism often results in a multitiered cascade of be personal. Ann Emerg Med 2002; 40(3):363-4. negative life events including loss of loved ones, displacement, lack of educational structure, and drastic Joshi P, Mofidi S, Sicherer SH. Interpretation of commercial changes in daily routine and community values. These food ingredient labels by parents of food-allergic numerous losses, challenges, and stresses affect children. J Allergy Clin Immunol 2002; 109(6):1019- children's brains, minds, and bodies in an orchestrated 21. whole-organism response. This paper describes these Abstract: BACKGROUND: To avoid allergic effects, synthesizing the current state of research on reactions, food-allergic consumers depend on the childhood traumatic stress reactions from the fields of ingredient labels of commercial products. Complex neuroscience, clinical psychology, and pediatric ingredient terminology (eg, casein and whey for milk) diagnostic epidemiology. and label ambiguities (eg, natural flavor and may contain peanut ) might compromise the ability of Josten LE, Savik K, Anderson MR et al. Dropping out of patients/parents to determine the safety of particular maternal and child home visits. Public Health Nurs products. OBJECTIVE: The purpose of this 2002; 19(1):3-10. investigation was to determine the accuracy of label Abstract: The purpose of this study was to examine the reading among parents of food-allergic children. relationship between nurse and client characteristics METHODS: Parents of children on restricted diets and the reason for client termination from public health attending our referral center were asked to review a nursing maternal and child home visits. The results group of 23 food labels taken from widely available indicate that clients who dropped out of services commercial products. For each label, each received more contacts from the nurses, missed more parent/parent pair was asked to indicate whether the appointments with the nurses, and were given advice product was safe for the allergic child and, if it was not, from the nurses on more topics. They also differed which foods restricted from the child's diet were in the from clients who continued with services until the product. RESULTS: There were 91 participants. nursing care plan goals were met in reference to marital Peanut was the most commonly restricted food (82 status, mental illness, source of payment for services, children), followed by milk, egg, soy, and wheat (60, and use of WIC and food stamps. Nurses whose clients 45, 27 and 16 children, respectively). Identification of were more likely to continue until goals were met were milk and soy was the most problematic: only 4 (7%) of higher in conscientiousness, learned more from 60 parents correctly identified all 14 labels that experience, and learned less from coworkers or indicated milk, and only 6 (22%) of 27 parents learning on their own. They also worked more hours correctly identified soy protein in 7 products. Peanut per week. These findings have implications for practice was correctly identified in 5 products by 44 (54%) of and research. the 82 parents restricting peanut. Wheat (10 labels) and egg (7 labels) were correctly identified by most parents Joyce PR, McKenzie JM, Luty SE et al. Temperament, (14/16 and 42/45, respectively). Correct label childhood environment and psychopathology as risk identification was associated with prior instruction by a factors for avoidant and borderline personality dietitian. CONCLUSIONS: With current labeling disorders. Aust N Z J Psychiatry 2003; 37(6):756-64. practices, most parents are unable to identify common Abstract: OBJECTIVE: To evaluate childhood allergenic food ingredients. These results strongly experiences (neglect and abuse), temperament and support the need for improved labeling with plain- childhood and adolescent psychopathology as risk English terminology and allergen warnings as well as factors for avoidant and borderline personality the need for diligent education of patients about disorders in depressed outpatients. METHOD: One reading labels. hundred and eighty depressed outpatients were evaluated for personality disorders. Risk factors of Joshi PT, O'Donnell DA. Consequences of child exposure to childhood abuse, parental care, temperament, conduct war and terrorism. Clin Child Fam Psychol Rev 2003; disorder symptoms, childhood and adolescent anxiety 6(4):275-92. disorders, depressive episodes, hypomania and alcohol Abstract: Acts of war and terrorism are increasingly and drug dependence were obtained by questionnaires prevalent in contemporary society. Throughout history, and interviews. RESULTS: Avoidant personality weaponry has become more efficient, accurate, and disorder can be conceptualized as arising from a powerful, resulting in more devastation and loss of combination of high harm avoidance (shy, anxious), human life. Children are often overlooked as victims of childhood and adolescent anxiety disorders and such violence. Around the world, children are exposed parental neglect. Borderline personality disorder can be to violence in multiple forms, frequently developing formulated as arising from a combination of childhood traumatic stress reactions. Such reactions are best abuse and/or neglect, a borderline temperament (high understood within the context of social-emotional and novelty seeking and high harm avoidance), and cognitive development, as children respond differently childhood and adolescent depression, hypomania, to the stress of violence depending on their conduct disorder and alcohol and drug dependence. developmental level. Furthermore, the violence of war CONCLUSIONS: Combinations of risk factors from 601
- 610. the three domainsof temperament, childhood behavior problems and are less often referred to mental experiences and childhood and adolescent health services than domestic adoptees. psychopathology make major contributions to the development of avoidant and borderline personality Jung H, Parent AS, Ojeda SR. Hypothalamic hamartoma: a disorders. paradigm/model for studying the onset of puberty. Endocr Dev 2005; 8:81-93. Juffer F, van Ijzendoorn MH. Behavior problems and mental Abstract: This article discusses the potential health referrals of international adoptees: a meta- mechanisms by which hypothalamic hamartomas analysis. JAMA 2005; 293(20):2501-15. (HHs) are formed and cause precocious puberty. The Abstract: CONTEXT: International adoption involves hypothesis is presented suggesting that HHs accelerate more than 40,000 children a year moving among more sexual development by producing bioactive substances than 100 countries. Before adoption, international that mimic - in an accelerated time-course - the cascade adoptees often experience insufficient medical care, of events underlying the normal initiation of puberty. It malnutrition, maternal separation, and neglect and is also proposed that because HHs contain key abuse in orphanages. OBJECTIVE: To estimate the transcriptional and signaling networks required to effects of international adoption on behavioral initiate and sustain a pubertal mode of gonadotropin- problems and mental health referrals. DATA releasing hormone (GnRH) release, they are able to SOURCES: We searched MEDLINE, PsychLit, and trigger the pubertal process at an earlier age. The ERIC from 1950 to January 2005 using the terms cellular components of this activating complex may adopt* combined with (behavior) problem, disorder, include: (a) neurons able to produce GnRH within the (mal)adjustment, (behavioral) development, clinical or HH: (b) controlling neurons synaptically connected to psychiatric (referral), or mental health; conducted a GnRH neurons in the HH itself and/or to neuronal manual search of the references of articles, books, book networks (including GnRH neurons) in the patient's chapters, and reports; and consulted experts for hypothalamus, and (c) signaling-competent astrocytic relevant studies. The search was not limited to English- and ependymoglial cells. It is also possible that the language publications. STUDY SELECTION: Studies developmental abnormalities leading to the formation that provided sufficient data to compute differences of HHs result from sporadic defects affecting the same between adoptees (in all age ranges) and nonadopted genes and hence the same morphogenic pathways controls were selected, resulting in 34 articles on involved in the embryonic development of the ventral mental health referrals and 64 articles on behavior hypothalamus and the floor of the third ventricle. problems. DATA EXTRACTION: Data on international adoption, preadoption adversity, and other Junqueira V, Pessoto UC, Kayano J et al. [Equity in the moderators were extracted from each study and health sector: evaluation of public policy in Belo inserted in the program Comprehensive Meta-analysis Horizonte, Minas Gerais State, Brazil, 1993-1997]. (CMA). Effect sizes (d) for the overall differences Cad Saude Publica 2002; 18(4):1087-101. between adoptees and controls regarding internalizing, Abstract: This article evaluates government measures externalizing, total behavior problems, and use of to reduce inequity in the health sector in Belo mental health services were computed. Homogeneity Horizonte from 1993 to 1997. Our hypothesis is that a across studies was tested with the Q statistic. DATA municipal administration committed to equity can SYNTHESIS: Among 25,281 cases and 80,260 reduce disparities in health with the support of the controls, adoptees (both within and between countries) Unified National Health System (SUS). The presented more behavior problems, but effect sizes methodology used an urban quality of life index in were small (d, 0.16-0.24). Adoptees (5092 cases) were Belo Horizonte to detect social inequalities in living overrepresented in mental health services and this conditions, as well as differences between the effect size was large (d, 0.72). Among 15,790 cases component indices in the infant mortality rate. Other and 30,450 controls, international adoptees showed municipal measures were assessed according to the more behavior problems than nonadopted controls, but investment resulting from the implementation of a effect sizes were small (d, 0.07-0.11). International participatory local budget and open planning process. adoptees showed fewer total, externalizing and The urban quality of life index appeared to be an internalizing behavior problems than domestic appropriate measure for orienting municipal adoptees. Also, international adoptees were less often administration. The infant mortality rate proved to be a referred to mental health services (d, 0.37) than good indicator for measuring inequality in health. domestic adoptees (d, 0.81). International adoptees There was a reduction in IMR and mortality reducing with preadoption adversity showed more total gaps in the districts studied. We observed greater problems and externalizing problems than international investment of physical and financial resources in the adoptees without evidence of extreme deprivation. districts with the lowest urban quality of life index, and CONCLUSIONS: Most international adoptees are it can thus be stated that the municipal administration well-adjusted although they are referred to mental reduced the prevailing inequalities. health services more often than nonadopted controls. However, international adoptees present fewer 602
- 611. Juretschke LJ. Ethicaldilemmas and the nurse practitioner in interest. Secondary outcomes included the severity of the NICU. Neonatal Netw 2001; 20(1):33-8. CLD, total ventilator and nasal continuous positive Abstract: With the emergence of advanced practice airway pressure days, grades 3 and 4 intracranial roles for nurses, including the role of the neonatal hemorrhage, periventricular leukomalacia, stages 3 and nurse practitioner (NNP), nurses are increasingly being 4 retinopathy of prematurity, necrotizing enterocolitis, placed in the position of making difficult decisions, pneumothorax, length of stay, late-onset sepsis, and especially in acute or emergency situations. NNPs, pneumonia. RESULTS: The percentage of infants who therefore, must have a working knowledge of the received dexamethasone during their NICU admission ethical decision-making process in order to make decreased from 49% in era 1 to 22% in era 3. Of those appropriate decisions at the bedside. who received dexamethasone, the median number of days of exposure dropped from 23.0 in era 1 to 6.5 in Kaan B, Toth Z, Fabian TK. [The role of sexual trauma as a era 3. The median total NICU exposure to cause of orofacial symptoms. Case report]. Fogorv Sz dexamethasone in infants who received at least 1 dose 2004; 97(1):37-40. declined from 3.5 mg/kg in era 1 to 0.9 mg/kg in era 3. Abstract: Authors describe a 58-sitting psychotherapy The overall amount of dexamethasone administered per of a 46-year-old female patient with psychogenic total patient population decreased 85% from era 1 to atypical facial pain. Sexual trauma in the childhood era 3. CLD was seen in 22% of infants in era 1 and was found as a cause of the psychogenic pain 28% in era 3, a nonsignificant increase. The severity of symptoms, leading to series of unnecessary extraction CLD did not significantly change across the 3 eras, of teeth in this case. Psychotherapeutic treatment led to neither did the mortality rate. We observed a the recovery of the somatic symptoms, and a moderate significant reduction in the use of mechanical improvement of the behaviour related to men of this ventilation as well as a decline in the incidence of late- patient. onset sepsis and pneumonia, with no other significant change in morbidities or length of stay. Kaempf JW, Campbell B, Sklar RS et al. Implementing CONCLUSIONS: Postnatal dexamethasone use in potentially better practices to improve neonatal premature infants born between 501 and 1250 g can be outcomes after reducing postnatal dexamethasone use sharply curtailed without a significant worsening in a in infants born between 501 and 1250 grams. Pediatrics broad range of clinical outcomes. Although a modest, 2003; 111(4 Pt 2):e534-41. nonsignificant trend was observed toward a greater Abstract: OBJECTIVE: The purpose of this article is to number of infants needing supplemental oxygen at 36 describe how a neonatal intensive care unit (NICU) weeks' postmenstrual age, the severity of CLD did not was able to reduce substantially the use of postnatal increase, the mortality rate did not rise, length of stay dexamethasone in infants born between 501 and 1250 g did not increase, and other benefits such as decreased while at the same time implementing a group of use of mechanical ventilation and fewer episodes of potentially better practices (PBPs) in an attempt to nosocomial infection were documented. decrease the incidence and severity of chronic lung disease (CLD). METHODS: This study was both a Kagan J. Biological constraint, cultural variety, and retrospective chart review and an ongoing multicenter psychological structures. Ann N Y Acad Sci 2001; evidence-based investigation associated with the 935:177-90. Vermont Oxford Network Neonatal Intensive Care Abstract: Although biological processes bias humans to Quality Improvement Collaborative (NIC/Q 2000). The develop particular cognitive, affective, and behavioral NICU specifically made the reduction of CLD and forms, the cultural context of growth shapes these dexamethasone use a priority and thus formulated a list forms in particular ways. Psychologists have been of PBPs that could improve clinical outcomes across 3 indifferent to the nature of the mental structures that time periods: era 1, standard NICU care that antedated mediate the varied psychological functions that are the the quality improvement project; era 2, gradual usual target of inquiry. This paper argues that schemata implementation of the PBPs; and era 3, full for perceptual events, motor programs, and semantic implementation of the PBPs. All infants who had a networks are distinct, although interdependent, forms birth weight between 501 and 1250 g and were that rest on different neurophysiologies. The biological admitted to the NICU during the 3 study eras were constraints are weakest on the semantic networks that included (era 1, n = 134; era 2, n = 73; era 3, n = 83). are influenced by the history, economy, religion, As part of the NIC/Q 2000 process, the NICU geography, and social structure of the society. These implemented 3 primary PBPs to improve clinical factors influence how cultures classify names for outcomes related to pulmonary disease: 1) gentle, low emotions, categories of self-membership, and popular tidal volume resuscitation and ventilation, permissive metaphors for human nature. One class of schemata is hypercarbia, increased use of nasal continuous positive derived from changes in body tone. Temperamental airway pressure; 2) decreased use of postnatal variation in the susceptibility to changes in body tone dexamethasone; and 3) vitamin A administration. The has relevance for understanding personality and a total dexamethasone use, the incidence of CLD, and vulnerability to anxiety disorders. the mortality rate were the primary outcomes of 603
- 612. Kagan J, SnidmanN, McManis M, Woodward S. Observational case series. METHODS: In a Temperamental contributions to the affect family of retrospective study, the records of all 118 consecutive anxiety. Psychiatr Clin North Am 2001; 24(4):677-88. patients seen in emergency room during an eleven- Abstract: The discovery of pharmacologic month period were reviewed. RESULTS: Ocular interventions that mute the intensity of anxiety and emergencies represented 4% of the 2917 new patients guilt in some individuals has been a benevolent gift to visiting the department of Ophthalmology during this those who suffer from these disabling states. Although time. There was a 2.1/1 male to female preponderance some commentators have wondered about the social and a peak age of presentation between 11 and 30 consequences of large numbers of asymptomatic years. The mean age was 26 years +/- 17. Ocular persons taking these drugs, few have questioned the trauma (68 patients) accounted for over two-fourths advantages for the smaller group of anguished patients. (57.6%) of the total cases. Only 16% of patients It is likely, however, that, during the next century, presented within 48 hours. Fifty-one percent of injuries scientists will discover a drug that eliminates the occurred to the left eye, 38% to the right, and 10% feeling components of guilt and remorse while leaving bilaterally. The commonest ocular injury problems intact the semantic knowledge that certain acts are were eyelid laceration (13 patients, 19.1%), post- ethically improper. An individual who took this drug traumatic iritis (12 patients, 17.6%), and corneal regularly would continue to know that deceiving a laceration and penetration (10 patients, 14.7%), friend, lying to a client, and stealing from an employer accounting for 51% (35 patients) of the total. Home- are morally wrong but would be protected from the and work-related ocular injuries accounted for 54% of uncomfortable feeling of guilt or remorse that all ocular injuries. Thirty-three percent of all ocular accompanies a violation of a personal moral standard. injuries were caused by assault and fight, and 15% It is reasonable to wonder, therefore, whether our were related to motor vehicle accident. For the non- society would be changed in a major way if many traumatic ocular emergencies, the main aetiological citizens were protected from guilt and remorse. Most factor was inflammation (18%). CONCLUSION: Our Western philosophers, especially Kant, made reason study showed that males account for the majority of the bedrock of conscience. People acted properly, Kant eye injuries and this class is more prone to assault- believed, because they knew that the behavior was related injuries. In our country prevention strategies morally right. All individuals wish to regard the self as must take account of these. virtuous and try to avoid the uncertainty that follows detection of the inconsistency that is created when they Kaiser RB, Noonan D. A weary Shepherd. Newsweek 2002; behave in ways that are not in accord with their view of 139(14):32. the self's desirable attributes. Kant believed that, although the moral emotions restrain asocial acts, they Kajioka EH, Itoman EM, Li ML, Taira DA, Li GG, were not necessary for the conduct of a moral life. On Yamamoto LG. Pediatric prescription pick-up rates the other hand, some philosophers, such as Peirce and after ED visits. Am J Emerg Med 2005; 23(4):454-8. Dewey, argued that anticipation of anxiety, shame, and Abstract: OBJECTIVE: To determine the compliance guilt motivate a continued loyalty to one's ethical rate in filling outpatient medication prescriptions standards. A person who was certain that he or she was written upon discharge from the emergency department protected from these uncomfortable emotions would (ED). METHODS: Emergency department records of find it easier to ignore the moral imperatives acquired children during a 3-month period were examined along during childhood and adolescence. It is not obvious with pharmacy claim data obtained in cooperation with that a drug that blocks remorse also will eliminate the the largest insurance carrier in the community (private mutual social obligations that make a society habitable; and Medicaid). Pharmacy claim data were used to nonetheless, a posture of vigilance that is appropriate validate the prescription pick-up date. RESULTS: for--unlike gorillas--humans can hold representations Overall, 65% of high-urgency prescriptions were filled. of envy, anger, and dislike toward people they have The prescription pick-up rate in the 0-to 3-year age never met for a very long time. While we wait for group (75%) was significantly higher than in the rest of future inquiry to resolve this issue, it is useful to the cohort (55%) ( P < .001). Children with private acknowledge that a satisfying analysis of this problem insurance were more likely to fill their prescriptions will require a deeper appreciation of the differences (68%) compared to children with Medicaid insurance between the representations of the biological events (57%) ( P = .03). CONCLUSION: This study that are the foundation of an emotion and the demonstrates that filling a prescription after discharge representations that define the semantic networks for from an ED represents a substantial barrier to the concepts good and bad. medication compliance. Kaimbo WK, Spileers W, Missotten L. Ocular emergencies Kalb LM, Loeber R. Child disobedience and noncompliance: in Kinshasa (Democratic Republic of Congo). Bull Soc a review. Pediatrics 2003; 111(3):641-52. Belge Ophtalmol 2002; (284):49-53. Abstract: Child disobedience and noncompliance is a Abstract: PURPOSE: To determine frequencies of recurring problem frequently brought to the attention of ocular emergencies and identify their nature. DESIGN: 604
- 613. pediatricians and othersworking with children and considered. their parents. This article reviews empirical studies concerning childhood noncompliance. Definitions of Kamibeppu K. Reconsideration of "motherhood" in noncompliance (also called disobedience) are contemporary Japan. Am J Psychoanal 2005; 65(1):13- presented, and observational studies that have 29. measured noncompliance in the laboratory and at home Abstract: In this paper, the author reconsiders are reviewed. Studies show considerable variability in "motherhood" in Japan. This reconsideration is based the prevalence of noncompliance, but demonstrate that on Japanese psychoanalytic knowledge and a case it is a frequent problem for parents. Longitudinal data study of a woman. As a child she was physically from the Pittsburgh Youth Study are presented to more abused by her father, and struggled throughout her life closely examine the onset and stability of with conflicts with her mother. The Japanese have noncompliance in childhood and adolescence. historically idealized the concept of "motherhood" and Evidence suggests that extreme childhood maintained that it was possible for women to become noncompliance is relatively stable over time, peaking the ideal mother for their children. The author slightly during early adolescence and decreasing during maintains that "motherhood" is not dependent only on late adolescence. Studies indicate that for some mothers, but is created and shared by fathers, children children noncompliance predicts aggression and and all of society. In psychotherapy, the therapist externalizing problems. Antecedents of noncompliance provides a "motherly" energy to the client and shares including parental discipline techniques and child the "motherhood" fantasy with the client to a certain characteristics are reviewed. Parent training programs extent. The therapist assists the client in the gradual designed to reduce noncompliance are described, and process of abandoning the desire to be loved by the the effectiveness of such programs is examined. ideal mother and accept "motherhood" from other sources. Kallstrom-Fuqua AC, Weston R, Marshall LL. Childhood and adolescent sexual abuse of community women: Kaminer Y. Cognitive group therapy for aggressive boys. J mediated effects on psychological distress and social Am Acad Child Adolesc Psychiatry 2005; 44(9):843; relationships. J Consult Clin Psychol 2004; 72(6):980- author reply 843-5. 92. Abstract: Possible mediators of sexual abuse severity Kaminski RA, Stormshak EA, Good RH 3rd, Goodman MR. were tested on the basis of D. Finkelhor and A. Prevention of substance abuse with rural head start Browne's (1985) traumagenic dynamics model with children and families: results of project STAR. Psychol 178 low-income African American, European Addict Behav 2002; 16(4 Suppl):S11-26. American, and Mexican American community women Abstract: The effectiveness of a comprehensive interviewed for Project HOW: Health Outcomes of intervention with preschool children aimed at reducing Women. This subsample reported contact sexual abuse the risk of later substance abuse was examined. The before the age of 18 years. Severity was level of force, intervention targeted risk factors during the preschool number of perpetrators, relationship to perpetrator, and years linked to later substance use in adolescence and age at first assault. As expected, structural equation adulthood. Head Start classrooms were randomly modeling showed powerlessness, and stigmatization assigned to either the intervention or the control group. largely mediated the effects of sexual abuse severity on A classroom-based curriculum was delivered by Head women's psychological distress in adulthood. Start teachers who received a number of training Powerlessness also mediated the effects of severity on workshops and continued consultation. Parent training maladaptive social relationships. The expected path and home visits were also provided to intervention from betrayal to relationships was nonsignificant. families. Positive parenting as well as parent-school Overall, the results support extension of D. Finkelhor involvement increased over the 1st year of and A. Browne's model. Possible interventions are intervention. Intervention families maintained the addressed. positive effects on parenting into the kindergarten year over a matched control group; however, effects on Kamer B, Bieganski T, Filipiak-Miastkowska I, Raczynska school bonding were not maintained. Improvements in J, Baranska D, Czyzewska S. [Difficulties in diagnosis social competence, reported by teachers and parents, of battered child syndrome in infant]. Pol Merkuriusz were found at the end of kindergarten. No changes Lek 2004; 16(94):368-72. were found for self-regulation. Abstract: The diagnosis of battered child syndrome in infants was reached on the basis of the risk factors Kamo T, Ujiie Y, Tamura A. [Actual situation and social appraisal in social and family history, combined with prognosis of women seeking psychiatric care at the clinical and roentgenographic examinations; the emergency hostel of Tokyo Metropolitan Women's difficulties in establishing the diagnosis are presented. Counseling Center]. Seishin Shinkeigaku Zasshi 2002; Long hospitalisation also revealed that the observed 104(4):292-309. injuries are due to child abuse. The interdisciplinary Abstract: The emergency hostel of Tokyo Metropolitan approach is needed when non-accidental injuries are 605
- 614. Women's Counseling Center,established in 1957, and civil courts. As a result of fears regarding liability, provides protection and care for about 600 Japanese or many child welfare professionals are resorting to foreign women per year. The women housed there need defensive practice strategies. METHOD: This article social support for various reasons such as prostitution, reviews recent court decisions and legislation in poverty, somatic or mental diseases, or domestic Canada regarding this issue in order to assess actual violence (DV). We investigated the sociodemographic risks. RESULTS: Social workers who act according to characteristics, psychiatric diagnoses and social accepted standards of practice and who in good faith prognoses of 2667 women who consulted the make difficult judgments to the best of their abilities, psychiatric clinic in the emergency hostel between will not be held to be criminally culpable or civilly 1961 and 1997. Seventy-four women consulted the negligent. CONCLUSION: It is concluded that child psychiatric clinic per year, on average. Most were aged welfare professionals who exercise reasonable caution between 20 and 49. During the study period, there was and engage in good clinical social work practice, good a gradual decline in the number referred through the record keeping, effective communication and prostitution prevention law. Psychiatric diagnoses at verification of information, can continue to strive to the first visit varied widely. Annual comparison offer the high quality services to children and their showed a gradual decrease in schizophrenia and manic- families as they have always done without any serious depressive illness, but an increase in substance abuse, fear of recrimination. psychogenic reaction, and personality disorder. Sociodemographically, most subjects appeared to have Kane JR, Hellsten MB, Coldsmith A. Human suffering: the been children from underprivileged backgrounds. The need for relationship-based research in pediatric end- social prognoses of 930 cases judged in March 1998 of-life care. J Pediatr Oncol Nurs 2004; 21(3):180-5. were good in 25%, moderate in 23% and poor in 48%. Abstract: Children living with and dying from The poor prognosis group contained significantly more advanced cancer and their families experience women with schizophrenia and personality disorder significant suffering. The cure of disease and the relief than the other two groups. The poor prognosis group of suffering are dual moral obligations of our tended to include more cases of substance abuse, while professions. To relieve suffering, health care providers the good prognosis group contained more cases of must understand the multiple dimensions of the person depression and mental retardation. Women in the DV who suffers and the complex set of relationships within group tended to have more children than those in the the natural and the clinical social networks. Pediatric non-DV group, and to have a higher prevalence of oncology research must include appropriately designed psychogenic reaction and a lower prevalence of studies with sound methodology and measurement schizophrenia. The DV group also tended to include strategies to test and refine theories that account for the more subjects with a moderate social prognosis and link between human relationships and the relief of fewer subjects with a poor social prognosis. suffering. Studies should assess as many theoretical Specialized treatment should be provided for women models as possible, including the social network, after emergency admission to the hostel and this perceptions of support, and provider-recipient treatment needs to be aimed at improving social interactions; their physical, emotional, behavioral, and adaptation of the hostel residents, especially those with spiritual concomitants; and their impact on medical schizophrenia, personality disorders and substance decision making and health outcomes. Future abuse. Victims of DV should receive more conscious directions in pediatric end-of-life care research must attention. In particular, prevention of mental disorders also include evaluating social and spiritual should be aimed not only at the residents but also their interventions developed on the basis of solid children. hypotheses regarding the positive and negative influences of interpersonal dynamics on the processes Kamoie B, Teitelbaum J, Rosenbaum S. "Megan's laws" and that mediate between suffering and well-being. the US Constitution: implications for public health policy and practice. Public Health Rep 2003; Kane P, Garber J. The relations among depression in fathers, 118(4):379-81. children's psychopathology, and father-child conflict: a meta-analysis. Clin Psychol Rev 2004; 24(3):339-60. Kanani K, Regehr C, Bernstein MM. Liability Abstract: Research on parental depression is beginning considerations in child welfare: lessons from Canada. to recognize the importance of studying fathers in Child Abuse Negl 2002; 26(10):1029-43. relation to maladaptive outcomes in their offspring. Abstract: OBJECTIVE: Recent years have been Paternal depression is hypothesized to correlate with fraught with investigations into the deaths of children internalizing and externalizing psychopathology in receiving child welfare services throughout North children and adolescents and to compromise adaptive America, Europe, and Australia. These inquiries have parent-child relationships (e.g., increased conflict). In attracted considerable media attention and public the present paper, meta-analytic procedures were outrage. Added to this have been increases in attempts applied to this literature to address the magnitude and to hold social workers in child welfare responsible for direction of covariation between paternal depression the abuse and deaths of children through the criminal and children's functioning. In addition, we tested 606
- 615. whether variation infindings could be accounted for by Kao YF, Liu SH. [A nursing experience with a child with study characteristics. Results indicated that paternal rape trauma by using therapeutic play in an emergency depression was significantly related to offspring room]. Hu Li Za Zhi 2005; 52(1):88-93. internalizing and externalizing psychopathology and Abstract: This article conceptualized a therapeutic father-child conflict. Larger effects for internalizing game theory to discuss the pickings process of a symptoms were associated with the use of community preschool sexually violated victim with respect to samples and symptom rating scales of internalizing nursing care delivery in our department of emergency problems. medicine. In cooperation with the victim, we offered support to prevent her from fearing loss of her capacity Kankkunen P, Vehvilainen-Julkunen K, Pietila AM. Ethical for self-defense when facing a similar scenario. The issues in paediatric nontherapeutic pain research. Nurs overall exercise included observation time, a return Ethics 2002; 9(1):80-91. outpatient visit and a follow-up phone interview. By Notes: GENERAL NOTE: KIE: KIE Bib: human using observation, role-play, leading drawing and experimentation/informed consent; human interviews, we used Piaget's Cognitive Child experimentation/minors; informed consent/minors Development model and game therapy theory to reduce Abstract: The purpose of this article is to describe the the victim's sense of fear and shame, inducing the main ethical issues in paediatric nontherapeutic victim to eliminate her confusion by talking and to qualitative pain research. It is based on an analysis of complete the whole pickings process. the research literature related to ethical issues in research and on experiences from a family interview Kaplan RM. There are worse things to celebrate. S Afr Med study focusing on pain assessment and management in J 2004; 94(4):267-8. children aged 1-6 years. In addition, different views concerning obtaining informed consent from children, Karapetyan AF, Sokolovsky YV, Araviyskaya ER, Zvartau as published in the research literature, are compared. EE, Ostrovsky DV, Hagan H. Syphilis among Ethical challenges occur during all stages of qualitative intravenous drug-using population: epidemiological research. The risks of emotional distress and possible situation in St Petersburg, Russia. Int J STD AIDS benefits of the results must be assessed prior to 2002; 13(9):618-23. conducting a study. However, risks and harm are Abstract: INTRODUCTION: An epidemic of syphilis difficult to avoid in a study in which the research area, and other sexually transmitted infections (STI) in the pain, raises emotional distress in both parents and Russian Federation is believed to be related to the rise children. The children's assent and parental permission in injection drug use. A study was carried out in are both required. It is essential to obtain informed collaboration with a non-governmental organization, consent from all family members when family research Foundation 'Vozvrastcheniye'. METHODS: Nine is conducted. Participants' privacy and confidentiality hundred and ten injection drug users participating in should be protected during data collection, analysis and the programme were tested for syphilis, HIV, hepatitis publication. Protecting children from harm may be C virus (HCV) and hepatitis B virus (HBV); 65 impossible during pain research in which they are participants who had laboratory markers for syphilis required to recall a painful postoperative period. and 45 syphilis-negative serosurvey subjects agreed to However, after data collection they can be assisted to participate in a questionnaire study. RESULTS: focus on pleasant activities, for example, by engaging Syphilis, HIV, HBV and HCV were diagnosed in 12%, in playful activities with them. Finally, the role of the 0%, 48% and 79% of drug users, respectively. nurse and the researcher should be carefully assessed, Prevalence of syphilis seromarkers was nine times especially in qualitative research, in order to be able to higher in females than in males, and strongly analyse the data and report the findings in an unbiased associated with sex work. CONCLUSIONS: The manner. results of the study indicate that resources to treat and prevent further infections including HIV should be Kanuga M, Rosenfeld WD. Adolescent sexuality and the prioritized toward risk reduction in drug injectors and internet: the good, the bad, and the URL. J Pediatr sex workers in St Petersburg. Adolesc Gynecol 2004; 17(2):117-24. Abstract: The Internet has become a widely used Karayiannis NB, Tao G, Xiong Y et al. Computerized resource for sexual health information, especially motion analysis of videotaped neonatal seizures of among adolescents. The appeal lies in the ease and epileptic origin. Epilepsia 2005; 46(6):901-17. anonymity with which online seekers can obtain advice Abstract: PURPOSE: The main objective of this and reassurance, particularly regarding sensitive topics. research is the development of automated video This article reviews the positive and negative processing and analysis procedures aimed at the influences of the Internet on this age group. Specific recognition and characterization of the types of aspects of how this medium affects adolescents as well neonatal seizures. The long-term goal of this research as how it can be used to assist them are discussed. is the integration of these computational procedures into the development of a stand-alone automated 607
- 616. system that couldbe used as a supplement in the contextual factors did not discriminate readers from neonatal intensive care unit (NICU) to provide 24-h per nonreaders, but infant temperament did. Fathers who day noninvasive monitoring of infants at risk for read aloud had infants who were less soothable and seizures. METHODS: We developed and evaluated a who displayed longer durations of orienting. The variety of computational tools and procedures that may possibility that book reading could serve as 1 mediator be used to carry out the three essential tasks involved of the temperament-cognition relationship is discussed. in the development of a seizure recognition and characterization system: the extraction of quantitative Kasen S, Cohen P, Skodol AE, Johnson JG, Smailes E, motion information from video recordings of neonatal Brook JS. Childhood depression and adult personality seizures in the form of motion-strength and motor- disorder: alternative pathways of continuity. Arch Gen activity signals, the selection of quantitative features Psychiatry 2001; 58(3):231-6. that convey some unique behavioral characteristics of Abstract: BACKGROUND: This study extends neonatal seizures, and the training of artificial neural previous findings of the risks posed by childhood networks to distinguish neonatal seizures from random major depressive disorder and other infant behaviors and to differentiate between psychopathological features for later personality myoclonic and focal clonic seizures. RESULTS: The disorder (PD) in a random sample of 551 youths. methods were tested on a set of 240 video recordings METHODS: Self-reports and mother reports were used of 43 patients exhibiting myoclonic seizures (80 cases), to evaluate DSM-III-R (Axes I and II) psychiatric focal clonic seizures (80 cases), and random infant disorders at mean ages of 12.7, 15.2, and 21.1 years. movements (80 cases). The outcome of the Logistic regression was used to examine the experiments verified that optical- flow methods are independent effects of major depressive disorder in promising computational tools for quantifying neonatal childhood or adolescence on 10 PDs in young seizures from video recordings in the form of motion- adulthood. RESULTS: Odds of dependent, antisocial, strength signals. The experimental results also verified passive-aggressive, and histrionic PDs increased by that the robust motion trackers developed in this study more than 13, 10, 7, and 3 times, respectively, given outperformed considerably the motion trackers based prior major depressive disorder. Those effects were on predictive block matching in terms of both independent of age, sex, disadvantaged socioeconomic reliability and accuracy. The quantitative features status, a history of child maltreatment, nonintact family selected from motion-strength and motor-activity status, parental conflict, preexisting PD in adolescence, signals constitute a satisfactory representation of and other childhood or adolescent Axis I neonatal seizures and random infant movements and psychopathological features, including disruptive and seem to be complementary. Such features lead to anxiety disorders. In addition, odds of schizoid and trained neural networks that exhibit performance levels narcissistic PD increased by almost 6 times and odds of exceeding the initial goals of this study, the sensitivity antisocial PD increased by almost 5 times given a prior goal being >or=80% and the specificity goal being disruptive disorder, and odds of paranoid PD increased >or=90%. CONCLUSIONS: The outcome of this by 4 times given a prior anxiety disorder. experimental study provides strong evidence that it is CONCLUSION: Personality disorders may represent feasible to develop an automated system for the alternative pathways of continuity for major depressive recognition and characterization of the types of disorder and other Axis I disorders across the child- neonatal seizures based on video recordings. This will adult transition. be accomplished by enhancing the accuracy and improving the reliability of the computational tools and Kashdan TB, Jacob RG, Pelham WE et al. Depression and methods developed during the course of the study anxiety in parents of children with ADHD and varying outlined here. levels of oppositional defiant behaviors: modeling relationships with family functioning. J Clin Child Karrass J, VanDeventer MC, Braungart-Rieker JM. Adolesc Psychol 2004; 33(1):169-81. Predicting shared parent--child book reading in Abstract: This study investigated the relation between infancy. J Fam Psychol 2003; 17(1):134-46. parental anxiety and family functioning. Parental Abstract: This study examined the degree to which anxiety and depression, child attention deficit parental contextual factors and infant characteristics hyperactivity disorder (ADHD), and oppositional predicted whether parents read aloud to their 8-month- defiant disorder (ODD) symptoms were all included as old infants. Discriminant function analysis revealed predictors of 3 measures of family functioning to that mothers with higher family incomes and those who examine the independent contributions of each. Using a reported less parenting stress and fewer general hassles self-report battery completed by 45 mother-father pairs, were more likely to read to their infants. Gender and 3 family functioning factors were derived: Parental temperament of the infant did not significantly predict Warmth and Positive Involvement, Intrusiveness and whether mothers would engage in shared reading. Negative Discipline, and Social Distress. Multilevel Furthermore, there was no evidence that mothers who modeling simultaneously estimated the unique reported reading aloud to their infants display more contributions of parental and child symptoms on family enriching parenting practices in the laboratory. Paternal functioning. Results indicated that parental anxiety was 608
- 617. negatively associated withParental Warmth and mother's intimate partner violence status [IPV], family Positive Involvement, Intrusiveness and Negative cohesion and adaptability, neighborhood disorder) Discipline, and Social Distress; parental depression uniquely predicted a child's internalizing distress and was only negatively associated with Social Distress. externalizing distress, and the amount of variance Child ODD symptoms had independent associations explained by the model. Results from the regression with all outcomes; no relations were found with model predicting internalizing distress indicates that ADHD. Sex moderated the effects of parental anxiety the five predictor variables accounted for 38% of the on Parental Warmth and Positive Involvement such variance. Two of the five predictors were significantly that only for mothers did greater anxiety lead to less related to child's internalizing distress scores: mother's Parental Warmth and Positive Involvement. intimate partner violence status and maternal psychological distress. Results from the regression Kashner TM, Carmody TJ, Suppes T et al. Catching up on model predicting externalizing distress indicates that health outcomes: the Texas Medication Algorithm the five predictor variables accounted for 8% of the Project. Health Serv Res 2003; 38(1 Pt 1):311-31. variance. The two predictors significantly related to Abstract: OBJECTIVE: To develop a statistic child's externalizing distress scores were levels of measuring the impact of algorithm-driven disease family cohesion and maternal psychological distress. management programs on outcomes for patients with Directions for future research and clinical implications chronic mental illness that allowed for treatment-as- are provided. usual controls to "catch up" to early gains of treated patients. DATA SOURCES/STUDY SETTING: Katon W, Sullivan M, Walker E. Medical symptoms without Statistical power was estimated from simulated identified pathology: relationship to psychiatric samples representing effect sizes that grew, remained disorders, childhood and adult trauma, and personality constant, or declined following an initial improvement. traits. Ann Intern Med 2001; 134(9 Pt 2):917-25. Estimates were based on the Texas Medication Abstract: Community studies have shown that stressful Algorithm Project on adult patients (age > or = 18) life events, psychological distress, and depressive and with bipolar disorder (n = 267) who received care anxiety disorders are associated with 1) a range of between 1998 and 2000 at 1 of 11 clinics across Texas. medical symptoms without identified pathology, 2) STUDY DESIGN: Study patients were assessed at increased health care utilization, and 3) increased costs. baseline and three-month follow-up for a minimum of In both primary care and medical specialty samples, one year. Program tracks were assigned by clinic. patients who have syndromes with ill-defined DATA COLLECTION/EXTRACTION METHODS: pathologic mechanisms (such as the irritable bowel Hierarchical linear modeling was modified to account syndrome and fibromyalgia) have been shown to have for declining-effects. Outcomes were based on 30-item significantly higher rates of anxiety and depressive Inventory for Depression Symptomatology-Clinician disorders than do patients with comparable, well- Version. PRINCIPAL FINDINGS: Declining-effect defined medical diseases and similar symptoms. Other analyses had significantly greater power detecting studies show that after adjustment for severity of program differences than traditional growth models in medical illness, patients with depression or anxiety and constant and declining-effects cases. Bipolar patients comorbid medical disease have significantly more with severe depressive symptoms in an algorithm- medical symptoms without identified pathology than driven, disease management program reported fewer do patients with a similar medical disease alone. Both symptoms after three months, with treatment-as-usual childhood maltreatment and psychological trauma in controls "catching up" within one year. adulthood have been associated with increased CONCLUSIONS: In addition to psychometric vulnerability to psychiatric illness and more medical properties, data collection design, and power, symptoms. The substantial functional impairment, investigators should consider how outcomes unfold distress, and costs associated with medical symptoms over time when selecting an appropriate statistic to without identified pathology suggest that research evaluate service interventions. Declining-effect studies promoting a better understanding of the analyses may be applicable to a wide range of biopsychosocial cause of these symptoms may yield treatment and intervention trials. pragmatic, cost-effective approaches to treatment in medical settings. Kaslow NJ, Heron S, Roberts DK, Thompson M, Guessous O, Jones C. Family and community factors that predict Katumba-Lunyenya J, Joss V, Latham P, Abbatuan C. internalizing and externalizing symptoms in low- Pulmonary tuberculosis and extreme prematurity. Arch income, African-American children: a preliminary Dis Child Fetal Neonatal Ed 2005; 90(2):F178-9; report. Ann N Y Acad Sci 2003; 1008:55-68. discussion F179-83. Abstract: To learn more about the roots of internalizing Notes: GENERAL NOTE: KIE: 29 refs. and externalizing problems in low-income, African- GENERAL NOTE: KIE: KIE Bib: AIDS; patient American children, aged 8-12 years, particularly for care/minors family and community factors, we aimed to determine Abstract: A mother, newly found to be positive for which variables (mother's psychological functioning, HIV, delivered her first baby at 25 weeks gestation. 609
- 618. The infant initiallydid well in spite of a symptomatic Katz LF, Woodin EM. Hostility, hostile detachment, and patent duct and a severe intraventricular haemorrhage, conflict engagement in marriages: effects on child and but became severely unwell needing further respiratory family functioning. Child Dev 2002; 73(2):636-51. support on day 18. Acid fast bacilli were found in Abstract: This study examined the relations between endotracheal secretions. After the baby's death, the patterns of marital communication, child adjustment, bacilli were confirmed to be Mycobacterium and family functioning. Couples with a 4- or 5-year-old tuberculosis, and the same organism was grown from child were divided into three groups (N = 126) based the mother's urine. The case raised challenging issues on observed patterns of emotional communication: in relatively uncharted territory in terms of treatment of Hostile couples showed a cumulative increase in the infant, public health issues, ethical decision negative speaker behaviors over the course of a high- making, and media management. conflict marital discussion; hostile-withdrawn couples showed a cumulative increase in both negative speaker Katz A. Neonatal HIV infection. Neonatal Netw 2004; and negative listener behaviors over the course of the 23(1):15-20. interaction; and engaged couples showed a cumulative Abstract: The purpose of this article is to describe the increase in both positive speaker and listener behaviors pertinent issues related to mother-to-child transmission over the course of the interaction. The families of these of HIV infection. Significant succcss has been three types of couples were then compared on child achieved in developed countries to reduce the outcomes (i.e., peer relations, behavior problems), incidence of this devastating disease in neonates parenting quality, co-parenting quality, and family- through screening of pregnant women, maternal level functioning. Differences in marital violence and antiretroviral therapy to reduce transmission, and marital satisfaction between marital couples were also cesarean section for delivery. Prophylaxis continues for examined in relation to family risk. Families in which the first six weeks of the newborn's life with couples were hostile-detached showed the most antiretroviral therapy and careful monitoring of clinical negative outcomes. Hostile-detached couples were well-being. Antiretroviral therapy offers significant more likely than hostile or conflict-engaging couples to reduction in the rate of mother-to child transmission, use more power-assertive methods of discipline; to be and this is presently the cornerstone of therapy for the ineffective in co-parenting their child; to have family HIV-infected pregnant woman. Clinical studies of units that were less cohesive, less playful, and more treatment modalities continue to offer new hope to conflictual; and to have children that exhibited prevent transmission of the virus to the fetus. Care for behavior problems. Results also indicated that marital the HIV infected newborn is highly complex and typology still accounted for significant variance in constantly evolving. All neonatal nurses should be child outcome after controlling for marital violence and aware of these issues so that they can be partners in the marital satisfaction. Differences in the absolute degree identification of new cases and the ongoing treatment of negative behaviors also did not account for results. of babies who are infected. Findings are discussed in terms of the detrimental impact of marital conflict on child and family Katz LF, Low SM. Marital violence, co-parenting, and functioning. family-level processes in relation to children's adjustment. J Fam Psychol 2004; 18(2):372-82. Kaufman JS, Dole N, Savitz DA, Herring AH. Modeling Abstract: A multimethod approach was used to community-level effects on preterm birth. Ann examine relations between marital violence, Epidemiol 2003; 13(5):377-84. coparenting, and family-level processes and children's Abstract: PURPOSE: We demonstrate modeling of adjustment in a community-based sample of marital community-level socioeconomic influences on risk of violence. Two hypotheses were tested, one in which preterm birth (< 37 weeks gestation) in the Pregnancy, family-level and co-parenting processes mediate Infection, and Nutrition (PIN) Study. METHODS: relations between marital violence and child Community-level information from the US Census was functioning and one in which marital violence and linked to 930 White and 817 African-American (Black) family-level/co-parenting processes function relatively participants from a prospective cohort in central North independently in influencing children's adjustment. Carolina through geocoded addresses, providing 123 Observations of family processes were made within a census tracts with community-level and individual- triadic parent-child interaction, and several dimensions level data for multi-level statistical analyses. of children's socioemotional adjustment (i.e., peer RESULTS: Preterm delivery was experienced by relations, behavior problems) were examined. Results 12.1% of Black and 10.4% of White participants. No indicated that hostile-withdrawn co-parenting mediated appreciable aggregation of risk by community was the relations between marital violence and children's discernable for White women. For Black women, anxiety and depression. Marital violence, co-parenting, random-coefficient logistic regression tract-specific and family-level processes also functioned preterm prevalence estimates ranged from 10.1% to independently in predicting child outcome. Findings 14.5%, "shrunk" from observed prevalences of 0% to are discussed in terms of the family dynamics present 100%. Adding tract-level variables to the model in maritally violent homes. representing median splits for household income and 610
- 619. percent of singlewomen heads of households with extraordinary means and casuistical consistency. dependents, adjusting for individual-level maternal age Kennedy Inst Ethics J 2002; 12(2):115-40. and household income, accounted for much of the Notes: GENERAL NOTE: KIE: 29 refs. 9 fn. remaining between-tracts variation. CONCLUSIONS: GENERAL NOTE: KIE: KIE Bib: patient care/minors; Residing in a wealthier tract (> $30,000/year median treatment refusal/minors income) was associated with reduced risk for Black Abstract: eThis article draws upon the Roman Catholic women, adjusted OR = 0.59 (95% CI: 0.36, 0.96). The distinction between "ordinary" and "extraordinary" estimated conditional effect of lower community means of medical treatment to analyze the case of prevalence of female headed households was OR = "Jodie" and "Mary," the Maltese conjoined twins 0.71 (95% CI: 0.43, 1.17). whose surgical separation was ordered by the English courts over the objection of their Roman Catholic Kavanagh R. Consent and confusion--who decides? Br J parents and Cormac Murphy-O'Connor, the Roman Perioper Nurs 2004; 14(11):489-91. Catholic Cardinal Archbishop of Westminister. It Abstract: Current trends in the NHS promote patient attempts to shed light on the use of that distinction by rights including the right to accept or refuse surgery. surrogate decision makers with respect to incompetent Valid consent when the patient appears to have patients. In addition, it critically analyzes various fluctuating competence can place theatre nurses in a components of the distinction by comparing the difficult position. This article explores the legal reasoning used by Catholic moralists in this case with framework in which the Department of Health consent the reasoning used in other cases that raise similar forms work and looks at the NMC's Code of issues, including women facing crisis pregnancies who Professional Conduct for standards of practice. prefer abortion to adoption and the Indiana "Baby Doe" case. Kavanaugh K, Savage T, Kilpatrick S, Kimura R, Hershberger P. Life support decisions for extremely Kawachi I, Berkman LF. Social ties and mental health. J premature infants: report of a pilot study. J Pediatr Urban Health 2001; 78(3):458-67. Nurs 2005; 20(5):347-59. Abstract: It is generally agreed that social ties play a Abstract: The purpose of this pilot study was to beneficial role in the maintenance of psychological describe decision making and the decision support well-being. In this targeted review, we highlight four needs of parents, physicians, and nurses regarding life sets of insights that emerge from the literature on social support decisions made over time prenatally and ties and mental health outcomes (defined as stress postnatally for extremely premature infants. Using the reactions, psychological well-being, and psychological collective case study method, one prenatal, one distress, including depressive symptoms and anxiety). postnatal, and one postdeath, if the infant had died, First, the pathways by which social networks and social tape-recorded interviews were conducted with each supports influence mental health can be described by parent. With parents' permission, prenatal interviews two alternative (although not mutually exclusive) were done with the physicians and nurses who talked to causal models-the main effect model and the stress- them about life support decisions for their infants. buffering model. Second, the protective effects of Twenty-five tape-recorded interviews were conducted social ties on mental health are not uniform across with six cases (six mothers, two fathers, six physicians, groups in society. Gender differences in support and two nurses). Hospital records were reviewed for derived from social network participation may partly documentation of life support decisions. Results of this account for the higher prevalence of psychological pilot study demonstrated that most parents wanted a distress among women compared to men. Social model of shared decision making and perceived that connections may paradoxically increase levels of they were informed and involved in making decisions. mental illness symptoms among women with low Parents felt that to be involved in decision making they resources, especially if such connections entail role needed information and recommendations from strain associated with obligations to provide social physicians. Parents also stressed the importance of support to others. Third, egocentric networks are nested encouragement and hope. In contrast, physicians within a broader structure of social relationships. The informed parents but most physicians felt that parents notion of social capital embraces the embeddedness of were the decision makers. Physicians used parameters individual social ties within the broader social to offer options or involve parents in decisions and structure. Fourth, despite some successes reported in became very directive at certain gestational ages. social support interventions to enhance mental health, Nurses reported that they believed that parents needed further work is needed to deepen our understanding of information from the physician first, then they would the design, timing, and dose of interventions that work, reinforce information. The results of this study offer an as well as the characteristics of individuals who benefit initial understanding of the decision support needs of the most. parents. Kawashima R, Taira M, Okita K et al. A functional MRI Kaveny MC. Conjoined twins and Catholic moral analysis: study of simple arithmetic--a comparison between children and adults. Brain Res Cogn Brain Res 2004; 611
- 620. 18(3):227-33. Depression in Recent Crime Victims. Behav Ther Abstract: The purpose of this study was to examine 2005; 36(3):235-44. brain areas involved in simple arithmetic, and to Abstract: Childhood maltreatment has been linked to compare these areas between adults and children. Eight adult depressive disorders. However, few studies have children (four girls and four boys; age, 9-14 years) and examined mechanisms through which childhood eight adults (four women and four men; age, 40-49 maltreatment may contribute to adult depression. Thus, years) were subjected to this study. Functional we examined the role of one potential mechanism of magnetic resonance imaging (fMRI) was performed this relationship, maladaptive cognitions, in a recently during mental calculation of addition, subtraction, and traumatized sample. Participants were adult women multiplication of single digits. In each group, the left who had been recently raped (n = 133) or physically middle frontal, bilateral inferior temporal and bilateral assaulted (n = 73). We examined whether maladaptive lateral occipital cortices were activated during each self-and other-cognitions mediated relationships task. The adult group showed activation of the right between childhood sexual, physical, and emotional frontal cortex during addition and multiplication tasks, abuse and current depression. Relationships between but the children group did not. Activation of the childhood sexual abuse and both current depression intraparietal cortex was observed in the adult group symptoms and diagnosis were mediated by during each task. Although, activation patterns were maladaptive cognitions about self. Relationships slightly different among tasks, as well as between between both childhood sexual abuse and childhood groups, only a small number of areas showed physical abuse and adult depressive symptoms were statistically significant differences. The results indicate mediated by maladaptive cognitions about others. that cortical networks involved in simple arithmetic are similar among arithmetic operations, and may not show Kegler MC, Stern R, Whitecrow-Ollis S, Malcoe LH. significant changes in the structure during the second Assessing lay health advisor activity in an intervention decade of life. to prevent lead poisoning in Native American children. Health Promot Pract 2003; 4(2):189-96. Kaye D, Mirembe F, Bantebya G. Risk factors, nature and Abstract: The purpose of this study is to assess patterns severity of domestic violence among women attending of lay health advisor (LHA) activity in an intervention antenatal clinic in Mulago Hospital, Kampala, Uganda. to reduce lead exposure in Native American children Cent Afr J Med 2002; 48(5-6):64-8. exposed to mine waste. A total of 39 LHAs were Abstract: OBJECTIVES: To determine the prevalence, recruited and trained to become LHAs from eight tribes types, severity and risk factors for domestic violence in northeastern Oklahoma. LHAs completed activity among women attending antenatal clinic. DESIGN: tracking forms over a 2-year intervention period to Cross sectional study. SETTING: The antenatal clinic, document contacts made with community groups and Mulago Hospital, the national referral hospital, individuals in their social networks. They engaged in Kampala, Uganda. SUBJECTS: Pregnant women (n = an average of 5.4 activities per month, reaching an 379) attending the antenatal clinic, on their index visit. average of 39 persons. Close members of their social METHODS: Interviewer-administered pre-coded networks were reached in 40.4% of the contacts; questionnaires about history of domestic violence persons outside of their networks were reached in 24% during the index pregnancy (prevalence, nature, of the contacts. This study suggests that 1 to 3 contacts severity, and associated factors from socio- per week may be a reasonable expectation for LHA demographic history, reproductive history, childhood activity. Findings also suggest that LHA interventions history and domicile); during the previous one year are a promising approach for engaging Native prior to the interview, or beyond the previous year. American communities in addressing an environmental MAIN OUTCOME MEASURES: History of domestic health problem. violence and its severity, type, risk factors and associated factors in the index pregnancy or prior to it. Keirse MJ. Evidence-based childbirth only for breech RESULTS: Over 57% of the subjects reported babies? Birth 2002; 29(1):55-9. moderate-to-severe abuse due to domestic violence. Abuse in childhood and witnessing abuse in childhood Keller AS. Caring and advocating for victims of torture. were significantly associated with domestic violence in Lancet 2002; 360 Suppl:s55-6. index pregnancy (p = 0.000). Staying with co-wife, adolescent pregnancy and the first pregnancy were Kellermann NP. Perceived parental rearing behavior in significantly associated with domestic violence. children of Holocaust survivors. Isr J Psychiatry Relat CONCLUSIONS: Domestic violence is common in Sci 2001; 38(1):58-68. pregnancy at Mulago; is moderate to severe and Abstract: Holocaust survivors have often been physical abuse is often associated with both sexual and described as inadequate parents. Their multiple losses psychological abuse. were assumed to create child-rearing problems around both attachment and detachment. Empirical research, Kaysen D, Scher CD, Mastnak J, Resick P. Cognitive however, has yielded contradictory evidence regarding Mediation of Childhood Maltreatment and Adult 612
- 621. the parenting behaviorof Holocaust survivors when legal assistants; the services of an attorney; and investigated with classical parenting instruments. The monthly support group meetings. The intervention present pilot-study investigated parental behavior with resulted in improved mental health scores, decreased a new self-report instrument that also included salient psychological distress scores, and increased social Holocaust dimensions. The parent perception of 159 support scores. Participants also experienced adult children of Holocaust survivors was thus improvement in the level of public benefits received compared with 151 control subjects. Factor analysis of and in their legal relationships with their grandchildren. data yielded four major kinds of parental rearing Implications of these findings for practice are behaviors: transmission; affection; punishing and over- highlighted. protection. While the second-generation group rated their parents higher on transmission, other differences Kelly J. Management. Lights, camera...action! Hosp Health in child-rearing practices were small, if taken as a Netw 2005; 79(3):25-6. whole. These findings largely support the descriptive literature on transgenerational transmission of trauma Kemp AM, Stoodley N, Cobley C, Coles L, Kemp KW. while at the same time refuting the view that Holocaust Apnoea and brain swelling in non-accidental head survivors function more inadequately than other injury. Arch Dis Child 2003; 88(6):472-6; discussion parents do. 472-6. Abstract: AIMS: (1) To identify whether infants and Kelley LS. Minor children and adult care exchanges with young children admitted to hospital with subdural community-dwelling frail elders in a St. Lucian village. haematomas (SDH) secondary to non-accidental head J Gerontol B Psychol Sci Soc Sci 2005; 60(2):S62-73. injury (NAHI), suffer from apnoea leading to Abstract: OBJECTIVE: Research on care of radiological evidence of hypoxic ischaemic brain community-dwelling frail elders typically includes damage, and whether this is related to a poor formal health service providers and adult members of prognosis; and (2) to determine what degree of trauma the informal care system. Involvement of children and is associated with NAHI. METHODS: Retrospective adolescents with elder care is largely undocumented. case series (1992-98) with case control analysis of 65 The aim of this article is to describe children's children under 2 years old, with an SDH secondary to involvement in elder care. These findings are part of an NAHI. Outcome measures were presenting symptoms, ethnographic community study that examined common associated injuries and apnoea at presentation, brain Western assumptions about elder care in a St. Lucian swelling or hypoxic ischaemic changes on village. METHODS: Data were obtained in a four- neuroimaging, and clinical outcome (KOSCHI). phase, 5-year, community-based ethnographic field RESULTS: Twenty two children had a history of study that included in-depth network analysis of elder apnoea at presentation to hospital. Apnoea was households. RESULT: One hundred eighty-eight significantly associated with hypoxic ischaemic brain informal caregivers assisted 14 elder networks in damage. Severe symptoms at presentation, apnoea, and obtaining the things they needed to live through diffuse brain swelling/hypoxic ischaemic damage were provision of 355 care activities. Forty-five children significantly associated with a poor prognosis. Eighty (ages 3(1/2) to 16) provided 111 of 355 (31%) care five per cent of cases had associated injuries consistent activities. The frail elders gave adults and children with a diagnosis of non-accidental injury. community member caregivers 196 and 94 benefits, CONCLUSIONS: Coma at presentation, apnoea, and respectively. DISCUSSION: Minor children are diffuse brain swelling or hypoxic ischaemia all predict integrally involved in reciprocal exchanges for elder a poor outcome in an infant who has suffered from care in this village. Although they do not provide all of SDH after NAHI. There is evidence of associated the same care activities as adults, they clearly assist violence in the majority of infants with NAHI. At this elders, especially with running errands. Elders point in time we do not know the minimum forces emphasized different motivational mechanisms for necessary to cause NAHI. It is clear however that it is involving minor children and adults in their care never acceptable to shake a baby. networks. Kemper AR, Fant KE, Clark SJ. Informing parents about Kelley SJ, Yorker BC, Whitley DM, Sipe TA. A multimodal newborn screening. Public Health Nurs 2005; intervention for grandparents raising grandchildren: 22(4):332-8. results of an exploratory study. Child Welfare 2001; Abstract: OBJECTIVE: To evaluate current rules and 80(1):27-50. regulations for educating parents about newborn Abstract: This article describes the results of an screening. DESIGN: Cross-sectional survey. exploratory study of a multimodal, home-based SAMPLE: Newborn screening program coordinators in intervention designed to reduce psychological stress, all 50 states and the District of Columbia. improve physical and mental health, and strengthen the MEASUREMENTS: Answers to a standardized semi- social support and resources of grandparents raising structured telephone survey in January 2004. grandchildren. The six-month intervention included RESULTS: Fifty programs provide standardized home visits by registered nurses, social workers, and 613
- 622. information about screening,and 32 of these have 70(6):1303-6. information available in multiple languages. Most Abstract: This article makes observations about policy programs (n=36) believe that parents should be implications and offers a combination of commentary informed about newborn screening as a part of prenatal and recommendation regarding the special issue on the care; however, none has rules or regulations requiring impact of childhood psychopathology interventions on this. Five require documented informed consent; only subsequent substance abuse. The authors mention one provides the consent form in a language other than forward-looking directives to expand the mandate for English. Hospitals and birthing centers are required by early intervention, to expand the research agenda for many programs to educate families, including randomized clinical trials, and to develop a policy- providing information (n=12), obtaining informed oriented evidence base. They also note topics that consent (n=5), informing parents of the right to refuse require consideration and offer recommendations with screening (n=13), and documenting refusal on regard to how to proceed. The special issue, as well as institutionally developed forms (n=9). We found this discussion, will spark thought and action directed considerable variation in policy language across the toward the evaluation of interventions for youths to newborn screening programs. CONCLUSIONS: The assess the degree to which treating mental disorders complexity of current newborn screening programs and has beneficial effects on the sequelae of the initial the likelihood of expansion in the number of conditions intervention target. on newborn screening panels present a unique opportunity and challenge for public health nurses to Kendall-Tackett K. The health effects of childhood abuse: ensure that these programs are effective and that care is four pathways by which abuse can influence health. integrated. Child Abuse Negl 2002; 26(6-7):715-29. Abstract: OBJECTIVES: This article describes four Kempes M, Matthys W, de Vries H, van Engeland H. possible pathways by which childhood abuse relates to Reactive and proactive aggression in children--a health problems in adults. METHOD: Literature on the review of theory, findings and the relevance for child long-term effects of childhood abuse is organized in a and adolescent psychiatry. Eur Child Adolesc health psychology framework describing behavioral, Psychiatry 2005; 14(1):11-9. social, cognitive, and emotional pathways. Key studies Abstract: The clinical population of aggressive children from the health psychology and behavioral medicine diagnosed as having an oppositional defiant disorder literature are included to demonstrate how these (ODD) or a conduct disorder (CD) is heterogeneous, pathways relate to health. RESULTS: Childhood abuse both with respect to behaviour and aetiology. Recently, puts people at risk of depression and post-traumatic the following distinction has been proposed that might stress disorder, participating in harmful activities, further clarify this heterogeneity: reactive aggression is having difficulties in relationships, and having negative an aggressive response to a perceived threat or beliefs and attitudes towards others. Each of these provocation, whereas proactive aggression is defined as increases the likelihood of health problems, and they behaviour that anticipates a reward. In this article we are highly related to each other. CONCLUSIONS: examine various aspects of this distinction. We will [1] Childhood abuse is related to health via a complex examine the evidence that reactive and proactive matrix of behavioral, emotional, social, and cognitive aggression are distinct phenomena by discussing the factors. Health outcomes for adult survivors are theories underlying the distinction between the unlikely to improve until each of these factors is subtypes in humans and we briefly review evidence for addressed. a similar distinction in animals; [2] we critically review the literature on the measurement in children via Kendrick D, Hapgood R, Marsh P. Do safety practices differ questionnaires and behavioural observations; we then between responders and non-responders to a safety point out that the correlation observed between the questionnaire? Inj Prev 2001; 7(2):100-3. subtypes is due to the fact that many children show Abstract: OBJECTIVE: To compare reported safety both types of aggression; [3] we review the literature practices between responders and non-responders to a on specific characteristics of the subtypes giving safety survey. DESIGN: Cross sectional survey at attention to social information processing, peer status, baseline compared with safety practices reported at biological correlates and developmental history, and subsequent child health surveillance checks. demonstrate that there is some evidence to suggest that SUBJECTS: Parents of children aged 3-12 months reactive and proactive aggression are distinct registered with practices participating in a controlled dimensions; [4] we discuss the relevance of the trial of injury prevention in primary care that did, and distinction between reactive and proactive aggression did not, respond to the baseline survey and who for child and adolescent psychiatry. subsequently attended child health surveillance checks. RESULTS: No difference in safety practices was found Kendall PC, Kessler RC. The impact of childhood between responders and non-responders to the survey psychopathology interventions on subsequent at the 6-9 month check. Responders were more likely substance abuse: policy implications, comments, and to report owning a stair gate (odds ratio (OR) 2.75, recommendations. J Consult Clin Psychol 2002; 95% confidence interval (CI) 1.82 to 4.16) and socket 614
- 623. covers (OR 2.16,95% CI 1.53 to 3.04) at the 12-15 of the study showed that higher rates of reported lax month check, and owning socket covers (OR 2.19, 95% disciplinary practices, less efficient parental coping, CI 1.34 to 3.61) at the 18-24 month check. Responders lower rates of father-child communication, and less were more likely to report greater than the median synchronous mother-child interactions were number of safety practices at the 18 month check. significantly associated with hyperactivity following CONCLUSIONS: Non-responders to a safety survey statistical adjustment for the effects of conduct appear to be less likely to report owning several items problems and other confounding factors. The best of safety equipment than responders. Further work is parenting predictor of hyperactivity was maternal needed to confirm these findings. Extrapolating the coping. The present findings suggest that the way in results of safety surveys to the population as a whole which parents interact with their preschool children may lead to over estimation of safety equipment may make a unique contribution to the development possession. and ongoing behavioral difficulties experienced by children with pervasive hyperactivity. Findings also Kennedy AE, Rubin KH, Hastings PD, Maisel B. highlight the importance of considering the role of Longitudinal relations between child vagal tone and fathers in the behavioral development of boys with parenting behavior: 2 to 4 years. Dev Psychobiol 2004; early tendencies to hyperactive and distractible 45(1):10-21. behavior problems. Abstract: The longitudinal relations between physiological markers of child emotion regulation and Kernic MA, Monary-Ernsdorff DJ, Koepsell JK, Holt VL. maternal parenting practices were examined from 2 to Children in the crossfire: child custody determinations 4 years of age. At Time 1, cardiac vagal tone was among couples with a history of intimate partner assessed for one hundred four 2-year-olds (54 females); violence. Violence Against Women 2005; 11(8):991- their mothers completed an assessment of parenting 1021. styles. Two years later, at Time 2, 84 of the original Abstract: Although most states mandate considerations participants were reassessed on measures of cardiac of intimate partner violence (IPV) in child custody vagal tone and parenting style. Results indicated both proceedings, little is known about how often a baseline cardiac vagal tone and maternal parenting preexisting history of IPV is effectively presented to practices to be stable from 2 to 4 years of age. the courts in dissolution cases and, when it is, what Children's cardiac vagal tone predicted specific effect it has on child custody and visitation outcomes. parenting practices from the toddler to preschool years. This retrospective cohort study examined the effects of Further, child cardiac vagal tone moderated maternal a history of IPV, further categorized by whether restrictive-parenting practices from 2 to 4 years of age; substantiation of that history existed and whether the mothers of children who were highly or moderately court handling the custody proceedings knew of that physiologically dysregulated were more likely to report history, on child custody and visitation outcomes. The restrictive parenting practices at both 2 and 4 years of findings from this study highlight several issues of age. concern regarding the reality of child custody among families with a history of IPV. These include two Kenny C. Keeping children out of harm's way. Nurs Times primary concerns: a lack of identification of IPV even 2005; 101(29):68-9. among cases with a documented, substantiated history, and a lack of strong protections being ordered even Kent G. Response to "Breastfeeding and human rights" (J among cases in which a history of substantiated IPV is Hum Lact. 2003; 19:357-361). J Hum Lact 2004; known to exist. 20(2):146-7; author reply 148. Kerns KA, Aspelmeier JE, Gentzler AL, Grabill CM. Kent H. Edmonton tackles shaken baby syndrome. CMAJ Parent-child attachment and monitoring in middle 2003; 168(2):207. childhood. J Fam Psychol 2001; 15(1):69-81. Abstract: Research on parent-child attachment and Keown LJ, Woodward LJ. Early parent-child relations and parental child rearing practices has been pursued family functioning of preschool boys with pervasive independently. The purpose of the present study was to hyperactivity. J Abnorm Child Psychol 2002; test whether a secure attachment relationship is related 30(6):541-53. to parental monitoring and child efforts to contribute to Abstract: This study examined the quality of parent- the monitoring process. This question was examined in child relationships and family functioning of preschool a cross-sectional study of third- and sixth-grade children with early onset hyperactivity by comparing a children and their parents. Attachment-based measures community sample of 33 pervasively hyperactive were used to tap child and parent perceptions of preschool boys with a comparison sample of 34 boys. attachment. Monitoring (i.e., parents' awareness of Mothers and children were assessed at home on a range children's whereabouts and activities) was assessed of interview, parent questionnaire, and observational through phone interviews with children and parents. measures of parenting and family functioning. Results Child contributions to monitoring were assessed with parent and child questionnaires. A more secure 615
- 624. attachment was relatedto closer monitoring and greater improving child health, it also challenges our current cooperation by the child in monitoring situations, perception of such programmes. Standard newborn especially at sixth grade. The findings illustrate the screening programmes are clearly justified by the fact importance of embedding attachment within a larger that early detection and treatment of affected child rearing context. individuals avoids significant morbidity and mortality. However, proposals to expand the scope and Kerr E, Cottee C, Chowdhury R, Jawad R, Welch J. The complexity of such testing are not all supported by a Haven: a pilot referral centre in London for cases of similar level of evidence for unequivocal benefit. We serious sexual assault. BJOG 2003; 110(3):267-71. argue that screening for genetic susceptibility to Abstract: OBJECTIVE: Several schemes have been complex disorders is inherently different from standard reported to improve treatment of rape and to encourage screening and, while of potential value, must be reporting. The development of a comprehensive considered separately from conventional testing. forensic and follow up service for complainants of sexual assault is described, and activities of the first Kershner M, Anderson JE. Barriers to disclosure of abuse year are reviewed. DESIGN: Retrospective review of among rural women. Minn Med 2002; 85(3):32-7. case records of complainants examined in The Haven. Abstract: The purposes of this study were to examine SETTING: Department of Sexual Health in a London the prevalence of abuse (physical, emotional, and teaching hospital. SAMPLE: All case records, 676 sexual) in women seeking care in rural medical clinics complainants, from the first year of cases seen in The and WIC voucher pick-up sites, and to discover ways Haven. METHODS: Description of setting up a service of improving the response of health care providers to in partnership between the National Health Service and violence. Data were collected in 8 medical clinics and the Metropolitan Police, called The Haven. Analysis of 17 WIC supplemental food program sites in 9 counties a standardised proforma used for case records. of west central Minnesota during January and February RESULTS: Mean age of complainants is 26 years 1997. Fifteen percent of respondents reported having (range 11-66); 6% were male. Assailant was had a discussion about abuse with a health care categorised as a stranger in 52% of cases; attack provider. Six of the 8 symptoms and injuries most involved physical violence in 50% of cases; 24% of associated with abuse indicate diminished emotional victims had genital injuries; 39% had other physical health. A series of barriers are identified as substantial injuries. Immediate care given at time of forensic obstacles to obtaining help and revealing abuse to examination included 30% of women receiving health care providers. The most frequently reported emergency contraception and 5% of clients receiving barriers were self-reliance, reliance on God, and post-exposure prophylaxis against HIV. Fifty-five reliance on friends and family. These findings show percent of clients returned for a sexual health screen that a large percentage of rural women experience and/or counselling. Thirty-one percent received abuse and that their health is adversely affected. The screening for sexually transmitted infections and 12% barriers to disclosure of abuse reported in this study were diagnosed with one or more infections. illustrate the complexity of disclosing abusive CONCLUSIONS: Requirements following sexual relationships in rural and other settings. Low screening assault include forensic examination, first aid, levels suggest that rural health care providers can postcoital contraception, prevention and management develop additional opportunities to discuss abuse with of sexually transmitted infections and psychosocial their patients. support. Provision of these services within a sexual health setting is feasible. Keupp H. [Resource support as the basis of projects for the prevention of violence and addiction]. Prax Kerruish N. In that case: a Lead Maternity Carer (LMC) is Kinderpsychol Kinderpsychiatr 2004; 53(8):531-46. discussing newborn health checks with a pregnant Abstract: Lastingly effective projects for the prevention woman and her partner. Response. N Z Bioeth J 2003; of violence and addiction must ask which resources 4(1):38-40. adolescents require for coping with their lives. A Notes: GENERAL NOTE: KIE: 7 refs. central criteria for a successful life is the creation of GENERAL NOTE: KIE: KIE Bib: informed coherence in one's inner life and thus the basis for consent/minors; mass screening becoming capable of functioning in society. In earlier social eras, the readiness to take on ready-made Kerruish NJ, Robertson SP. Newborn screening: new identity packages was the central criteria for coping developments, new dilemmas. J Med Ethics 2005; with life. Today, this depends on individual adaptation 31(7):393-8. and identity work, and thus the capability for self- Notes: GENERAL NOTE: KIE: KIE Bib: genetic organisation, for "intentionality" or "embedding". screening; patient care/minors Children and young people need "free spaces" in their Abstract: Scientific and technological advances are worlds, in order to be able to outline themselves and to lending pressure to expand the scope of newborn act formatively upon their everyday environment. The screening. Whereas this has great potential for future prospects of adolescents depend upon their options for learning the "craft of freedom". Sustainable 616
- 625. key qualifications forcoping with life in globalised, about 70% of the women who were at risk of digital capitalism must grasp education as a hard- unintended pregnancy were not using any method of headed process in which the subject's capacity for self- contraception following OC discontinuation. Husband's organisation is to be given optimal encouragement, so education was positively associated with the that the patchwork of their own identity can succeed as substitution of OCs with another contraceptive method. a self-determined creative project. Effective OC use should be advocated through adequate counselling about how to take it correctly, the Kezic S, Mihanovic M, Zilic-Dzeba J, Sain I. Influence of possibility of side-effects and their proper management alcohol abuse of the father on the intensity of clinical and, more importantly, the possible alternative picture of posttraumatic stress disorder. Coll Antropol contraceptive method should OCs prove unsatisfactory 2005; 29(2):533-5. or unsuitable. Better provider-client interactions along Abstract: The subject of the study is the influence of with improved access to the newly established alcohol abusing father on the clinical picture of PTSD community clinics could be instrumental in the patient. The father plays an important identification continued and effective use of OCs. role in the psychological development of his son. Therefore it is to be expected that an alcohol abusing Khang YH, Cho SI, Yang S, Lee MS. [Socioeconomic father will become a (negative) role model for his son differentials in health and health related behaviors: and that he will also later on in stressful situations try findings from the Korea Youth Panel Survey]. J Prev to reduce the anxiety and depression by consuming Med Pub Health 2005; 38(4):391-400. larger quantities of alcoholic drinks. The aim of the Abstract: OBJECTIVE: This study examined the study is to find out whether there are differences in socioeconomic differentials for the health and health PTSD clinical picture in patients whose fathers abused related behaviors among South Korean middle school alcohol and in those whose fathers did not have such students. METHODS: A nationwide cross-sectional problem. The participating patients were from the interview survey of 3,449 middle school second-grade Psychiatric hospital "Sveti Ivan". Mississippi and students and their parents was conducted using a Watson scales were applied, as well as a questionnaire stratified multi-stage cluster sampling method. The named "Early traumas" from which the variable response rate was 93.3%. The socioeconomic position "alcohol abuse of the father" was selected. The analysis indicators were based on self-reported information shows that the participants who in their family histories from the students and their parents: parental education, had fathers who abused alcohol developed a milder father's occupational class, monthly family income, clinical picture of PTSD, i.e. they reactions to the stress out-of-pocket expenditure for education, housing later on were less sensitive compared to the control ownership, educational expectations, educational group of participants whose fathers did not abuse performance and the perceived economic hardships. alcohol and whose clinical pictures of the disorder The outcome variables that were measured were also were more severe. based on the self-reported information from the students. The health measures included self-rated Khan MA. Factors associated with oral contraceptive health conditions, psychological or mental problems, discontinuation in rural Bangladesh. Health Policy Plan the feelings of loneliness at school, the overall 2003; 18(1):101-8. satisfaction of life and the perceived level of stress. Abstract: Oral contraceptives (OCs) account for half of The health related behaviors included were smoking, all modern contraceptive methods used in Bangladesh, alcohol drinking, sexual intercourse, violence, bullying however, discontinuation remains fairly high in OC and verbal and physical abuse by parents. RESULTS: use. This paper identifies factors associated with Socioeconomic differences for the health and health discontinuation of OC use, where discontinuation related behaviors were found among the eighth grade refers to cessation of OC use in the 6 months prior to boys and girls of South Korea. However, the pattern the survey. The data for this study were drawn from a varied with gender, the socioeconomic position survey on OC compliance in rural Bangladesh. A total indicators and the outcome measures. The prevalence of 1600 OC users, current or past, aged 15 to 49 years rates of the overall dissatisfaction with life for both were interviewed; of these, 36% discontinued OC use. genders differed according to most of the eight Of the women who discontinued, 47% reported the socioeconomic position indicators. All the health experience of side-effects as the main reason for OC measures were significantly different according to the discontinuation. Multivariate analysis identified lack of perceived economic hardship. However, the fieldworker's visit as the strongest predictor of OC socioeconomic differences in the self-rated health discontinuation; women who were not visited by conditions and the psychosocial or mental problems fieldworkers had a four-fold risk of discontinuing OC were not clear. The students having higher use. Discontinuation of OC use decreased with socioeconomic position tended to be a perpetrator of increased duration of use and number of living bullying while those students with lower children. OC discontinuation was associated with side- socioeconomic position were more likely to be a effect experiences, lack of husband's support in OC use victim. CONCLUSIONS: The perceived economic and failure to purchase OCs. Of great concern is that hardships predicted the health status among the eighth 617
- 626. graders of SouthKorea. The overall satisfaction of life negatively influence the consent rate for perinatal was associated with the socioeconomic position autopsies. Intervention strategies aimed at changing indicators. Further research efforts are needed to nurses' attitudes should be considered. explore the mechanisms on how and why the socioeconomic position affects the health and health Kiesner J, Poulin F, Nicotra E. Peer relations across related behaviors in this age group. contexts: individual-network homophily and network inclusion in and after school. Child Dev 2003; Kharaboyan L, Avard D, Knoppers BM. Storing newborn 74(5):1328-43. blood spots: modern controversies. J Law Med Ethics Abstract: Peer relations across 2 contexts (in school 2004; 32(4):741-8. and after school) were examined for 577 participants, Notes: GENERAL NOTE: KIE: 41 refs. approximately 12 years old, from 3 middle schools in GENERAL NOTE: KIE: KIE Bib: blood donation; Milan, Italy. The primary research questions were: Do mass screening peer networks from different contexts uniquely contribute to explaining variance in individual Khong TY. Falling neonatal autopsy rates. BMJ 2002; behavior? Do measures of peer preference and peer 324(7340):749-50. network inclusion across contexts uniquely contribute to explaining individual depressive symptoms? Khong TY, Arbuckle SM. Perinatal pathology in Australia Structural equation models showed that both the in- after Alder Hey. J Paediatr Child Health 2002; school and the after-school peer networks uniquely 38(4):409-11. contributed to explaining variance in 2 types of individual problem behavior (in-school problem Khong TY, Turnbull D, Staples A. Provider attitudes about behavior, after-school delinquency), and that similarity gaining consent for perinatal autopsy. Obstet Gynecol with the 2 peer networks varied according to behaviors 2001; 97(6):994-8. specific to each context and across gender. Finally, Notes: GENERAL NOTE: KIE: 27 refs. both in-school and after-school peer network inclusion GENERAL NOTE: KIE: KIE Bib: informed consent contributed to explaining variance in depressive Abstract: OBJECTIVE: To examine the attitudes of symptoms, after controlling for classroom peer neonatologists, obstetricians, midwives, and neonatal preference. nurses toward perinatal autopsy and survey physicians about whom they perceive influence women's decisions Kiess W, Gausche R, Keller A, Burmeister J, Willgerodt H, on autopsy consent. METHODS: A postal survey that Keller E. Computer-guided, population-based incorporated a questionnaire of eight fictitious case screening system for growth disorders (CrescNet) and scenarios and combined three factors (confidence of on-line generation of normative data for growth and antemortem diagnosis, intention to have future development. Horm Res 2001; 56 Suppl 1:59-66. pregnancy, and parental attitude toward autopsy) in Abstract: The mean age at which the diagnosis of various permutations was sent to various Australian growth disorders such as Turner's syndrome, growth physicians and nurses (all consultant neonatologists hormone (GH) deficiency or true GH-dependent working in neonatal intensive care units and a sample gigantism is established is still rather late in many of consultant obstetricians, midwives, and neonatal countries around the world. In addition, the question of nurses in level III maternity hospitals). Respondents secular trends in a given population and the rate at were asked to rate how likely they were to seek consent which childhood obesity is increasing in industrialized for or suggest autopsies on a seven-point Likert scale countries make it mandatory to establish a time- (1 = certainly will not, 7 = certainly will). Interactions adapted system to develop percentiles for body height, between factors and respondents were measured by weight and body mass index (BMI) and also to develop analysis of variance, and differences were compared a screening system for growth disorders. In 1998 we using Mann-Whitney U, chi(2), and generalized established a network, now involving more than 160 estimating equation tests. RESULTS: The overall paediatric practices in Germany and seven paediatric response rate was 70% (neonatologists 57%, endocrinology departments. Paediatricians record obstetricians 62%, midwives 77%, and neonatal nurses heights, weights and growth velocities of all children in 75%). Neonatologists (median score 7, interquartile their care and systematically feed the data into the range 7, 7) were more likely to ask for autopsies than database at our centre usually by mailing formatted, neonatal nurses (5; 2, 6) (P <.001), as were structured data tickets. Data are then continuously obstetricians (7; 7, 7) compared with midwives (6; 3, 7) analysed at the centre and the paediatricians in the (P <.001). Physicians rated midwives and neonatal network are informed immediately about their nurses as having some to substantial influence on individual patients' growth situations via phone or E- mothers' decisions about consent for autopsy. mail (feedback system). Regular annual conferences CONCLUSION: Physicians are not averse to seeking including structured reports, scientific presentations consent for perinatal autopsies. Midwives and nurses and discussion groups are organized for all participants are influenced by the three factors studied, which might at our centre. By May 2001, the data of 83,721 children and adolescents had been analysed. The mean values 618
- 627. for height were1-1.5 cm higher than the mean values period. Most of these charges were paid by private in the German Synthetic Growth Curve, which serves insurers. CONCLUSIONS: This study provides as an internal standard. However, and most evidence supporting recent substantial increases in importantly, in comparison with the internal standard childhood ATV-related injuries. The hospitalization and historical normative data from Germany and impact of ATV-related injuries among children is Switzerland, there is a continuous increase in the 97th considerable. Our data support the need for ongoing percentile for weight and BMI, while the third creative attempts to identify effective strategies to percentile remains unchanged. In addition, many decrease ATV injuries among children. children with short stature and tall stature due to a variety of endocrine disorders and genetic diseases Kilpatrick DG, Ruggiero KJ, Acierno R, Saunders BE, which had not been diagnosed previously are now Resnick HS, Best CL. Violence and risk of PTSD, being identified. In conclusion, the databank allows for major depression, substance abuse/dependence, and a continuous adaptation of normative curves based on a comorbidity: results from the National Survey of large number of children in a given population, i.e. Adolescents. J Consult Clin Psychol 2003; 71(4):692- eastern Germany. Secondly, the system allows for 700. detection of pathological growth curves and is already Abstract: With a national household probability sample serving to diagnose growth disorders in a defined of 4,023 telephone-interviewed adolescents ages 12-17, population in a systematic way. this study provides prevalence, comorbidity, and risk- factor data for posttraumatic stress disorder (PTSD), Kihlstrom JF, McNally RJ, Loftus EF, Pope HG Jr. The major depressive episode (MDE), and substance problem of child sexual abuse. Science 2005; abuse/dependence (SA/D). Roughly 16% of boys and 309(5738):1182-5; author reply 1182-5. 19% of girls met criteria for at least 1 diagnosis. Six- month PTSD prevalence was 3.7% for boys and 6.3% Killingsworth JB, Tilford JM, Parker JG, Graham JJ, Dick for girls, 6-month MDE prevalence was 7.4% for boys RM, Aitken ME. National hospitalization impact of and 13.9% for girls, and 12-month SA/D prevalence pediatric all-terrain vehicle injuries. Pediatrics 2005; was 8.2% for boys and 6.2% for girls. PTSD was more 115(3):e316-21. likely to be comorbid than were MDE and SA/D. Abstract: OBJECTIVE: All-terrain vehicle (ATV) Results generally support the hypothesis that exposure injuries among children represent a significant and to interpersonal violence (i.e., physical assault, sexual growing problem. Although state-level analyses have assault, or witnessed violence) increases the risk of characterized some aspects of pediatric ATV-related these disorders and of diagnostic comorbidity. injuries, little information on the national impact on hospitalization is available. This study was designed to Kim HS. [Development of a sublimation program for characterize more fully the patterns of injury, hospital Korean adolescents' aggression.]. Taehan Kanho length of stay, and hospital charges associated with Hakhoe Chi 2004; 34(1):81-92. ATV-related injuries, with a nationally representative Abstract: PURPOSE: The purpose of this study was to sample. METHODS: Analyses were based on the 1997 identify a path diagram for the influence of family, and 2000 Healthcare Cost and Utilization Project Kids' personality, sexual abuse, drug abuse, coping Inpatient Database (KID). The KID is the only strategies, and aggressive impulsiveness on aggression, national, all-payer database of hospital discharges for and to develop a sublimation program for Korean children. KID data were weighted to represent all adolescent's aggression. METHOD: Data was collected discharges from general hospitals in the United States. by self-report questionnaires. Subjects consisted of Discharges with external cause-of-injury codes 2,111 adolescents. A proportional stratified random consistent with off-road ATV-related injuries were sampling method was used. The major instrument was selected, and the affected population was described. the Mental Health Questionnaire for Korean Nationally representative rates of ATV-related injuries Adolescents, and the Cronbach's Alpha ranged from.54 were calculated, and changes between 1997 and 2000 to.95 for each subscale. Statistical methods were Chi- were documented. RESULTS: An estimated 5292 square, correlation analysis, and path analysis. children were hospitalized because of ATV-related RESULT: The strongest contributing variables on injuries during the 2-year period, and hospitalizations aggression were person-related aggressive increased 79.1% between 1997 and 2000. Rates of impulsiveness, antisocial personality, self-injured ATV-related hospitalization were highest among aggressive impulsiveness, gender, sexual abuse, adolescent white male subjects, consistent with psychosomatic symptoms II, drug abuse, age, parent- previous studies. Most patients had hospital lengths of child relationship, alcohol abuse and cognitive stay of <4 days (68%), but 10% had stays of >8 days. avoidance coping strategies in the order named. Also Injury severity varied considerably, with more than one the author developed a multi-systemic sublimation third of patients sustaining moderate to severe injuries. program for Korean adolescents's aggression. The Approximately 1% of hospitalizations resulted in in- multi-systemic sublimation program involves four hospital deaths. Total hospital charges for this injury domains including adolescents, parents, peers and mechanism were 74367677 dollars for the 2-year study community, and has several therapeutic sub-programs 619
- 628. for each domain.CONCLUSION: The ecology of Kinard EM. Characteristics of maltreatment experience and human development is composed of multiple, academic functioning among maltreated children. integrated levels of organization, including biological, Violence Vict 2001; 16(3):323-37. individual-psychological, social-interpersonal, cultural, Abstract: This article examined the impact of and historical levels. Therefore, this multi-systemic maltreatment characteristics on academic functioning sublimation program will prevent and decrease the rate in a sample of school-age maltreated children. Results of aggressive behavior among Korean adolescents. revealed several differences among three types of maltreatment subgroups (physical abuse, neglect, and Kim S, Brody GH. Longitudinal pathways to psychological sexual abuse) on characteristics of maltreatment adjustment among Black youth living in single-parent experience. Few maltreatment characteristics were households. J Fam Psychol 2005; 19(2):305-13. significantly related to measures of academic Abstract: A 5-wave model linking family and maternal functioning, but the findings suggest that the effects of functioning to youth psychological adjustment was maltreatment characteristics should be examined tested with 139 single-mother-headed African separately for different types of maltreatment. American families with young adolescents (mean age = 11 years at recruitment) living in the rural South. King G, Trocme N, Thatte N. Substantiation as a multitier Structural equation modeling indicated that an process: the results of a NIS-3 analysis. Child Maltreat accumulation of family risk factors at Wave 1 was 2003; 8(3):173-82. linked with maternal psychological functioning at Abstract: BACKGROUND: Previous studies on child Wave 2, which forecast competence-promoting maltreatment reporting have focused mainly on one parenting practices at Wave 3. These parenting level of substantiation. This article analyzes factors practices indirectly forecast youth externalizing and influencing the multitiered substantiation process. internalizing behaviors 2 years later at Wave 5, through METHOD: The 1993 Third National Incidence Study youth self-regulation at Wave 4. The hypothesized (NIS-3) data of substantiated and non-substantiated model was retested, controlling for Wave 1 youth reported incidents (N=7,263) of maltreatment were externalizing and internalizing behaviors. All paths analyzed. Substantiation was classified into three remained significant, indicating that the model categories: unfounded, indicated, and founded. accounted for change in youth psychological Independent variables included demographic adjustment across 4 years. characteristics, case-processing variables, and maltreatment characteristics. DATA ANALYSIS: Kimberly MB, Forte AL, Carroll JM, Feudtner C. Pediatric Bivariate and multiple logistic regression (MLR) do-not-attempt-resuscitation orders and public schools: analyses were calculated to determine whether a national assessment of policies and laws. Am J demographic and case processing variables predicted Bioeth 2005; 5(1):59-65. unfounded or founded/indicated dispositions. Second- Notes: GENERAL NOTE: KIE: 19 refs. level analysis examined demographic, case processing, GENERAL NOTE: KIE: KIE Bib: resuscitation orders and maltreatment characteristics as predictors of Abstract: Some children living with life-shortening founded or indicated status. RESULTS: These results medical conditions may wish to attend school without showed that 60.2% of CPS investigations conducted the threat of having resuscitation attempted in the event were evaluated as unfounded, about 22% were of cardiopulmonary arrest on the school premises. categorized as founded, and 17% were classified as Despite recent attention to in-school do-not-attempt- indicated. In the MLR analysis for the first level of resuscitation (DNAR) orders, no assessment of state substantiation, case processing variables were highly laws or school policies has yet been made. We significant predictors of founded/indicated status. In therefore sought to survey a national sample of the second-level substantiation MLR model, cases in prominent school districts and situate their policies in the mid-range income level (dollars 15,000-29,999) the context of relevant state laws. Most (80%) school had a lower probability (adjusted OR = .58, p = .02) of districts sampled did not have policies, regulations, or being founded than those of less than dollars 15,000, protocols for dealing with student DNARs. A similar and reports involving Hispanic children (OR = 3.04, p majority (76%) either would not honor student DNARs = .05) were more likely than the "all other" race-ethnic or were uncertain about whether they could. Frequent social classification to have been substantiated as contradictions between school policies and state laws founded. CONCLUSIONS: This analysis of NIS-3 data also exist. Consequently, children living with life- suggests that a three-tiered rather than a two-tiered shortening conditions who have DNARs may not have system is a more accurate representation of the CPS these orders honored if cardiopulmonary arrest were to substantiation process. Further analysis of occur on school premises. Coordinated efforts are substantiation patterns is required to provide a basis for needed to harmonize school district, state, and federal developing more effective investigation systems. approaches in order to support children and families' right to have important medical decisions honored. King JA, Mandansky D, King S, Fletcher KE, Brewer J. Early sexual abuse and low cortisol. Psychiatry Clin Neurosci 2001; 55(1):71-4. 620
- 629. Abstract: Post-traumatic stressdisorder (PTSD) is a frequently associated with fractures at other sites mental health disorder precipitated by a stressful event within the mandible, ipsilateral body fractures being that produces fear or terror in the individual. Post- the most common. CONCLUSIONS: Updated data on traumatic stress disorder studies, particularly in early the association of patient age and mechanism of injury sexual abuse, have been associated with with fracture pattern can guide treating physicians in neuroendocrine dysfunction, most notably the anticipating and diagnosing traumatic mandible hypothalamic-pituitary-adrenal (HPA) axis. Since the fractures. literature on PTSD and neuroendocrine factors in young subjects has been sparse, the present studies King TM, Rosenberg LA, Fuddy L, McFarlane E, Sia C, were designed to look at the basal functioning of the Duggan AK. Prevalence and early identification of HPA axis in response to early sexual abuse in girls language delays among at-risk three year olds. J Dev aged 5 to 7 years. Morning salivary samples were Behav Pediatr 2005; 26(4):293-303. collected for cortisol determination from subjects and Abstract: The aims of this study were fourfold: to controls who were scheduled for a physical exam by document the prevalence of language delays in a their pediatrician. The present study shows that sample of at-risk 3 year olds; to assess the effectiveness subjects who had been abused within the last couple of of a home visiting program in preventing early months had significantly lower cortisol in comparison language delays; to determine how often parents, to control subjects (age, social economic status and pediatric providers, and home visitors identified early race matched). The data suggest that children may have language delays; and to assess the effectiveness of a an impaired HPA axis after early trauma. home visiting program in improving early identification of language delays. The Preschool King RE, Scianna JM, Petruzzelli GJ. Mandible fracture Language Scale, Third Edition (PLS-3) was patterns: a suburban trauma center experience. Am J administered to 513 at-risk 3 year olds participating in Otolaryngol 2004; 25(5):301-7. a randomized trial of home visiting services. Families Abstract: PURPOSE: Mandible fractures are among randomized to home visiting were expected to receive the most frequently seen injuries in the trauma center weekly to quarterly visits throughout the 3 years of this setting. Recent shifts in the mechanism and age study. The content of home visits included teaching distribution of patients sustaining these injuries are parents about child development, role-modeling well documented. This study attempts to define current, parenting skills, and linking families to a medical predictable patterns of fracture based on patient home. Identification of delays was measured using characteristics and mechanism of injury. MATERIAL structured parent interviews and review of primary care AND METHODS: The charts of 134 patients with 225 and home visiting records. At age 3 years, 10% of mandible fractures treated over a 7-year period by the children had severe language delays, defined as scoring Otolaryngology-Head and Neck Surgery, Plastic and >or=2 SD below the national mean on the PLS-3, Reconstructive Surgery and Oral-Maxillofacial Surgery whereas 49% scored >or=1 SD below the national services, our institution, were retrospectively reviewed. mean. No differences in prevalence were seen between Patients were categorized based on age, mechanism of children who did and did not receive home visiting. fracture, and anatomic location of fracture. Among children with severe delays, 42% were Multivariate analysis of data was performed to identified by parents, 33% by pediatric providers, and determine significant relationships among groups. 24% by home visitors. Among children with any RESULTS: Violent crimes such as assault and gunshot delays, 24% were identified by parents, 25% by wounds accounted for the majority of fractures (50%) pediatric providers, and 17% by home visitors. No in this study, with motor vehicle accidents less likely differences in rates of identification were seen between (29%). Overall, parasymphyseal fractures were most children who did and did not receive home visiting. frequent (35%), whereas angle and body fractures were Thus, while language delays were highly prevalent also common (15% and 21%, respectively). There was among these at-risk children, rates of identification a statistically significant association of motor vehicle were low, even among children with severe delays. accidents with parasymphyseal fractures (45%), and Home visiting was not effective in either preventing gunshot wounds with body fractures (36%), whereas language delays or improving early identification. This assault victims had a higher than predicted frequency suggests that pediatric providers and home visiting of angle fractures (27%) and fewer parasymphyseal programs need to reexamine their approaches to fractures (19%). Patients aged 17 to 30 were more recognizing and intervening with early language likely to suffer from gunshot wounds, whereas older delays. adults (age 31-50) were more likely to be assault victims. Patients over age 50 suffered fractures from King WJ, Klassen TP, LeBlanc J et al. The effectiveness of falls at a higher than expected rate. Although children a home visit to prevent childhood injury. Pediatrics and young adults seemed to suffer more 2001; 108(2):382-8. parasymphyseal fractures and older adults body Abstract: OBJECTIVE: To examine the effectiveness fractures, these correlations failed to show statistical of a home visit program to improve home safety and significance. Parasymphyseal fractures were most decrease the frequency of injury in children. We 621
- 630. examined the effectsof the program on 1) parental home injury (fall, scald, burn, poisoning or ingestion, injury awareness and knowledge; 2) the extent that choking, or head injury while riding a bicycle), a non- families used home safety measures; 3) the rate of targeted injury, or a medical illness. RESULTS: We injury; and 4) the cost effectiveness of the intervention. contacted 774 (66%) of the 1172 original participants. DESIGN: A randomized, controlled trial. SETTING: A A higher proportion of participants in the intervention multicenter trial conducted at 5 hospitals in 4 Canadian group (63%) reported that home visits changed their urban centers. PARTICIPANTS: Children <8 years knowledge, beliefs, or practices around the prevention old, initially enrolled in an injury case-control study, of home injuries compared with those in the non- were eligible to participate. Intervention. Subsequent to intervention group (43%; p<0.001). Over the 36 month a home inspection conducted to determine baseline follow up period the rate of injury visits to the doctor hazard rates for both groups, participants in the was significantly less for the intervention group (rate intervention group received a single home visit that ratio = 0.74; 95% CI 0.63 to 0.87), consistent with the included the provision of an information package, original (12 month) study results (rate ratio = 0.69; discount coupons, and specific instruction regarding 95% CI 0.54 to 0.88). However, the effectiveness of home safety measures. Main RESULTS: The median the intervention appears to be diminishing with time age was 2 years, with males comprising ~60% of (rate ratio for the 12-36 month study interval = 0.80; participants. The experimental groups were comparable 95% CI 0.64 to 1.00). CONCLUSIONS: A home safety at outset in terms of case-control status, age, gender, visit was able to demonstrate sustained, but modest, and socioeconomic status. Parental injury awareness effectiveness of an intervention aimed at improving and knowledge was high; 73% correctly identified home safety and reducing injury. This study reinforces injury as the leading cause of death in children, and an the need of home safety programs to focus on passive intervention effect was not demonstrated. The adjusted intervention and a simple well defined message. odds ratios (ORs) for the home inspection items indicated that significant safety modifications only Kinnair D. Put the child first. Interview by Pat Healy. Nurs occurred in the number of homes having hot water not Stand 2003; 18(4):16-7. exceeding 54 degrees C (OR: 1.31, 95% confidence interval [CI]: 1.14, 1.50) or the presence of a smoke Kinsley M. The thin line between love and lust. Time 2002; detector (OR: 1.45, 95% CI: 0.94, 2.22). However, the 159(17):49. intervention group reported home safety modifications of 62% at 4 months and significantly less injury visits Kipp J, Killick L, Kipp W. Predicting in-home time of to the doctor compared with the nonintervention group community care professionals. Int J Health Care Qual (rate ratio: 0.75; 95% CI: 0.58, 0.96). The total costs of Assur Inc Leadersh Health Serv 2002; 15(1):11-6. care for injuries were significantly lower in the Abstract: The aim of this study was to test whether the intervention group compared with the nonintervention client homebound score (CHS), the case management group with a cost of $372 per injury prevented. intensity score (CMIS) and the client priority visit CONCLUSIONS: An intervention using a single home score (CPVS) could be used to predict in-home time of visit to improve the extent to which families use safety professional caregivers in the Aspen community care measures was found to be insufficient to influence the program. A random sample of 34 community care long-term adoption of home safety measures, but was clients from the different geographical areas of the effective to decrease the overall occurrence of injuries. Aspen Regional Health Authority was selected and the Future programs should target a few, well-focused, home visits for each client were tracked for three evidence-based areas including the evaluation of high- months. Information such as client demographics, the risk groups and the effect of repeated visits on client diagnostic category, number and in-home time of outcome. visits was collected. In addition, the CHS, the CMIS and the CPVS were measured for each client. Data King WJ, LeBlanc JC, Barrowman NJ et al. Long term were analyzed, using a robust variance estimator effects of a home visit to prevent childhood injury: regression model. CMIS was found to be the best three year follow up of a randomized trial. Inj Prev predictor of in-home time (coefficient 9.521, p > 2005; 11(2):106-9. 0.001), followed by the CHS and the CPVS. Abstract: OBJECTIVE: To assess the long term effect of a home safety visit on the rate of home injury. Kirby S. Bias, innateness and domain specificity. J Child DESIGN: Telephone survey conducted 36 months after Lang 2004; 31(4):927-30; discussion 963-8. participation in a randomized controlled trial of a home safety intervention. A structured interview assessed Kirisci L, Tarter RE, Vanyukov M, Reynolds M, Habeych participant knowledge, beliefs, or practices around M. Relation between cognitive distortions and injury prevention and the number of injuries requiring neurobehavior disinhibition on the development of medical attention. SETTING: Five pediatric teaching substance use during adolescence and substance use hospitals in four Canadian urban centres. disorder by young adulthood: a prospective study. PARTICIPANTS: Children less than 8 years of age Drug Alcohol Depend 2004; 76(2):125-33. presenting to an emergency department with a targeted 622
- 631. Abstract: OBJECTIVE: Previousresearch has reported that hospital professionals failed to negotiate demonstrated that neurobehavior disinhibition the transfer of caregiving responsibility to parents. increases the risk for a diagnosis of substance use CONCLUSIONS: Services need to work in partnership disorder (SUD). This investigation tested the with families and with each other at both strategic and hypothesis that a deficiency in the capacity to appraise operational levels, to develop integrated and co- the effects of alcohol and drugs and interpret social ordinated services that can meet the needs of this group interactions mediates the relation between of families. neurobehavior disinhibition in childhood and SUD by early adulthood. METHODS: Boys with fathers having Kiros GE, White MJ. Migration, community context, and lifetime SUD (N=88) and no SUD or other psychiatric child immunization in Ethiopia. Soc Sci Med 2004; disorder (N=127) were prospectively tracked from ages 59(12):2603-16. 10-12 to 19 years. Neurobehavior disinhibition was Abstract: This paper examines the relationship between evaluated at baseline followed by assessments of parental migration status and child immunization in cognitive distortions and substance use involvement in Southern Ethiopia, a region characterized by high early and mid-adolescence. SUD outcome was mortality and morbidity. Using the 1997 Community evaluated up to age 19 years. RESULTS: Cognitive and Family Survey and a multilevel modeling distortions (age 12-14 years) mediated the association approach, we find that children born to rural-rural between neurobehavior disinhibition (age 10-12 years) migrant mothers have significantly less chance of and marijuana use (age 16 years) which, in turn, receiving full immunization coverage than children predicted SUD by age 19 years. Cognitive distortions born to non-migrant mothers. The social mechanism in early adolescence did not directly predict SUD by that explains this huge disparity is that rural-rural young adulthood. CONCLUSIONS: Inaccurate social migrant women have limited social networks in the cognition, significantly predicted by childhood host community. In addition, significant variation in neurobehavior disinhibition, biases development receiving complete immunization is found by age of toward marijuana use prodromal to SUD. These results child (a likely period effect), mother's education, and indicate that cognitive processes, in conjunction with distance to nearest health center. Marked child psychological self-regulation, comprise important immunization differentials are also observed by components of the individual liability to SUD. ethnicity. The results from the multilevel analysis confirm the persistence of substantial community Kirk S, Glendinning C. Developing services to support effects, even after controlling for a standard array of parents caring for a technology-dependent child at personal and household characteristics. Given the low home. Child Care Health Dev 2004; 30(3):209-18; levels of vaccination among children born to migrant discussion 219. women, health policy interventions and information Abstract: BACKGROUND: A group of children with campaigns might be effectively augmented to reach complex health care needs have emerged as a result of such migrant women and their children. Community medical advances and government policies and ethnic group effects suggest that further targeting emphasizing the community as the arena for care. of health activities could be efficient and effective. Some of these children remain dependent on the medical technology that enabled them to survive and Kisida N, Holditch-Davis D, Miles MS, Carlson J. Unsafe require care of a complex and intensive nature to be caregiving practices experienced by 3-year-old children carried out by their parents at home. AIMS: To explore born prematurely. Pediatr Nurs 2001; 27(1):13-8, 23-4. the experiences of families caring at home for a Abstract: Unsafe caregiving practices were studied in technology-dependent child; to examine their needs for relation to risk factors for unintentional injuries as practical and other support; and to examine how far reported in the literature. A total of 54 premature services are currently meeting these needs. Methods In- children at 3 years of age and their mothers were depth interviews were conducted with the parents of 24 observed twice in their homes for 2-hour periods, and technology-dependent children and with 44 health, the HOME Inventory was scored at one of the visits. social care and other professionals. RESULTS: Field notes from these visits were analyzed for unsafe Services in the community were not sufficiently practices, including hazards in the environment and developed to support this group of families. Major inadequate parental supervision. Unsafe practices problems were identified in the purchasing and occurred for approximately 30% of the children provision of both short-term care/home support studied. T-tests indicated that children with no unsafe services and specialist equipment/therapies in the practices had higher HOME scores than children with community. Service provision could be poorly planned unsafe practices. In addition, lower HOME scores and and co-ordinated at an operational level and few later birth order were correlated with a greater number families had a designated key worker. Parents felt that of unsafe practices. Maternal age and education, family professionals did not always recognize either the size, child birthweight, and maternal perception of emotional costs entailed in providing care of this nature child vulnerability were not related to the presence of or their expertise in caregiving. Information-giving to unsafe caregiving practices. The findings also suggest parents was often described as poor and participants that the HOME Inventory may have promise as a 623
- 632. useful tool inscreening for unsafe caregiving of Klein M. [Child of drug addicted parents--facts, risks, preschool children. solutions]. Kinderkrankenschwester 2005; 24(6):230-4. Kiss C. Third joint meeting of Rumanian and Hungarian Kleinbard P. The New York City Beacons: rebuilding pediatric hematologists/oncologists. Med Pediatr Oncol communities of support in urban neighborhoods. New 2002; 38(5):368. Dir Youth Dev 2005; (107):27-34, table of contents. Abstract: Established in 1991 in New York City and Kitamura T. [Early-rearing experience and environment as now operating in at least seven other cities, Beacons etiological factors for adult-onset depressive disorder]. are designed to rebuild communities of support for Seishin Shinkeigaku Zasshi 2004; 106(1):84-7. children and youth in urban neighborhoods. The Beacon framework is based on research findings and Kivitie-Kallio S, Tupola S. [Shaken baby syndrome]. practitioner experience indicating that programs taking Duodecim 2004; 120(19):2306-12. a youth development approach are more effective than those focused on "fixing" specific youth problems. Klahr D. Commentary: new kids on the connectionist Successful Beacon programs provide positive ways to modeling block. Dev Sci 2004; 7(2):165-6. meet young people's need for safety, a sense of belonging, and mastery; they also provide opportunities Klassen AF, Lee SK, Barer M, Raina P. Linking survey data for decision making and contributing to others. There with administrative health information: characteristics are currently eighty Beacons in New York City, associated with consent from a neonatal intensive care serving about 140,000 youth and adults annually. unit follow-up study. Can J Public Health 2005; Beacons have been replicated in several parts of the 96(2):151-4. country, including Denver, Minneapolis, Oakland, Abstract: BACKGROUND: Health services and Palm Beach County, Philadelphia, San Francisco, and population health research often depends on the ready Savannah. The Youth Development Institute of the availability of administrative health data. However, the Fund for the City of New York provides technical linkage of survey-based data to administrative data for assistance and training to Beacons in New York City health research purposes has raised concerns about and in all seven replication sites. privacy. Our aim was to compare consent rates to data linkage in two samples of caregivers and describe Kleinman PK. Hangman's fracture caused by suspected child characteristics associated with consenters. METHODS: abuse. J Pediatr Orthop B 2004; 13(5):348; author Subjects included caregivers of children admitted at reply 348. birth to neonatal intensive care units (NICU) in British Columbia and caregivers of a sample of healthy Kljakovic M, Parkin C. The presence of medical students in children. Caregivers were asked to sign a consent form practice consultations. Rates of patient consent. Aust enabling researchers to link the survey information Fam Physician 2002; 31(5):487-9. with theirs and their child's provincially collected Abstract: OBJECTIVE: To measure the frequency of health records. Bivariate analysis identified sample nonconsent encountered by medical students and characteristics associated with consent. These were describe the influence of gender. METHOD: An entered into logistic regression models. RESULTS: observational study of general practice teaching The sample included 1,140 of 2,221 NICU children consultations. RESULTS: Subjects: 63 students (40% and 393 of 718 healthy children. The overall response female), 67 general practitioners (30% female), and rate was 55% and the response rate for located families 2572 patients (56% female). Outcome: 3.4% of all was 67.1%. Consent to data linkage with the child data patients (79% female) did not give consent (4.6% for was given by 71.6% of respondents and with caregiver male students; 1.6% for female; OR = 3.0, 95% CI 1.7- data by 67% of respondents. Families of healthy 5.3). The rates of nonconsent did not vary between age children were as likely to provide consent as families groups for men but occurred mainly in the 15-44 years of NICU children. Higher rates of consent were age group for women. Male students encountered more associated with being a biological parent, not requiring nonconsenting female patients than female students, survey reminders, involvement in a parent support particularly in consultations with female GPs. group, not working full-time, having less healthy CONCLUSION: Consent to allow medical students to children, multiple births and higher income. be present in general practice consultations is usually CONCLUSION: The level of consent achieved provided. It is typically declined for male students by suggests that when given a choice, most people are young women attending women doctors. willing to permit researcher access to their personal health information for research purposes. There is Klosinski G. [Child sexual abuse. How to deal with scope for educating the public about the nature and suspected abuse?]. MMW Fortschr Med 2001; importance of research that combines survey and 143(5):29-31. administrative data to address important health Abstract: Sexual abuse in children is defined as the questions. exploitation of children by adults for the sexual 624
- 633. gratification of thelatter. A particular problem is Kmietowicz Z. MPs call for smacking to be outlawed. BMJ sexual violence within the family. The chronicity of the 2003; 326(7404):1414. abuse, by means of which the child is precipitated into role conflicts is typical. Whether inside or outside the Knapp JF, Soden SE, Dasouki MJ, Walsh IR. A 9-month-old family, sexual abuse almost always has negative effects baby with subdural hematomas, retinal hemorrhages, on the child's development. When such abuse is and developmental delay. Pediatr Emerg Care 2002; suspected, a gentle physical examination and an 18(1):44-7. empathetic age-adapted psychiatric diagnostic work-up are indicated. The overriding objective of an Knight DB. Neonatal shaken baby syndrome--lessons to be intervention is to protect the child. The indication of learned. Arch Dis Child Fetal Neonatal Ed 2003; psychotherapy is determined by the severity of the 88(2):F161; author reply F161-2. symptomatology. Among other things, prevention strategies are aimed at increasing the autonomy of the Knight S, Olson LM, Cook LJ, Mann NC, Corneli HM, child. Dean JM. Against all advice: an analysis of out-of- hospital refusals of care. Ann Emerg Med 2003; Kluge EH. Canada, the U.S., and the NICU: cultural 42(5):689-96. differences and ethical consequences. J Clin Ethics Abstract: STUDY OBJECTIVE: We examine the 2001; 12(3):297-301. characteristics of patients involved in out-of-hospital Notes: GENERAL NOTE: KIE: Kluge, Eike-Henner emergency medical services (EMS) incidents that W result in refusal of care and determine the rates of GENERAL NOTE: KIE: 9 refs. subsequent EMS, emergency department (ED), and GENERAL NOTE: KIE: KIE Bib: health care/foreign inpatient care, as well as death within 7 days. countries; patient care/minors; resource METHODS: Utah statewide EMS data identifying allocation/biomedical technologies refusals of care were probabilistically linked to Utah statewide ED, inpatient, and death certificate data Kluger Y, Mayo A, Hiss J et al. Medical consequences of within 7 days of the initial EMS refusals for 1996 to terrorist bombs containing spherical metal pellets: 1998. Refusals were defined as incidents in which field analysis of a suicide terrorism event. Eur J Emerg Med treatment or transport was refused and did not include 2005; 12(1):19-23. incidents in which EMS providers deemed care or Abstract: OBJECTIVE: Various metal objects added to transport unnecessary. RESULTS: Of 277244 EMS explosives increase and diversify the wounding from incidents, 14109 (5.1%) resulted in refusals of care. For bombing; especially favoured are spherical missiles for all age groups, motor vehicle crash dispatches resulted their special injuring characteristics. Our objective was in the highest rate of refusal of care, ranging from 8.0% to study the medical consequences and ballistic effects to 11.7%. Slightly more than 3% of patients involved on human tissue of spherical metal pellets used in in a refusal of care incident had a subsequent EMS terrorist bombings. METHODS: The clinical and dispatch within a week. One fifth of the patients forensic data of all bodily injured casualties of a involved in EMS refusals of care had a subsequent ED suicide terrorist bombing in a crowded hotel dining visit. Less than 2% of the EMS refusal patients were room were analysed retrospectively. RESULTS: Of the hospitalized; hospitalization was highest among 250 people at the scene, 164 were injured, with 91 children younger than 3 years and adults older than 64 (55.5%) suffering bodily injuries; 30 of them died. The years. Twenty-five adults died within a week of immediately deceased had disseminated tissue damage refusing EMS care, of whom 19 (76.0%) were older and their bodies were saturated with steel spheres. than 64 years. CONCLUSION: Refusal of care Thirty-two immediate survivors sustained severe incidents are a small segment of all EMS incidents. injuries (Injury Severity Score > or =16), and all They arise from a variety of situations, and the risk for suffered tissue penetration by the pellets. Twenty-three missed intervention may be minimal. (32%) underwent surgery and 15 (21%) required intensive care. CONCLUSIONS: Metal pellets Knoester PD, Belitser SV, Deckers CL et al. Patterns of propelled by the explosion enhanced the secondary lamotrigine use in daily clinical practice during the first pattern of injury and injured even patients remote from 5 years after introduction in the Netherlands. J Clin the origin. Tissue destruction and specific organ Pharm Ther 2004; 29(2):131-8. injuries among survivors were limited. To evaluate and Abstract: OBJECTIVE: Follow-up data on the long- manage victims of terrorist bombings properly, medical term effectiveness (efficacy and tolerability) of teams should become familiar with these severe lamotrigine are limited. A useful though crude measure injuries. for effectiveness in daily clinical practice is the treatment retention rate determined from drug Kmietowicz Z. Children face same social problems as they dispensing data. This study describes the baseline did 100 years ago. BMJ 2005; 330(7484):163. characteristics, the usage patterns and the retention rate of this antiepileptic drug (AED) in a population-based 625
- 634. cohort of lamotrigineusers in the Netherlands during development of children's aggression: a replication and the first 5 years after its registration in 1995. Data from extension. Child Maltreat 2005; 10(2):92-107. this cohort are compared with those from the initial Abstract: To understand the effects of neglectful randomized clinical trials (RCTs) in patients with parenting, poor supervision, and punitive parenting in refractory epilepsy. METHODS: This retrospective the development of children's aggression, 218 children cohort study used dispensing data from community ages 4 to 8 years who were disadvantaged and their pharmacies. Baseline characteristics and usage patterns mothers were recruited from two states to develop a were evaluated for first time users of lamotrigine in this sample that was diverse with respect to degree of study. Usage patterns were characterized as continued, urbanization and ethnicity. Multimethod and add-on or discontinued use during the patient multisource indices of the predictive constructs (Social observation time window. Cox regression analysis was Disadvantage, Denial of Care Neglect, Supervisory used to explore possible relationships between baseline Neglect, and Punitive Discipline) and the criterion characteristics and specific usage patterns defined. The construct (Aggression) were used in a test of a baseline characteristics and discontinuation rates in this theoretical model using structural equation modeling. cohort study were compared with RCT data reported in The results established the role of care neglect, medical literature. RESULTS: A total of 3598 supervisory neglect, and punitive parenting as lamotrigine users were identified. The mean age of the mediators of the role of social disadvantage in the population was 39 years and 54% were female. On development of children's aggression, the importance average, patients used two other AEDs at the start of of distinguishing between two subtypes of neglect, and lamotrigine therapy and approximately 6% of the the need to consider the role of discipline in concert patients had no history of prior AED use. The with neglect when attempting to understand the discontinuation rate was 25% after 1 year, and parenting in the development of aggression. approximately 32% at the end of the 5-year study. Addition of another drug or discontinuation was seen Knutson JF, Johnson CR, Sullivan PM. Disciplinary choices in more than half of the population 3 years after the of mothers of deaf children and mothers of normally start of therapy. Concurrent use of valproic acid was hearing children. Child Abuse Negl 2004; 28(9):925- associated with a better retention rate. Absence of AED 37. history, use of antidepressants, or use of migraine Abstract: OBJECTIVE: To assess the disciplinary abortive drugs resulted in an increased likelihood of preferences of mothers of profoundly deaf children and discontinuing lamotrigine. The population from RCTs normally hearing children in a test of the hypothesized differed from the study cohort with respect to age, link between child disabilities and punitive parenting. concurrent use of AEDs and length of follow-up. METHOD: Disciplinary preferences of mothers CONCLUSION: Data from RCTs cannot easily be seeking a cochlear implant for their profoundly deaf extrapolated to daily clinical practice. In this large, child (n=57), mothers not seeking an implant for their observational study, lamotrigine therapy failed in a deaf child (n=22), and mothers of normally hearing considerable number of patients, although the mean children (n=27) were assessed using an analog task in retention rate was better than previously reported by which subjects select discipline in response to slide others. Population-based linkage of health care records images of children engaging in normative or frankly can be used to further clarify the effectiveness of deviant behaviors that are potentially irritating. lamotrigine. RESULTS: Results indicated that mothers of children with profound hearing impairments were more likely to Knoppers BM, Avard D, Cardinal G, Glass KC. Science and select physical discipline in response to depicted child society: children and incompetent adults in genetic transgressions and more likely to escalate to physical research: consent and safeguards. Nat Rev Genet 2002; discipline when the depicted child was described as 3(3):221-5. persisting in the transgression. Additionally, escalation Notes: GENERAL NOTE: KIE: KIE Bib: genetic was more probable in response to scenes depicting research; human experimentation/informed consent; children engaged in dangerous and destructive acts human experimentation/special populations than in rule-violating acts. CONCLUSIONS: Findings Abstract: Recent changes to the legal and ethical were consistent with the hypothesized link between criteria that govern the inclusion of children and childhood disabilities and child maltreatment as well as incompetent adults in genetic research are likely to lead the hypothesis that children with disabilities associated to advances in research, but might leave the rights of with communication problems could be at risk of the participants in this research in need of additional physical abuse. safeguards. Here, we discuss why this might be and propose policy considerations that could help to protect Kochanska G, Aksan N, Nichols KE. Maternal power the rights of these particularly vulnerable groups of assertion in discipline and moral discourse contexts: research participants. commonalities, differences, and implications for children's moral conduct and cognition. Dev Psychol Knutson JF, DeGarmo D, Koeppl G, Reid JB. Care neglect, 2003; 39(6):949-63. supervisory neglect, and harsh parenting in the Abstract: Parental power assertion is traditionally 626
- 635. studied in thebehavioral domain--discipline triggered randomization (P<.001 for each). Discussion of by the child's immediate misbehavior--but rarely in the specific clinical trial details and the presence of a nurse cognitive domain--parent-child discussions of the during the conference were associated with child's past misbehavior. Maternal power assertion was understanding. Eighty-four percent of children were observed in "do" and 'don't" discipline contexts from enrolled in a leukemia trial. CONCLUSIONS: Despite 14 to 45 months and in the context of mother-child oral and written explanation, half of the parents in this discourse about a recent misbehavior at 56 months. study did not understand randomization for childhood Mothers' use of power cohered across the "do," 'don't," leukemia trials. To make informed consent more and discourse contexts, but its implications were effective, future research must seek to improve domain specific. Power assertion in the 'don't" communication during this critical interchange. discipline context predicted behavioral outcomes (more moral conduct at 56 and 73 months, less antisocial Koelsch S, Fritz T, Schulze K, Alsop D, Schlaug G. Adults conduct at 73 months) but not cognitive outcomes and children processing music: an fMRI study. (moral cognition at 56 and 73 months). Power assertion Neuroimage 2005; 25(4):1068-76. in the discourse context predicted less mature moral Abstract: The present study investigates the functional cognition but not moral or antisocial conduct. Mothers' neuroanatomy of music perception with functional high Neuroticism predicted more power assertion in all magnetic resonance imaging (fMRI). Three different three contexts. Child effects were examined. subject groups were investigated to examine developmental aspects and effects of musical training: Kochansky GE, Herrmann F. Shame and scandal: Clinical 10-year-old children with varying degrees of musical and Canon Law perspectives on the crisis in the training, adults without formal musical training priesthood. Int J Law Psychiatry 2004; 27(4):299-319. (nonmusicians), and adult musicians. Subjects made judgements on sequences that ended on chords that Kodish E, Eder M, Noll RB et al. Communication of were music-syntactically either regular or irregular. In randomization in childhood leukemia trials. JAMA adults, irregular chords activated the inferior frontal 2004; 291(4):470-5. gyrus, orbital frontolateral cortex, the anterior insula, Notes: GENERAL NOTE: KIE: 39 refs. ventrolateral premotor cortex, anterior and posterior GENERAL NOTE: KIE: KIE Bib: human areas of the superior temporal gyrus, the superior experimentation/informed consent; human temporal sulcus, and the supramarginal gyrus. These experimentation/minors structures presumably form different networks Abstract: CONTEXT: Most children diagnosed as mediating cognitive aspects of music processing (such having leukemia become research subjects in as processing of musical syntax and musical meaning, randomized clinical trials (RCTs), but little is known as well as auditory working memory), and possibly about how randomization is explained to or understood emotional aspects of music processing. In the right by parents. OBJECTIVE: To investigate physicians' hemisphere, the activation pattern of children was explanation and parental understanding of similar to that of adults. In the left hemisphere, adults randomization in childhood leukemia RCTs. DESIGN showed larger activations than children in prefrontal AND SETTING: A multisite study of the informed areas, in the supramarginal gyrus, and in temporal consent communication process for RCTs of childhood areas. In both adults and children, musical training was leukemia. Consecutive cases were recruited from correlated with stronger activations in the frontal pediatric oncology inpatient wards at 6 US children's operculum and the anterior portion of the superior hospitals associated with major academic medical temporal gyrus. centers from July 1, 1999, until December 31, 2001. The informed consent conferences were observed and Koh TH, Collie L, Budge D, Butow P. Informed consent in audiotaped, and the information obtained was coded neonatal randomised trials. Lancet 2001; and analyzed. Parents were interviewed shortly after 357(9266):1445-6. the conference to ascertain their understanding. Notes: GENERAL NOTE: KIE: 4 refs. PARTICIPANTS: Parents and members of the health GENERAL NOTE: KIE: KIE Bib: human care team who participated in 137 informed consent experimentation/informed consent; human conferences for children with newly diagnosed acute experimentation/minors leukemia. MAIN OUTCOME MEASURES: Observed explanations of randomization and parental Kohlhaas M, Wiegmann L, Gaszczyk M, Walter A, understanding of randomization after the consent Schaudig U, Richard G. [Lacrimal duct treatment with conference. RESULTS: Randomization was explained ring intubation in injuries of the upper and lower by physicians in 83% of cases and a consent document eyelids]. Ophthalmologe 2001; 98(8):743-6. was presented during the conference in 95% of cases. Abstract: BACKGROUND: Treating injuries of the Interviews after the conference demonstrated that 68 lacrimal system with a silicon intubation is an (50%) of 137 parents did not understand approved method to prevent post-traumatic epiphora. randomization. Parents of racial minority and lower MATERIALS AND METHODS: Between 1990 and socioeconomic status were less likely to understand 627
- 636. 1999, operations werecarried out on 44 patients with scores. The childrearing practices, maternal injuries of the canaliculi with silicon ring intubations. socioeconomic status (SES) and age, and infants' Interesting for us were the age distribution, causes of gestational age at birth (GA) explained 45% of the injuries, localisation and mid- to long-term variance in infants' cognitive scores. The infants' GA, postoperative complications. RESULTS: The age of maternal SES and age, and NCATS scores accounted the patients was between 1.75 and 74 years, 48% of the for 32% of the motor scores on the BSID II. injuries were caused by household accidents, 23% by DISCUSSION AND CONCLUSION: The findings violence, 20% by traffic accidents and 9% by job- partially support a link between aspects of the mothers' related accidents. The canaliculus inferior was injured childrearing behaviors and their infants' cognitive in 68% of all patients. We found 10 postoperative developmental status. For motor developmental status, complications, e.g. ectropia, a too long silicon ring or the association appeared stronger with the infants' granuloma. We found a positive anatomical readapted characteristics than with maternal childrearing lacrimal system in 88% and 12% of our patients practices and behaviors tested in this study. complained of distinct to severe epiphora. CONCLUSIONS: The treatment of lacrimal laceration Kolowski J, Nowak KM. [Infanticide in the light of post- with a silicon intubation is an excellent method but mortem findings and court files from the period 1990- special care should be taken with correct positioning of 2000 (selected problems)]. Arch Med Sadowej the lid margin. Kryminol 2005; 55(2):125-9. Abstract: Drawing upon 28 court files of the District Kolobe TH. Childrearing practices and developmental Court in Poznan and 30 post-mortem protocols--from expectations for Mexican-American mothers and the the Department of Forensic Medicine at Poznan developmental status of their infants. Phys Ther 2004; Medical Academy. This article tackles the issue of 84(5):439-53. infanticide in the period from 1990 to 2000. The aim of Abstract: BACKGROUND AND PURPOSE: The this paper was to find answers to the following impact of parent education programs on early questions: what was the social background and mental intervention programs is not thought to be uniform state of female offenders? How was infanticide among children from majority and minority committed? In order to solve certain research populations. This study examined the relationship problems, a document examination technique was between maternal childrearing practices and behaviors employed to analyse the contents of the documents and the developmental status of Mexican-American available. Female offenders were aged between 17 to infants. SUBJECTS: Participants were 62 Mexican- 42 years. In the majority of cases (56.7%), perpetrators American mother-infant pairs. The infants' mean were occupationally active, single young women with a adjusted age was 12 months (SD=1.7, range=9-14). A low level of education and having a working-class third of the children were diagnosed with background. In the majority of cases (80%), active developmental delays and referred for early infanticide was committed. Most frequently, infanticide intervention by physicians or therapists when the was committed by shutting a child into a tight space, children received their medical follow-up. The group and tamponade of throat and larynx. Passive infanticide was stratified according to socioeconomic status and was committed in 20% of cases, with infants left acculturation using the Bidimensional Acculturation without care at the place of birth. No case of psychosis Scale for Hispanics. This scale uses cutoff points to was determined in the examined material. classify individuals into 3 levels of acculturation. METHODS: Information on childrearing practices and Komen M. Physical child abuse and social change. Judicial behaviors was gathered using the Parent Behavior intervention in families in The Netherlands, 1960- Checklist (PBC), the Home Observation for 1995. Child Abuse Negl 2003; 27(8):951-65. Measurement of the Environment (HOME) Inventory, Abstract: OBJECTIVE: To show changes in the way and the Nursing Child Assessment Teaching Scale juvenile judges and judicial child protection workers (NCATS). Infants' developmental status was assessed deal with physical child abuse in the period 1960-1995 by use of the Bayley Scales of Infant Development II in the Netherlands. METHOD: The study is based on (BSID II). The Pearson product moment correlation, an analysis of files on adolescent and younger children partial correlations, Fisher z transformation, and placed by juvenile judges in the Dutch judicial child multiple regression analyses were used to examine the protection system during the 1960s, 1970s, 1980s, and relationship between childrearing practices and 1990s. RESULTS: The prevalence of very severe parenting behaviors, demographic factors, and infants' physical violence against children was lower in the developmental status. RESULTS: Maternal nurturing recent files than in the older files. Spanking and other behaviors, parent-child interaction, and quality of the minor violence acts were noted more often than in the home environment were positively correlated with the older files. In the 1960s files, the parents talked still infants' cognitive development. Maternal years of rather openly about the physical punishments they used education modified the observed relationship between in child rearing. In spite of the growing attention for PBC and BSID II scores but not the observed and increasing concern about child abuse among relationship between HOME Inventory and NCATS professionals, judicial child protection workers 628
- 637. intervened less harshlyin recent cases of physical child treatment preferred at their own institution over other abuse than in the 1960s. CONCLUSION: The decrease options even when they predict better outcomes from in severe physical child abuse may indicate that another approach. Further, many physicians do not physical child abuse is actually becoming a less serious disclose all reasonable management options to parents problem in the Dutch judicial child protection system. of infants with HLHS. These findings raise doubts as to But that may not be the case because of the increased whether parents are given adequate information to reluctance of parents to report and changes in make truly informed decisions. intervention practices. Other than expected, the growing sensibility for child abuse did not mean more Koniak-Griffin D, Anderson NL, Brecht ML, Verzemnieks effective control by judicial child protection workers. I, Lesser J, Kim S. Public health nursing care for Possible reasons for these changes are discussed, adolescent mothers: impact on infant health and including the strengthening of the position of selected maternal outcomes at 1 year postbirth. J perpetrators in law proceedings and the emancipation Adolesc Health 2002; 30(1):44-54. of children and women in society. Abstract: PURPOSE: To compare effects of an early intervention program (EIP) of intense home visitation Kon AA, Ackerson L, Lo B. How pediatricians counsel by public health nurses (PHNs) with effects of parents when no "best-choice" management exists: traditional public health nursing care (TPHN) on infant lessons to be learned from hypoplastic left heart health and selected maternal outcomes of adolescent syndrome. Arch Pediatr Adolesc Med 2004; mothers. METHODS: EIP adolescents (N = 102) 158(5):436-41. received preparation-for-motherhood classes and Notes: GENERAL NOTE: KIE: 23 refs. individual home visits (from pregnancy through 1 year GENERAL NOTE: KIE: KIE Bib: allowing to postpartum) from PHNs employed in a county health die/infants; informed consent/minors; patient department. Participants were predominantly Latina care/minors (64%) and African-American (11%) and from Abstract: BACKGROUND: Hypoplastic left heart impoverished backgrounds. Infant health outcomes syndrome (HLHS) is a life-threatening congenital were determined based on medical record data; cardiac defect. Three mutually exclusive management interviews and standardized questionnaires evaluated options exist: the Norwood palliative procedure, other program effects (e.g., maternal educational cardiac transplantation, and comfort care without achievement and psychological status). Data were surgical intervention. OBJECTIVES: To assess which analyzed using Chi-square and repeated measures management options are presented to parents of infants ANOVA. RESULTS: Infants of EIP mothers with HLHS, and to determine what factors influence experienced significantly fewer total days (n = 74) and physicians' recommendations. DESIGN: Cross- actual episodes (n = 14) of hospitalization during the sectional survey. SETTING: Fourteen of the largest first year of life than those receiving TPHN (n = 154, n pediatric cardiac surgery centers in the United States. = 24, respectively). Similarly, positive program effects PARTICIPANTS: Attending physicians in were found for immunization rates. There were no neonatology, cardiology, critical care practice, and group differences in emergency room visits or repeat cardiac surgery. INTERVENTION: A survey was pregnancy rates. Alcohol, tobacco, and marijuana use distributed asking physicians what options they present significantly increased from pregnancy through 1 year to parents of infants with HLHS and what their postpartum in both groups but remained markedly recommendations are in general, as well as physician lower than rates prior to pregnancy (lifetime rates). perceptions of HLHS outcomes and demographic CONCLUSIONS: These findings demonstrate the information. MAIN OUTCOME MEASURES: Which positive effects of a PHN home visitation program on options physicians discuss and which they recommend. health outcomes for children of adolescent mothers. RESULTS: Of 454 eligible physicians 257 (57%) Days of infant hospitalization were substantially responded to the survey, of which 110 make treatment reduced and immunization rates increased during the recommendations to parents. Neonatologists were least first year of life for children of EIP mothers. Greater likely to recommend surgery. Physicians who efforts need to be directed toward preventing repeat recommend surgery recommend procedures performed pregnancy and return to substance use following at their own institution over those performed elsewhere childbirth in at-risk adolescent mothers. (odds ratio, 2.80; 95% confidence interval, 2.24-3.51). Twenty-six percent of physicians do not discuss Konrad K, Gauggel S, Schurek J. Catecholamine functioning nonsurgical management, and 25% of those at centers in children with traumatic brain injuries and children that do not perform cardiac transplantation do not with attention-deficit/hyperactivity disorder. Brain Res discuss this option. The recommendations physicians Cogn Brain Res 2003; 16(3):425-33. make to parents are poorly associated with their Abstract: Recent studies suggest that children with predictions of postoperative outcomes. attention-deficit/hyperactivity disorder (ADHD) and CONCLUSIONS: Physician recommendations to children with traumatic brain injuries (TBI) show parents are poorly associated with their estimates of changes in similar neuronal networks, including the outcomes, and some physicians recommend the dopaminergic (DA) and norepinephrinergic (NA) 629
- 638. systems. Therefore, indirectmeasures of catecholamine Abstract: OBJECTIVE: The aim of this study was to activity were assessed. Twenty-six children with TBI, examine preschoolers' perceptions of maternal 31 children with ADHD, and 26 normal controls, 8 to discipline's unfairness. The participants' gender, age, 12 years of age, were investigated with a 90-min SES, family intactness and sibship size were examined cognitive test battery. Before and after the tests, urine for their possible relevance to such perceptions. samples were collected to measure catecholamine METHOD: Five vignettes, describing forms of activity in response to cognitive stress. Spontaneous discipline the literature suggests constitute eyeblinking as an indirect measure of DA activity was psychological maltreatment, were presented to 57 counted. Children with TBI and ADHD excreted preschoolers (27 boys and 30 girls). They included significantly more normetanephrine in resting excessive withdrawal of privileges, withdrawal of situations and less epinephrine (EPI) after cognitive entertainment, differential treatment of siblings, stress, and showed a decreased blink rate compared to threatening power assertion, and public humiliation. normal controls. Children with TBI also showed a The children had to decide on the fairness or unfairness higher excretion of metanephrine in the resting of each vignette in which a child was disciplined in situation in comparison to children with ADHD and each of these ways by his/her mother. They were then controls. Whereas children with ADHD showed a asked to offer an explanation for each of their choices. higher tonic activity of the NA system and a less RESULTS: Of the five forms of discipline employed in adaptive EPI excretion in response to cognitive stress, the vignettes, children judged differential treatment of children with TBI seem to be additionally impaired in siblings as more unfair than either power assertion their tonic EPI excretion. Our study provides further (threatening spanking), or public humiliation. No support for similar but also different neurobiochemical differences were found for withdrawal of privileges or characteristics in both groups. entertainment. Of the various predictor variables employed, preschoolers from smaller families were Konrad K, Neufang S, Thiel CM et al. Development of more likely to judge threatening to spank as unfair. As attentional networks: an fMRI study with children and well, compared to boys, girls and children from larger adults. Neuroimage 2005; 28(2):429-39. families were more likely to judge differential Abstract: Data on the development of the attentional treatment as unfair. Age, SES, and family intactness systems remain scarce. We used structural and event- had no effect on discipline judgements likely because related functional magnetic resonance imaging to of their limited range. CONCLUSIONS: The findings investigate differences in the neural mechanisms suggest that preschoolers can offer views on the associated with alerting, reorienting, and executive fairness or unfairness of parental disciplinary practices, control of attention between children (ages 8 to 12 and can differentiate among them. Further, not all years) and adults, while controlling for effects of forms of parental discipline were viewed by performance and brain morphology. Behaviorally, preschoolers as unfair. Yet it has to be appreciated that children exhibited a numerically smaller alerting effect the vignettes employed here were adapted for younger and significantly larger invalidity (reorienting) and children, hence they may not have appeared as negative interference (executive control of attention) effects. as in studies involving older children and adults. Neurally, children showed significantly reduced brain activation in a priori defined regions-of-interest in Konu A, Rimpela M. Well-being in schools: a conceptual right-sided frontal-midbrain regions during alerting, in model. Health Promot Int 2002; 17(1):79-87. the right-sided temporo-parietal junction during Abstract: Health and well-being have mostly been reorienting of attention, and in the dorsolateral separated from other aspects of school life. Health prefrontal cortex during executive control of attention. services and health education have been available for In addition, children activated significantly more brain school-aged children in Western societies for a long regions outside the a priori defined regions-of-interest, time. Recently, more comprehensive school health such as the superior frontal gyrus during reorienting programmes have been developed, e.g. the WHO and the superior temporal gyrus during executive 'health promoting school' and 'coordinated school control of attention. Functional group differences health programme' in the USA. They focus on how to overlapped with structural group differences in gray implement health promotion and health education in matter volume in particular within the frontopolar school. However, a theoretically grounded model based areas. The data suggest that there is a transition from on the sociological concept of well-being is needed for functional yet immature systems supporting attentional planning and evaluation of school development functions in children to the more definitive adult programmes. The School Well-being Model is based networks and that the differences observed may reflect on Allardt's sociological theory of welfare and assesses both developmental changes in cognitive strategies and well-being as an entity in school setting. Well-being is morphology. connected with teaching and education, and with learning and achievements. Indicators of well-being are Konstantareas MM, Desbois N. Preschoolers perceptions of divided into four categories: school conditions the unfairness of maternal disciplinary practices. Child (having), social relationships (loving), means for self- Abuse Negl 2001; 25(4):473-88. fulfilment (being) and health status. 'Means for self- 630
- 639. fulfilment' encompasses possibilitiesfor each pupil to children in residential treatment. METHODS: A study according to his/her own resources and purposive sample of 20 registered nurses and child care capabilities. 'Health status' is seen through pupils' workers were interviewed about their experiences symptoms, diseases and illnesses. Each well-being working in residential treatment and their knowledge category contains several aspects of pupils' life in about child development and child sexual abuse and its school. The model takes into account the important application to practice. Data from interviews and field impact of pupils' homes and the surrounding notes were analysed using dimensional analysis. community. Compared with others, The School Well- FINDINGS: Caregivers had limited knowledge of the being Model's main differences are the use of the well- sequelae of child sexual abuse. Developmentally being concept, the definition of health and the appropriate behaviour of sexually abused children, as subcategory means for self-fulfilment. Making the well as behavioural manifestations of child sexual outline of the well-being concept facilitates the abuse, were often misinterpreted and mismanaged. development of theoretically grounded subjective and CONCLUSION: Residential care of sexually abused objective well-being indicators. children should be based on sound developmental principles and caregiver sensitivity. Kooiman CG, van Rees Vellinga S, Spinhoven P, Draijer N, Trijsburg RW, Rooijmans HG. Childhood adversities Koopman LP, Wijga A, Smit HA et al. Early respiratory and as risk factors for alexithymia and other aspects of skin symptoms in relation to ethnic background: the affect dysregulation in adulthood. Psychother importance of socioeconomic status; the PIAMA study. Psychosom 2004; 73(2):107-16. Arch Dis Child 2002; 87(6):482-8. Abstract: BACKGROUND: Affect regulation is Abstract: AIMS: To evaluate ethnic differences in the assumed to be a biologically based function that can prevalence of respiratory and skin symptoms in the become disrupted by inadequate parenting and by first two years of life. METHODS: A total of 4146 traumatic experiences. We studied the relation between children participated in the Prevention and Incidence of the perceived parental parenting style, and sexual and Asthma and Mite Allergy (PIAMA) study. Parents physical abuse, with alexithymia, dissociation, anxiety completed questionnaires on respiratory and skin and depression. METHODS: In a cross-sectional study symptoms, ethnic background, and other potential psychiatric outpatients were administered a structured confounders during pregnancy, and at 3 months, 1 year, interview on childhood physical and sexual abuse and and 2 years of age. RESULTS: In the first year, "non- they completed a number of questionnaires about the Dutch" children (compared with "Dutch" children) had parenting styles of their parents, and about alexithymia, a higher prevalence of runny nose with itchy/watery dissociation and mood pathology. RESULTS: Maternal eyes (11.0% versus 5.0%). In the second year, a higher and paternal parenting styles were moderately prevalence of wheeze at least once (26.7% versus correlated with alexithymia and depression. The 18.5%), night cough without a cold (24.6% versus paternal parenting style was also correlated with 15.5%), runny nose without a cold (34.1% versus dissociation. Optimal parenting of one of the parents 21.3%), and runny nose with itchy/watery eyes (13.7% had a buffering effect on the degree of alexithymia, but versus 4.6%) was found. Adjustment for various not on the severity of other forms of affect confounders, especially adjustment for socioeconomic dysregulation. The effect of sexual or physical abuse factors, reduced most associations between ethnicity did not add to that of parental parenting style in terms and respiratory symptoms. Only runny nose with of predicting affect dysregulation. However, a itchy/watery eyes in the second year of life was positively perceived maternal parenting style was independently associated with non-Dutch ethnicity found to have a buffering effect in terms of the degree (adjusted odds ratio 2.89, 95% CI 1.3-6.4). of alexithymia, if sexual abuse had also taken place. CONCLUSIONS: Non-Dutch children more often had CONCLUSIONS: Perceived parenting does appear to respiratory symptoms in the first two years of life than be of some significance in the development of Dutch children. This could largely be explained by alexithymia. Optimal parenting of one of the parents differences in socioeconomic status. Follow up of the may protect against the development of alexithymia cohort will determine whether this higher prevalence of when the parenting of the other parent is perceived as respiratory symptoms in children with non-Dutch non-optimal. However, it is likely that other factors ethnicity represents an increased risk of developing besides parental care and sexual or physical abuse play allergic disease rather than non-specific or infection an important role in the development of an adequate related respiratory symptoms. affect regulation. Koos O, Gergely G. A contingency-based approach to the Kools S, Kennedy C. Child sexual abuse treatment: etiology of 'disorganized' attachment: the 'flickering misinterpretation and mismanagement of child sexual switch' hypothesis. Bull Menninger Clin 2001; behavior. Child Care Health Dev 2002; 28(3):211-8. 65(3):397-410. Abstract: OBJECTIVE: The purpose of the study was Abstract: The authors present a new approach to the to examine caregiver understanding of the impact of etiology of disorganized attachment based on child sexual abuse and the management of abused contingency detection theory. According to this view, 631
- 640. the relevant commonfactor in parental maltreatment being very scared (HR=1.29, 95% CI=1.02, 1.62). In and unresolved loss that leads to disorganized subgroup analyses, no significant interactions were attachment has to do with the type of "deviant found between trauma and sex, socio-economic status, contingency environment" that both of these conditions or baseline health. CONCLUSIONS: In this large generate. In such environments, infants experience prospective study, we found a moderate increase in the periods of being in control followed by periods of risk of arthritis among persons reporting multiple sudden loss of control over the caregiver's behavior. traumatic experiences in childhood. The authors hypothesize that this adversely affects the developmental unfolding of the infant's innate Kopelman LM, Murphy TF. Ethical concerns about federal "contingency detection module" (Gergely & Watson, approval of risky pediatric studies. Pediatrics 2004; 1999), which normally involves a maturational shift 113(6):1783-9. around 3 months from an initial attention bias for Notes: GENERAL NOTE: KIE: 19 refs. perfectly contingent stimulation to an emerging GENERAL NOTE: KIE: KIE Bib: human preference for less-than-perfect social contingencies. experimentation/ethics committees; human The periodically changing controllability of abusive experimentation/minors; human and dissociating "unresolved" attachment figures is experimentation/regulation hypothesized to block this process and to lead to the Abstract: The US Federal Code limits research with defensive fixation of a dysfunctional "flickering healthy children to no more than a minimal risk of contingency switch" mechanism with two dominant harm; it restricts research with children who have some and competing target positions (self-oriented vs. other- disorder or condition to no more than a minor increase oriented). This results in the dissociative style of over minimal risk, unless potential harms are offset by attention and behavioral organization characteristic of potential benefits to them, as in therapeutic studies. disorganized infant attachment. The authors summarize Higher risk studies require "407 approval," named after the preliminary results of an empirical study that the relevant section of the code describing provides support for this model in 6.5-month-old requirements. Rarely used until recently, 407 approval infants using a modified Still-Face situation (the Mirror requirements include Institutional Review Board Interaction Situation). The study demonstrates approval and authorization by the Secretary of the differential emotional and behavioral reactions to Department of Health and Human Services after sudden loss of maternal contingency and a specific consultation with a panel of experts; a period for public interest in exploring the perfectly contingent self-image comment; and assurances that there are adequate in the mirror in infants who at 12 months become permission, consent, and assent. This 407-approval categorized as "disorganized" in the Strange Situation. mechanism contains both procedural and interpretative ambiguities, which raise ethical concerns about 1) the Kopec JA, Sayre EC. Traumatic experiences in childhood expertise represented on advisory panels, 2) the scope and the risk of arthritis: a prospective cohort study. Can of the information offered to the public for comment J Public Health 2004; 95(5):361-5. and its potential conflicts with investigators' Abstract: BACKGROUND: Recent data suggest that intellectual property or commercial interests, 3) psychosocial factors, including childhood and whether any upper level of risk exists, and 4) how it adulthood stressors, may play a significant role in the conforms with other policies such as the best interest of development of chronic musculoskeletal pain and other the child standard in the law or in medical decision symptoms. The purpose of this study was to determine making. if traumatic experiences in childhood are associated with an increased risk of self-reported arthritis later in Kopels S, Charlton T, Wells SJ. Investigation laws and life. METHODS: We used longitudinal data (N=9,159) practices in child protective services. Child Welfare from the first 3 cycles of the National Population 2003; 82(6):661-84. Health Survey (NPHS) in Canada. New cases of Abstract: This study was triggered by the experience of arthritis were identified using an interviewer- one state agency when a state audit found that its administered questionnaire. Psychological trauma in investigation response and completion rates of child childhood or adolescence was measured by a 7-item abuse and neglect reports did not reach 100%. At questionnaire asking about physical abuse, fearful compliance rates of 99.6% and 97.58%, respectively, experiences, hospitalization, being sent away from the auditors and news media reported a lack of home, and 3 types of parental disturbance. The effects compliance by the state child welfare agency. This of trauma were examined in a multivariable discrete- article reviews the approaches legislatures and agencies time proportional hazards model. RESULTS: The have used to address and resolve problems of ensuring incidence of self-reported arthritis was 27.1 per 1,000 agency responsiveness without setting standards and person-years. We found a relative risk of 1.17 (95% expectations that are impossible to meet. CI=0.92, 1.48) for one traumatic event and 1.27 (95% CI=0.99, 1.62) for two or more traumatic events. Korbanka JE, Gaede RC. An MMPI-2 scale to identify Independent effects were observed for prolonged reported history of emotional abuse. Psychol Rep 2003; hospitalization (HR=1.33, 95% CI=1.05, 1.68) and 632
- 641. 92(2):593-4. with any certainty, many of them experience labour Abstract: A 42-item MMPI-2 scale classified 97.5% of and delivery in referral communities as a crisis event 201 clinic outpatients into groups reporting or not fraught with anxiety. The literature suggests that, reporting prior emotional abuse. within a regionalized perinatal system, small maternity services can offer safe care provided that an efficient Koren G, Nulman I, Chudley AE, Loocke C. Fetal alcohol mechanism for intrapartum transfer has been spectrum disorder. CMAJ 2003; 169(11):1181-5. established. This commentary provides recommendations for sustainable maternity care that Korenbrot CC, Ehlers S, Crouch JA. Disparities in will meet the needs of women, their families, and hospitalizations of rural American Indians. Med Care maternity caregivers in rural communities. The 2003; 41(5):626-36. recommendations stem from a rural maternity care Abstract: BACKGROUND: Disparities in program of research, consultations with communities, hospitalization rates, particularly rates for avoidable and review of relevant epidemiologic and policy hospitalizations, are indicators of potentially unmet literature. health needs and inefficient use of health resources. Hospitalization rates that the Indian Health Service Koroukian SM. Uterine rupture among women with a prior (IHS) can report underestimate disparities for cesarean delivery. N Engl J Med 2002; 346(2):134-7. American Indians (AIs) and Alaska Natives (ANs) relative to other Americans, because the IHS cannot Koschel MJ. Emergency: is it child abuse? Am J Nurs 2003; track all hospitalizations of AIs/ANs in their user 103(4):45-6. population. OBJECTIVES: To compare hospitalization and avoidable hospitalization rates for a rural AI/AN Koslap-Petraco MB, Parsons T. Communicating the benefits user population with those of non-Indians living in the of combination vaccines to parents and health care same counties where both groups use the same hospital providers. J Pediatr Health Care 2003; 17(2):53-7. system, regardless of the expected source of payment. Abstract: Infants may receive as many as 5 separate RESEARCH DESIGN: Retrospective analysis of injections at an office visit in order to comply with the California hospital discharge data for 1996 linked to 2002 childhood immunization schedule. Many parents rural IHS user data for 1995 and 1996 (3920 and healthcare providers disagree with administering 4 hospitalizations) compared with a random sample of or 5 injections at one visit, and therefore may delay discharge data for the rest of the non-Indian population some injections until another visit. This practice may in the 37 counties of the IHS Contract Health Service lead to decreased compliance and can increase costs for delivery area (7840 hospitalizations). MEASURES: the parent. New combination vaccines will help to Hospitalization and avoidable hospitalization rates and simplify the immunization schedule, and health care risk ratios (RRs). RESULTS: Hospitalization and providers will need to be able to address parental avoidable hospitalization rates were both higher for the concerns regarding these vaccines. Nurses are often AI/AN user population than for the non-Indian general responsible for administering vaccines in the office population. The age-adjusted hospitalization ratios setting, and therefore are also influential in deciding were 72% higher for men (RR 1.72, confidence which vaccines should be ordered. The purpose of this interval [CI] 1.40-2.12) and 52% higher for women article is to educate nurses on communicating the (RR 1.52, CI 1.36-1.92). The comparable ratios for benefits of combination vaccines to parents and other avoidable hospitalizations were 136% higher for men healthcare providers. (RR 2.36, CI 1.52-3.29) and 106% higher for women (RR 2.06, CI 1.32-3.50). CONCLUSIONS: Disparities Kostelny K, Wessells M. Psychosocial aid to children after in both hospitalization and avoidable hospitalization the Dec 26 tsunami. Lancet 2005; 366(9503):2066-7. rates of rural AIs/ANs in California were previously undetected by either federal IHS or state hospital Kotagal UR, Robbins JM, Kini NM, Schoettker PJ, Atherton discharge data alone. At least some of the disparities HD, Kirschbaum MS. Impact of a bronchiolitis are likely reducible with improved access to care. guideline: a multisite demonstration project. Chest 2002; 121(6):1789-97. Kornelsen J, Grzybowski S. Is local maternity care an Abstract: STUDY OBJECTIVES: The purpose of this optional service in rural communities? J Obstet study was to determine the impact of a multisite Gynaecol Can 2005; 27(4):329-31. implementation of an evidence-based clinical practice Abstract: There has been a precipitous decline in the guideline for bronchiolitis. DESIGN: Before and after number of rural communities across Canada providing study. SETTING: Eleven Child Health Accountability local maternity care. The evidence suggests that the Initiative (CHAI) study hospitals. PATIENTS: outcome for newborns may be worse as a result. There Children < 12 months of age with a first-time episode is also an emerging understanding of the significant of bronchiolitis. INTERVENTION: The guideline was physiological and psychosocial consequences for rural implemented in December 1998. Complete parturient women. Because they cannot plan for birth preimplementation and postimplementation 633
- 642. administrative data onhospital admissions, resource Eight percent of the newborns, but none of the adults, utilization, and length of stay were available from had a low secretion of both cytokines. Thirty-six seven study hospitals. At five sites, chart reviews were percent of the neonates, but only 5% of the adults, had conducted for data on the number and type of a high IL-10 and a low IFN-gamma secretion. Thirty- bronchodilators used. MEASUREMENTS AND one percent of the neonates and 18% of the adults had a RESULTS: Complete administrative data were high IFN-gamma secretion, but a low IL-10 secretion. available for 846 historical control subjects and 792 We conclude that neonates have an immature IL-10 study patients. Length of stay decreased significantly. and IFN-gamma response as compared with adults. While the proportion of eligible patients who received However, individual neonates may have a mature any bronchodilator did not change (84%), the cytokine secretion, whereas others may have a Th1- or proportion of patients who received albuterol decreased a Th2-directed immune response. from 80 to 75% after guideline implementation (p < 0.03). For patients who received bronchodilators, the Kowal AK, Krull JL, Kramer L. How the differential mean (+/- SD) number of doses decreased from 13.6 treatment of siblings is linked with parent-child +/- 14.0 to 7.3 +/- 9.1 doses (p < 0.0001). For patients relationship quality. J Fam Psychol 2004; 18(4):658- who received albuterol, the mean number of doses 65. decreased from 12.8 +/- 11.8 to 6.4 +/- 7.8 doses (p < Abstract: Little is currently known about the 0.0001). Other resource use decreased modestly. significance of parents' unequal treatment of siblings Hospital readmission rates within 7 days of discharge and their relationships with their children; for example, were unchanged. CONCLUSIONS: We successfully are high levels of differential treatment consistently extended the implementation of an evidence-based indicative of poorer parent-child relationships? clinical practice guideline from one hospital to seven Associations among differential parenting practices, hospitals. Within just a single bronchiolitis season, perceptions of the fairness of these practices, and some significant changes in practice were seen. The parent-child relationship quality were assessed from multisite CHAI collaborative appears to be a promising the perspectives of adolescent siblings and their parents laboratory for large-scale quality improvement in 74 maritally intact families. Multilevel random initiatives. coefficient modeling revealed that the magnitude of differential treatment was associated with more Kotch JB. Psychological maltreatment. Pediatrics 2003; negative parent-child relationships only when 111(2):444-5; author reply 444-5. adolescents perceived differential treatment to be unfair. Differential treatment judged to be fair is not Kotiranta-Ainamo A, Rautonen J, Rautonen N. Imbalanced linked with negative parent-child relationships. Results cytokine secretion in newborns. Biol Neonate 2004; highlight the importance of examining all family 85(1):55-60. members' viewpoints about the legitimacy of Abstract: In adults, a balance between Th1 and Th2 differential treatment and of encouraging family cytokine networks has been proposed to be associated members to discuss their understanding of these events. with a healthy status. Newborn babies are reported to express Th2-type immune reactions. Further, the Kozyrskyj AL, Dahl ME, Chateau DG, Mazowita GB, impaired protection of newborn babies against Klassen TP, Law BJ. Evidence-based prescribing of infections has been attributed to a deficient secretion of antibiotics for children: role of socioeconomic status interferon gamma (IFN-gamma) and interleukin-10 and physician characteristics. CMAJ 2004; 171(2):139- (IL-10). Using IFN-gamma and IL-10 as surrogate 45. markers of Th1 and Th2 orientation, we compared the Abstract: BACKGROUND: Evidence-based guidelines patterns of IFN-gamma and IL-10 secretion by for antibiotic use are well established, but peripheral blood mononuclear cells between 52 healthy nonadherence to these guidelines continues. This study newborns and 35 adults. The baseline secretion of IFN- was undertaken to determine child, household and gamma in adults was similar to that of newborns. The physician factors predictive of nonadherence to lipopolysaccharide-stimulated IFN-gamma secretion evidence-based antibiotic prescribing in children. was higher in newborns than in adults, whereas the METHODS: The prescription and health care records concanavalin-A-stimulated IFN-gamma secretion was of 20 000 Manitoba children were assessed for 2 higher in adults. The unstimulated and stimulated IL- criteria of nonadherence to evidence-based antibiotic 10 secretion was significantly lower in newborns than prescribing during the period from fiscal year 1996 in adults. Using a threshold level of 1,000 pg/ml, we (April 1996 to March 1997) to fiscal year 2000: receipt classified neonates and adults on the basis of their of an antibiotic for a viral respiratory tract infection stimulated IL-10 and IFN-gamma secretion. Four (VRTI) and initial use of a second-line agent for acute different groups were identified: IL-10-oriented otitis media, pharyngitis, pneumonia, urinary tract secretion, IFN-gamma- oriented secretion, balanced infection or cellulitis. The likelihood of nonadherence high secretion, and balanced low secretion. Only 25% to evidence-based prescribing, according to child of the neonates had a high IL-10 and a high IFN- demographic characteristics, physician factors gamma secretion as compared with 77% of the adults. (specialty and place of training) and household income, 634
- 643. was determined fromhierarchical linear modelling. Imagery rehearsal therapy was an effective treatment Child visits were nested within physicians, and the option for chronic nightmares in this adjudicated most parsimonious model was selected at p < 0.05. adolescent population. RESULTS: During the study period, 45% of physician visits for VRTI resulted in an antibiotic prescription, Krantz G, Garcia-Moreno C. Violence against women. J and 20% of antibiotic prescriptions were for second- Epidemiol Community Health 2005; 59(10):818-21. line antibiotics. Relative to general practitioners, the Abstract: Violence against women is now well odds ratio for antibiotic prescription for a VRTI was recognised as a public health problem and human 0.51 (95% confidence interval [CI] 0.42-0.62) for rights violation of worldwide significance. It is an pediatricians and 1.58 (95% CI 1.03-2.42) for other important risk factor for women's ill health, with far specialists. The likelihood that an antibiotic would be reaching consequences for both their physical and prescribed for a VRTI was 0.99 for each successive mental health. This glossary aims to describe various 10,000 Canadian dollars increase in household income. forms of interpersonal violence that are directed Pediatricians and other specialists were more likely towards women and girls. Terms and basic concepts than general practitioners to prescribe second-line used in research and policy on this public health antibiotics for initial therapy. Both criteria for problem will be explained. nonadherence to evidence-based prescribing were 40% less likely among physicians trained in Canada or the Krause ED, Mendelson T, Lynch TR. Childhood emotional United States than among physicians trained elsewhere. invalidation and adult psychological distress: the INTERPRETATION: The links that we identified mediating role of emotional inhibition. Child Abuse between nonadherence to evidence-based antibiotic Negl 2003; 27(2):199-213. prescribing in children and physician specialty and Abstract: OBJECTIVE: To evaluate a model in which location of training suggest opportunities for chronic emotional inhibition mediates the relationship intervention. The independent effect of household between a history of childhood emotional invalidation income indicates that parents also have an important or abuse and adult psychological distress. METHOD: role. One hundred and twenty-seven participants completed a series of self-report questionnaires, and a subset of Krakow B, Sandoval D, Schrader R et al. Treatment of this group (n=88) completed an additional measure of chronic nightmares in adjudicated adolescent girls in a current avoidant coping in response to a laboratory residential facility. J Adolesc Health 2001; 29(2):94- stressor. Structural equation modeling was used to 100. evaluate and compare a full and partial mediational Abstract: PURPOSE: To evaluate imagery rehearsal model. RESULTS: Findings strongly supported a therapy for the treatment of chronic nightmares in a model in which a history of childhood emotional sample of adolescent girls. METHODS: Adolescent invalidation (i.e., psychological abuse and parental girls ranging in age from 13 to 18 years were recruited punishment, minimization, and distress in response to from the Wyoming Girls School in Sheridan, Wyoming negative emotion) was associated with chronic (treatment group, n = 9; control group, n = 10). These emotional inhibition in adulthood (i.e., ambivalence girls had previously suffered a high prevalence of over emotional expression, thought suppression, and unwanted sexual experiences in childhood and avoidant stress responses). In turn, emotional inhibition adolescence, and thus many suffered from nightmares, significantly predicted psychological distress, including sleep complaints, and posttraumatic stress symptoms. depression and anxiety symptoms. CONCLUSION: Imagery rehearsal therapy was provided in a 1-day (6- This study found support for a model in which the h) workshop. Imagery rehearsal consists of three steps, relation between recollected negative emotion all of which are performed in the waking state: (a) socialization in childhood and adult psychological select a nightmare, (b) "change the nightmare any way distress was fully mediated by a style of inhibiting you wish," and (c) rehearse the images of the new emotional experience and expression. Although it is version ("new dream") 5 to 20 min each day. Control likely that childhood emotional inhibition is functional participants received no intervention. RESULTS: At (e.g., reduces parental distress and rejection), results baseline, these girls had been suffering from suggest that chronic emotional inhibition may have nightmares, on average, for 4.5 years, and they long-term negative consequences for the inhibitor. reported experiencing 20 nightmares per month, which occurred at a frequency of at least one bad dream every Krause G, Blackmore C, Wiersma S et al. Marijuana use and other night. At 3 months, self-reported, retrospectively social networks in a community outbreak of assessed nightmare frequency measured in nights per meningococcal disease. South Med J 2001; 94(5):482- month decreased 57% (p =.01, d = 1.4) and measured 5. in nightmares per month decreased 71% (p =.01, d = Abstract: BACKGROUND: We examined the role of 1.7) in the treatment group, compared with no social networks and marijuana smoking in a significant changes in the control group. No significant community outbreak of infections due to Neisseria changes were noted for sleep and posttraumatic stress meningitidis. METHODS: We interviewed all patients disorder measures in either group. CONCLUSION: 635
- 644. and their contacts.Isolates were tested by pulsed field Krisin, Basri H, Fryauff DJ et al. Malaria in a cohort of electrophoresis and multilocus enzyme electrophoresis. Javanese migrants to Indonesian Papua. Ann Trop Med RESULTS: Nine cases of meningococcal disease Parasitol 2003; 97(6):543-56. occurred in the outbreak; isolates from seven cases Abstract: The epidemiology of infection by with positive cultures were identical. Multiple Plasmodium falciparum and P. vivax was investigated overlapping social networks were found for case- among Javanese migrants to an endemic region of patients and their contacts. All case-patients were Papua, Indonesia. A cohort of 243 migrants from Java linked by the marijuana-related activities of their was followed for malaria in a new settlement village in contacts. CONCLUSION: Investigation of social the endemic Armopa area of north-eastern Papua, networks and marijuana exposure might help identify beginning on the day each migrant arrived in the close contacts of patients with meningococcal disease village. The subjects were monitored during home and help prevent secondary infections. visits (three/week) and by the twice-monthly production of bloodsmears that were checked for Kreidler M. Group therapy for survivors of childhood sexual malarial parasites. At the end of 33 months, 159 (65%) abuse who have chronic mental illness. Arch Psychiatr of the subjects remained under follow-up. The Nurs 2005; 19(4):176-83. prevalence of parasitaemia in the village declined from Abstract: Medication and supportive services are 16% among those already living there when the study usually the approaches used to treat women with began in August 1996, to 5% when the study finished chronic mental illness (CMI). The goal of this study in June 1999. Over this period, 596 infections by P. was to evaluate the outcomes of group therapy for falciparum and 723 by P. vivax occurred in the cohort, women with CMI in comparison with those for women 22 and 27 of the subjects each experiencing at least six without CMI, all of whom experienced childhood infections by P. falciparum and P. vivax, respectively. sexual abuse. The sample ( N=121) consisted of The incidence of malarial infection was higher during women, all of whom were sexually abused as children. the first and second years post-migration (3.2 and 2.7 The results indicated that abused women with CMI had infections/person-year) than during the third (1.2 improved self-esteem and decreased symptom scores at infections/person-year). Although the geometric mean the same rate as abused women without CMI. It was parasite counts for P. falciparum increased over time suggested that nurses can play an essential role in their (1209, 1478, and 1830 parasites/microl in the first, practice with this population. second and third years, respectively), the corresponding values for P. vivax (497, 535 and 490 Kringlen E. [Sexual abuse, recovered memory and multiple parasites/microl) showed no such trend. Only one of personality disorder]. Tidsskr Nor Laegeforen 2002; the nine subjects who developed severe malaria 122(2):202-8. (requiring intravenous quinine therapy) was a child, giving an odds ratio for a case of severe malaria being Krischer MK, Sevecke K, Lehmkuhl G, Steinmeyer EM. in an adult of 6.1 (P=0.08). [Less severe sexual child abuse and its sequelae: are there different psychic and psychosomatic symptoms in Krueger DW. Body self. Development, psychopathologies, relation to various forms of sexual interaction?]. Prax and psychoanalytic significance. Psychoanal Study Kinderpsychol Kinderpsychiatr 2005; 54(3):210-25. Child 2001; 56:238-59. Abstract: A typology of less severe sexual encounters Abstract: Ego development or, more broadly, the sense was used to analyze short and long term sequelae of of self has at its core a cohesive, distinct, and accurate sexual abuse via intimate skin contact. Well known body self. Compromise of body self development as a theoretical approaches on the harmful effects of sexual result of early overstimulation, empathic unavailability abuse were tested. Do we find different peri- and or nonresponse of the caretaker, and inconsistency or posttraumatic reactions dependent upon varied forms selectivity of response can lead to specific of sexual interactions with children? A cluster analysis developmental arrests, including body-image was calculated with symptom variables that were distortions, nonintegration of body self and described in 141 child statements taken out of written psychological self, and difficulties in the regulation of expert opinions. Afterwards variance analyses of these tension states and affect. The individual may then symptom clusters were conducted in reference to six attempt to repair those disrupted developmental needs different abuse constellations. Different symptom by such symptomatic expressions as eating disorders, profiles were found for these six abuse constellations. compulsive exercise, substance abuse, and the creation Panic symptoms, shame related feelings, avoidant of physical danger, as a step toward integration of mind behavior and physical reactions showed significant and body as well as a defensive antidote to painful results. The sequelae to different forms of less severe affect. In the psychoanalytic treatment of these sexual child abuse differ and depend more upon the patients, the need for the analyst's attunement to the situational dynamic than upon the kind of relationship patient's development of body self as well as between adult and child. psychological self development is illustrated by clinical vignettes of the enactments and attempted restitution of specific developmental trauma. 636
- 645. Kruse RL, EwigmanBG, Tremblay GC. The Zipper: a using the techniques of modern brain imaging, are method for using personal identifiers to link data while revealing the temporal and structural aspects of preserving confidentiality. Child Abuse Negl 2001; language processing by the brain and suggesting new 25(9):1241-8. views of the critical period for language. Computer Abstract: OBJECTIVE: This report describes a method scientists, modeling the computational aspects of for linking separate confidential data sets that contain childrens' language acquisition, are meeting success personal identifying information while preserving using biologically inspired neural networks. Although a required anonymity. METHODS: Research data were consilient view cannot yet be offered, the cross- linked with child abuse and neglect (CAN) report data disciplinary interaction now seen among scientists by an independent "safe" analyst using an identical set pursuing one of humans' greatest achievements, of unique identifier codes assigned to each case in both language, is quite promising. data sets after all personal identifiers had been removed. RESULTS: The research team never learned Kujiraoka Y, Sato M, Tsuruta W, Yanaka K, Takeda T, CAN report status of individuals, the state agency Matsumura A. Shaken baby syndrome manifesting as never saw the research data, and the desired analyses chronic subdural hematoma: importance of single were completed using the merged data set. photon emission computed tomography for treatment CONCLUSIONS: The method was successfully used indications--case report. Neurol Med Chir (Tokyo) to merge data from separate sources without divulging 2004; 44(7):359-62. confidential information. Abstract: A boy with shaken baby syndrome first presented at age 3 months with acute subdural Kryszak AC. Prohibiting procreation: a step in the right hematoma (SDH) and was treated by subdural tapping direction to protect the children of deadbeat dads; an at a local hospital. Chronic SDH was identified at a analysis of the court decision in State v. Oakley. J Law rehabilitation center at age 19 months. The chronic Health 2002-2003; 17(2):327-57. SDH appeared to have developed within the preceding 16 months. His physical and mental development was Kubiak SP. Trauma and cumulative adversity in women of a already delayed. Magnetic resonance (MR) imaging disadvantaged social location. Am J Orthopsychiatry revealed a 20-mm thick right chronic SDH with 2005; 75(4):451-65. midline shift and small bilateral subdural effusions. Abstract: This study expands conceptual and empirical The chronic SDH had compressed the right cerebral perspectives on stress exposure by evaluating hemisphere. MR imaging also disclosed bilateral cumulative exposure in 79 drug-convicted women. cerebral atrophy. 99mTc-ethylcysteinate dimer single Logistic regression determined that (a) posttraumatic photon emission computed tomography (SPECT) stress disorder (PTSD) increased 40% with each revealed decreased cerebral blood flow (CBF) in the trauma and (b) adding chronic stressors increased the non-hematoma hemisphere, although CBF is said to predictability of PTSD. This study supports cumulative decrease on the chronic SDH side, especially if midline adversity models and the importance of social location. shift is present. Burr hole craniotomy with external drainage was performed, but the patient showed no Kuhl PK, Tsao FM, Liu HM, Zhang Y, De Boer B. change in CBF postoperatively, although the volume of Language/culture/mind/brain. Progress at the margins hematoma decreased. The patient was clinically between disciplines. Ann N Y Acad Sci 2001; 935:136- unchanged immediately after the operation. In this 74. case, SPECT measurement of CBF was important in Abstract: At the forefront of research on language are evaluating the pathophysiology of the delays in new data demonstrating infants' strategies in the early physical and mental growth. Atrophy of the bilateral acquisition of language. The data show that infants hemispheres was the major mechanism in the perceptually "map" critical aspects of ambient language decreased CBF, not the compression by chronic SDH. in the first year of life before they can speak. Statistical MR imaging and SPECT can determine the surgical and abstract properties of speech are picked up through indications for chronic SDH in patients with cortical exposure to ambient language. Moreover, linguistic atrophy. experience alters infants' perception of speech, warping perception in a way that enhances native-language Kulvichit K. Circumpapillary retinal ridge in the shaken- speech processing. Infants' strategies are unexpected baby syndrome. N Engl J Med 2004; 351(19):2021. and unpredicted by historical views. At the same time, research in three additional disciplines is contributing Kumar S, Ng B, Howie W. The improvement of obsessive- to our understanding of language and its acquisition by compulsive symptoms in a patient with schizophrenia children. Cultural anthropologists are demonstrating treated with clozapine. Psychiatry Clin Neurosci 2003; the universality of adult speech behavior when 57(2):235-6. addressing infants and children across cultures, and this is creating a new view of the role adult speakers play in Kummeling I, Thijs C, Penders J et al. Etiology of atopy in bringing about language in the child. Neuroscientists, infancy: the KOALA Birth Cohort Study. Pediatr 637
- 646. Allergy Immunol 2005; 16(8):679-84. to reduce adolescent problem behaviors. Dissemination Abstract: The aim of the KOALA Birth Cohort Study of research-based family interventions has been slow, in the Netherlands is to identify factors that influence with most practitioners still implementing ineffective the clinical expression of atopic disease with a main programs. This article reviews 2 federal studies that focus on lifestyle (e.g., anthroposophy, vaccinations, involved national searches for effective family antibiotics, dietary habits, breastfeeding and breast interventions targeting pre-birth to adolescence: milk composition, intestinal microflora composition, Preventing Substance Abuse Among Children and infections during the first year of life, and gene- Adolescents: Family-Centered Approaches (Center for environment interaction). The recruitment of pregnant Substance Abuse Prevention, 1998) and Strengthening women started in October 2000. First, participants with America's Families (R. Alvarado, K. L. Kumpfer, K. 'conventional lifestyles' (n = 2343) were retrieved from Kendall, S. Beesley, & C. Lee-Cavaness, 2000). an ongoing prospective cohort study (n = 7020) on Results identified 3 effective prevention approaches, 13 pregnancy-related pelvic girdle pain. In addition, principles of effectiveness, and 35 programs. pregnant women (n = 491) with 'alternative lifestyles' Recommendations include increased dissemination with regard to child rearing practices, dietary habits research on training and technical assistance systems, (organic, vegetarian), vaccination schemes and/or use adoption with fidelity and quality, and gender-, age-, of antibiotics, were recruited through organic food and culturally sensitive adaptations. shops, anthroposophic doctors and midwives, Steiner schools, and dedicated magazines. All participants Kumpfer KL, Bluth B. Parent/child transactional processes were enrolled between 14 and 18 wk of gestation and predictive of resilience or vulnerability to "substance completed an intake questionnaire on family history of abuse disorders". Subst Use Misuse 2004; 39(5):671- atopy and infant care intentions. Documentation of 98. other relevant variables started in the pregnant mother Abstract: This article discusses implications of a and covered the first and third trimester as well as early theoretical model of resilience--the Resilience childhood by repeated questionnaires at 14-18, 30, and Framework, including the impact of parent/child 34 wk of gestation and 3, 7, 12, and 24 months post- transactional processes in moderating or mediating a partum. A subgroup of participants, including both child's biological or environmental risks and later conventional and alternative lifestyles, was asked to substance misuse. Research is presented on behavioral consent to maternal blood sampling, breast milk and a and emotional precursors of substance abuse disorders faecal sample of the infant at 1 month post-partum, in children of substance users. Detrimental processes capillary blood at age 1 yr, venous blood and within dysfunctional family environments are observation of manifestation of atopic dermatitis presented followed by a listing of strategies for during home visits at the age of 2 yr (using the UK increasing resilience in youth by improving family working party criteria and the severity scoring of atopic dynamics. The value in elucidating these interactive dermatitis index), and buccal swabs for DNA isolation processes is to increase our understanding of ways to from child-parent trios. From the start, ethical approval reduce the impact of risk factors. Prevention providers and informed consent procedures included gene- should use these strategies as benchmarks for selecting environment interaction studies. Follow-up at 3 and 7 or developing effective family-focused prevention months post-partum was completed with high response programs. Resources are presented for finding effective rates (respectively 90% and 88% in the conventional family interventions as well as an example of a family group, and 97% and 97% in the alternative group). The intervention based on resilience principles, namely the home visits at 2 yr of age will be completed in 2005. Strengthening Families Program. Recommendations Preliminary results show that we have succeeded in are made for future research and better dissemination recruiting a large population with various lifestyle of evidence-based family interventions. choices with a fairly large contrast with regard to dietary habits (including organic foods, vegetarian Kunken FR, McGee EM, Stell LK. Strap him down. diet), vaccination schemes and/or use of antibiotics. Hastings Cent Rep 2001; 31(1):24; discussion 24-6. We have also been able to collect a large number of Notes: GENERAL NOTE: KIE: Kunken, Frederic R; faecal samples (n = 1176) and capillary blood samples McGee, Ellen M; Stell, Lance K at age 1 yr (n = 956). Furthermore, a large proportion GENERAL NOTE: KIE: KIE Bib: health of the participants have consented with genetic studies. care/economics; professional ethics Mid 2006 we expect to report our first results on the relationship between the various exposures in early life Kunst JL. Fraught with the utmost danger: the object and childhood atopy. An outline of the focus and relations of mothers who kill their children. Bull design of the KOALA Birth Cohort Study is presented. Menninger Clin 2002; 66(1):19-38. Abstract: The author explores the psychodynamics of Kumpfer KL, Alvarado R. Family-strengthening approaches maternal filicide from an object relations perspective. for the prevention of youth problem behaviors. Am Among psychotic women, the murder of the child Psychol 2003; 58(6-7):457-65. reflects a critical interplay among the mother's Abstract: Effective parenting is the most powerful way 638
- 647. neurobiology, constitution, developmentalexperiences, environmental factors are stronger predictors of age of and complex internal object world. Two types of first drink than family history. personality structure are discussed. For the disorganized type, the psychodynamic scenario Kupkova L, Bendukidze N, Slavcev A, Ivaskova E. The involves attempts to contend with the danger of Czech Bone Marrow Donor Registry. Ann Transplant massive internal breakdown. For the organized type, 2001; 6(2):46-9. the scenario involves attempts to contend with the Abstract: OBJECTIVE: The Czech Bone Marrow danger of persecution and annihilation. For these Donor Registry (CBMD)--established 9 years ago, women, physical violence is used because of failures in operates within the National HLA Centre, a constituent mentalization, and is an enactment of catastrophic part of the Department of Immunology at the Institute internal anxieties. for Clinical and Experimental Medicine. The Czech Cord Blood Register (CSCB) was recently established Kuperman S, Chan G, Kramer JR et al. Relationship of age (in 1996) and started its activities. METHODS: CBMD of first drink to child behavioral problems and family is responsible for maintaining a database of HLA typed psychopathology. Alcohol Clin Exp Res 2005; volunteer donors, for performing national and 29(10):1869-76. international searches in the file of bone marrow Notes: CORPORATE NAME: Collaborative Study on transplantation as well as for coordinating the the Genetics of Alcoholism communication between participating centres. Abstract: BACKGROUND: Studies have implicated a RESULTS: The operation of the CBMD registry wide variety of variables as being associated with an requires the modern communication technology for the early age of first drink (AFD). AFD in turn has been exchange of data with local organisations (donor and associated with a variety of negative outcomes in transplant centres) and with international BM adolescence and early adulthood. This study is organisations and networks abroad (Bone Marrow designed to quantify the contributions of these Donors Worldwide--BMDW, National Marrow Donor antecedent variables to prediction of AFD; in particular Program--NMDP, European Donor Secretariat E.D.S., it will carefully examine the involvement of variables European Marrow Donor Information System-- in four areas (child characteristics, family EMDIS). CONCLUSIONS: The CBMD is fully demographics, family psychopathology, and child integrated into international cooperation. The HLA behavior problems). METHODS: Using data from a typed unrelated stem cells from Prague can be selected multicenter study on alcoholism, we first investigated for patients in the whole world. the differences between two groups of children (ages 7 to 17 years), one from families heavily loaded for Kuritarne IS. [Childhood trauma in the etiology of alcohol dependence and the other from population borderline personality disorder]. Psychiatr Hung 2005; controls. Second, a multidomain, multistep regression 20(4):256-70. model using child characteristics, family Abstract: Serious, prolonged intrafamilial childhood demographics, family psychopathology, and child sexual abuse is considered to be the main etiological behavior problems was performed to determine factor in about half of the patients with borderline significant contributors to predicted AFD. RESULTS: personality disorder in the USA. Special features of Five variables initially contributed to the prediction of childhood interpersonal trauma leading to the AFD. These included gender, age at interview, the development of borderline personality disorder are the number of adult sibs with alcohol dependence, being seriousness of the trauma and the fact that it is sexual held back a year in school, and conduct scale score. in nature. Serious intrafamilial childhood abuse can However, the number of conduct symptoms appeared lead not only to the classic post-traumatic stress to contain the contributions of gender and being held syndrome, but can influence all aspects of personality back a grade in school, and these two variables were development, including the distortion of the sense of subsequent removed from the model. The remaining identity, self-regulation, and the patterns of three variables explained 45% of the model variance; interpersonal relations. Viewed from the perspective of age at interview accounted for 38.3%, conduct scale the trauma concept, the entire range of adult borderline score accounted for 6.2%, and the number of alcohol- symptoms are considered as being the consequences of dependent adult sibs accounted for 0.5%. No family severe complex traumatic experiences. Other clinicians history measures of alcohol dependence or antisocial regard such an abuse as a marker of the severity of personality disorder were contributory to the prediction familial dysfunction and emphasize the role of other model for AFD. CONCLUSIONS: Both the "number pathogenic factors, such as biparental neglect and of conduct symptoms" and the "number of adult sibs biological vulnerability of the pre-borderline child. with alcohol dependence" are inversely associated with predicted AFD. The latter variable appears marginally Kuznetsova T, Staessen JA, Kawecka-Jaszcz K et al. predictive of AFD and suggests a condition in which Quality control of the blood pressure phenotype in the the child's household, regardless of strength of family European Project on Genes in Hypertension. Blood history of AD (or antisocial personality disorder), Press Monit 2002; 7(4):215-24. appears conducive to early drinking. Thus, child and 639
- 648. Abstract: OBJECTIVES: Inthe European Project on was used to examine the relative contributions of age, Genes in Hypertension (EPOGH) standardized accuracy, and response latency on activation. Our epidemiological methods were used to determine analysis showed that age was the most significant complex phenotypes consisting of blood pressure (BP) predictor of activation in these brain regions. These in combination with other traits. In this report, we findings provide strong evidence for a process of present the quality control of one of the BP protracted functional maturation of bilateral fronto- phenotypes. METHODS: In seven European countries parietal neural networks involved in VSWM eight different research groups recruited random development. At least two neural systems involved in samples of nuclear families. Trained observers VSWM mature together: (i) a right hemisphere visuo- measured the BP five times consecutively with the spatial attentional system, and (ii) a left hemisphere participants in the seated position at each of two phonological storage and rehearsal system. These separate home visits, 1 to 3 weeks apart, according to observations suggest that visually and verbally the guidelines of the British Hypertension Society. mediated mnemonic processes, and their neural Quality assurance and quality control of this BP representations, develop concurrently during childhood phenotype were implemented according to detailed and adolescence and into young adulthood. instructions defined in the protocol of the EPOGH study. RESULTS: On 31 August 2001, BP Kyncl J, Paget WJ, Havlickova M, Kriz B. Harmonisation of measurements of 2476 subjects were available for the acute respiratory infection reporting system in the analysis. Fewer BP readings than the five planned per Czech Republic with the European community visit occurred in one of the eight centres, but only in networks. Euro Surveill 2005; 10(3):30-3. 0.4% of the home visits. Across centres the relative Abstract: Respiratory virus activity is detected in frequency of identical consecutive readings for systolic Europe each winter, yet the precise timing and size of or diastolic blood pressure varied from 0 to 6%. The this activity is highly unpredictable. The impact of occurrence of odd readings ranged from 0 to 0.1%. Of influenza infection and/or acute respiratory infection in the 49,488 systolic and diastolic BP readings, 24.0% European countries is continuously monitored through ended on a zero (expected 20%). In most EPOGH a variety of surveillance systems. All of these sources centres there was a progressive decline in the BP from of information are used to assess the nature and extent the first to the second home visit. Overall, these of activity of influenza and other respiratory viruses, decreases averaged 2.36 mmHg [95% confidence and to offer guidance on the prevention and control of interval (CI): 1.98-2.74, P < 0.001] for systolic BP and morbidity and mortality due to influenza at a local, 1.74 mmHg (95% CI: 1.46-2.02, P < 0.001) for national and international level. The early warning diastolic BP. CONCLUSIONS: Quality assurance and system for a forthcoming influenza epidemic is mainly control should be planned at the design stage of a based on the use of a set of thresholds. In the Czech project involving BP measurement and implemented Republic, the acute respiratory infection (ARI) from its very beginnings until the end. The procedures reporting system, with automated data processing, uses of quality assurance set up in the EPOGH study for the a statistical model for the early detection of unusual BP measurements resulted in a well-defined BP increased rates of the monitored indicators. The phenotype, which was consistent across centres. collected data consists of the number of ARI, the number of complications due to ARI and the Kwon H, Reiss AL, Menon V. Neural basis of protracted population registered with the reporting general developmental changes in visuo-spatial working practitioners and paediatricians, all collected separately memory. Proc Natl Acad Sci U S A 2002; in five age groups. To improve the reporting system in 99(20):13336-41. the Czech Republic, clinical data on the weekly Abstract: Developmental studies have shown that incidence of influenza-like illness (ILI) within the same visuo-spatial working memory (VSWM) performance population and the same age groups was started in improves throughout childhood and adolescence into January 2004. These data fit the European young adulthood. The neural basis of this protracted Commission's recently adopted ILI case definition and development is poorly understood. In this study, we allows a better comparison of data with other countries used functional MRI (fMRI) to examine VSWM in Europe, in particular those participating in EISS function in children, adolescents, and young adults, (European Influenza Surveillance Scheme). ages 7-22. Subjects performed a 2-back VSWM experiment that required dynamic storage and Labouvie E, Bates ME. Reasons for alcohol use in young manipulation of spatial information. Accuracy and adulthood: validation of a three-dimensional measure. J response latency on the VSWM task improved Stud Alcohol 2002; 63(2):145-55. gradually, extending into young adulthood. Age-related Abstract: OBJECTIVE: To evaluate the reliability and increases in brain activation were observed in focal validity of a measure of reasons for use, which is based regions of the left and right dorsolateral prefrontal on a cognitive mediational view of alcohol use as a cortex, left ventrolateral prefrontal cortex (including means for affect regulation. METHOD: Data for this Broca's area), left premotor cortex, and left and right study were obtained from the Rutgers Health and posterior parietal cortex. Multiple regression analysis Human Development Project. Self-reports of young 640
- 649. men and womenaged 25 to 31 years (N = 1,176; 598 a good alternative to methadone treatment in pregnant women) were used to obtain measures of reasons for women. use, coping use, sex-enhancing use, use intensity and use problems. Regression analyses and structural Laflamme L, Engstrom K, Moller J, Hallqvist J. Peer equation modeling were used to assess a hypothesized victimization during early adolescence: an injury model of relationships between these variables. trigger, an injury mechanism and a frequent exposure RESULTS: Factor analysis of 33 reasons for use in school. Int J Adolesc Med Health 2003; 15(3):267- yielded three hypothesized dimensions: social reasons, 79. disinhibition reasons and suppression reasons. Abstract: There is a documented effect of peer Although moderately correlated with each other, they victimization in school as an injury trigger, but the exhibited distinct relationships with other use variables. question of differences between children according to Increases in social reasons were related to decelerating age and sex remains unexplored. Nor do we know the increases in use intensity, but increases in disinhibition role played by school peer victimization as a direct and suppression reasons were associated with injury mechanism. OBJECTIVE: The study considered accelerating increases in use intensity Social reasons age and sex differences with regard to peer did not relate to use problems, whereas suppression victimization's triggering effect on physical injury, its reasons were strongly related to use problems even direct relation to injury (i.e. physical violence), and its when controlling for use intensity. CONCLUSIONS: age- and gender-specific frequency and manner of Suppression reasons not only motivate reactive coping occurrence. METHOD: Data were gathered through use in response to the appraisal of stressful situations, structured interviews with children aged 10-15 years, they are also likely to instigate "prophylactic" or residing in Stockholm County in Sweden during two proactive coping use in anticipation of the possible consecutive school years, and who had been occurrence of stressors, thereby blunting the emotional hospitalized due to injury (n = 592). RESULTS: Peer impact of encounters that would otherwise have been victimization operated on injury risk-both indirectly as appraised as stressful and aversive. a trigger of injurious events (most of which are unintentional), and directly as a causal mechanism in Lachman P. Understanding the current position of research relation to intentional physical harm. Further, in Africa as the foundation for child protection intentionally injured children frequently knew their programs. Child Abuse Negl 2004; 28(8):813-5. offender(s)--often from school--and, in those instances, had been previously victimized by them. There is a Lacroix I, Berrebi A, Chaumerliac C, Lapeyre-Mestre M, quantitative and a qualitative difference in the manner Montastruc JL, Damase-Michel C. Buprenorphine in in which occasional and frequent victims are pregnant opioid-dependent women: first results of a victimized by their peers. CONCLUSION: Peer prospective study. Addiction 2004; 99(2):209-14. victimization impacts on children's safety and is a Abstract: AIM: To report results on the prospective common element in the school background of many follow-up of 34 pregnant women exposed to children. Differences between occasional and frequent buprenorphine maintenance for opiate dependence. victims in forms and consequences of victimization are DESIGN AND SETTING: Prospective multicentre more remarkable than those based on sex and age of study: all pregnant women receiving buprenorphine as the child, with the exception of victimization as a direct maintenance therapy were included as early as possible cause of injury. during their pregnancy. PARTICIPANTS: The pregnant women were recruited from opiate Lagerberg D. Parents' observations of sexual behaviour in maintenance therapy centres, general practitioner- pre-school children. Acta Paediatr 2001; 90(4):367-9. networks involved in addiction, maternity hospitals and Abstract: This commentary on the Larsson and Svedin centres for drug information during pregnancy. study of sexual behaviour in pre-school children, MEASUREMENTS: Women: drugs and medications published in the present issue of Acta Paediatrica, consumed, medical and obstetrical events; offspring: centres around three questions: 1. How can normal withdrawal syndrome, malformation, neonatal disease. sexual behaviour in children be distinguished from FINDINGS: The buprenorphine-exposed pregnancies problematic behaviour? 2. What characterizes the resulted in 31 live births, one stillbirth, one sexual development of the normal child? 3. Can spontaneous abortion and one voluntary termination. A knowledge about normal and problematic sexual neonatal withdrawal syndrome was observed in 13 behaviour be used to screen for sexual abuse or to cases (41.9%) and eight of these babies required opiate confirm cases of sexual victimization? It is treatment. Two neonates had a malformation: a recommended that the inventory used by the authors be premature ductus arteriosus stricture and a tragus standardized on a representative sample of Swedish appendix. CONCLUSION: Taken together with other children, because this would enhance its usefulness in prospective studies, no alarming results were observed distinguishing normal from problematic behaviour. It is concerning pregnancy outcomes. However, further data further recommended that research about sexual from the comparative prospective study are required to development in children be based on person-oriented determine whether buprenorphine can be considered as rather than on variable-oriented analyses. It is finally 641
- 650. argued that knowledgeabout normal and problematic Among children who met criteria for CD, their number sexual behaviour may not contribute to more effective of covert but not overt CD symptoms improved screening or confirmation procedures in suspicions of prediction of future APD, controlling for SES. sexual abuse. However, knowledge about normal sexual behaviour is valuable in studies of sexual Laing IA. Clinical aspects of neonatal death and autopsy. behaviour in different categories of children, e.g. in the Semin Neonatol 2004; 9(4):247-54. developmentally delayed or psychosocially deprived. Abstract: An autopsy carried out by a trained perinatal Conclusion: By helping to identify problematic sexual pathologist can provide parents and professionals with behaviour in individual children, a standardized new information about the cause of a baby's death. It is inventory could guide professionals in detecting extremely stressful for parents to be asked for autopsy possible psychological problems accompanying the authorisation. The request is also very demanding for behaviour. the staff. The rates of neonatal autopsy have been declining since 1990 and, almost certainly, the adverse Lahey BB, Applegate B, Waldman ID, Loft JD, Hankin BL, publicity surrounding the Alder Hey enquiry Rick J. The structure of child and adolescent precipitated a further fall in authorisation rates. Only a psychopathology: generating new hypotheses. J re-establishment of trust between parents and Abnorm Psychol 2004; 113(3):358-85. professionals can reverse this trend. This trust is Abstract: To begin to resolve conflicts among current founded on excellent perinatal communication and competing taxonomies of child and adolescent clinical care. The child's death must be managed in the psychopathology, the authors developed an interview most empathetic way, with an understanding of covering the symptoms of anxiety, depression, bereavement and the grief support required. If the inattention, and disruptive behavior used in the parents and professionals work together as a team, the Diagnostic and Statistical Manual of Mental Disorders parents should sense the commitment of staff to their (4th ed.; DSM-IV; American Psychiatric Association, family. They may then be more likely to understand the 1994), the International Statistical Classification of importance of autopsy and to provide authorisation. Diseases and Related Health Problems (ICD-10; World Health Organization, 1992), and several implicit Laing IA, McIntosh N. Practicalities of consent. Lancet taxonomies. This interview will be used in the future to 2004; 364(9435):659. compare the internal and external validity of alternative Notes: GENERAL NOTE: KIE: 2 refs. taxonomies. To provide an informative framework for GENERAL NOTE: KIE: KIE Bib: informed future hypothesis-testing studies, the authors used consent/minors; mass screening principal factor analysis to induce new testable hypotheses regarding the structure of this item pool in a Laloe V. Epidemiology and mortality of burns in a general representative sample of 1,358 children and hospital of Eastern Sri Lanka. Burns 2002; 28(8):778- adolescents ranging in age from 4 to 17 years. The 81. resulting hypotheses differed from the DSM-IV, Abstract: This 2-year prospective study examined the particularly in suggesting that some anxiety symptoms epidemiology and mortality of 345 patients admitted are part of the same syndrome as depression, whereas with burn injuries. Sixty-four percent of all burns were separation anxiety, fears, and compulsions constitute a accidental in nature and at least 25% were self- separate anxiety dimension. inflicted. The rest were due to assaults or had a doubtful cause. The median age was 22 years. Forty- Lahey BB, Loeber R, Burke JD, Applegate B. Predicting one percent of the accidents were due to the fall of a future antisocial personality disorder in males from a homemade kerosene bottle lamp. The main cause was clinical assessment in childhood. J Consult Clin flames, followed by scalds. Females outnumbered Psychol 2005; 73(3):389-99. males in all categories of burns except cases of assault, Abstract: It is essential to identify childhood predictors and suffered from a higher mortality. Most at risk of of adult antisocial personality disorder (APD) to target accidental burns were children between 1 and 4 years, early prevention. It has variously been hypothesized who suffered primarily from scalds. Self-inflicted that APD is predicted by childhood conduct disorder burns were most common among women aged 20-29 (CD), attention-deficit/hyperactivity disorder (ADHD), years. The overall median total body surface area or both disorders. To test these competing hypotheses, (TBSA) burned was 16%. Self-inflicted and 'doubtful' the authors used data from a single childhood burns were much more extensive and more often fatal diagnostic assessment of 163 clinic-referred boys to than accidental ones. The overall mortality rate was predict future APD during early adulthood. Childhood 27%. Burns involving more than 50% of the body Diagnostic and Statistical Manual of Mental Disorders surface area were invariably fatal. Mortality was (3rd ed., rev.; American Psychiatric Association, 1987) highest in the elderly and in the 20-29 years age group. CD, but not ADHD, significantly predicted the boys' Burns were the first single cause of mortality in the subsequent APD. An interaction between surgical wards. The case is made for the establishment socioeconomic status (SES) and CD indicated that CD of more Burns Units. predicted APD only in lower SES families, however. 642
- 651. Lam LT. Attentiondeficit disorder and hospitalization early responsive parenting have a special importance owing to intra- and interpersonal violence among for children's development or is consistency across children and young adolescents. J Adolesc Health early childhood necessary? Dev Psychol 2001; 2005; 36(1):19-24. 37(3):387-403. Abstract: PURPOSE: To investigate the associations Abstract: The role of early versus ongoing maternal between intra-and interpersonal violence and related responsiveness in predicting cognitive and social injuries and the diagnosis of attention deficit disorder development was examined in home visits for mothers, (ADD) among children and young adolescents. full-term children (n = 103), and medically low-risk (n METHODS: This was a population-based = 102) and high-risk (n = 77) preterm children at 5 epidemiological study that analyzed data routinely ages. There were 4 maternal clusters based on warm collected on hospitalized patients owing to injuries. and contingent responsiveness behaviors observed Data were obtained from the routinely collected early (at 6, 12, and 24 months) and late (at 3 and 4 inpatient statistics. Information included patients' years): high early, high late; high early, low late; low demographics, diagnostic classifications of admitting early, moderate late; and low early, low late. Children, problem, classification of external causes of injury, especially preterm children, showed faster cognitive length of stay, and outcome of hospitalization. Patients growth when mothers were consistently responsive. with comorbidity of ADD were identified by the ICD- Social growth was similar in the consistently 9CM diagnosis code. Data were analyzed univirately responsive (high-high) and the early-responsive using Pearson Chi-square tests. Logistic regression inconsistent (high-low) clusters, but greater analyses were also applied to calculate the adjusted deceleration at 4 years among children with mothers in odds ratio and their corresponding 95% confidence the inconsistent cluster refuted the notion of a unique intervals. RESULTS: Significant associations between role for early responsiveness. The importance of suicide and self-harm, injuries owing to assault, and consistent responsiveness, defined by an affective- diagnosis of ADD were found. Patients diagnosed with emotional construct, was evident even when a broader ADD stayed in the hospital longer than others, constellation of parenting behaviors was considered. disregarding the cause of their injury. CONCLUSION: Children and adolescents with ADD are at risk of being Langeland W, Draijer N, van den Brink W. Psychiatric victims of assaults, as well as suicide and self harm. comorbidity in treatment-seeking alcoholics: the role of Assessment for ADD can be considered as part of childhood trauma and perceived parental dysfunction. school-age childhood screening programs. Alcohol Clin Exp Res 2004; 28(3):441-7. Abstract: BACKGROUND: This study among Lamberg L. Researchers seek roots of pedophilia. JAMA treatment-seeking alcoholics examined the relationship 2005; 294(5):546-7. between childhood abuse (sexual abuse only [CSA], physical abuse only [CPA], or dual abuse [CDA]) and Landau R. Posthumous sperm retrieval for the purpose of the presence of comorbid affective disorders, anxiety later insemination or IVF in Israel: an ethical and disorders, and suicide attempts, controlling for the psychosocial critique. Hum Reprod 2004; 19(9):1952- potential confounding effects of other childhood 6. adversities (early parental loss, witnessing domestic Abstract: In October 2003, the Attorney General of the violence, parental alcoholism, and/or dysfunction) and Government of Israel published guidelines allowing adult assault histories. METHOD: We assessed 155 (33 posthumous sperm retrieval for the purpose of later females, 122 males) treatment-seeking alcoholics using insemination or IVF by the surviving female partner. the European Addiction Severity Index, the Structured This paper presents an ethical and psycho-social Trauma Interview, and the Composite International critique of the guidelines, which challenges their basic Diagnostic Interview. RESULTS: The severity of premise that personal autonomy over-rides any other childhood abuse was associated with posttraumatic ethical principle and argues that the autonomy of the stress disorder (PTSD) and suicide attempts in females adult should not over-ride the well-being of the and with PTSD, social phobia, agoraphobia, and offspring. It also shows that, despite the centrality of dysthymia in males. Among men, multiple logistic autonomy in the guidelines, they actually infringe on regression models showed that CPA and CDA were not the autonomy of the deceased, and pose challenges to independently associated with any of the examined that of the surviving partner. It questions the propriety comorbid disorders or with suicide attempts. However, and very possibility of ascertaining the 'presumed CSA independently predicted comorbid social phobia, wishes' of the deceased for a posthumous child. agoraphobia, and PTSD. For the presence of comorbid Finally, it argues against the document's presentation of affective disorders (mainly major depression) and posthumous sperm retrieval as a medical procedure and suicide attempts, maternal dysfunctioning was contends that, on the contrary, medicine and science particularly important. CSA also independently are suborned to the exploitation of the dead. contributed to the number of comorbid diagnoses. For females, small sample size precluded the use of Landry SH, Smith KE, Swank PR, Assel MA, Vellet S. Does multivariate analyses. CONCLUSION: Childhood abuse is an important factor in understanding clinical 643
- 652. impairment in treatedalcoholics, especially regarding Lantz PE. The evidence base for shaken baby syndrome: comorbid phobic anxiety disorders, PTSD, and response to Reece et al from 41 physicians and suicidality. These findings underline the importance of scientists. BMJ 2004; 329(7468):741-2. routine assessment of childhood trauma and possible trauma-related disorders in individuals presenting to Laor N, Wolmer L, Spirman S, Wiener Z. Facing war, alcohol treatment services. More studies with bigger terrorism, and disaster: toward a child-oriented samples sizes of female alcohol-dependent patients are comprehensive emergency care system. Child Adolesc needed. Psychiatr Clin N Am 2003; 12(2):343-61. Abstract: The combination of the overwhelming nature Langeland W, van den Brink W. Child sexual abuse and of disasters and the massive losses they engender gives substance use disorders: role of psychiatric rise to a complex clinical and social picture with comorbidity. Br J Psychiatry 2004; 185:353. longterm physical, psychological, and social effects on children, families, and communities. The authors Langevin R. A study of the psychosexual characteristics of suggest that to assess the damage properly, implement sex killers: can we identify them before it is too late? interventions on a large scale, keep tabs on rising Int J Offender Ther Comp Criminol 2003; 47(4):366- needs, and restore societal function, mental health 82. professionals must adopt an ecologic systems Abstract: Thirty-three sex killers were compared to 80 approach. This approach entails working within and sexual aggressives, 23 sadists, and 611 general sex together with related institutions (education, health, offenders on sexual history and preferences, substance local government) and assisting other committed abuse crime, violence, mental illness, personality, professionals within these institutions to mediate care. neurological and endocrine abnormalities. Compared to This is of utmost importance in the area of children's other groups, sex killers started their criminal careers care because of their particular vulnerability and their earlier, more often had been to reform school, were special importance for families and society. For this members of criminal gangs, set fires, and were cruel to reason, the authors suggest that emergency mental animals. They tended so show more sadism, fetishism, health systems be better designed and implemented and voyeurism. They more often collected while keeping children at the center of their focus. An pornography, but they did not use it in their offenses. essential component of the ecologic systems approach They more often abused drugs and some suffered from is improved education for mental health professionals, drug induced psychoses. Their most common diagnosis providing them the appropriate tools to cope with was antisocial personality disorder, but only 15.2% met widespread disaster and the expertise to apply these criteria for psychopathy. Sex killers showed most signs tools. This approach, however, is not enough. A good of neuropsychological impairment, grades failure, and outcome cannot be achieved without preparedness on learning disabilities. Results suggest that greater the part of the other relevant institutions and the emphasis be placed on studying adolescent sex community as a whole. Greater awareness is needed offenders and conduct disordered children which may among local and national authorities of the importance help identify potential sex killers. of metaadaptive systems and of local, national, and international networking. In the current global village Lansford JE, Chang L, Dodge KA et al. Physical discipline that is threatened by pervasive terrorism, no and children's adjustment: cultural normativeness as a community must face it alone. The challenge of a moderator. Child Dev 2005; 76(6):1234-46. disaster to one community is a challenge to all. By Abstract: Interviews were conducted with 336 mother- working together we can lessen the devastating impact child dyads (children's ages ranged from 6 to 17 years; of these events, save countless lives, prevent untold mothers' ages ranged from 20 to 59 years) in China, suffering, and maintain hope for a better world for India, Italy, Kenya, the Philippines, and Thailand to children. examine whether normativeness of physical discipline moderates the link between mothers' use of physical Laposata E, Verhoek-Oftedahl W. Rhode Island's Child discipline and children's adjustment. Multilevel Death Review Team. Med Health R I 2005; 88(9):323- regression analyses revealed that physical discipline 5. was less strongly associated with adverse child outcomes in conditions of greater perceived Lareau AC. Who decides? Genital-normalizing surgery on normativeness, but physical discipline was also intersexed infants. Georgetown Law J 2003; 92(1):129- associated with more adverse outcomes regardless of 51. its perceived normativeness. Countries with the lowest Notes: GENERAL NOTE: KIE: 136 fn. use of physical discipline showed the strongest GENERAL NOTE: KIE: KIE Bib: informed association between mothers' use and children's consent/minors; patient care/minors behavior problems, but in all countries higher use of physical discipline was associated with more Larkin M. Paediatric heart sounds assessed by computer. aggression and anxiety. Lancet 2001; 357(9271):1856. 644
- 653. Larrea C, FreireW. Social inequality and child malnutrition weekly via telephone, was visited monthly, and in four Andean countries. Rev Panam Salud Publica underwent an extensive home interview quarterly. 2002; 11(5-6):356-64. RESULTS: The incidence of new symptoms in the Abstract: OBJECTIVE: To analyze the effects of month before quarterly home visits ranged from 8.9% socioeconomic, regional, and ethnic conditions on to 12.4% for individuals and from 32% to 39.7% for chronic malnutrition in four Andean countries of South households. Four factors were significantly associated America: Bolivia, Colombia, Ecuador, and Peru. with infection. Drinking only bottled water increased METHODS: The study was based on Demographic and risk (relative risk [RR], 2.1; 95% confidence interval Health Surveys (DHS) for Colombia (1995), Peru [CI], 1.2-3.7). Using hot water (RR, 0.7; 95% CI,.5-.9) (1996), and Bolivia (1997), and on a Living Standard and bleach (RR, 0.29; 95% CI,.23-.66) for laundry and Measurement Survey for Ecuador (1998). We reporting that germs were most likely to be picked up developed an index of household socioeconomic status in the kitchen (RR, 0.5; 95% CI,.3-.8) were protective. using categorical principal components analysis. We No other hygiene practices, including hand washing, broke down the prevalence of stunting by were associated with infection risk. CONCLUSIONS: socioeconomic status (SES), ethnicity, place of Further studies of a potential role for bottled water in residence (large cities, small cities, towns, and infections are warranted, as is a renewed appreciation countryside), and region (highland region versus other for the potential protective role of laundry practices areas of the country). We applied smoothed regression such as using bleach and hot water. curves and linear functions to analyze SES effects on stunting, with specific models for Bolivia, Ecuador, Larson EL, Lin SX, Gomez-Pichardo C, Della-Latta P. and Peru. RESULTS: Bolivia, Ecuador, and Peru have Effect of antibacterial home cleaning and handwashing similar characteristics, with high stunting prevalences products on infectious disease symptoms: a overall; higher stunting prevalences in their highland randomized, double-blind trial. Ann Intern Med 2004; areas, particularly among indigenous populations; and 140(5):321-9. strong socioeconomic disparities. Colombia, in Abstract: BACKGROUND: Despite the widespread contrast, has a lower stunting prevalence and smaller household use of cleaning and personal hygiene regional disparities. The socioeconomic gradient of products containing antibacterial ingredients, their stunting is strong in all four countries, with prevalence effects on the incidence of infectious disease symptoms rates in the poorest deciles at least three times as high have not been studied. OBJECTIVE: To evaluate the as those in the top decile. DISCUSSION: The sharp effect of antibacterial cleaning and handwashing contrast between the conditions found in Bolivia, products for consumers on the occurrence of infectious Ecuador, and Peru and those in Colombia may be the disease symptoms in households. DESIGN: result of specific ethnic factors affecting indigenous Randomized, double-blind clinical trial. SETTING: groups; a particular diet profile in the highland areas, Northern Manhattan inner-city neighborhood, New with low protein and micronutrient intake; and York. PARTICIPANTS: 238 primarily Hispanic differences in the long-term economic and social households (1178 persons) that included at least one development paths that the countries have taken. Along preschool-age child. Interventions: Households were with the strong socioeconomic gradient in all the randomly assigned to use either antibacterial or countries, the weight of ethnic and regional factors nonantibacterial products for general cleaning, laundry, suggests the need to reduce inequality as well as to and handwashing. All products were commercially comprehensively improve education and housing, available, but the packaging was blinded and the better target health and nutrition programs, and products were provided free to participants. implement participatory programs integrated into MEASUREMENTS: Hygiene practices and infectious indigenous cultures. disease symptoms were monitored by weekly telephone calls, monthly home visits, and quarterly Larson EL, Lin SX, Gomez-Pichardo C. Predictors of interviews for 48 weeks. RESULTS: Symptoms were infectious disease symptoms in inner city households. primarily respiratory: During 26.2% (717 of 2736) of Nurs Res 2004; 53(3):190-7. household-months, 23.3% (640 of 2737) of household- Abstract: BACKGROUND: Despite the fact that months, and 10.2% (278 of 2737) of household- hygienic practices have been associated with reduced months, one or more members of the household had a risk of infection for decades, the potential role of runny nose, cough, or sore throat, respectively. Fever specific home hygiene and cleaning practices in was present during 11% (301 of 2737) of household- reducing risk have not been explicated. OBJECTIVE: months, vomiting was present in 2.2% (61 of 2737), This study aimed to determine the incidence and diarrhea was present in 2.5% (69 of 2737), and boils or predictors of infectious disease symptoms over a 48- conjunctivitis were present in 0.77% (21 of 2737). week period in inner city households. METHODS: Differences between intervention and control groups Cleaning and hygiene practices and the incidence of were not significant for any symptoms (all unadjusted infectious disease symptoms were closely monitored and adjusted relative risks included 1.0) or for numbers prospectively for 48 months in 238 households. Each of symptoms (overall incidence density ratio, 0.96 household was contacted by trained interviewers [95% CI, 0.82 to 1.12]). CONCLUSIONS: The tested 645
- 654. antibacterial products didnot reduce the risk for assigned by 3rd and 4th graders (n = 117) to symptoms of viral infectious diseases in households expectations of potential perpetrators from their that included essentially healthy persons. This does not potential victims. Each participant was requested to preclude the potential contribution of these products to imagine potential incidents of school violence where reducing symptoms of bacterial diseases in the home. four familiar classmates were presented as protagonists (i.e., perpetrator and victim). An orderly manipulation Larsson I, Svedin CG. Sexual behaviour in Swedish of the combination of the level (high or low) of preschool children, as observed by their parents. Acta aggressiveness and susceptibility to victimization in Paediatr 2001; 90(4):436-44. each protagonist was made. The participants were Abstract: Issues of what constitutes normal and healthy informed whether or not the victim was about to childhood sexual behaviour have acquired new deliver tangible rewards, display signs of suffering, or implications in the light of child sexual abuse. retaliate (2*2*2 = 8 conditions). For each potential Increased knowledge in this area is therefore of vital incident, the participant estimated the likelihood that an importance and studies in different countries are attack will take place. The following order of needed. In the present study parents of 231 children importance was found: Reward > Retaliation > aged 3-6 y were asked to answer questionnaires about Suffering. Victim's aggressiveness was slightly their child's behaviour at home. The questionnaire effective. From an applied perspective, most notable is consisted of four sections: demographic data, a general the tendency to lower the likelihood of violence when behaviour checklist, a sexual behaviour inventory, and the educator knows about the incidents. attitudinal questions to the parents. The results showed that children in Sweden exhibit a wide range of sexual Lassaletta A, Martino R, Gonzalez-Santiago P, Torrijos C, behaviour, most of them developmentally related. Cebrero M, Garcia-Frias E. Reversal of an Some behaviour appeared to be very rare in a antihistamine-induced coma with flumazenil. Pediatr normative sample of preschool children and included Emerg Care 2004; 20(5):319-20. behaviours usually referred to as sexualized and Abstract: Flumazenil is a competitive antagonist with problematic. Reports on sexual behaviour in the specific action at the central benzodiazepine receptor. children were also related to general behaviour reports, It is used when benzodiazepine intoxication is the parent's socioeconomic level, parental attitudes suspected. Its use has also been reported in cannabis towards child sexuality and the openness of family intoxication, chloral hydrate overdose, hepatic habits. Conclusion: There is a need for further national encephalopathy, and alcohol intoxication. We report studies in different settings, to help create a better the case of a 7-month-old male infant with a depressed understanding of what constitutes both normative and level of consciousness after intentional intoxication of deviant sexual behaviour in children. antihistamines, whose mental status fully recovered after administration of flumazenil. To our knowledge, Lasher LJ, Feldman MD. Celiac disease as a manifestation this is the first case in children where flumazenil has of Munchausen by proxy. South Med J 2004; 97(1):67- been reported to reverse antihistamine-induced coma. 9. Abstract: In typical cases of Munchausen by proxy Latalski M, Skorzynska H, Pacian A, Sokol M. maltreatment, a mother feigns or produces illness in her Intensification of the phenomenon of violence in the child. Her primary goal is to accrue emotional family environment of teenagers. Ann Univ Mariae gratification, and no mental disorder better accounts for Curie Sklodowska [Med] 2004; 59(1):467-73. the behavior. We present the first published case in Abstract: Childhood and adolescence are the periods of which the principal manufactured ailment was celiac life when the experience of violence accumulates. As sprue. In addition, a panoply of other ailments ranging socially weaker individuals, children and teenagers are from seizures to behavioral abnormalities was reported. exposed to violence. The factors that increase the risk The case is also very unusual in the involvement of the of child maltreatment include, above all, social and paternal grandmother and, to a lesser extent, the cultural factors and the stress that family suffer from. paternal grandfather as the perpetrators. Although The literature on this subject distinguishes four definitive intervention to protect the child occurred categories of child maltreatment, namely: emotional, only after 7 years had passed, multidisciplinary physical, negligence and sexual abuse. The survey teamwork ultimately resulted in a successful outcome involved 250 representatives of high school teenagers for the child, who is now doing well. aged 15-20, including 145 girls and 105 boys. The research method was the survey estimating the Scale of Laskov-Peled R, Wolf Y. School violence in the eyes of the Battered Child Syndrome (for teenagers and adults). beholders: an integrative aggression-victimization The results show that a big group of teenagers admitted perspective. Int J Offender Ther Comp Criminol 2002; to having experienced at least one of four kinds of 46(5):603-18. domestic violence. The group is not uniform, however, Abstract: Five experiments explored, within the and the socio-cultural factors that affect the kind and framework of functional measurement, the importance intensification of the phenomenon of violence have been revealed. The most frequent reasons for using 646
- 655. violence are: lowlevel of education, unemployment of event detection times. The accuracy rate and robustness parents and material status connected with this fact, of the ANFIS with SCS with two EMG signals low frequency of attendance to religious services, suggests its applicability to ES control. alcohol abuse, and place of living. On account of the intensification of the phenomenon of violence in the Lauritsen AK, Charles AV. [Forensic examination of domestic environment and both direct and distant sexually abused children]. Ugeskr Laeger 2001; consequences of the phenomenon in the form of mental 163(18):2485-8. and physical disorders of individuals as well as the Abstract: INTRODUCTION: The Department of dangers for the proper development of the society that Forensic Medicine, Aarhus, performs examinations of result from it, there is a need to continue doing research children suspected to have been sexually abused when on this phenomenon. reported to and requested by the police. A preliminary study was taken to evaluate all cases in one year Lau BW. Does the stress in childhood and adolescence including the legal outcome. MATERIAL AND matter? A psychological perspective. J R Soc Health METHODS: The material included all cases in one 2002; 122(4):238-44. year, all examined on request by the police. All written Abstract: Although stress in adults is well researched material including court decisions were reviewed. and acknowledged, little has been discussed on the RESULTS: The material included 34 cases with three existence and reactions of children and adolescents to boys, median-age 11 years, and 31 girls, median age stress, despite the mounting evidence that they are six years, at the time of examination. The sexual abuse frequently among the most affected victims of a variety events were fondling, vaginal (14), anal (7) and oral (5) of threatening events. In reality stress is a normal part intercourse as well as showing pornography. The of a child's or adolescent's life and encompasses medical examination was most often performed more common, developmental stressors of daily life and than one week after the abuse. The examination those arising from unusual or traumatic experiences. revealed normal findings in 20 cases, non specific Apart from more well known stress from family findings including erythema of the vestibulum in 13 instability, poverty and life transitions, it is easy to cases and in only one child was a traumatic lesion with forget or ignore the many school pressures and rupture of the hymen seen. The perpetrators were increasingly common social phenomenon of the above 25 years of age and were family members or 'hurried child' in modern life. We can make plans of someone known to the child. Eight perpetrators were intervention and prevention only when the condition is convicted in court, of whom three admitted having recognised by the health care professionals. abused the child. DISCUSSION: The time interval between the sexual abuse and the time of examination Lauer RT, Smith BT, Betz RR. Application of a neuro-fuzzy is important to the ano-genital findings at the network for gait event detection using examination. A medical examination in cases of sexual electromyography in the child with cerebral palsy. child abuse seldom provides legal proof of sexual IEEE Trans Biomed Eng 2005; 52(9):1532-40. abuse. The most important evidence is the story told by Abstract: An adaptive neuro-fuzzy inference system the child. Therefore, the examination is a supplement (ANFIS) with a supervisory control system (SCS) was which may support or remain neutral to the story told used to predict the occurrence of gait events using the by the child. electromyographic (EMG) activity of lower extremity muscles in the child with cerebral palsy (CP). This is Lautze S, Leaning J, Raven-Roberts A, Kent R, Mazurana anticipated to form the basis of a control algorithm for D. Assistance, protection, and governance networks in the application of electrical stimulation (ES) to leg or complex emergencies. Lancet 2004; 364(9451):2134- ankle muscles in an attempt to improve walking ability. 41. Either surface or percutaneous intramuscular electrodes Abstract: This article presents an introduction to the were used to record the muscle activity from the causes and characteristics of armed conflicts. It reviews quadriceps muscles, with concurrent recording of the some of the key humanitarian crises that broke new gait cycle performed using a VICON motion analysis ground in terms of the technologies and practices that system for validation of the ANFIS with SCS. Using developed at the field level in response to each new one EMG signal and its derivative from each leg as its complex emergency, with particular focus on the health inputs, the ANFIS with SCS was able to predict all gait sector. It introduces the concept of humanitarian events in seven out of the eight children, with an governance as a framework for addressing the average absolute time differential between the VICON consequences and implications of the failure of recording and the ANFIS prediction of less than 30 ms. worldwide governance for the protection of civilians in Overall accuracy in predicting gait events ranged from armed conflict. Here, we term humanitarian 98.6% to 95.3% (root mean-squared error between 0.7 governance to include the use of international and 1.5). Application of the ANFIS with the SCS to the humanitarian law and human rights instruments to prediction of gait events using EMG data collected two govern the behaviour of state and non-state months after the initial data demonstrated comparable organisations in conflict zones in a way that protects results, with no significant differences between gait the lives and livelihoods of affected populations. We 647
- 656. note, however, thatterrorist concerns appear to be and/or a specific IgE assay. The most frequent cause of replacing humanitarian logic in the network of anaphylaxis was a neuromuscular blocking agent worldwide governance. (69.2%). Latex was less frequently incriminated (12.1%) than in previous reports. A significant Laverdino M. An issue that came to my attention recently difference was observed between the incidence of regarding child benefit. RCM Midwives 2005; anaphylactic reactions observed with each 8(5):232. neuromuscular blocking agent and the number of patients who received each drug during anaesthesia in Lawhon G. Challenges in providing developmentally France throughout the study period (P<0.0001). supportive care: a case presentation. J Obstet Gynecol Succinylcholine and rocuronium were most frequently Neonatal Nurs 2003; 32(3):387-92. incriminated. Clinical reactions to neuromuscular Abstract: A developmentally supportive family- blocking drugs were more severe than to latex. The centered approach to care is extremely valuable for diagnostic value of specific IgE assays was confirmed. even the most critically ill infant. This case These results are consistent with changes in the presentation of Martha, a severely small for gestational epidemiology of anaphylaxis related to anaesthesia and age twin born at 30 weeks gestation, highlights three are an incentive for the further development of allergo- major areas in which clinical care is enhanced through anaesthesia clinical networks. the integration of neurobehavioral observation: self- regulation, comfort, and family advocacy. The ethical Lazzarini Z, Rosales L. Legal issues concerning public principles of autonomy, beneficence, and integrity health efforts to reduce perinatal HIV transmission. were relied upon to ensure her humane care. Yale J Health Policy Law Ethics 2002; 3(1):67-98. Notes: GENERAL NOTE: KIE: 152 fn. Lawrence PR, Magee T, Bernard A. Reshaping primary GENERAL NOTE: KIE: KIE Bib: AIDS; public health care: the Healthy Steps Initiative. J Pediatr Health Care 2001; 15(2):58-62. Le Fanu J. Roy Meadow. Lancet 2005; 366(9484):450. Abstract: The Healthy Steps Initiative, funded by the Commonwealth Fund in New York and developed and Le Fanu J. Wrongful diagnosis of child abuse--a master implemented by Boston University School of theory. J R Soc Med 2005; 98(6):249-54. Medicine, is an enhanced approach to pediatric care in the first 3 years of life. The goals of this effort in Le Grand R, Mondloch CJ, Maurer D, Brent HP. Expert face transforming pediatric care include (a) supporting the processing requires visual input to the right hemisphere physical and emotional development of each infant and during infancy. Nat Neurosci 2003; 6(10):1108-12. young child; (b) supporting a parental sense of Abstract: Adult expertise in face processing is confidence in their child-rearing knowledge and skills; mediated largely by neural networks in the right and (c) supporting the clinical effectiveness of pediatric hemisphere. Here we evaluate the contribution of early primary care practices to meet the needs of young visual input in establishing this neural substrate. We children and families. The Healthy Steps Initiative compared visually normal individuals to patients for enhances well-child care to achieve these goals by whom visual input had been restricted mainly to one providing child development information and support hemisphere during infancy. We show that early as part of an expanded approach to pediatric primary deprivation of visual input to the right hemisphere care. Healthy Steps offers both pediatric practices and severely impairs the development of expert face families a vehicle for meeting the needs of infants and processing, whereas deprivation restricted mainly to young children within a preventative framework. This the left hemisphere does not. Our results indicate that unique program, which is being quantitatively and the neural circuitry responsible for adults' face qualitatively evaluated over 3 years, has been initiated expertise is not pre-specified, but requires early visual in more than 24 pediatric sites nationwide. experience. However, the two hemispheres are not equipotent: only the right hemisphere is capable of Laxenaire MC, Mertes PM. Anaphylaxis during anaesthesia. using the early input to develop expertise at face Results of a two-year survey in France. Br J Anaesth processing. 2001; 87(4):549-58. Notes: CORPORATE NAME: Groupe d'Etudes des Leander L, Granhag PA, Christianson SA. Children exposed Reactions Anaphylactoides Peranesthesiques to obscene phone calls: what they remember and tell. Abstract: Between January 1, 1997 and December 31, Child Abuse Negl 2005; 29(8):871-88. 1998, 467 patients were referred to one of the allergo- Abstract: OBJECTIVE: This case study examined anaesthesia centres of the French GERAP (Groupe children's reports from an obscene phone call (i.e., a d'Etudes des Reactions Anaphylactoides verbal sexual abuse). We investigated which type of Peranesthesiques) network and were diagnosed as information the children reported, the completeness having anaphylaxis during anaesthesia. Diagnosis was and accuracy of the children's statements, and whether established on the basis of clinical history, skin tests there were systematic patterns in terms of memory 648
- 657. distortions and omissions. METHOD: The Psychol 2005; 41(1):124-34. completeness and the accuracy of the children's Abstract: Observational methods were used to examine statements were examined by matching 64 children's aggressive children's peer relations in 2 contexts: when statements given during police interviews with a being teased by a peer and when interacting with a best detailed documentation of each phone call, made by the friend. Because aggressive children may have more perpetrator during the actual phone calls. RESULTS: difficulty than nonaggressive children in both peer All children remembered the phone call per se, but they contexts, the authors also examined whether relations were found to omit almost all of the sexual and between behaviors across contexts varied as a function sensitive information (perpetrator's questions and of aggression. Results indicated that aggression was statements) and about 70% of the neutral information related to children's behavior when provoked. given by the perpetrator. However, the children were Children's behavior when provoked was associated accurate in the information they did report. with fewer positive and more negative interactions with CONCLUSIONS: The fact that the children did their best friend, particularly for aggressive children. remember more of the neutral information suggests that Results are discussed with respect to social norms in they actually remembered the sexual information as middle childhood and informing interventions for well, but that they chose not to report it. Results aggressive children. indicate that children who have been sexually abused may remember more than they report in an initial LeBlanc JC, Binder CE, Armenteros JL et al. Risperidone interview. One possible underlying reason is that reduces aggression in boys with a disruptive behaviour children experience shame or embarrassment. disorder and below average intelligence quotient: analysis of two placebo-controlled randomized trials. Lear JG. Schools and adolescent health: strengthening Int Clin Psychopharmacol 2005; 20(5):275-83. services and improving outcomes. J Adolesc Health Abstract: The present study aimed to analyse the effect 2002; 31(6 Suppl):310-20. of risperidone on a priori defined core aggression Abstract: School-based health services have made items. Data were pooled from 163 boys (aged 5-12 limited contributions to the well-being of school-age years, with or without comorbid attention- children. However, they have the potential for deficit/hyperactivity disorder) with a DSM-IV promoting health and improving service delivery for 50 diagnosis of either conduct disorder or oppositional million children and adolescents enrolled in the nation's defiant disorder who had participated in either of two schools. Recent changes in health care, particularly the identical, 6-week, randomized, double-blind, placebo- spread of managed care and development of integrated controlled trials. All received treatment with either health service networks, have reawakened mainstream placebo or oral risperidone solution (0.01-0.06 interest in school health and created the possibility for mg/kg/day). Subjects had below average intelligence strengthening its efficiency and effectiveness.Two [intelligence quotient (IQ) 36-84] and a score of > or promising strategies for enabling school health =24 on the Conduct Problem subscale of the Nisonger programs to fulfill their potential are being Child Behaviour Rating Form (N-CBRF). An expert implemented by the Massachusetts state government advisory panel selected six core aggression items from and by an Austin, Texas, hospital system. These the N-CBRF, from which a total Aggression Score strategies suggest measures to create either closely (AS, range 0-18) was constructed. Compared to those linked school and community health systems or fully treated with placebo, risperidone-treated subjects integrated school/community child health systems that experienced significantly greater mean decreases from may have widespread benefit for children and their baseline in the AS at each of weeks 1-6 (P<0.001). By families.Barriers to fully implementing these strategies study endpoint, aggression among risperidone-treated and replicating them in other communities will include subjects had declined by 56.4% (mean baseline AS the challenge of securing adequate funding, 10.1; mean endpoint AS 4.4), which was more than disagreements regarding the appropriate content of a twice that of placebo-treated subjects (mean baseline school health program, and opposition to new staffing AS 10.6; mean endpoint AS 8.3; 21.7% reduction). and employment arrangements from professional and Risperidone was efficacious in reducing symptoms of union organizations. Whether this moment of aggression in boys of below average IQ with disruptive opportunity yields gains for child health and school behaviour disorders. health will, for the most part, depend on forces outside school health. Success will be particularly dependent Lee AC, Hau KL, Fong D. CT findings in hyperacute non- on the degree to which the managed care plans or large accidental brain injury. Pediatr Radiol 2001; 31(9):673- health care organizations see value in building more 4. comprehensive child health systems or identify financial benefits from linking more closely with Lee AC, Lam SY. Nonaccidental methadone poisoning. Clin school-based services. Pediatr (Phila) 2002; 41(5):365-6. Leary A, Katz LF. Observations of aggressive children Lee CM, Beauregard C, Bax KA. Child-related during peer provocation and with a best friend. Dev 649
- 658. disagreements, verbal aggression,and children's experiencing domestic violence. Violence Vict 2004; internalizing and externalizing behavior problems. J 19(5):573-91. Fam Psychol 2005; 19(2):237-45. Abstract: This study examined the association between Abstract: Dual-income parents (N = 122 couples) with physical domestic violence (PDV) and reported child an oldest child 18-60 months of age completed the maltreatment in a cohort of children at risk for Child-Rearing Disagreements Scale (E. N. Jouriles et maltreatment. Participants were 219 6- to 7-year-old al., 1991), the Child Behavior Checklist (T. M. children and their caregivers. PDV was measured by Achenbach & L. A. Rescorla, 2000), and the Verbal combining caregivers' self-reports and children's Aggression subscale of the Conflicts and Problem- reports, while child maltreatment was based on state Solving Scale (P. K. Kerig, 1996). Replicating the Division of Social Services Central Registry records. results of E. N. Jouriles et al. (1991) and extending Among 219 child-caregiver pairs studied, 42 (19.2%) these findings to daughters and fathers, the authors had at least one maltreatment report in the 2 years found links between child-related disagreements and following the interviews. PDV consistently predicted parental ratings of child behavior problems in this low- child maltreatment, with adjusted odds ratios ranging risk sample. There were no links between fathers' from 2.96 to 3.46. In addition, we investigated reports of verbal aggression and child behavior interactions between PDV and other predictors of child problems. Among mothers, however, use of verbal maltreatment. Among Aid to Families with Dependent aggression mediated the link between child-related Children (AFDC) participants, PDV was highly disagreements and ratings of sons' internalizing associated with child maltreatment. However, this problems. Verbal aggression did not moderate the link pattern was not observed among subjects who did not between child-related disagreements and child behavior have AFDC. There is an increased incidence of child problems for either mothers or for fathers. maltreatment reports in families experiencing PDV. AFDC participation intensified the probability of child Lee G. Removing the labels, meeting the needs. RCM maltreatment in the presence of PDV. Findings also Midwives J 2002; 5(4):135. suggest that in households experiencing PDV, social supports may protect children from maltreatment. Lee JH, Kim HY, Park YA. Rearing behavior and rearing stress of fathers with children of preschool and school Lee MB, Rotheram-Borus MJ. Parents' disclosure of HIV to age. Taehan Kanho Hakhoe Chi 2004; 34(8):1491-8. their children. AIDS 2002; 16(16):2201-7. Abstract: PURPOSE: This study was conducted to Abstract: OBJECTIVE: Parents' disclosure of their compare the paternal rearing behavior and rearing HIV serostatus to all of their children is described over stress level between fathers with a preschooler and time and the impact of disclosure is examined for their fathers with school children so that it can be utilized as adolescent children.DESIGN A representative cohort a basic source for developing parental rearing of parents living with HIV (n = 301) and their education programs. METHODS: A descriptive adolescent children (n = 395) was recruited and comparative method was conducted to identify the assessed repeatedly over 5 years. METHODS: paternal rearing behavior and paternal rearing stress. Disclosures by parents living with HIV of their HIV Respondents were 361 fathers who had either status to their children were examined in three ways: (i) preschoolers (n=189) or children of elementary age trends in disclosure over 5 years to all children; (ii) (n=172). RESULTS: Comparing the two group's factors associated with parental disclosure; and (iii) the means, the rearing activity score and rearing stress impact of disclosure on adolescent children (not there were significant differences. In the school younger children). RESULTS: Parents were more children's group's father, 'outdoor activity' and likely to disclose to older (75%) than to younger 'guidance on discipline activity' were significantly children (40%). Mothers were more likely to disclose higher than the other group. In the preschool children's earlier than fathers and they disclosed more often to fathers group, 'play interaction activity' was statistically their daughters than to their sons. Parents were more significant higher than the other, and the child-part likely to disclose over time to children of all ages; mean score of paternal rearing stress was significantly disclosure did not vary according to parents' ethnicity, higher than the other group. The correlation between socio-economic status, self-esteem, or mental health paternal rearing behavior and paternal rearing stress, symptoms. Disclosure was significantly more common indicates that more paternal rearing behavior means among parents with poor health, more stressful life less paternal rearing stress. CONCLUSION: These events, larger social networks, and those who perceived results of this study will help design more effective their children experiencing more HIV-related stigma. rearing programs for fathers that have either preschool Over time, poor health status and a self-destructive children or school children by providing the basic data coping style were associated with higher rates of for paternal rearing behaviors and paternal rearing disclosure. Parental disclosure was significantly stress. associated with more problem behaviors and negative family life events among their adolescent children. Lee LC, Kotch JB, Cox CE. Child maltreatment in families CONCLUSION: Parental disclosure of HIV status is similar to disclosures by parents with other illnesses. 650
- 659. Clinicians must assistpatients to make individual AQP-4 was localized to the plasma membranes of decisions regarding disclosure. astrocytes including the perivascular end-feet. Gene expression associated with increased AQP-4 was Lee TC, Barshes NR, Washburn WK et al. Split-liver evaluated by high throughput gene expression analysis transplantation using the left lateral segment: a using Affymetrix GeneChip U133A and related gene collaborative sharing experience between two distant networks were investigated with Ingenuity Pathways centers. Am J Transplant 2005; 5(7):1646-51. Analysis. AQP-4 expression was associated with a Abstract: Split-liver transplantation (SLT) increases the decrease in expression of the dystrophin gene, a protein pool of organs for pediatric orthotopic liver implicated in the anchoring of AQP-4 in perivascular transplantation (pOLT). With increased collaboration endfeet. The decreased expression of dystrophin may and organ sharing, transplant centers can fully indicate a loss of polarity in the distribution of AQP-4 maximize the use of all split donor allografts. Herein, in astrocytes. We conclude that the perturbed we report the collaborative results between two distant expression of AQP-4 and dystrophin may be one factor centers involved in a sharing alliance. The current underlying the loss of ion and water homeostasis in the study consists of a retrospective review of 56 pediatric sclerotic hippocampus and hypothesize that the LLS transplants performed at two collaborating centers reported changes may contribute to the epileptogenic between 9/1997 and 10/2003. Fifty-three patients (41% properties of the sclerotic tissue. Status 1) were transplanted using 56 left lateral segment (LLS) grafts. Sixteen percent of LLS grafts Leeder JS. Developmental and pediatric pharmacogenomics. were shared between the two institutions. Overall Pharmacogenomics 2003; 4(3):331-41. patient survival at both 1 and 3 years was 90% and Abstract: Children, as well as adults, should benefit 90%, respectively. Overall graft survival at both 1 and from the discoveries of the genomic era. Many diseases 3 years was 82% and 82%, respectively. Shared patient with complex etiologies originate during childhood and graft survival was 89% and 89%, respectively. (e.g., asthma, autism, attention deficit/hyperactivity There was an 11% biliary complication and 18% disorder, epilepsy and juvenile rheumatoid arthritis) vascular complication rate. Five patients required and persist into adulthood. Attempts to better retransplantation. In conclusion, SLT increases the understand the genetic basis of age-specific disease number of available allografts for pOLT. While SLT is processes requires an appreciation that the period of technically demanding, with a significant learning human development encompasses the prenatal period curve, patient and graft survival rates compare through adolescence, and is a rapidly changing, favorably with United Network Organ Sharing dynamic process. As a result, pharmacologic (UNOS) averages. Sharing of grafts between centers is modulation of developing gene networks may have a safe and effective way to maximize organ usage and unintended and unanticipated consequences that do not should be actively pursued through collaborative become apparent or relevant until later in life. Thus, networks. there is considerable potential for large-scale pharmacogenomic technologies to impact the Lee TS, Eid T, Mane S et al. Aquaporin-4 is increased in the development and utilization of new therapeutic sclerotic hippocampus in human temporal lobe strategies in children. epilepsy. Acta Neuropathol (Berl) 2004; 108(6):493- 502. Leeder JS. Translating pharmacogenetics and Abstract: The hippocampus of patients with mesial pharmacogenomics into drug development for clinical temporal lobe epilepsy is often hardened and shrunken, pediatrics and beyond. Drug Discov Today 2004; a condition known as sclerosis. Magnetic resonance 9(13):567-73. imaging reveals an increase in the T2-weighted signal, Abstract: Pharmacogenetic and pharmacogenomic while diffusion weighted imaging shows a higher investigations conducted in children must consider that apparent diffusion coefficient in sclerotic hippocampi, human development from conception through to indicating increased water content. As water transport adolescence is a rapidly changing, dynamic process. appears to be coupled to K+ clearance and neuronal An improved understanding of the gene networks that excitability [4], the molecular basis of the perturbed are involved in growth and development and of the water homeostasis in the sclerotic hippocampus was unintended consequences of modulating those systems explored. The expression of aquaporin-4 (AQP-4), the could provide insights into the susceptibility of an predominant water channel in the brain, was studied individual to drug-induced birth defects and to with quantitative real time PCR analysis, light pediatric adverse drug reactions. Furthermore, these microscopic immunohistochemistry and high- technologies potentially present the opportunity to resolution immunogold labeling. A significant increase develop novel, effective treatments for childhood in AQP-4 was observed in sclerotic, but not in non- diseases and for adult diseases that manifest primarily sclerotic, hippocampi obtained from patients with during childhood. The lack of pharmacogenetic and medically intractable temporal lobe epilepsy. This pharmacogenomic investigations in children and the increase was positively correlated with an increase in potential to impact on all age groups provides a the astrocyte marker glial fibrillary acidic protein. considerable incentive to invest in this area of research. 651
- 660. Leestma JE. Caseanalysis of brain-injured admittedly recommended antibiotics and antiviral treatments for shaken infants: 54 cases, 1969-2001. Am J Forensic bioterror agents have not been approved for use in Med Pathol 2005; 26(3):199-212. children, and children undergoing smallpox Abstract: The English-language medical case literature vaccination have a higher incidence of complications was searched for cases of apparent or alleged child than adults. Pediatric anesthesiologists should expect to abuse between the years 1969 and 2001. Three- be part of the pediatric care team and must be careful to hundred and twenty-four cases that contained detailed observe infection control procedures to limit the spread individual case information were analyzed yielding 54 of disease caused by bioterror attack. cases in which someone was recorded as having admitted, in some fashion, to have shaken the injured Leite AJ, Puccini RF, Atalah AN, Alves Da Cunha AL, baby. Individual case findings were tabulated and Machado MT. Effectiveness of home-based peer analyzed with respect to shaking as being the cause for counselling to promote breastfeeding in the northeast the injuries reported. For all 54 admittedly-shaken- of Brazil: a randomized clinical trial. Acta Paediatr infant cases, the provided details regarding the shaking 2005; 94(6):741-6. incidents and other events are reported. Data in the Abstract: AIMS: To evaluate the effectiveness of case reports varied widely with respect to important home-based peer counselling to increase breastfeeding details. Only 11 cases of admittedly shaken babies rates for unfavourably low birthweight babies. showed no sign of cranial impact (apparently free- METHODS: Randomized clinical trial carried out in shaken). This small number of cases does not permit maternity hospitals and households in Fortaleza, one of valid statistical analysis or support for many of the the regions in Brazil with very low income; 1003 commonly stated aspects of the so-called shaken baby mothers and their newborns were selected in eight syndrome. maternity hospitals. Newborns needed were healthy and weighed less than 3000 g. INTERVENTION: Leiferman JA, Ollendick TH, Kunkel D, Christie IC. Breastfeeding counselling, conducted by lay Mothers' mental distress and parenting practices with counsellors from the community, during home visits infants and toddlers. Arch Womens Ment Health 2005; carried out on days 5, 15, 30, 60, 90 and 120 after birth. 8(4):243-7. MAIN OUTCOME MEASURE: Feeding methods in Abstract: The purpose of this study was to examine the fourth month of life. RESULTS: The intervention whether maternal mental distress affects parenting increased exclusive breastfeeding (24.7% vs 19.4%; practices related to monitoring activities (i.e. daily p=0.044), delayed the introduction of formula and routines, enrichment activities). The nationally increased the time infants substituted breastfeeding to representative sample consisted of 1638 mothers. bottle milk (bottle milk 33.4% in the control group and Maternal mental distress was assessed by the 5-item 20.1% in the intervention group; p=0.00002). When Mental Health Index (MHI). Logistic regression comparing the frequency of artificial breastfeeding models were conducted, controlling for covariates (e.g. versus all other forms of breastfeeding marital status, education level, etc.). Approximately (exclusive+predominant+partial), the intervention 14% of the women reported high levels of mental increased breastfeeding rates in 39% (RR=0.61; CI distress and 25% of the women failed to engage in 95%: 0.50-0.75); 15% of children were free from enrichment activities or consistent daily routines with artificial feeding (absolute risk reduction). The number their children. There was a significant adverse of families to be visited to avoid one child receiving relationship between mental distress and routines, with artificial feeding (NNT) was 7 (CI 95%: 5-13). women who were mentally distressed being more CONCLUSIONS: Breastfeeding counselling, promoted likely to not engage in daily routines. There was no by lay counsellors, can impact favourably on exclusive significant relationship between mental distress and breastfeeding rates and contribute to delaying the enrichment activities. Race differentials were evident utilization of milk formula and weaning. The among these relationships. These findings highlight the intervention has great application potential because prevalence of maternal mental distress and its most cities in the northeast of Brazil count on deleterious effects on select parenting behaviors. community health workers that could do the counselling. Leissner KB, Holzman RS, McCann ME. Bioterrorism and children: unique concerns with infection control and Leitenberg H, Gibson LE, Novy PL. Individual differences vaccination. Anesthesiol Clin North America 2004; among undergraduate women in methods of coping 22(3):563-77, viii. with stressful events: the impact of cumulative Abstract: Treatment of child victims of a bioterrorism childhood stressors and abuse. Child Abuse Negl 2004; attack is complicated because they may be more 28(2):181-92. vulnerable to the agents used and may suffer more Abstract: OBJECTIVE: The purpose of the current complications from the treatment strategies. Isolation study was to determine if a history of greater exposure and other infection control measures can be to different types of adverse and/or abusive experiences psychologically harmful to young children and may in childhood would influence coping strategies used by require that they undergo sedation. Most of the undergraduate women to deal with new stressful events 652
- 661. in young adulthood.METHOD: A sample of 828 dissatisfaction. Most (81.5%) of the participants felt women undergraduates from a New England state that Rettnet provided helpful advice concerning their university participated in this questionnaire study. child's management. They also indicated that Rettnet Disengagement and engagement coping strategies used was useful in dealing with their child's education and as in response to recent stressors were compared in a source of carer support. They rated it highly (mean groups who had none, one, two, or three or more types 8.1 on a scale of 1 to 10), and the most common reason of adverse and/or abusive childhood experiences given for recommending the service to other parents (sexual abuse, physical abuse, witnessing domestic was the emotional support provided. E-mail listservs violence, having an alcoholic parent, and parental can play an important role in disseminating information rejection). RESULTS: There was an increased reliance and providing networking and support to parents of on disengagement methods of coping (wishful children with rare disorders. Their impact and thinking, problem avoidance, social withdrawal, and influence warrant attention from health professionals, self-criticism) as a function of more extensive child including neurologists. abuse histories. Engagement methods of coping (problem solving, cognitive restructuring, social LeRoy BW, Walsh PN, Kulik N, Rooney M. Retreat and support, and express-emotions), however, did not show resilience: life experiences of older women with a corresponding decrease as a function of increased intellectual disabilities. Am J Ment Retard 2004; exposure to different types of childhood stressors 109(5):429-41. and/or abuse. CONCLUSIONS: This study Abstract: Older women with intellectual disabilities demonstrates that undergraduate women with remain the least studied and understood members of cumulative adverse and/or abusive childhood histories the disability population, and yet they often live well are particularly at-risk of relying on maladaptive into late adulthood. In this exploratory study we used disengagement coping strategies to deal with various extensive interviews to examine the demographics, new stressors later in life. economic and personal safety nets, health, social roles, and well-being of 29 Irish and American older women Lemay G. The time for revolution. Midwifery Today Int with intellectual disabilities. Results suggest that these Midwife 2002; (62):46, 64. women have very limited resources, social networks, and opportunities. All the women were poor and most Leon IG. Adoption losses: naturally occurring or socially lived in group residences, with paid staff as their main constructed? Child Dev 2002; 73(2):652-63. allies and careproviders. They reported that their health Abstract: The American definition of kinship based on was good, though it often limited their activities. biological ties, the practice of closed adoption, and Despite their societal limitations, these women reported stigmas associated with adoption may decisively this is the happiest period of their lives. influence adoption-related losses. Cross-cultural and historical accounts of adoption that do not apply to Les Whitbeck B, Chen X, Hoyt DR, Adams GW. these contemporary American constructs of parenthood Discrimination, historical loss and enculturation: and practices of adoption suggest outcomes that are not culturally specific risk and resiliency factors for as integrally based on loss. Adoption in infancy is alcohol abuse among American Indians. J Stud Alcohol defined as parenting a child with one set of (adoptive) 2004; 65(4):409-18. parents and two (adoptive and birth) families. Abstract: OBJECTIVE: This report investigates the Implications for adoption research, policy, and practice effects of discrimination, historical loss and are discussed. enculturation on meeting diagnostic criteria for 12- month alcohol abuse among American Indians who Leonard H, Slack-Smith L, Phillips T, Richardson S, share a common culture in the upper Midwest. We D'Orsogna L, Mulroy S. How can the Internet help introduce an empirical measure of historical loss and parents of children with rare neurologic disorders? J hypothesize that historical loss will mediate the effects Child Neurol 2004; 19(11):902-7. of discrimination on meeting 12-month diagnostic Abstract: The objective of this study was to determine criteria for alcohol abuse. We also hypothesize that the value of an e-mail listserv for parents of children enculturation will be negatively associated with 12- with Rett syndrome, a rare neurologic disorder. This month alcohol abuse and mediate or moderate the Web-based survey was completed by parents and effects of discrimination. METHOD: A sample of 452 carers. The setting was an e-mail listserv established by (351 women) American-Indian parents/caretakers the International Rett Syndrome Association for (mean age: women = 39 years, men = 42 years) of parents of children with Rett syndrome and other children ages 10 to 12 years participated in diagnostic interested persons. The participants included members interviews for lifetime and 12-month alcohol abuse. of the e-mail listserv Rettnet. The main outcome The subjects' perceptions of discrimination, historical measures were the perceived advantages and loss and enculturation were also measured. Structural disadvantages of the listserv, overall rating of equation modeling was used to evaluate direct and usefulness, and reasons for satisfaction or potential mediating effects of latent constructs of enculturation (a resiliency factor) and historical loss (a 653
- 662. risk factor) onthe relationship between discrimination criteria of the Diagnostic and Statistical Manual of and meeting criteria for 12-month alcohol abuse. Mental Disorders, 4th ed. Other mental health and RESULTS: Historical loss mediated the effects of learning problems were common in the sample; 58.5% discrimination on 12-month alcohol abuse among of subjects met screening criteria for oppositional women. Enculturation neither mediated nor moderated defiant disorder/conduct disorder, 32.7% met screening the effects of discrimination but had an independent criteria for anxiety/depression, and approximately one- negative effect on alcohol abuse. In a combined model third had an active individualized education program in comprising both enculturation and historical loss, the place or had received an individualized education effects of discrimination on 12-month alcohol abuse program in the past. On evaluation, the SANDAP were mediated. CONCLUSIONS: This study presents protocol was acceptable and feasible for all important new evidence that historical loss affects stakeholders. However, additional barriers to American-Indian alcohol abuse. It also provides implementing the AAP ADHD guidelines were evidence for the resiliency effects of enculturation on identified, including 1) limited information in the alcohol abuse. guidelines regarding the use of specific ADHD rating scales, the evaluation and treatment of children with Leslie LK, Weckerly J, Plemmons D, Landsverk J, Eastman discrepant and/or negative results, and the indications S. Implementing the American Academy of Pediatrics for psychologic evaluation of learning problems, 2) attention-deficit/hyperactivity disorder diagnostic families' need for education regarding ADHD and guidelines in primary care settings. Pediatrics 2004; support, 3) characteristics of physical health and 114(1):129-40. mental health plans that limited care for children with Abstract: OBJECTIVES: To evaluate the feasibility of ADHD, and 4) limited knowledge and use of potential the San Diego Attention-Deficit/Hyperactivity community resources. CONCLUSIONS: Our results Disorder Project (SANDAP) protocol, a pediatric indicate that children presenting for evaluation of community-initiated quality improvement effort to possible ADHD in primary care offices have complex foster implementation of the American Academy of clinical characteristics. Providers need mechanisms for Pediatrics (AAP) attention-deficit/hyperactivity implementing the ADHD diagnostic guidelines that disorder (ADHD) diagnostic guidelines, and to identify address the physician education and delivery system any additional barriers to providing evidence-based design aspects of care that were developed in the ADHD evaluative care. METHODS: Seven research- SANDAP protocol. Additional barriers were also naive primary care offices in the San Diego area were identified. Careful attention to these factors will be recruited to participate. Offices were trained in the necessary to ensure the sustained provision of quality SANDAP protocol, which included 1) physician care for children with ADHD in primary care settings. education, 2) a standardized assessment packet for parents and teachers, 3) an ADHD coordinator to assist Lester BM, Andreozzi L, Appiah L. Substance use during in collection and collation of the assessment packet pregnancy: time for policy to catch up with research. components, 4) educational materials for clinicians, Harm Reduct J 2004; 1(1):5. parents, and teachers, in the form of handouts and a Abstract: The phenomenon of substance abuse during website, and 5) flowcharts delineating local paths for pregnancy has fostered much controversy, specifically referral to medical subspecialists, mental health regarding treatment vs. punishment. Should the practitioners, and school-based professionals. The pregnant mother who engages in substance abuse be assessment packet included the parent and teacher viewed as a criminal or as someone suffering from an versions of the Vanderbilt ADHD Diagnostic Rating illness requiring appropriate treatment? As it happens, Scales. In this study, we chose a conservative there is a noticeably wide range of responses to this interpretation of the AAP ADHD guidelines for matter in the various states of the United States, diagnosing ADHD, requiring that a child met criteria ranging from a strictly criminal perspective to one that for ADHD on both the parent and teacher rating scales. does emphasize the importance of the mother's A mixed-method analytic strategy was used to address treatment. This diversity of dramatically different feasibility and barriers, including quantitative surveys responses illustrates the failure to establish a uniform with parents and teachers and qualitative debriefing policy for the management of this phenomenon. Just as sessions conducted an average of 3 times per year with there is lack of consensus among those who favor pediatricians and office staff members. RESULTS: punishment, the same lack of consensus characterizes Between December 2000 and April 2003, 159 children those states espousing treatment. Several general policy were consecutively enrolled for evaluation of school recommendations are offered here addressing the and/or behavioral problems. Clinically, only 44% of critical issues. It is hoped that by focusing on these the children met criteria for ADHD on both the parent fundamental issues and ultimately detailing statistics, and teacher scales, and 73.5% of those children were policymakers throughout the United States will categorized as having the combined subtype. More consider the course of action that views both pregnant than 40% of the subjects demonstrated discrepant mother and fetus/child as humanely as possible. results on the Vanderbilt scales, with only the parent or teacher endorsing sufficient symptoms to meet the Letourneau EJ, Schoenwald SK, Sheidow AJ. Children and 654
- 663. adolescents with sexualbehavior problems. Child check-up and hepatitis B vaccination, to sex workers Maltreat 2004; 9(1):49-61. (SW). Sera were collected from 121 men, urine Abstract: Youth with substantial sexual behavior samples from 115 men and a questionnaire was filled problems (n = 166) were compared with youth from the in by 43 MSW. In 45.5% of MSW one or more STI same sample with few sexual behavior problems (n = were diagnosed (including hepatitis B), 76% on 413) and with no sexual behavior problems (n = 943). laboratory testing at first screening, 9% through It was hypothesized that youth with significant sexual symptomatology at first visit. The prevalence of HIV behavior problems would be characterized by higher was 10.8%, hepatitis B virus (HBV) infection 28.9%, rates of sexual and physical abuse and higher rates of syphilis 12.5%, gonorrhoea 1.7% and Chlamydia internalizing problems relative to youth without sexual trachomatis 9.7%. More than 50% of non-immune behavior problems and that all youth would evidence a MSW completed their three-dose hepatitis B positive treatment response to multisystemic therapy. vaccination course. Prevalence of STI is concordant Relative to youth with no sexual behavior problems, with published data on MSW; this population clearly youth with significant sexual behavior problems were requests and deserves particular attention and more likely to have been sexually or physically abused approach. There is an important difference in and had higher rates of internalizing and externalizing sociodemographic and behavioural characteristics behavior problems. These youth were also more likely between MSW working in the red light district and to include girls, were younger, and had more social those working on the street. Health promotion should problems than youth with no sexual behavior problems. be tailored to the different subpopulations and outreach Youth in all groups responded with clinically relevant appears to be a successful tool. and statistically significant reductions in problem behaviors at posttreatment. Lev-Or H. Childhood neglect and its effects a personal perspective. Isr J Psychiatry Relat Sci 2002; 39(3):183- Letourneau NL, Stewart MJ, Barnfather AK. Adolescent 7. mothers: support needs, resources, and support- education interventions. J Adolesc Health 2004; Leve LD, Kim HK, Pears KC. Childhood temperament and 35(6):509-25. family environment as predictors of internalizing and Abstract: Adolescent mothers are prone to live in poor externalizing trajectories from ages 5 to 17. J Abnorm conditions, lack adequate financial resources, suffer Child Psychol 2005; 33(5):505-20. high stress, encounter family instability, and have Abstract: Childhood temperament and family limited educational opportunities. These factors environment have been shown to predict internalizing contribute to inadequate parent-child interactions and and externalizing behavior; however, less is known diminished infant development. Social support can about how temperament and family environment promote successful adaptation for adolescent mothers interact to predict changes in problem behavior. We and their children. This review article describes the conducted latent growth curve modeling on a sample support needs and challenges faced by adolescent assessed at ages 5, 7, 10, 14, and 17 (N = 337). parents and their children, the support resources Externalizing behavior decreased over time for both available to and accessed by adolescent parents, and sexes, and internalizing behavior increased over time existing support-education intervention studies, to for girls only. Two childhood variables (fear/shyness provide directions for future research. Relevant and maternal depression) predicted boys' and girls' age- research published between January 1982 and February 17 internalizing behavior, harsh discipline uniquely 2003 was obtained from online database indices and predicted boys' age-17 internalizing behavior, and retrieved article bibliographies. Frequently encountered maternal depression and lower family income uniquely problems included small sample sizes and attrition, predicted increases in girls' internalizing behavior. For lack of suitable comparison groups, and measurement externalizing behavior, an array of temperament, inconsistencies. When planning support-education family environment, and Temperament x Family interventions, content, duration, intensity, mode, level, Environment variables predicted age-17 behavior for intervention agents, and targets should be considered. both sexes. Sex differences were present in the Future research can address these challenges. prediction of externalizing slopes, with maternal depression predicting increases in boys' externalizing Leuridan E, Wouters K, Stalpaert M, Van Damme P. Male behavior only when impulsivity was low, and harsh sex workers in Antwerp, Belgium: a descriptive study. discipline predicting increases in girls' externalizing Int J STD AIDS 2005; 16(11):744-8. behavior only when impulsivity was high or when Abstract: The objective of this study was to describe fear/shyness was low. the prevalence of sexually transmitted infections (STI), sociodemographic and behavioural characteristics in a Leventhal JM. The field of child maltreatment enters its fifth population of male sex workers (MSW) in Antwerp, decade. Child Abuse Negl 2003; 27(1):1-4. Belgium. Between September 1999 and March 2004, 129 MSW were reached by Gh@pro, an outreach Leverich GS, McElroy SL, Suppes T et al. Early physical programme providing preventive health care, free STI 655
- 664. and sexual abuseassociated with an adverse course of the concept of reasonable suspicion, 2 of which are bipolar illness. Biol Psychiatry 2002; 51(4):288-97. reported here. Respondents were asked to imagine that Abstract: BACKGROUND: There is growing they had examined a child for an injury that may have awareness of the association between physical and been caused by abuse and that they had gathered as sexual abuse and subsequent development of much information as they felt was possible. They then psychopathology, but little is known, however, about were asked to quantify (in 2 different ways) the degree their relationship to the longitudinal course of bipolar of likelihood needed for suspicion of child abuse to rise disorder. METHODS: We evaluated 631 outpatients to the level of reasonable suspicion. The physicians with bipolar I or II disorder for general demographics, were asked to identify (using a differential-diagnosis a history of physical or sexual abuse as a child or framework) how high on a rank-order list "abuse" adolescent, course of illness variables, and prior suicide would have to be for it to rise to the level of reasonable attempts, as well as SCID-derived Axis I and patient suspicion (ie, first on the list, second, third, and so on, endorsed Axis II comorbidity. RESULTS: Those who down to tenth). The second framework, estimated endorsed a history of child or adolescent physical or probability, used a visual analog scale of 0% to 100% sexual abuse, compared with those who did not, had a to determine how likely suspected abuse would have to history of an earlier onset of bipolar illness, an be for physicians for them to feel that they had increased number of Axis I, II, and III comorbid reasonable suspicion. That is, would they need to feel disorders, including drug and alcohol abuse, faster that there was a 99% likelihood that abuse occurred cycling frequencies, a higher rate of suicide attempts, before they felt that they had reasonable suspicion, a and more psychosocial stressors occurring before the 1% likelihood, or something in between? In addition to first and most recent affective episode. The standard demographic features, respondents were retrospectively reported associations of early abuse queried regarding their education on child abuse, with a more severe course of illness were validated education on reasonable suspicion, frequency of prospectively. CONCLUSIONS: Greater appreciation reporting child abuse, and (self-reported) expertise of the association of early traumatic experiences and an regarding child abuse. The main outcome measures adverse course of bipolar illness should lead to were physician responses on the 2 scales for preventive and early intervention approaches that may interpreting reasonable suspicion. RESULTS: lessen the associated risk of a poor outcome. Pediatricians (n = 1249) completed the survey (61% response rate). Their mean age was 43 years; 55% were Levetown M. New programs for children living with life- female; and 78% were white. Seventy-six percent were threatening conditions. Tex Med 2001; 97(8):60-3. board certified, and 65% reported being in primary Abstract: Palliative care is not commonly available to care. There were no remarkable differences in most children who die. Some children who die need responses based on age, gender, expertise with child comprehensive child- and family-centered services for abuse, frequency of reporting child abuse, or practice all their lives, or for several years, followed by type. The responses of pediatric residents were bereavement care. Other children who die have needs indistinguishable from experienced physicians, and the that are emergent, acute, and short term with regard to responses of primary care pediatricians were no medical care but very long term with regard to different from pediatric subspecialists. Wide variation bereavement needs. Exciting new initiatives may soon was found in the thresholds that pediatricians set for change the experience of children living with life- what constituted reasonable suspicion. On the threatening conditions and their families. differential-diagnosis scale (DDS), 12% of pediatricians responded that abuse would have to rank Levi BH, Brown G. Reasonable suspicion: a study of first or second on the DDS before the possibility rose Pennsylvania pediatricians regarding child abuse. to the level of reasonable suspicion, 41% indicated a Pediatrics 2005; 116(1):e5-12. rank of third or fourth, and 47% reported that a rank Abstract: OBJECTIVE: It has long been assumed that anywhere from fifth to as low as tenth still qualified as mandated reporting statutes regarding child abuse are reasonable suspicion. On the estimated-probability self-explanatory and that broad consensus exists as to scale (EPS), 35% of pediatricians responded that for the meaning and proper application of reasonable reasonable suspicion to exist, the probability of abuse suspicion. However, no systematic investigation has needed to be 10% to 35%. By contrast, 25% of examined how mandated reporters interpret and apply respondents identified a 40% to 50% probability, 25% the concept of reasonable suspicion. The purpose of stipulated a 60% to 70% probability, and 15% required this study was to identify Pennsylvania pediatricians' a probability of >or=75%. In comparing individual understanding and interpretation of reasonable responses for the 2 scales (ie, paired comparisons suspicion in the context of mandated reporting of between each pediatrician's DDS ranking and the suspected child abuse. Methodology. An anonymous estimated probability he or she identified), 85% were survey was sent (Spring 2004) to all members of the found to be internally inconsistent. To be logically Pennsylvania chapter of the American Academy of consistent, any score >or=50% on the EPS would need Pediatrics (n = 2051). Participants were given several to correspond to a DDS ranking of 1; an EPS score of operational frameworks to elicit their understanding of >or=34% would need to correspond with a DDS 656
- 665. ranking no lowerthan 2; an EPS score of >or=25% no Abstract: Based on our review of the literature, we lower than a DDS ranking of 3; and so on. What we present the first use of coiling in an infant with a found, however, was that pediatricians commonly traumatic artery aneurysm that resulted from shaken indicated that reasonable suspicion required a 50% to baby syndrome. Computed tomography (CT) scans 60% probability that abuse occurred, but at the same showed a skull fracture, hemorrhagic subdural time, they responded that child abuse could rank as low collections, multiple parenchymal contusions, and as fourth or fifth on the DDS and still qualify as intraventricular and subarachnoid hemorrhages in a 3- reasonable suspicion. CONCLUSIONS: The majority week-old infant who presented with lethargy, poor of states use the term "suspicion" in their mandated feeding, and seizure. These multiple injuries were reporting statutes, and according to legal experts, consistent with shaken baby syndrome. After closed- "reasonable suspicion" represents an accurate head injury medical management, including subdural generalization of most mandated reporting thresholds. taps, the baby was discharged home. When increasing Our data show significant variability in how seizures and hydrocephalus developed 8 months later, pediatricians interpret reasonable suspicion, with a CT angiographic scans showed a pseudoaneurysm of range of responses so broad as to question the the anterior cerebral artery. We successfully occluded assumption that the threshold for mandated reporting is the aneurysm with pushable coils placed via a understood, interpreted, or applied in a coherent and microcatheter and treated the obstructive consistent manner. If the variability described here hydrocephalus with endoscopic third ventriculostomy. proves generalizable, it will require rethinking what We show that minimally invasive radiological and society can expect from mandated reporters and what surgical techniques may be effective in managing the sort of training will be necessary to warrant those sequelae of trauma in children. expectations. Levitan RD, Rector NA, Sheldon T, Goering P. Childhood Levin AV. Ophthalmology of shaken baby syndrome. adversities associated with major depression and/or Neurosurg Clin N Am 2002; 13(2):201-11, vi. anxiety disorders in a community sample of Ontario: Abstract: Retinal hemorrhages are an important issues of co-morbidity and specificity. Depress Anxiety indicator of Shaken Baby syndrome. However, a 2003; 17(1):34-42. thorough description which includes the number, type, Abstract: It has been well established that early and distribution pattern of hemorrhages can be useful adversity is a major risk factor for depression and for in determining their specificity. In particular, numerous anxiety disorders in various populations and age pre-retinal, intraretinal, and subretinal hemorrhages groups. Few studies have considered the relative extending out to the edges of the retina and/or splitting strength of these associations and the possible role of of the retina (traumatic retinoschisis) seem to be co-morbid depression/anxiety in understanding them. particularly indicative of shaking with a very narrow Using data from a large community sample of Ontario, differential diagnosis. Shaking appears to be a key Canada, we examined the relative strength of the element in creating hemorrhagic retinopathy. associations between early physical abuse, sexual abuse, and/or parental strain with depression alone, Levin HS, Hanten G, Zhang L, Swank PR, Hunter J. anxiety alone, and co-morbid depression/anxiety. The Selective impairment of inhibition after TBI in current sample consisted of 6,597 individuals 15-64 children. J Clin Exp Neuropsychol 2004; 26(5):589-97. years of age who were interviewed using the World Abstract: Inhibition was studied in 12 children who had Health Organization Composite International had sustained as severe traumatic brain injury (TBI) at Diagnostic Interview (CIDI). Using a multivariate least 1 year earlier and in 15 control children. On the design, we compared early adversity scores across four flanker task, which involved pressing a button diagnostic study groups including normal controls, corresponding to the direction of an arrow, the TBI individuals with major depression but no anxiety group performed less accurately than controls under disorders, individuals with one or more anxiety interference (flankers were incongruent with arrow) disorders without major depression, and individuals and go-no-go (adjacent stimulus signaled child to with co-morbid major depression and anxiety. withhold response) conditions, but not neutral or Individuals with past disorders were considered facilitation (flankers were congruent) conditions. separately from those with current disorders. For both Response latency was related to age and task condition, past and current disorders, highly significant but not group. Severe TBI in children may disrupt differences in early adversity scores were found across development of distributed networks mediating the four study groups. A novel and robust finding, inhibition. consistent across all analyses, was a marked association between early sexual abuse and co-morbid Levine NB, Tanaka T, Jones BV, Crone KR. Minimally depression and anxiety but not the "pure" disorders. A invasive management of a traumatic artery aneurysm strong association between early parental strain and resulting from shaken baby syndrome. Pediatr major depression (independent of anxiety) was also Neurosurg 2004; 40(3):128-31. found. The overall pattern of results suggest that there may be unique relationships linking particular 657
- 666. adversities to particularmanifestations of depression anticipated. Clinicians must remember that parents may and anxiety disorders later in life. A particularly strong have different beliefs regarding the effectiveness of association between early sexual abuse and co-morbid treatment and different tolerance for treatment risks. depression/anxiety was found. Practitioners must keep avenues of communication open, remain open-minded, and not assume a "don't Levy S. The lesser of two evils: a contextual view of the ask, don't tell" posture in the context of providing a English case of the conjoined twins. Med Law 2003; medical home to the increasing number of children 22(1):1-9. diagnosed with autism. Notes: GENERAL NOTE: KIE: 6 fn. GENERAL NOTE: KIE: KIE Bib: patient care/minors Lewis MW, Petry NM. Relationship between custodial Abstract: In 2000 conjoined twin girls were born in status and psychosocial problems among cocaine- Manchester, England. They were joined in such a way abusing parents initiating substance abuse treatment. that it was impossible to separate them to enable both Am J Addict 2005; 14(5):403-15. twins to survive. Their bodies were fused at the lower Abstract: Using the Addiction Severity Index and Brief abdomen and they shared an aorta and a bladder. Their Symptom Inventory, drug use and psychosocial arms and legs were at right angles to their conjoined problems are compared between 93 custodial and 125 trunk. The situation of the conjoined twins is of non-custodial mothers and fathers initiating outpatient supreme importance as a private tragedy for their treatment for cocaine dependence. Compared to non- family. The resulting litigation also presents an custodial parents, custodial parents experienced more important landmark in English law. In deciding the fate severe current cocaine and alcohol problems, including of the two children, the Court of Appeal provided an spending more money on cocaine and alcohol, as well authoritative review, analysis and application of family as using more cocaine and being intoxicated on more law and medical law with regard to neonates. The most days. Non-custodial parents demonstrated more significant legal legacy of the case, however, may well psychological distress, more prior history of alcohol be in the field of criminal law by way of the court's problems, and greater current employment and legal interpretation and application of the defences of problems than custodial parents. Suggestions are made necessity and self-defence. for differential treatment plans based on these findings. Levy SE, Hyman SL. Use of complementary and alternative Lewis TC, Robins TG, Joseph CL et al. Identification of treatments for children with autistic spectrum disorders gaps in the diagnosis and treatment of childhood is increasing. Pediatr Ann 2003; 32(10):685-91. asthma using a community-based participatory research Abstract: Interventions considered to be CAM are in approach. J Urban Health 2004; 81(3):472-88. constant flux. New treatments emerge, older treatments Abstract: The goal of this investigation was to use a become less popular, and the cycle recurs. Data community-based participatory research approach to supporting new treatments should be scrutinized for develop, pilot test, and administer an asthma screening scientific study design, clinical safety, and scientific questionnaire to identify children with asthma and validity. Many families approach the clinician armed asthma symptoms in a community setting. This study with brochures, handouts, and printouts from Web sites was conducted as the recruitment effort for Community that are dedicated to the care and support of parents Action Against Asthma, a randomized trial of a and children with ASD. A recent web search using household intervention to reduce exposure to "autism and detoxification" resulted in almost 8,000 environmental triggers of asthma and was not designed sites. The Defeat Autism Now! (DAN!) Project arose as a classic prevalence study. An asthma screening in 1995 from collaboration of members of the Autism questionnaire was mailed and/or hand delivered to Research Institute. The DAN! Project advocates a parents of 9,627 children, aged 5 to 11 years, in two specific and extensive protocol for diagnosis and geographic areas of Detroit, Michigan, with treatment and can be viewed at predominantly African American and Hispanic http://www.autism.com/ari/#dan. The scientific populations. Additional questionnaires were distributed validation and support for many interventions is via community networking. Measurements included incomplete and disparate from the recommendation in parent report of their child's frequency of respiratory the American Academy of Pediatrics Policy Statement. symptoms, presence of physician diagnosis of asthma, Families should be encouraged to discuss all proposed and frequency of doctor-prescribed asthma medication investigations or treatments they wish to try with their usage. Among the 3,067 completed questionnaires, primary care provider so the practitioner can serve as 1,570 (51.2% of returned surveys, 16.3% of eligible the medical home (Sidebar, page 688). The clinician population) were consistent with asthma of any should communicate and collaborate with the family severity and 398 (12.9% of returned surveys, 4.1% of and educational professionals to encourage objective eligible population) met criteria for moderate-to-severe identification of what works. With increasing access to asthma. Among those meeting criteria for moderate-to- health information and societal pressure for families to severe asthma, over 30% had not been diagnosed by a actively participate in their health management, physician, over one half were not taking daily asthma continued growth of interest in CAM can be medication, and one quarter had not taken any 658
- 667. physician-prescribed asthma medicationin the past RESULTS: Child behavior problems were prevalent in year. Screening surveys conducted within the context children aged 2-6 years: 71.4% for temper tantrums; of a community-based participatory research 48.2% for swearing; 36.0% for nocturnal bed-wetting; partnership can identify large numbers of children with 29.9% for disobedience; 29.5% for difficulty initiating undiagnosed and/or undertreated moderate-to-severe sleep; and 17.0% for picky eating. Child behavior asthma. These children are likely to benefit from problems significantly differed across Hani, Yi, Hui, interventions to reduce morbidity and improve quality Miao and Han ethnic groups. Logistic regression of life. indicated that ethnicity of Hui compared with Han, younger children, prenatal risk factors, being a twin, Li J. Integration of HIV/AIDS and family planning. Lancet ineffective child-rearing behaviors such as pampering, 2005; 366(9491):1077. corporal punishment, swaddling, family disagreement among child-rearing contributed independently to the Li P, Farkas I, MacWhinney B. Early lexical development in risk for child behavior problems. CONCLUSIONS: a self-organizing neural network. Neural Netw 2004; The child behavior problems were prevalent in children 17(8-9):1345-62. aged 2-6 years in rural minority children of China. Abstract: In this paper we present a self-organizing Ineffective family child-rearing practices increase risk neural network model of early lexical development for child behavior problems. called DevLex. The network consists of two self- organizing maps (a growing semantic map and a Licanin I, Laslo E, Kelly KB, Lagerkvist B, Fisekovic S. growing phonological map) that are connected via Comparing youth health in Sweden and Bosnia. Med associative links trained by Hebbian learning. The Arh 2004; 58(2):91-2. model captures a number of important phenomena that Abstract: The Adolescence Medical Group in Sweden occur in early lexical acquisition by children, as it has performed a questionnaire every second year since allows for the representation of a dynamically changing 1990. The questionnaire is performed during school linguistic environment in language learning. In our hours in seventh and ninth grade and also in the second simulations, DevLex develops topographically grade in the upper secondary school (gymnasium). The organized representations for linguistic categories over questionnaire is completed anonymously. The schools time, models lexical confusion as a function of word are not chosen by statistical methods, but more density and semantic similarity, and shows age-of- depending on youth-health-iterested school doctors and acquisition effects in the course of learning a growing nurses who have interest in these studies. The result of lexicon. These results match up with patterns from these studies has been used locally in each community, empirical research on lexical development, and have but also been reported for example i Acta Pediatrica. significant implications for models of language After the war in Bosnia there has been different acquisition based on self-organizing neural networks. projects to help to build up the countries health system, for example in psychiatry. The question was laso raised Li TK, Hewitt BG, Grant BF. Alcohol use disorders and how the youth health was in Bosnia. Representatives mood disorders: a National Institute on Alcohol Abuse from the Adolescence section in Sweden were invited and Alcoholism perspective. Biol Psychiatry 2004; to Bosnia to introduce the questionnaire and also to 56(10):718-20. help in analysing the results. We were also in Bosnia to present results to local authorities and those who Li Y, Shi A, Wan Y, Hotta M, Ushijima H. Child behavior performed the study locally. problems: prevalence and correlates in rural minority areas of China. Pediatr Int 2001; 43(6):651-61. Lichtenstein B, Sharma AK, Wheat JR. Health inequity: the Abstract: BACKGROUND: Ethnicity may possibly plight of uninsured children in a rural Alabama county associate with different maternal child-rearing practices and the plan to cure it. Fam Community Health 2005; and child developmental problems. The aim of this 28(2):156-67. study was to better understand epidemiological features Abstract: Many children in the United States do not and correlates of child behavior problems in a large have access to health insurance. Providing health sample of children in economically disadvantaged rural insurance for children has been particularly challenging minority areas of China and to provide reference data in rural America. This article describes and evaluates a for subsequent intervention of child developmental local plan to provide access to health care for school problems. METHODS: A total of 1222 rural mother- children in a rural Alabama county. A triangulated child pairs belonging to Hani, Yi, Hui, Miao and Han methodology (personal interviews, ad hoc survey focus were drawn from four economically disadvantaged groups, US census and health fair data) was used in the minority counties in Yunnan Province of China. Well- evaluation. Gains were made in enrolling children trained investigators completed child physical despite some limitations, especially in rural outreach. examination and measurements (height and weight) in The most successful aspect of the program was a village clinics and interviews of mothers at partnership between local leaders, health providers, and respondents' homes using a structured questionnaire. educators to provide impetus for a coordinated plan. The stability of the program is uncertain because of 659
- 668. diminishing resources andthe negative effects of although current understanding of the etiology of SAD economic recession. posits an interaction between psychological and biological factors. Risk factors include environmental Liebelt EL. Therapeutics and toxicology issues associated and parenting influences and dysfunctional cognitive with the agitated, violent, or psychotic pediatric and conditioning events in early childhood. The patient. Curr Opin Pediatr 2004; 16(2):199-200. neurobiology of SAD appears to involve neurochemical dysfunction, as evidenced by studies of Liebl B, Nennstiel-Ratzel U, von Kries R et al. Expanded neuroreceptor imaging, neuroendocrine function, and newborn screening in Bavaria: tracking to achieve profiles of response to specific medications. Clinical requested repeat testing. Prev Med 2002; 34(2):132-7. trials have demonstrated that benzodiazepines and Abstract: OBJECTIVES: Expansion of newborn antidepressants are effective in the treatment of SAD. screening programs may increase the risk of missing The selective serotonin reuptake inhibitors are cases through procedural failures. A coordinated emerging as the first-line treatment for SAD, based on process quality assurance procedure to track recalls their proven safety, tolerability, and efficacy. Goals for was, therefore, introduced in parallel to expansion ongoing future research include development of (including MS-MS and 17alpha-OHP) in Bavaria. approaches to achieve remission, to convert METHODS: Using comprehensive computerized nonresponders and partial responders to full registration and automated monitoring a state-funded responders, and to prevent relapse and maintain long- center coordinated all individual measures to achieve term efficacy.This monograph explores the complete testing of all repeat requests-case-specific epidemiology, clinical presentation, and differential contacts to physicians, midwives, and parents. Mailing diagnosis of SAD, with a focus on neural circuitry of and phoning from the center were supplemented by social relationships and neurochemical dysfunction. local public health activities including home visits if The prevalence, rates of recognition and treatment, needed. RESULTS: Among 243,422 children tested in patterns of comorbidity, quality-of-life issues, and 1999 and 2000 overall recall was 3.62% (8,809 natural history of SAD are discussed as well as children): 0.30% (726) were due to sample inadequacy, pharmacologic and psychosocial treatment strategies 1.35% (3,282) to early sampling (<48 h), and 1.97% for SAD. (4,801) to abnormal results. Of all recalls, 80.9% were received following the initial request, 1,679 (19.1%) Light KC, Grewen KM, Amico JA, Boccia M, Brownley required special efforts. Of these, 873 were achieved KA, Johns JM. Deficits in plasma oxytocin responses following a single and 601 following repeated central and increased negative affect, stress, and blood activities, and 102 were achieved following local pressure in mothers with cocaine exposure during support. Sixty-three cases of parental refusal and 47 pregnancy. Addict Behav 2004; 29(8):1541-64. untraceable children remained. Altogether, 98.8% Abstract: In animals, oxytocin enhances maternal recalls were achieved, corresponding to 99.96% of all behavior and lowers blood pressure (BP) and negative tested children for which definite screening results affect, while parturitional cocaine disrupts oxytocin could be obtained. CONCLUSIONS: Expansion of activity and increases maternal neglect and aggression. newborn screening programs does not necessarily Thus, we compared oxytocin, BP, maternal behavior, mean unsolvable problems in tracking of recalls if and affect in mothers of infants who used cocaine adequate logistics is established in parallel. (cocaine, n = 10) or did not (no drug, n = 25) during pregnancy. Laboratory BP and circulating oxytocin, Liebowitz MR, Ninan PT, Schneier FR, Blanco C. catecholamines, and cortisol were examined before and Integrating neurobiology and psychopathology into during a speech stressor on 2 days, with vs. without evidence-based treatment of social anxiety disorder. prestress baby holding. Ambulatory monitoring CNS Spectr 2005; 10(10):suppl13 1-11; discussion 12- assessed BP, urinary norepinephrine, and cortisol for 3; quiz 14-5. 24 h at home. The cocaine group had lower oxytocin Abstract: Social anxiety disorder (SAD) is a common, levels, greater hostility and depressed mood, less chronic psychiatric disorder characterized by a support from others and mastery over life events, persistent fear of social or performance situations in higher BP during all events of testing without the baby, which embarrassment can occur. This disorder and higher ambulatory BP and urinary norepinephrine typically appears during the mid-adolescent years and at home, while cortisol and epinephrine responses were is unremitting throughout life if not properly treated. blunted. Although they tended to hold their babies less SAD presents as two subtypes: the more common and often at home, baby holding in the laboratory led to debilitating generalized form, and the nongeneralized decreased BP in cocaine mothers who then did not form, which consists predominantly of performance differ from no-drug mothers in BP or observed affect. anxiety. The majority of patients with SAD have comorbid mental disorders, including mood, anxiety, Lijtmaer R. Psychoanalysis and visual art: a female painter and substance abuse. No single development theory has and her dilemma. J Am Acad Psychoanal 2002; been proposed to account for the origins of SAD, 30(3):475-88. Abstract: Since ancient times, creativity, genius, or 660
- 669. special artistic accomplishmentshave been a topic of Medical records were reviewed for comparison of age, curiosity. The case presentation that follows describes gender, cause of injury, clinical presentation, surgical a painters resistance to success. The patient's management, and outcome. Diagnosis was made by developmental history associated with issues of computed tomography and/or magnetic resonance maternal deprivation and paternal abuse had an effect imaging. RESULTS: There were 20 boys and 16 girls, in her artistic creation. Furthermore, her difficulties with ages ranging from 1 to 11 months (average, 5.9 with achievement and acknowledgment of audience months). The most common cause of CSDH was head attention were defenses to sabotage her creativity. Her injury (44.5%), followed by shaken baby syndrome economic struggle was another ingredient used (36.1%). The most common clinical presentations were defensively for fear of success. As suggested by seizure, bulging fontanel, and consciousness Ambers and Burke (2000), artistically inclined disturbance. Continuous external subdural drainage individuals have greater fluidity of self-other was the definite treatment in 34 patients (94.4%). The boundaries, more preoccupation with early separation- drains were left in place for no more than 9 days. Only individuation issues and are more vulnerable to self- two (5.6%) patients needed permanent fragmentations anxiety. The patient presented subduroperitoneal shunting. No obvious complication manifests some of these symptoms. However, needing was found. At follow-up (17-160 months; mean, 86.6 to work full-time to support herself, and painting only months), 23 (63.9%) had good recovery, 5 (13.9%) had in spare time, added to her resistances. V's frustrations, moderate disability, 3 (8.3%) had severe disability, 4 anxieties, and guilt related to her creation are explored. (11.1%) were in a vegetative state, and 1 (2.8%) died. CONCLUSION: Continuous external subdural Lima MS, Soares BG, Mari Jde J. Mental health drainage was an effective treatment in infantile CSDH, epidemiological research in South America: recent with a low complication rate and good clinical findings. World Psychiatry 2004; 3(2):120-2. outcome. It might be considered as a strategy before Abstract: This paper aims to review the recent mental subduroperitoneal shunting in the treatment of CSDH health epidemiological research conducted in South in infants. America. The Latin American and the Caribbean (LILACS) database was searched from 1999 to 2003 Lin KC, Yang MS, Liu HC, Lirng JF, Wang PN. using a specific strategy for identification of cohort, Generalized Kohonen's competitive learning case-control and cross-sectional population-based algorithms for ophthalmological MR image studies in South America. The authors screened segmentation. Magn Reson Imaging 2003; 21(8):863- references and identified relevant studies. Further 70. studies were obtained contacting local experts in Abstract: Kohonen's self-organizing map is a two-layer epidemiology. 140 references were identified, and 12 feedforward competitive learning network. It has been studies were selected. Most selected studies explored used as a competitive learning clustering algorithm. In the prevalence and risk factors for common mental this paper, we generalize Kohonen's competitive disorders, and several of them used sophisticated learning (KCL) algorithm with fuzzy and fuzzy-soft methods of sample selection and analysis. There is a types called fuzzy KCL (FKCL) and fuzzy-soft KCL need for improving the quality of psychiatric journals (FSKCL). These generalized KCL algorithms fuse the in Latin America, and for increasing the distribution competitive learning with soft competition and fuzzy c- and access to research data. Regionally relevant means (FCM) membership functions. We then apply problems such as violence and substance abuse should these generalized KCLs to MRI and MRA be considered in designing future investigations in this ophthalmological segmentations. These KCL-based area. MRI segmentation techniques are useful in reducing medical image noise effects using a learning Limura B. Birth in Japan. Midwifery Today Int Midwife mechanism. They may be particularly helpful in 2005; (74):60-1, 69. clinical diagnosis. Two real cases with MR image data recommended by an ophthalmologist are examined. Lin CL, Hwang SL, Su YF et al. External subdural drainage First case is a patient with Retinoblastoma in her left in the treatment of infantile chronic subdural eye, an inborn malignant neoplasm of the retina hematoma. J Trauma 2004; 57(1):104-7. frequently metastasis beyond the lacrimal cribrosa. The Abstract: BACKGROUND: The management of second case is a patient with complete left side chronic subdural hematoma (CSDH) in infants remains oculomotor palsy immediately after a motor vehicle controversial. The purpose of this study was to analyze accident. Her brain MRI with MRA, skull routine, the clinical characteristics of CSDH in infancy and orbital CT, and cerebral angiography did not reveal evaluate the efficacy of continuous external subdural brainstem lesions, skull fractures, or vascular drainage in the treatment of infantile CSDH. anomalies. These generalized KCL algorithms were METHODS: We prospectively collected 36 used in segmenting the ophthalmological MRIs. KCL, consecutive infants with CSDH, to receive continuous FKCL and FSKCL comparisons are made. Overall, the external subdural drainage as the initial management. FSKCL algorithm is recommended for use in MR image segmentation as an aid to small lesion diagnosis. 661
- 670. Lindbloom EJ, EwigmanBG, Hickner JM. Practice-based pathways from income to young children's research networks: the laboratories of primary care development. Dev Psychol 2002; 38(5):719-34. research. Med Care 2004; 42(4 Suppl):III45-9. Abstract: A variety of family processes have been Abstract: Medical research has traditionally been based hypothesized to mediate associations between income in academic centers, and the findings are frequently not and young children's development. Maternal emotional applicable in community primary care settings. The distress, parental authoritative and authoritarian result is a large gap between the possible and the behavior (videotaped mother-child interactions), and practical in delivering high-quality primary medical provision of cognitively stimulating activities (Home care in the United States. Practice-based research Observation for Measurement of the Environment networks (PBRNs), laboratories for primary care [HOME] scales) were examined as possible mediators clinical research, are the appropriate vehicles for in a sample of 493 White and African American low- uniting the worlds of community primary care practice birth-weight premature infants who were followed and clinical research. Although they have received from birth through age 5. Cognitive ability was little attention in the mainstream of clinical and health assessed by standardized test, and child behavior services research, PBRNs have already reported a problems by maternal report, when the children were 3 variety of findings useful for primary care providers, and 5 years of age. As expected, family income was and these networks have helped to identify key issues associated with child outcomes. The provision of in healthcare delivery that affect important outcomes. stimulating experiences in the home mediated the In this report, we outline the rationale for and history of relation between family income and both children's PBRNs. We describe the organization and work of outcomes; maternal emotional distress and parenting several productive PBRNs, giving examples of their practices mediated the relation between income and studies that have changed the standards of modern children's behavior problems. primary care practice. Finally, we describe a developing electronic process for identifying research Lipley N. Rough justice? Emerg Nurse 2003; 11(2):5. questions obtained directly from primary care providers that can be used to focus the national primary Lipman EL. Don't let anyone bully you into thinking care research agenda on questions of clinical relevance bullying is not important! Can J Psychiatry 2003; and importance. As electronic technologies are fully 48(9):575. developed and tested, they will facilitate communication between clinicians and researchers, Listernick R. A 9-year-old boy with bizarre behavior and thereby improving the effectiveness and efficiency of growth delay. Pediatr Ann 2003; 32(5):292-5. practice-based research. Litt IF. Separation of church and "state". J Adolesc Health Linden DW, Doron MW. Eyes of Texas fasten on life, death 2002; 31(1):1. and the premature infant. NY Times (Print) 2002; F5, F8. Little L, Hamby SL. Memory of childhood sexual abuse Notes: GENERAL NOTE: KIE: KIE Bib: allowing to among clinicians: characteristics, outcomes, and die/infants current therapy attitudes. Sex Abuse 2001; 13(4):233- 48. Linkins RW. Immunization registries: progress and Abstract: This paper reports preliminary data on a challenges in reaching the 2010 national objective. J sample of therapists with memory of childhood sexual Public Health Manag Pract 2001; 7(6):67-74. abuse. Therapists who reported experiencing childhood Abstract: Immunization registries are confidential, sexual abuse (CSA, n = 131) were compared with population-based, computerized information systems therapists who suspected sexual abuse but had no that contain data about children's immunizations and memories (n = 24) on variables related to abuse have been described as the cornerstone of characteristics, outcomes, and perceived difficulties immunization delivery in the 21st century. Work to working with clients with a CSA history. Therapists ensure the privacy of registry participants and the who suspected abuse, in contrast to those who made confidentiality of their information, recruit provider definite reports, were more likely to report that the participation, overcome technical and operational perpetrator was a family member, that their CSA did challenges, and identify sustainable funding streams not involve physical contact, that there was alcoholism has resulted in 24 percent of children less than 6 years in their families of origin, and that the CSA had of age currently in an immunization registry in the negative effects on their relationships with their own United States. New solutions will be needed before children, ability to trust others, sexual satisfaction, and reaching the national health objective of increasing the work life. Therapists who suspected abuse also proportion of children to 95 percent in a fully reported more difficulty treating CSA clients because operational immunization registry by 2010. of interpersonal pulls during sessions, arousal without memories of abuse, and some countertransferential Linver MR, Brooks-Gunn J, Kohen DE. Family processes as behaviors. These findings indicate that issues related to 662
- 671. personal trauma shouldbe addressed during training compulsive disorder and trichotillomania: a and practice. phenomenological comparison. BMC Psychiatry 2005; 5(1):2. Little L, Kantor GK. Using ecological theory to understand Abstract: BACKGROUND: Similarities between intimate partner violence and child maltreatment. J obsessive-compulsive disorder (OCD) and Community Health Nurs 2002; 19(3):133-45. trichotillomania (TTM) have been widely recognized. Abstract: This article describes the relation between Nevertheless, there is evidence of important differences intimate partner violence (IPV) and child maltreatment between these two disorders. Some authors have using an ecological model. It further clarifies the conceptualized the disorders as lying on an OCD multidimensionality of IPV and child maltreatment at spectrum of conditions. METHODS: Two hundred and the individual, family, community, and societal levels. seventy eight OCD patients (n = 278: 148 male; 130 The article reviews the dynamics of IPV and the female) and 54 TTM patients (n = 54; 5 male; 49 relationship issues between mother and child when IPV female) of all ages were interviewed. Female patients is present. Areas relevant to nursing, such as were compared on select demographic and clinical assessment and intervention with mothers and children, variables, including comorbid axis I and II disorders, are addressed along with professional biases and and temperament/character profiles. RESULTS: OCD understanding. This article expands the community patients reported significantly more lifetime disability, nurses' conceptualization of intimate violence issues but fewer TTM patients reported response to treatment. and strengthen his or her nursing interventions. OCD patients reported higher comorbidity, more harm avoidance and less novelty seeking, more maladaptive Liu J, Raine A, Venables PH, Mednick SA. Malnutrition at beliefs, and more sexual abuse. OCD and TTM age 3 years and externalizing behavior problems at symptoms were equally likely to worsen during ages 8, 11, and 17 years. Am J Psychiatry 2004; menstruation, but OCD onset or worsening was more 161(11):2005-13. likely associated with pregnancy/puerperium. Abstract: OBJECTIVE: Poor nutrition is thought to CONCLUSIONS: These findings support previous predispose to externalizing behavior problems, but to work demonstrating significant differences between date there appear to have been no prospective OCD and TTM. The classification of TTM as an longitudinal studies testing this hypothesis. This study impulse control disorder is also problematic, and TTM assessed whether 1) poor nutrition at age 3 years may have more in common with conditions predisposes to antisocial behavior at ages 8, 11, and 17 characterized by stereotypical self-injurious symptoms, years, 2) such relationships are independent of such as skin-picking. Differences between OCD and psychosocial adversity, and 3) IQ mediates the TTM may reflect differences in underlying relationship between nutrition and externalizing psychobiology, and may necessitate contrasting behavior problems. METHOD: The participants were treatment approaches. drawn from a birth cohort (N=1,795) in whom signs of malnutrition were assessed at age 3 years, cognitive Locke LM, Prinz RJ. Measurement of parental discipline measures were assessed at ages 3 and 11 years, and and nurturance. Clin Psychol Rev 2002; 22(6):895-929. antisocial, aggressive, and hyperactive behavior was Abstract: This paper reviews the measurement of assessed at ages 8, 11, and 17 years. RESULTS: In parental discipline and nurturance over the past 20 relation to comparison subjects (N=1,206), the children years. Discipline and nurturance are two of the most with malnutrition signs at age 3 years (N=353) were heavily referenced constructs in the parenting research more aggressive or hyperactive at age 8 years, had literature, but there are varying ways to operationalize more externalizing problems at age 11, and had greater them with respect to both method and content. The conduct disorder and excessive motor activity at age review considered 76 questionnaires that purported to 17. The results were independent of psychosocial assess discipline, nurturance, or both. The evaluation adversity and were not moderated by gender. There included examination of a total of 27 interview was a dose-response relationship between degree of schedules that used either in-person or telephone malnutrition and degree of externalizing behavior at structured questions or a vignette format and focused ages 8 and 17. Low IQ mediated the link between on discipline and nurturance or discipline only. A total malnutrition and externalizing behavior at ages 8 and of 33 observational systems were reviewed, the 11. CONCLUSIONS: These results indicate that majority of which addressed both discipline and malnutrition predisposes to neurocognitive deficits, nurturance. All measures were profiled, and several which in turn predispose to persistent externalizing noteworthy instruments were discussed. behavior problems throughout childhood and Recommendations were offered regarding how to adolescence. The findings suggest that reducing early strengthen measurement and scientific understanding malnutrition may help reduce later antisocial and of discipline and nurturance, including the need for aggressive behavior. greater attention to cultural variation and measurement equivalence issues. Lochner C, Seedat S, du Toit PL et al. Obsessive- Loffredo CA, Wilson PD, Ferencz C. Maternal diabetes: an 663
- 672. independent risk factorfor major cardiovascular Abstract: BACKGROUND: Acute subdural hematoma malformations with increased mortality of affected in infants is distinct from that occurring in older infants. Teratology 2001; 64(2):98-106. children or adults because of differences in mechanism, Abstract: BACKGROUND: Intensive medical care of injury thresholds, and the frequency with which the women with diabetes has reduced their risks of bearing question of nonaccidental injury is encountered. The infants with congenital anomalies. To assess the purpose of this study is to analyze the clinical preventive potential of preconceptional care, the data characteristics of acute subdural hematoma in infancy, of a population-based study of cardiovascular to discover the common patterns of this trauma, and to malformations (CVM) were analyzed to determine the outline the management principles within this group. morphogenetic specificity of maternal diabetes risks, METHODS: Medical records and films of 21 cases of the morbidity and mortality of the infants, and maternal infantile acute subdural hematoma were reviewed characteristics that might affect these risks. retrospectively. Diagnosis was made by computed METHODS: The Baltimore-Washington Infant Study tomography or magnetic resonance imaging. Medical was a case-control study (1981-1989) that included all records were reviewed for comparison of age, gender, live born infants with confirmed CVM; control infants cause of injury, clinical presentation, surgical were a representative sample of the birth cohort. A management, and outcome. RESULTS: Twenty-one questionnaire administered in home visits recorded infants (9 girls and 12 boys) were identified with acute parental information on social, medical, occupational, subdural hematoma, with ages ranging from 6 days to and environmental factors. For these analyses of 12 months. The most common cause of injury was preconceptional diabetes risks, the case group excluded shaken baby syndrome. The most common clinical chromosomal and mendelian disorders and was divided presentations were seizure, retinal hemorrhage, and into 3 developmental categories and 12 diagnostic consciousness disturbance. Eight patients with large groups. RESULTS: Preconceptional maternal diabetes subdural hematomas underwent craniotomy and was strongly associated with CVM of early embryonic evacuation of the blood clot. None of these patients origin (odds ratio [OR] = 4.7, 95% confidence interval developed chronic subdural hematoma. Thirteen [CI] 2.8-7.9) and with cardiomyopathy (OR = 15.1, patients with smaller subdural hematomas were treated 95% CI 5.5-41.3), but not with obstructive and conservatively. Among these patients, 11 developed shunting defects (OR = 1.4, 95% CI 0.7-3.0). There chronic subdural hematomas 15 to 80 days (mean = 28 was heterogeneity within these developmental days) after the acute subdural hematomas. All patients categories: among laterality defects, diabetes was with chronic subdural hematomas underwent burr hole associated only with cardiovisceral and atrioventricular and external drainage of the subdural hematoma. At discordance (OR = 10.0, 95% CI 3.7-27.0); among follow-up, 13 (62%) had good recovery, 4 (19%) had outflow tract anomalies, the risk was strongly moderate disability, 3 (14%) had severe disability, and associated with normally related great arteries (OR = 1 (5%) died. Based on GCS on admission, one (5%) 6.6, 95% CI 3.2-13.3) but not with simple had mild (GCS 13-15), 12 (57%) had moderate (GCS transpositions; and among atrioventricular septal 9-12), and 8 (38%) had severe (GCS 8 or under) head defects, diabetes was associated with the complete but injury. Good recovery was found in 100% (1/1), 75% not with the partial forms (OR = 22.8, 95% CI 7.4- (8/12), and 50% (4/8) of the patients with mild, 70.5). The association in early CVM was strongest moderate, and severe head injury, respectively. Sixty- among infants with multisystem, predominantly three percent (5/8) of those patients undergoing VACTERL, anomalies. All-cause mortality of infants operation for acute subdural hematomas and 62% with CVM was 39% among those with diabetic (8/13) of those patients treated conservatively had good mothers and 17.8% in those with nondiabetic mothers. outcomes. CONCLUSIONS: Infantile acute subdural Deceased infants of diabetic mothers were also more hematoma if treated conservatively or neglected, is an likely to have extracardiac anomalies (P = 0.041), to be important cause of infantile chronic subdural born prematurely (P = 0.007), and to have low birth hematoma. Early recognition and suitable treatment weight (P = 0.011). Multivariate analyses of maternal may improve the outcome of this injury. If treatment is factors revealed no significant confounders of the delayed or the condition is undiagnosed, acute subdural diabetes associations. CONCLUSIONS: The evidence hematoma may cause severe morbidity or even fatality. of diabetes-induced major cardiac defects is of urgent clinical significance. The effectiveness of early Loimer L, Bichler A, Brezinka C et al. [Guideline of the preconceptional care in the prevention of congenital Austrian Society of Gynecology and Obstetrics on anomalies has been demonstrated repeatedly. suspected sexual offenses. November 2001 status]. Wien Klin Wochenschr 2002; 114(5-6):233-5. Loftus E. Dispatch from the (un)civil memory wars. Lancet 2004; 364 Suppl 1:s20-1. Lonczak HS, Abbott RD, Hawkins JD, Kosterman R, Catalano RF. Effects of the Seattle social development Loh JK, Lin CL, Kwan AL, Howng SL. Acute subdural project on sexual behavior, pregnancy, birth, and hematoma in infancy. Surg Neurol 2002; 58(3-4):218- sexually transmitted disease outcomes by age 21 years. 24. Arch Pediatr Adolesc Med 2002; 156(5):438-47. 664
- 673. Abstract: OBJECTIVE: Toexamine the long-term achieved a good fit with the data (Comparative Fit effects of the full Seattle Social Development Project Index [CFI] = 0.93). A second-order structural model intervention on sexual behavior and associated fit the data well (CFI = 0.91) and also explained 45% outcomes assessed at age 21 years. DESIGN: of the variance in alcohol misuse at age 16. The SDM Nonrandomized controlled trial with long-term follow- partially and significantly mediated the direct effect of up. SETTING: Public elementary schools serving age-14 alcohol use on age-16 alcohol misuse. children from high-crime areas in Seattle, Wash. CONCLUSIONS: The risk and protective processes PARTICIPANTS: Ninety-three percent of the fifth- specified by the SDM serve as potential targets for the grade students enrolled in either the full-intervention or prevention or reduction of adolescent alcohol misuse. control group were successfully interviewed at age 21 years (n = 144 [full intervention] and n = 205 Longjohn MM, Christoffel KK. Are medical societies [control]). INTERVENTIONS: In-service teacher developing a standard for gun injury prevention? Inj training, parenting classes, and social competence Prev 2004; 10(3):169-73. training for children. MAIN OUTCOME MEASURES: Abstract: CONTEXT: Following heightened gun Self-report measures of all outcomes. RESULTS: The violence in the 1990s, many medical societies in the full-intervention group reported significantly fewer United States adopted policies on the topic. sexual partners and experienced a marginally reduced OBJECTIVE: Identify points of firearm violence risk for initiating intercourse by age 21 years as policy agreement among large medical organizations. compared with the control group. Among females, DESIGN: Fourteen national medical societies-clinical treatment group status was associated with a focus, demonstrated interest in gun injury prevention, significantly reduced likelihood of both becoming >2000 members-were selected for policy review in pregnant and experiencing a birth by age 21 years. 2002. Policies were categorized on areas covered and Among single individuals, a significantly increased items within these. Consensus areas were addressed by probability of condom use during last intercourse was >/=7/14 societies.Consensus items were included by predicted by full-intervention group membership; a >/=7/14 societies, shared items by 5-6. RESULTS: significant ethnic group x intervention group There were five consensus areas: access prevention, interaction indicated that after controlling for gun commerce, research, public education, and clinical socioeconomic status, single African Americans were counseling. There were four consensus items: especially responsive to the intervention in terms of restricting gun access by enforcing existing laws, this outcome. Finally, a significant treatment x ethnic restricting access to all guns at the point of sale, group interaction indicated that among African restricting access to handguns at the point of sale, and Americans, being in the full-intervention group creating a national database on gun injury and death. predicted a reduced probability of contracting a Shared items promote violence prevention, clinical sexually transmitted disease by age 21 years. education on risks of guns in the home, treating guns as CONCLUSION: A theory-based social development consumer products, restricting gun access to children, program that promotes academic success, social bans on automatic weapons, and promoting trigger competence, and bonding to school during the locks. CONCLUSIONS: Large medical societies in the elementary grades can prevent risky sexual practices United States agree on key approaches for reducing and adverse health consequences in early adulthood. gun injury mortality and morbidity. Future research will be needed to track the evolution of this emerging Lonczak HS, Huang B, Catalano RF et al. The social standard for physician action, which now includes the predictors of adolescent alcohol misuse: a test of the consensus areas and items. It promises to be, in effect, social development model. J Stud Alcohol 2001; a medical standard of care for gun injury prevention. 62(2):179-89. The United States experience may be useful to others Abstract: OBJECTIVE: This study was conducted to working on gun injury prevention. investigate the ability of the social development model (SDM) to predict alcohol misuse at age 16 and to Longo RE. Emerging issues, policy changes, and the future investigate the ability of the SDM to mediate the of treating children with sexual behavior problems. effects of alcohol use at age 14 on alcohol misuse at Ann N Y Acad Sci 2003; 989:502-14. age 16. METHOD: The sample of 807 (411 males) is Abstract: Children and adolescents with sexual from the longitudinal panel of the Seattle Social behavior problems are a growing national concern. Development Project which, in 1985, surveyed all While the field continues to make advances, we have consenting fifth-grade students from 18 elementary much more work to do. We are working in a difficult schools serving high-crime neighborhoods in Seattle, and trying period for juvenile justice. It is a time when Washington. Alcohol use was measured at age 14, many are willing to give up on adolescents or punish predictors of alcohol misuse were measured at age 15 them as we do adults. We have reached a point where and alcohol misuse was measured at age 16. Structural many in our society do not know about, or care to equation modeling was used to examine the fit of the understand, the complex issues that are the roots of model to the data. RESULTS: All factor loadings were violence and sexual violence in youth. Certainly their highly significant and the measurement model faith in the resiliency of youth has been tarnished. Nine 665
- 674. critical areas thatneed to be taken into account when years, SE 2.21, without differences between sexes (p = working with youth with sexual behavior problems are 0.25); 6) Potential causes were divides into tree addressed. These areas include the unfortunate but categories: I "the patient doesn't remember associated continued trickle-down and use of adult-based facts" (30.1%, II: psychological or physical stress treatment models to treat youth with sexual behavior (39.8%), III: facts related to sexual trauma (30.1%). problems, changes in juvenile law that have an impact The differences (p = 0.0001); 7) Analyzed in general on our ability to treat these youths effectively, the need by sec, the most common cause was psychological- for continued research in developing typologies for physical stress rather than sexual trauma in men, while youths with sexual behavior problems and valid and among women sexual trauma was most common than reliable risk assessment scales, continued work with psychological-physical stress (p = 0.03); 8) Analyzed understanding and developing dynamic risk factors for by age groups: in the under 5 years-old group: main sexually abusive youth, the need to develop better cause was "I don't remember". In 5.1-25-years-old treatments for special populations of youth with sexual group: sexual trauma; and psychological-physical behavior problems, the need for a continuum of care, stress was the main cause in > 25 years-old group (p what constitutes best practice in treating youths with 0.0001). CONCLUSIONS: 1) Women suffer from or sexual behavior problems, the need for developing and consult much more frequently than man; 2) Once the refining standards of care, and the need for continued disease is present, there would not be differences in public education that supports prevention efforts to age, age of onset, or time or evolution into proportions reduce sexual abuse by youth. by sex; 3) The continue forms were the predominant ones; 4) The probable associated causes vary for each Lopez Gaston AR, Andrusch A, Catuogno P, Lopez De age group; 5) The sub-group "I don't remember" could Luise G, Vazquez P. [History of patients with pelvic represent in many cases a mismatch learning, but not floor dysfunction]. Acta Gastroenterol Latinoam 2003; constantly (there are cases of stress in familiar 33(2):79-92. context); 6) In the subgroup "late childhood- Abstract: OBJECTIVES: 1) To determine differences adolescence" the predominant causes were traumatic between sexes; 2) To determine differences by sex and experiences in erotic zones (rapping intent, sexual age groups in symptom onset, time of evolution, abuse, fantasies, elimination of parasites by the anus); clinical forms and probable associated causes. 7) in the subgroup "older than 25 years-old" the POPULATION AND SAMPLE: 83 consecutive predominant causes were physical stress, (violence, patients with diagnosed PCP (X age = 50.9 SE 2.21). accidents, surgery) or emotional stress (familiar 25 males (30.1% x 51.2 years-old, SE 4.1) and 58 environment, social environment, affective losses). females (69.9%, X 50.8 years-old, SE 2.2). Patients Some paradigmatic cases are presented. Anismus with organic colon-rectum pathology (with the would be a complex situation involving an striated, exception of hemorrhoidal pathology, proctologic voluntary, automatizated muscle (puborectalis) surgery and active anus fissure) had been excluded. controlling independently genital-sexual, urinary and METHODS: Colonic Double-contrasted Rx, rectum- ano-rectal functions. sigma endoscopy, and eventually a Colonofibroscopy Historic facts and syndromic protocol. Diagnosis Lopez-Herrera G, Garibay-Escobar A, Alvarez-Zavala BJ et criteria: 1) Perineal inspection: perineal contraction al. Severe combined immunodeficiency syndrome with pujo; 2) Rectal tact; 3) Ano-Rectum manometry associated with colonic stenosis. Arch Med Res 2004; with perfused system; 4) 150 ml Rectal balloon 35(4):348-58. expulsion dynamic; 5) Utoreported signs and Abstract: BACKGROUND: This is the first report in symptoms from a cuestionnaire ad hoc. Division into Mexico of a case of severe combined evolutive groups (continuous and intermittent). immunodeficiency syndrome (SCID) associated with Division by age (< = 5, 5.1-25, > 25 years old). colonic stenosis. The patient was an 8-month-old Experiment design: descriptive, comparative, Mexican female who died at this age. She suffered correlation, prospective, simple blind. STATISTICS: infections due to microorganisms such as Levene, descriptive, chi square, ANOVA, Kruskall- Mycobacterium tuberculosis, bacille Calmette-Guerin Wallis, Kendal tau b. RESULTS: 1) Difference in sex (BCG), Candida sp., and Pneumocystis carinii; and had proportion was significative (p = 0.0001); 2) There frequent diarrhea. She was HIV-negative without were not differences between sexes in age media at the familial history of immunodeficiency. The aim of the moment of the study (p = 0.92; 3) The continue work was to analyze the immunologic status of this evolutive form represented 77.1%, (p = 0.0001) but patient. METHODS: Peripheral blood from the patient there weren't differences between sexes (p = 0.19) and from a healthy matched control were analyzed by There weren't evolutive differences between age flow cytometry to determine peripheral leukocytes and groups. (p = 0-78) 4) Age of onsec: x = 24.04 years- production of cytokines and their receptors in T- old, SE 2.02 (4-80 years-old), without differences lymphocytes and monocytes. Immunohistochemical between sexes (p = 0.16). 14.5% started before age of analysis was performed in spleen and lymph node 5, 85% after that age, without differences between sections from the patient and control samples to assess sexes (p = 0.07); 5) The time of evolution x = 26.7 alterations in architectural and cellular distribution 666
- 675. within these lymphoidtissues. RESULTS: Peripheral complex behavioral disorder, with features compatible blood analysis demonstrated reduced numbers of both with orbitofrontal and Kluver-Bucy syndromes. T and B cells and defective expression of cytokines by activated T cells. Postmortem analysis revealed very Lorber MF. Psychophysiology of aggression, psychopathy, small T and B cell zones in spleen and lymph nodes, and conduct problems: a meta-analysis. Psychol Bull absence of germinal centers and follicular dendritic cell 2004; 130(4):531-52. networks, and two zones of stenosis at level of colon Abstract: A meta-analysis of 95 studies was conducted sigmoides. CONCLUSIONS: As a whole, these data to investigate the relations of heart rate (HR) and are consistent with severe combined immunodeficiency electrodermal activity (EDA) with aggression, (SCID) syndrome; thus, we conclude that this patient psychopathy, and conduct problems. Analyses revealed may have had a variant of SCID syndrome associated a complex constellation of interactive effects, with a with intestinal stenosis. failure in some cases of autonomic patterns to generalize across antisocial spectrum behavior Lopez J, Lopez V, Rojas D et al. Effect of psychostimulants constructs. Low resting EDA and low task EDA were on distinct attentional parameters in attentional associated with psychopathy/sociopathy and conduct deficit/hyperactivity disorder. Biol Res 2004; problems. However, EDA reactivity was positively 37(3):461-8. associated with aggression and negatively associated Abstract: Although there is extensive literature about with psychopathy/sociopathy. Low resting HR and the effects of stimulants on sustained attention tasks in high HR reactivity were associated with aggression and attentional deficit/hyperactivity disorder (ADHD), little conduct problems. Physiology--behavior relations is known about the effect of these drugs on other varied with age and stimulus valence in several cases. attentional tasks involving different neural systems. In Empirical and clinical implications are discussed. this study we measured the effect of stimulants on ADHD children, both in the electroencephalographic Lorber MF, O'leary SG. Mediated paths to over-reactive (EEG) activity during sustained attentional tasks and in discipline: mothers' experienced emotion, appraisals, psychometric performance during selective attentional and physiological responses. J Consult Clin Psychol tasks. These tasks are known to rely on different 2005; 73(5):972-81. cortical networks. Our results in children medicated Abstract: The present investigation was designed to with 10 mg of d-amphetamine administered 60 min evaluate whether mothers' emotion experience, before the study indicate (i) a significant increase in autonomic reactivity, and negatively biased appraisals amplitude but not latency of the P300 component of the of their toddlers' behavior and toddlers' rates of event-related potential (ERP) during the sustained misbehavior predicted over-reactive discipline in a attentional task and (ii) a significant improvement in mediated fashion. Ninety-three community mother- the reaction times and correct responses in the selective toddler dyads were observed in a laboratory attentional task. In addition to supporting the use of interaction, after which mothers' emotion experience stimulants in children with attentional and appraisals of their toddler's behavior were deficit/hyperactivity disorder, these results show a measured via a video-recall procedure. Autonomic multifocal activity improvement of cortical structures physiology and over-reactive discipline were measured linked to dopamine, and interestingly, to attention. All during the interactions. Mothers' negatively biased these analyses are framed in a wider study of diverse appraisals mediated the relation between emotion attentional functions in this syndrome. experience and over-reactive discipline. Heart rate reactivity predicted discipline independent of this Lopez-Meza E, Corona-Vazquez T, Ruano-Calderon LA, mediation. Toddler misbehavior appeared to be an Ramirez-Bermudez J. Severe impulsiveness as the entry point into the above process. Interventions that primary manifestation of multiple sclerosis in a young more actively target physiological and experiential female. Psychiatry Clin Neurosci 2005; 59(6):739-42. components of mothers' emotion may further reduce Abstract: Severe impulsiveness in the absence of their over-reactive discipline. apparent neurological signs has rarely been reported as a clinical presentation of multiple sclerosis (MS). An Lorber MF, O'Leary SG, Kendziora KT. Mothers' 11-year-old female developed progressive and overreactive discipline and their encoding and sustained personality disturbances including appraisals of toddler behavior. J Abnorm Child Psychol disinhibition, hypersexuality, drug abuse, 2003; 31(5):485-94. aggressiveness and suicide attempts, without Abstract: The relations of observed overreactive neurological signs. She was given several unsuccessful discipline with mothers' tendencies to notice negative, psychopharmacological and psychotherapeutic relative to positive, child behavior (preferential interventions. At age 21, a diagnosis of MS was made, negative encoding), and mothers' negative appraisals of confirmed by imaging, laboratory and neutral and positive child behavior (negative appraisal neurophysiological studies. Although unusual, MS may bias), were examined in mothers of toddlers. The produce pure neurobehavioral disturbances. In the mothers rated both their own children's and unfamiliar present case, widespread demyelinization produced a 667
- 676. children's behavior. Negativeappraisal bias with explaining how GISs are applied, we stressed their respect to mothers' own (but not unfamiliar) children ability to integrate data, which makes it possible to was related to mothers' overreactivity, independent of perform epidemiologic evaluations in a simpler, faster, child misbehavior. Overreactivity was not related to automated way that simultaneously analyzes multiple mothers' preferential negative encoding either of their variables with different levels of aggregation. In this own or of unfamiliar children's behavior. However, in study, GISs were applied in analyzing infant mortality the case of mothers' own children, preferential negative data with three levels of aggregation in countries of the encoding moderated the relation between negative Americas from 1995 to 2000. RESULTS: Infant appraisal bias and overreactive discipline, such that the mortality in the Region of the Americas was estimated negative appraisal bias-overreactivity relation was at an overall average of 24.4 deaths per 1,000 live significant only in the context of high preferential births. However, the inequalities that were found negative encoding. indicate that the probability of an infant death is almost 20 times greater in the less developed countries of the Lorenz JM. Prenatal counseling and resuscitation decisions Region than in more developed ones. Mapping infant at extremely premature gestation. J Pediatr 2005; mortality throughout the Region of the Americas 147(5):567-8. allowed us to identify the countries that need to focus more attention on health policy and health programs, Lorenz JM. The roles of the community and physician in but not to determine what specific actions are of the treatment decisions for extremely premature infants. highest priority. An analysis of smaller geopolitical Paediatr Perinat Epidemiol 2002; 16(1):5-7. units (states and municipalities) revealed important differences within countries. This shows that, as is true Loughrey J. Medical information, confidentiality and a of data for the entire Region of the Americas, using child's right to privacy. Leg Stud (Soc Leg Scholars) national-level average figures for indicators can 2003; 23(3):510-35. obscure the differences that exist within countries. Notes: GENERAL NOTE: KIE: 154 fn. When we examined the relationship between female GENERAL NOTE: KIE: KIE Bib: confidentiality/legal illiteracy and malnutrition as determinants of infant aspects; patient care/minors mortality in Brazil and Ecuador, we identified social Abstract: Following the Gillick case in 1986, it was and epidemiologic strata where risk factors had recognised that mature minors were owed a duty of different distribution patterns and that thus require confidentiality in respect of their medical information. health interventions that match their individual social Subsequent cases confirmed that the duty was also and epidemiologic profiles. CONCLUSIONS: With owed to non-competent children, including infants, but this type of epidemiologic study using GISs at the local without explaining the basis for finding the existence level of health services, it is easy to see how a health of such a duty and its scope. It is particularly unclear event and its risk factors behave at a specific period in when and upon what legal basis a doctor could disclose time. It is also possible to identify patterns in the information to parents when their child wished to keep spatial distribution of risk factors and in these factors' it confidential. This paper will examine the law of potential impact on health. Using GISs in an confidentiality as it applies to children, identifying appropriate way will make it easier to deliver more issues which are problematic. Developments in the law effective, equitable public health services. of personal confidences which have taken place as a result of the Human Rights Act 1998, and the Lu D, Medeiros LJ, Eskenazi AE, Abruzzo LV. Primary recognition of Article 8 rights as part of the law, will follicular large cell lymphoma of the testis in a child. be reviewed and analysed from the perspective of the Arch Pathol Lab Med 2001; 125(4):551-4. duty of confidence owed to children in respect of their Abstract: Primary follicular lymphoma of the testis in medical information. Finally, the paper will offer an childhood is extremely rare. To our knowledge, only 5 explanation of a basis for disclosure to parents which cases have been reported to date. We report a case in a minimises violations of a minor's autonomy. 6-year-old boy who presented with painless right scrotal enlargement. Right radical orchiectomy Loyola E, Castillo-Salgado C, Najera-Aguilar P, Vidaurre revealed a follicular large cell lymphoma with diffuse M, Mujica OJ, Martinez-Piedra R. [Geographic areas confined to the testis and epididymis, clinical information systems as a tool for monitoring health stage IE. Immunohistochemical stains demonstrated inequalities]. Rev Panam Salud Publica 2002; that the neoplastic cells were of B-cell lineage, positive 12(6):415-28. for CD10, CD20, CD79a, and BCL-6. Staining for Abstract: OBJECTIVE: To show how geographic CD21 accentuated networks of dendritic reticulum information systems (GISs) can be used as cells within the nodules. The cells were negative for technological tools to support health policy and public BCL-2, p53, and T-cell antigens. There was no health actions. METHODS: We assessed the evidence of the t(14;18) detected by polymerase chain relationship between infant mortality and a number of reaction. The data suggest that follicular lymphoma of socio-economic and geographic determinants. In the testis in children has a different pathogenesis than follicular lymphoma in adults. 668
- 677. Lubsen-Brandsma MA. [Adhesionsof the labia minora in with lesion or neuroimaging data allowing descriptions three young girls]. Ned Tijdschr Geneeskd 2003; of brain-behavior relations to be made with increasing 147(2):53-6. confidence. One such battery is the Cambridge Abstract: Three girls, 2, 5 and 6 years of age, had labial Neuropsychological Testing Automated Battery adhesions: one without complaints but whose mother (CANTAB), and current studies in which the was anxious about abnormal anatomy of the external CANTAB has been used to measure executive genitalia, one with urinary problems because of functions in children are reviewed. CONCLUSIONS: pooling of the urine in the almost completely covered Computerized batteries of this type can record aspects vagina, relapsing after surgical intervention, and one of performance that are difficult for psychometrists to with irregular adhesions because of sexual abuse. In all achieve, and these may reflect activity in developing three, after (repeated) application of oestrogen cream neural networks with more sensitivity than can be the adhesions reduced or disappeared. Adhesions of the achieved with traditional tests. However, before labia minora can often be noticed under the age of 8 computerized test administration becomes a routine years and dissolve after that age during the period of part of pediatric neuropsychological assessment, progressive natural oestrogen production. Therapy several obstacles must be overcome. Despite these consists of application of oestrogen cream on the limitations, it is concluded that computerized contact surface of the labia minora. Surgical treatment assessment can improve the field by facilitating the is disputable and causes a high recurrence, probably collection of normative and clinical data. higher than conservative treatment. Luecken LJ, Lemery KS. Early caregiving and physiological Lucassen A, Parker M. Revealing false paternity: some stress responses. Clin Psychol Rev 2004; 24(2):171-91. ethical considerations. Lancet 2001; 357(9261):1033-5. Abstract: Inadequate early caregiving has been Notes: GENERAL NOTE: KIE: Lucassen, Anneke; associated with risks of stress-related psychological Parker, Michael and physical illness over the life span. Dysregulated GENERAL NOTE: KIE: 20 refs. physiological stress responses may represent a GENERAL NOTE: KIE: KIE Bib: confidentiality; mechanism linking early caregiving to health genetic counseling; truth disclosure outcomes. This paper reviews evidence linking early caregiving to physiological responses that can increase Luce R. The Children Act: key points and implications for vulnerability to stress-related illness. A number of nursing. Nurs Times 2005; 101(17):26-7. high-risk family characteristics, including high conflict, Abstract: This article sets out the key points of the divorce, abuse, and parental psychopathology, are Children Act 2004 and considers the implications for considered in the development of stress vulnerability. practice, with particular regard to the patient Three theoretical pathways linking caregiving to assessment process and the links between adult physiological stress responses are outlined: genetic, behaviour and child protection. psychosocial, and cognitive-affective. Exciting preliminary evidence suggests that early caregiving can Lucey J. Abuse of people trying to protect children from impact long-term physiological stress responses. abuse. Lancet 2001; 358(9292):1556. Directions for future research in this area are suggested. Luciana M. Practitioner review: computerized assessment of neuropsychological function in children: clinical and Lueder GT. Retinal hemorrhages in accidental and research applications of the Cambridge nonaccidental injury. Pediatrics 2005; 115(1):192; Neuropsychological Testing Automated Battery author reply 192. (CANTAB). J Child Psychol Psychiatry 2003; 44(5):649-63. Lugina HI, Johansson E, Lindmark G, Christensson K. Abstract: BACKGROUND: Computers have been used Developing a theoretical framework on postpartum for a number of years in neuropsychological care from Tanzanian midwives' views on their role. assessment to facilitate the scoring, interpretation, and Midwifery 2002; 18(1):12-20. administration of a variety of commonly used tests. Abstract: OBJECTIVES: to describe a theoretical There has been recent interest in applying framework developed from the views of midwives in computerized technology to pediatric relation to provision of systematic postpartum care. neuropsychological assessment, which poses unique DESIGN: qualitative focus group study using grounded demands based on the need to interpret performance theory approach. SETTING: Dar es Salaam, Tanzania. relative to the child's developmental level. FINDINGS: PARTICIPANTS: 49 nurse-midwives in five focus However, pediatric neuropsychologists have tended to group discussions each having 9-11 participants. implement computers in the scoring, but not FINDINGS: the components of the Basic Social administration, of tests. This trend is changing based Process of 'Becoming a good resource and support on the work of experimental neuropsychologists who person for the postpartum woman' consisted of frequently combine data obtained from test batteries 'reflection' as an entry point into the process. 669
- 678. Integration, networking, balancing,and dealing with Lugosi CI. Playing God: Mary must die so Jodie may live reality, emerged as categories related to process longer. Issues Law Med 2001; 17(2):123-65. activities. The category of 'defining abilities' required Notes: GENERAL NOTE: KIE: 312 fn. that midwives become aware of their competency and GENERAL NOTE: KIE: KIE Bib: patient care/minors; their limitations in reflection and all process activities, treatment refusal/minors so that improvement can be part of 'getting ready', a Abstract: In 2000, conjoined twins were born in category that describes what needs to be done at England. What made this case unique was the fact that individual and health system level to prepare for if the twins remained unseparated, medical opinion systematic postpartum care programmes. The 'caring' held they would die; if they were separated one twin category was linked to an outcome of the process would live, and one twin would die; the parents refused 'doing things in the right way', which means providing to consent to separation; and the hospital charged with quality postpartum care. The conditional matrix shows their care brought the matter to court. The trial court the midwife as an individual affected by several micro and court of appeal approved of the surgery, which was and macro conditions. CONCLUSIONS: the proposed promptly performed, resulting in the immediate death theoretical framework can be used in understanding the of the weaker twin. The author argues that there is no dynamics of work situations and in assisting midwives justification in law or morality for the courts' decisions, to achieve the goal of being good resource and support and that, in fact, the courts' decisions over-rule prior persons for postpartum women. Interventions for precedent and effectively divorced law from morality. midwives should focus on the major components of the framework but also on the concepts that relate the Luhmann UF, Lin J, Acar N et al. Role of the Norrie disease proposed framework to other central concepts in pseudoglioma gene in sprouting angiogenesis during midwifery and nursing, issues in the theory-practice development of the retinal vasculature. Invest gap, empowerment, political awareness, involvement Ophthalmol Vis Sci 2005; 46(9):3372-82. in policy making, decision making and dealing with job Abstract: PURPOSE: To characterize developmental stress. defects and the time course of Norrie disease in retinal and hyaloid vasculature during retinal development and Lugina HI, Lindmark G, Johansson E, Christensson K. to identify underlying molecular angiogenic pathways Tanzanian midwives' views on becoming a good that may be affected in Norrie disease, exudative resource and support person for postpartum women. vitreoretinopathy, retinopathy of prematurity, and Midwifery 2001; 17(4):267-78. Coats' disease. METHODS: Norrie disease Abstract: OBJECTIVES: to explore midwives' views in pseudoglioma homologue (Ndph)-knockout mice were relation to the provision of systematic postpartum care. studied during retinal development at early postnatal DESIGN: qualitative focus group study using grounded (p) stages (p5, p10, p15, and p21). Histologic theory approach. SETTING: Dar es Salaam, Tanzania. techniques, quantitative RT-PCR, ELISA, and Western PARTICIPANTS: 49 nurse/midwives in five focus blot analyses provided molecular data, and scanning group discussions, each having 9-11 participants. laser ophthalmoscopy (SLO) angiography and FINDINGS: eight categories were identified: electroretinography (ERG) were used to obtain in vivo 'reflecting', 'getting ready', 'defining abilities', data. RESULTS: The data showed that regression of 'networking', 'integrating', 'balancing', 'dealing with the hyaloid vasculature of Ndph-knockout mice reality', and 'caring'. The identified core category that occurred but was drastically delayed. The development integrated and encapsulated all other categories was of the superficial retinal vasculature was strongly 'becoming a good resource and support person for delayed, whereas the deep retinal vasculature did not postpartum woman'. The mediating factors found to form because of the blockage of vessel outgrowth into have potential for influencing how a midwife can the deep retinal layers. Subsequently, microaneurysm- function in order to become a good resource and like lesions formed. Several angiogenic factors were support person were: a) the structure and approach in differentially transcribed during retinal development. maternal and child health services, b) midwives' Increased levels of hypoxia inducible factor-1alpha knowledge, attitude and skills, c) informal sources of (HIF1alpha) and VEGFA, as well as a characteristic knowledge to parents, and d) cultural beliefs and ERG pattern, confirmed hypoxic conditions in the practices. CONCLUSION: the findings of this study inner retina of the Ndph-knockout mouse. provide an understanding of the way midwives feel and CONCLUSIONS: These data provide evidence for a think about the provision of postpartum care. The crucial role of Norrin in hyaloid vessel regression and findings demonstrate that midwives need support in in sprouting angiogenesis during retinal vascular their efforts to achieve what they consider necessary development, especially in the development of the deep for postpartum care. Interventions for educating and retinal capillary networks. They also suggest an early supporting midwives should be targeted at enabling and a late phase of Norrie disease and may provide an them to deal with all the factors that influence their role explanation for similar phenotypic features of allelic and help them to identify and use better strategies to retinal diseases in mice and patients as secondary provide quality care. consequences of pathologic hypoxia. 670
- 679. Lukefahr JL, AngelCA, Hendrick EP, Torn SW. Child into clinical practice. DESIGN: Descriptive report of abuse by percutaneous insertion of sewing needles. the collaborative neonatal skin care research-based Clin Pediatr (Phila) 2001; 40(8):461-3. practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Luna G, Adye B, Haun-Hood M, Berry M, Taylor L, Thorn Association of Neonatal Nurses. SETTING: Neonatal R. Intentional injury treated in community hospitals. intensive-care unit (NICU) and special-care nurseries Am J Surg 2001; 181(5):463-5. and well-baby nurseries in 51 hospitals located Abstract: BACKGROUND: The impact of intentional throughout the United States. PARTICIPANTS: injury in major metropolitan trauma centers has been Member site coordinators (N = 51), nurses who work at established. Nonaccidental injury has become an the selected sites, and the neonates observed during increasingly important component of trauma care in both the pre- and postimplementation phases of the mid-sized urban areas. To determine the medical and project (N = 2,820). METHOD: An evidence-based economic impact of personal violence in the Spokane, clinical practice guideline was developed, sites were Washington, community we undertook a 5-year selected from all respondents of the call for sites, site retrospective review. PATIENTS AND METHODS: coordinator training was provided, data collection was Trauma registries were used to identify all victims of facilitated by project-specific data collection tools, and intentional injury admitted between May 1, 1994, and the project was evaluated by the science team. MAIN April 31, 1999. Demographic data, blood alcohol, OUTCOME MEASURES: Diversity and numbers of mechanism, injury severity, hospital course, and sites represented, patient representation, site outcome were abstracted from the registries. Financial coordinator knowledge of neonatal skin care pre- and data were obtained from hospital financial offices. postimplementation, use of project-designed SETTING: Spokane, Washington, has a population of implementation tools, satisfaction with project 200,000 with 400,000 in the metropolitan area. Trauma guideline and the data collection process, changes in patients are triaged to hospitals according to practices and product use, and site coordinators' Washington Administrative Code guidelines, experiences during guideline implementation. supervised by central medical control. The two level II RESULTS: Fifty-one sites completed the project, and two level III facilities are staffed by private representing NICU, special-care, and well-baby practice surgeons and serve a referral area of 650,000. nurseries in both academic and community hospital RESULTS: Five hundred eighty-one intentional injury settings in 27 states. Registered nurses working in these patients were admitted. This represented 15% of all sites totaled 4,754 full-time equivalent positions significant injuries. Males accounted for 80% of the (FTEs) (in NICU/special-care and well-baby patients and 84%were Caucasian. The mean patient age nurseries). Site coordinators demonstrated increased was 30 years, only one quarter were listed as knowledge of research-based neonatal skin care and employed. Sixteen percent of the injuries were self- satisfaction with the implementation tools and data inflicted, gunshot was the most common mechanism collection process. Product use changed, reflecting (39%). Alcohol was involved in one half of the acquisition of new knowledge. Barriers to injuries. Sixty-three patients died, 39 died prior to implementation of the guideline were identified. intensive care unit admission. Hospital stay averaged CONCLUSIONS: The AWHONN/NANN Neonatal 6.4 days, with a mean hospital charge of $18,000. Skin Care Research-Based Practice Project Hospitals were reimbursed at 67%. Surgeons collected demonstrated increased knowledge among site 31% of billed fees. Fewer than one third of patients had coordinators who received training, facilitated changes any form of private insurance. CONCLUSIONS: in neonatal skin care as defined by the practice Intentional injury is a significant component of trauma guideline, and thus advanced evidence-based clinical care in our community. Patients are seriously injured practice. and the fatality rate is high. Care is expensive and poorly funded. Lund CH, Osborne JW. Validity and reliability of the neonatal skin condition score. J Obstet Gynecol Lund CH, Kuller J, Lane AT, Lott JW, Raines DA, Thomas Neonatal Nurs 2004; 33(3):320-7. KK. Neonatal skin care: evaluation of the Abstract: OBJECTIVE: To demonstrate the validity AWHONN/NANN research-based practice project on and reliability of the Neonatal Skin Condition Scale knowledge and skin care practices. Association of (NSCS) used in the Association of Women's Health, Women's Health, Obstetric and Neonatal Obstetric and Neonatal Nurses (AWHONN) and the Nurses/National Association of Neonatal Nurses. J National Association of Neonatal Nurses (NANN) Obstet Gynecol Neonatal Nurs 2001; 30(1):30-40. neonatal skin care evidence-based practice project. Abstract: OBJECTIVE: To develop and evaluate an SETTING: NICU and well-baby units in 27 hospitals evidence-based clinical practice guideline for located throughout the United States. assessment and routine care of neonatal skin, educate PARTICIPANTS: Site coordinators (N = 27) and nurses about the scientific basis for practices neonates (N = 1,006) observed during both the pre and recommended in the guideline, and design procedures postimplementation phases of the original neonatal that facilitate implementation of the project guideline skin care project. METHOD: To assess reliability, two 671
- 680. consecutive NSCS assessmentson a single infant were and the neonates (N= 2,820) observed during both the analyzed. Site coordinators were contacted after the pre- and postimplementation phases of the project. original project was concluded. Sites indicating that a METHOD: Site coordinators received specialized single nurse scored all infant skin observations education in neonatal skin care and implemented an provided data that were used to evaluate intrarater evidence-based clinical practice guideline addressing reliability. Sites using more than one nurse to score 10 aspects of neonatal skin care. Baseline observations skin observations provided data that were used to of skin condition, care practices, and environment of assess interrater reliability. To assess validity, the newly admitted neonates were collected by site following variables were used from the original data coordinators. Postimplementation observations were set: the Neonatal Skin Condition Scale (NSCS), with then completed. MAIN OUTCOME MEASURES: three subscales for dryness, erythema, and breakdown; Skin condition was assessed with the Neonatal Skin birth weight in grams; number of skin score Condition Score (NSCS), which ranges from a score of observations for each infant; and the prevalence of three (best condition) to a score of nine (worst infection, defined as a positive blood culture. condition), based on dryness, erythema, and skin RESULTS: For intrarater reliability, 16 sites used a breakdown. Changes in frequency of selected skin care single nurse for all NSCS assessments; total NSCS practices were used to assess the effectiveness and assessments 475. For interrater reliability, 11 sites used feasibility of using the practice guideline in everyday multiple raters; total assessments 531. The NSCS clinical practice. Aspects of the care environment with demonstrated adequate reliability for each of the three potential effect on skin integrity were monitored to subscales and for the total score, with the percent determine risk factors. RESULTS: Fifty-one site agreement between scores ranging from 68.7% to coordinators made 11,468 systematic assessments of 85.4% (intrarater) and 65.9% to 89% (interrater); all 2,464 NICU and SCU newborns and 356 well Kappas were significant at p < .001 and were in the newborns. Baseline skin scores were better in well moderate range for reliability. The validity of the newborns compared with premature newborns. After NSCS was demonstrated by the findings that smaller implementation of the guideline, skin condition was infants were 6 times more likely to have erythema improved, as reflected by less visible dryness, redness, (chi2(6) = 109.55, p < .0001), and approximately twice and skin breakdown in both the NICU/SCU and well as likely to have the most severe breakdown (chi2(6) = newborns. The guideline was integrated into care, as 108.01, p < .0001). Infants with more observations evidenced by increased use of emollients, particularly (longer length of stay) had higher skin scores (odds with premature infants, and decreased frequency of ratio = 1.21, p < .0001), and an increased probability of bathing. A relationship was shown between selected infection was noted for infants with higher skin scores aspects of the environment and alterations in skin (odds ratio = 2.25, p < .0001). CONCLUSIONS: The integrity. CONCLUSIONS: Use of the Neonatal Skin Condition Score (NSCS) is reliable AWHONN/NANN Neonatal Skin Care Research- when used by single and multiple raters to assess Based Clinical Practice Guideline was successfully neonatal skin condition, even across weight groups and implemented at 51 sites, and effectiveness was racial groups. Validity of the NSCS was demonstrated demonstrated by changed care practices and improved by confirmation of the relationship of the skin skin condition in premature and full-term newborns. condition scores with birth weight, number of The results of this project support a wider observations, and prevalence of infection. dissemination of the project's practice guideline for neonatal skin care. Lund CH, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA. Neonatal skin care: clinical outcomes of the Lundborg P. Young people and alcohol: an econometric AWHONN/NANN evidence-based clinical practice analysis. Addiction 2002; 97(12):1573-82. guideline. Association of Women's Health, Obstetric Abstract: AIMS: To analyse the determinants of youth and Neonatal Nurses and the National Association of drinking behaviour within an economic -theoretical Neonatal Nurses. J Obstet Gynecol Neonatal Nurs framework. The paper focuses especially on the effects 2001; 30(1):41-51. of (a) having parents willing to supply alcohol, (b) Abstract: OBJECTIVE: To test the effectiveness of an living in a single-parent household, (c) having parents evidence-based clinical practice guideline for neonatal who are currently unemployed and (d) having received skin care on selected clinical outcomes for newborns in education about alcohol, narcotics and tobacco. neonatal intensive-care units (NICU), special-care units DESIGN, SETTING AND PARTICIPANTS: A (SCU), and well-baby nurseries. DESIGN: Prospective Swedish cross-sectional survey data on 833 individuals evaluation of the collaborative neonatal skin care aged 12-18 years was used to analyse the effects of the research-based practice project of the Association of above variables on participation in drinking, frequency Women's Health, Obstetric and Neonatal Nurses and of drinking, intensity of drinking and binge drinking. the National Association of Neonatal Nurses. Separate analyses were conducted for beer, wine and SETTING: NICU and well-baby units in 51 hospitals spirits. Care was taken in using appropriate located throughout the United States. econometric methods for the questions posed (negative PARTICIPANTS: Member site coordinators (N = 51) binomial regression, censored regression and probit 672
- 681. regression). FINDINGS: Havingparents willing to transport and transport issues pertaining to networking supply alcohol increased frequency (P < 0.05) of beer, of neonatal medical care are highlighted and illustrated wine and spirits consumption, intensity (P < 0.05) of with reference to local experience in British Columbia. wine, spirits and illicit alcohol consumption, and increased probabilities (P < 0.10) of binge drinking and Lupton D, Fenwick J. 'They've forgotten that I'm the mum': participation in drinking (P < 0.05). No effects were constructing and practising motherhood in special care seen from living in a single-parent household. Having nurseries. Soc Sci Med 2001; 53(8):1011-21. received education about alcohol, narcotics and Abstract: Little sociological research has sought to tobacco had a negative association only with intensity investigate the ways in which women with hospitalized (P < 0.10) of beer consumption. Having a father who newborn infants construct and practice motherhood. was currently unemployed was associated with an This article seeks to address this lacuna, using data increased (P < 0.05) probability of binge drinking but a from a qualitative research project based in two reduced (P < 0.05) frequency of wine consumption. Australian neonatal nurseries. Thirty-one mothers of CONCLUSIONS: The positive effect of having parents hospitalized newborns and 20 neonatal nurses were willing to supply alcohol could reflect that these interviewed, and other data were obtained via individuals face lower acquisition costs or lower observations of the nurseries, tape-recorded verbal psychological costs in consumption. It could also interactions between parents and nursery staff and reflect a price effect, if the individual receives the casual conversations with mothers and nurses. The data alcohol free from his or her parents. revealed that while the mothers' and nurses' discourses on what makes a 'good mother' in the context of the Lung FW, Lin TJ, Lu YC, Shu BC. Personal characteristics neonatal nursery converged to some extent, there were of adolescent prostitutes and rearing attitudes of their important differences. The mothers particularly parents: a structural equation model. Psychiatry Res emphasized the importance of physical contact with 2004; 125(3):285-91. their infants and breastfeeding, while the nurses Abstract: The aim of this study was to investigate the privileged presence in the nursery and willingness to risk factors of family structure, personality traits, and learn about the infant's condition and treatment. There other variables among adolescent prostitutes. The was evidence of power struggles between the mothers subjects comprised 158 adolescent prostitutes in a and nurses over the handling and treatment of the halfway house as the case group and 65 high school infants, which had implications for how the mothers girls as the control group. Data were collected by using constructed and practised motherhood. The mothers questionnaires about demographic information, the attempted to construct themselves as 'real mothers', Junior Eysenck Personality Questionnaire and the which involved establishing connection with their Parental Bonding Instrument. A high rate of tobacco, infants and normalizing them. In time, many of the alcohol and drug use was found in the case group. mothers sought to position themselves as the 'experts' Numerous factors distinguished the cause-effect on their infants. For their part, the nurses attempted to relationship among adolescent prostitutes. Of all risk position themselves as 'teachers and monitors of the factors studied, maternal protection, paternal care, parents', 'protectors of the infants' and 'experts' by neurotic characteristics, tobacco use, discontinuous virtue of their medical training and experience. schooling and a dysfunctional family had the most Differences in defining the situation resulted in direct effect. These results provide useful information frustration, resentment and anger on the part of the for the evaluation of and interventions with adolescent mothers and disciplinary and surveillance actions on prostitution. the part of many of the nurses, both covert and overt. The nurses' attitude to and treatment of the mothers Luoma R, Raboei E, Fadallah S, al-Sherif N. [On was integral in the development of the mothers' investigating sexual abuse of a child]. Duodecim 2001; relationship with their infants in the nurseries, and this 117(9):1004; author reply 1005. influence extended beyond discharge of the infants. Lupton BA, Pendray MR. Regionalized neonatal emergency Lush L, Walt G, Ogden J. Transferring policies for treating transport. Semin Neonatol 2004; 9(2):125-33. sexually transmitted infections: what's wrong with Abstract: This article reviews the components that global guidelines? Health Policy Plan 2003; 18(1):18- facilitate an effective neonatal emergency transport 30. network, and discusses the human resources required Abstract: The paper uses a case study of the for safe transport, including a section focused on the development of syndromic management for treating option of an expanded role for the paramedic. In sexually transmitted infections (STIs) and subsequent addition, the topics of transport equipment, policies recommending worldwide use of syndromic communications, quality assurance, data management, management guidelines. These treatment policies family support and education are addressed in the emerged in the late 1970s from researchers and public context of a neonatal transport programme. Finally, health physicians working in sub-Saharan Africa where elements involved in the organization of neonatal they had to treat large numbers of STIs in difficult circumstances. Syndromic management was initially 673
- 682. developed in specificlocal epidemiological and Abstract: Although many of the pioneers of behavior resource situations. By the late 1980s, the World analysis thought on a large scale and encouraged others Health Organization had adopted syndromic to do so, most behavior analytic projects have remained management as policy, and began to promote it small scale. The intent of this article is to urge the globally in the form of algorithms and training application of behavior analytic principles on a large guidelines. Dissemination was assisted by the context scale. This article begins with a brief history of applied of the rapid spread of HIV/AIDS and the apparent behavior analysis. It then describes some early effectiveness of syndromic management for treating behavior analysts who thought big and describes STIs and slowing the transmission of HIV/AIDS. In the several examples of large-scale behavioral projects. It mid 1990s, international donors interested in HIV then shows how behavior analysis fits well with the control and women's reproductive health took it up, and public health model and describes how behavior encouraged national programmes to adopt the new analytic principles can be implemented broadly to guidelines. Implementation, however, was a great deal combat public health problems. The article ends with more complex than anticipated, and was exacerbated some practical advice for behavior analysts on how to by differences between three rather separate policy think big and speculates on the future of behavior networks involved in the dissemination and execution analysis. of the global guidelines. The analysis focuses on two parts of the process of policy transfer: the organic Lyford J, Breen N, Grove M. Diabetes training for schools development of scientific and medical consensus using a community partnership model in rural Oregon. around a new policy for the treatment of STIs; and the Diabetes Educ 2003; 29(4):564-7, 570, 573. formulation and subsequent dissemination of international policy guidelines. Using a political Lynch L, Bemrose S. It's good to talk: pre- and post-birth science approach, we analyze the transition from interaction. Pract Midwife 2005; 8(3):17-20. clinical tools to global guidelines, and the associated Abstract: This article describes the development of debates that accompanied their use. Finally, we evidence-based pictorial information and activity cards comment on the way current global guidelines need to that can be used with parents in the antenatal and be adapted, given the growth in knowledge. postnatal period. The focus of this project is on developing early pre- and post-birth interaction Luthar SS, Doyle K, Suchman NE, Mayes L. Developmental between the baby and its family. AIM: To develop a themes in women's emotional experiences of way of working with parents-to-be and their families in motherhood. Dev Psychopathol 2001; 13(1):165-82. pregnancy and the early postnatal days that will Abstract: In this study, women's levels of ego improve interaction and communication to maximise development and their psychological difficulties were the baby' full potential. OBJECTIVES: To develop examined in relation to feelings in the maternal role. information cards and activities that are evidence based The sample consisted of 91 mothers from diverse to support positive early interaction and socioeconomic backgrounds. Ego development was communication. To support parent baby attachment assessed by the Washington University Sentence prior to birth. To support parent-baby attachment post Completion Test, and psychological difficulties were birth. To establish good patterns of parent-baby operationalized by self-reported global communication from an early age. To provide the baby symptomatology, maternal substance abuse, and with maximum stimulation to aid brain development, expressed anger. Outcome variables included feelings physical development and growth, hearing and of satisfaction, distress, and support in the maternal communication skills (Verney 1981). To increase role, as well as the degree to which negative and parents' self-esteem. To involve family members. To positive emotions were integrated in response to reduce sibling rivalry. hypothetical vignettes of challenging everyday child- rearing experiences. Hypotheses were that women at Lynch ME, Coles CD, Corley T, Falek A. Examining high levels of ego development would show greater delinquency in adolescents differentially prenatally deterioration in the presence versus absence of self- exposed to alcohol: the role of proximal and distal risk reported adjustment problems than would those at factors. J Stud Alcohol 2003; 64(5):678-86. lower levels. A series of interaction effects each Abstract: OBJECTIVE: An association has been indicated trends consistent with the hypotheses. These reported between prenatal alcohol exposure and results add to accumulating evidence that tendencies delinquent behavior in adolescents. Problems are toward self-examination, characteristic of high believed to be particularly significant for those who developmental levels, do not inevitably serve were exposed prenatally but do not have full fetal protective functions but may be linked with heightened alcohol syndrome (FAS). The goals of this study were reactivity to negative intrapsychic forces. (1) to examine the relation between a range oflevels of prenatal exposure and delinquent behavior in a Lutzker JR, Whitaker DJ. The expanding role of behavior community sample and (2) to examine the effect of analysis and support: current status and future other current risk factors, in addition to prenatal directions. Behav Modif 2005; 29(3):575-94. 674
- 683. exposure, on delinquentbehavior. METHOD: In this school entry. METHOD: Participants were 63 five- study, 250 low income, predominantly black youths year-olds from low-income families, half of whom (mean age = 15.1 years) and their primary caregivers were referred to parent-infant home-visiting services participated in an evaluation that included measures of during the first 18 months of life due to concerns about delinquency, life stress, substance use, behavior the caretaking environment. Families received between problems, parenting practices, negative peer influence, 0 and 18 months of weekly home visits based on infant caregiver substance use and the dysmorphia age at entry into the study. At age 5, children were characteristic of FAS. Three groups were drawn from a rated by teachers on the Preschool Behavior sample initially seen at birth: Alcohol-exposed and Questionnaire for behavior problems in the classroom dysmorphic (n = 39), alcohol-exposed, nondysmorphic and by parents both on the Simmons Behavior (n = 77) and nonexposed controls (n = 48). A special Checklist for behavior problems at home and on the education contrast group (n = 84) was recruited at Achenbach Social Competence Items for positive play adolescence to control for disability status. RESULTS: behaviors with friends. RESULTS: With initial family The exposure groups did not differ from controls on risk status and child gender controlled, teacher-rated measures of variety and frequency of delinquent hostile behavior problems decreased in dose-response behavior; boys engaged in a wider range of delinquent relation to the duration of early home-visiting services, acts than girls did. Regression analysis for the full which accounted for 15% of the variance in child sample revealed that higher adolescent life stress, hostile behavior. Parents' reports of positive play higher self-reported drug use and lower parental behaviors were positively linearly related to service supervision were significantly related to a wider range duration. Parents' reports of behavior problems were of delinquent acts. CONCLUSIONS: Other current less reliably related to service duration than teacher influences should be considered in addition to prenatal reports. CONCLUSIONS: Early home-visiting services alcohol exposure in interpreting the development of reduced the incidence of aggressive behavior problems delinquency in alcohol-exposed adolescents. These among socially at-risk children for up to 3.5 years after results demonstrate the importance of examining risk the end of services. factors and controlling effects of sociocultural influences and disability status when working with Lyons-Ruth K, Yellin C, Melnick S, Atwood G. Childhood clinical samples. experiences of trauma and loss have different relations to maternal Unresolved and Hostile-Helpless states of Lynskey MT, Hall W. Attention deficit hyperactivity mind on the AAI. Attach Hum Dev 2003; 5(4):330-52; disorder and substance use disorders: Is there a causal discussion 409-14. link? Addiction 2001; 96(6):815-22. Abstract: This study of 45 high-risk mothers and Abstract: Attention-deficit hyperactivity disorder infants examined the current indirect effects model of (ADHD), characterized by restless, inattentive and intergenerational transmission of disorganized hyperactive behaviours, is a relatively common attachment, which posits that maternal childhood childhood disorder that affects approximately 5% of experiences of loss or trauma contribute to maternal the general population. There has been controversy states of mind on the AAI which in turn contribute to about whether ADHD increases risks of developing infant disorganization. The severity of experiences of substance use disorders. The available evidence both abuse and loss were examined in relation to both suggests that, in the absence of conduct disorder, Unresolved states of mind and Hostile-Helpless states ADHD is not associated with an increased risk of of mind on the AAI and to infant disorganization at substance use problems in males. There is only limited both 12 and 18 months. Neither the experience of evidence on the role of ADHD in the aetiology of parental death in childhood nor the severity of abuse in substance use disorders among females. While ADHD childhood was related to Unresolved states of mind on has traditionally been considered as a childhood the AAI. Instead, an Unresolved state of mind and the disorder, it may also occur in adults; research needs to experience of parental death contributed independently examine the extent to which ADHD in adulthood and additively to the prediction of infant increases the risk of substance use disorders. disorganization at 12 months. At 18 months, an indirect effects model was supported in relation to Hostile- Lyon A. Perinatal autopsy remains the "gold standard". Arch Helpless but not Unresolved states of mind, in that Dis Child Fetal Neonatal Ed 2004; 89(4):F284. severity of trauma had no direct relation to infant disorganization but severity of trauma was related to Lyons-Ruth K, Melnick S. Dose-response effect of mother- Hostile-Helpless states of mind which in turn predicted infant clinical home visiting on aggressive behavior infant disorganization. Unresolved states of mind and problems in kindergarten. J Am Acad Child Adolesc experiences of parental loss did not add to prediction of Psychiatry 2004; 43(6):699-707. disorganization at 18 months. The findings suggest that Abstract: OBJECTIVE: The objective of this follow-up the influence of maternal trauma on infant attachment study was to assess the long-term effects of clinical may become more prominent at 18 months as the infant infant home-visiting services on child outcomes at makes the transition to toddlerhood. The results also suggest that a more complex etiologic model may be 675
- 684. needed of theaspects of early experience that surrogacy arrangement as a positive experience. contribute to adult Unresolved states of mind on the AAI. Macdonald AJ. Maintaining older people's dignity and autonomy in healthcare settings. Whole system must be Mabe PA, Josephson AM. Child and adolescent looked at to prevent degrading treatment. BMJ 2001; psychopathology: spiritual and religious perspectives. 323(7308):340. Child Adolesc Psychiatr Clin N Am 2004; 13(1):111- 25, vii-viii. MacDonald KS, Matukas L, Embree JE et al. Human Abstract: This article addresses the relationship leucocyte antigen supertypes and immune between children's religious beliefs and spiritual susceptibility to HIV-1, implications for vaccine practices and the presence of psychopathology. Study design. Immunol Lett 2001; 79(1-2):151-7. of this subject represents a formidable task due to the Abstract: T cell responses against HIV-1 have been complexity and diversity of the constructs involved, identified in a number of exposed uninfected heterogeneity in religious beliefs and practices, and the populations. We hypothesized that the ability to mount difficulty in discriminating between the independent an effective T cell response is partly determined by the effects of religion and culture. Nevertheless, broad human leucocyte antigens (HLA) phenotype of the links between child psychopathology and individual. We examined whether certain HLA spiritual/religious beliefs and practices are proposed. supertypes were associated with differential HIV-1 On the whole, the available empiric data suggest that susceptibility in sexually exposed adults and in the religion is primarily health promoting in direct, setting of mother to child HIV-1 transmission. By positive benefits for children and in indirect, positive multivariate analysis, decreased HIV-1 infection risk effects through parent and family functioning, although was strongly associated with possession of a cluster of there are isolated exceptions. When spirituality and closely related class I HLA alleles (A2/6802 supertype) religious beliefs/practices are associated with negative in sexually exposed adults (Hazard ratio=0.42, 95% mental health outcomes in children or their families, confidence intervals (CI): 0.22-0.81, P=0.009) and evidence points to "poorness-of-fit," based on an perinatally exposed infants (Odds ratio=0.12, 95% CI: interaction between the child's psychopathology and 0.03-0.54, P=0.006). The alleles in this HLA supertype aspects and religious beliefs/practice. Clinical are known in some cases, to present the same peptide implications of the findings and proposels are outlined. epitopes (termed 'supertopes'), for T cell recognition. The identification of HIV-1 supertopes, which are MacCallum F, Lycett E, Murray C, Jadva V, Golombok S. associated with protection from HIV-1 infection, has Surrogacy: the experience of commissioning couples. important implications for the application of epitope- Hum Reprod 2003; 18(6):1334-42. based HIV-l vaccines in a variety of racial groups. Notes: GENERAL NOTE: KIE: 23 refs. GENERAL NOTE: KIE: KIE Bib: surrogate mothers Machado-Coelho GL, Caiaffa WT, Genaro O, Magalhaes Abstract: BACKGROUND: Findings are presented of PA, Mayrink W. Risk factors for mucosal a study of families with a child created through a manifestation of American cutaneous leishmaniasis. surrogacy arrangement. This paper focuses on the Trans R Soc Trop Med Hyg 2005; 99(1):55-61. commissioning couples' reports of their experiences. Abstract: A case-comparison study was carried out to METHODS: A total of 42 couples with a 1-year-old identify risk factors for mucosal manifestations of child born through surrogacy were assessed using a American cutaneous leishmaniasis (ACL) in southeast standardized semi-structured interview. Data were Brazil, using a series of 2820 patients, diagnosed with obtained on motivations for surrogacy, details about ACL between 1966 and 1999. The significant factors the surrogate mother, experience of surrogacy during independently associated with mucosal leishmaniasis pregnancy and after birth and disclosure of the were: gender, age, nutritional status and length of surrogacy to friends and family. RESULTS: Couples disease. Mucosal leishmaniasis occurred 1.7 times had considered surrogacy only after a long period of more frequently among males than females; twice as infertility or when it was the only option available. often in individuals older than 22 years compared with Couples retrospectively recalled their levels of anxiety the younger group; almost four times as often in throughout the pregnancy as low, and relationships individuals with severe malnutrition compared with between the couple and the surrogate mother were those who were well nourished; and almost four times found to be generally good. This was the case more frequently in individuals reporting the disease for regardless of whether or not the couple had known the more than 4 months compared with those reporting a surrogate mother prior to the arrangement. After the shorter duration of the disease. Among individuals birth of the child, positive relations continued with the older than 22 years the risk of mucosal leishmaniasis large majority of couples maintaining some level of increased significantly (from 1.9 to 9.6) as the contact with the surrogate mother. All couples had told nutritional status decreased, when compared with family and friends about the surrogacy and were younger and well-nourished patients. The planning to tell the child. CONCLUSIONS: characteristics herein described and correlated with Commissioning couples generally perceived the 676
- 685. severe forms couldbe used as diagnostic markers as Composite International Diagnostic Interview and a part of clinical screening in areas endemic for ACL. self-completed questionnaire on child abuse were administered to a probability sample (N=7,016) of Macintosh MC. Continuous fetal heart rate monitoring: is Ontario residents 15 to 64 years of age. RESULTS: there a conflict between confidential enquiry findings Those reporting a history of childhood physical abuse and results of randomized trials? J R Soc Med 2001; had significantly higher lifetime rates of anxiety 94(1):14-6. disorders, alcohol abuse/dependence, and antisocial behavior and were more likely to have one or more MacKenzie JM. Dural haemorrhage in non-traumatic infant disorders than were those without such a history. deaths: an observation on Smith vs. Geddes. Women, but not men, with a history of physical abuse Neuropathol Appl Neurobiol 2004; 30(3):311; author had significantly higher lifetime rates of major reply 312. depression and illicit drug abuse/dependence than did women with no such history. A history of childhood Mackner LM, Crandall WV. Oral medication adherence in sexual abuse was also associated with higher rates of pediatric inflammatory bowel disease. Inflamm Bowel all disorders considered in women. In men, the Dis 2005; 11(11):1006-12. prevalence of disorders tended to be higher among Abstract: The purpose of this study was to examine those who reported exposure to sexual abuse, but only reports of adherence to oral medications, parent-child the associations with alcohol abuse/dependence and the concordance in reports of adherence, and factors category of one or more disorders reached statistical associated with poor adherence in adolescents with significance. The relationship between a childhood inflammatory bowel disease (IBD). Participants were history of physical abuse and lifetime psychopathology 50 children with IBD 11 to 17 years of age and their varied significantly by gender for all categories except parents. Parents completed an adherence interview and for anxiety disorders. Although not statistically the Child Behavior Checklist, Family Assessment significant, a similar relationship was seen between Device, and demographics questionnaires. Separately, childhood history of sexual abuse and lifetime adolescents completed the adherence interview and the psychopathology. CONCLUSIONS: A history of abuse Piers Harris Self-Concept Scale, Children's Depression in childhood increases the likelihood of lifetime Inventory, and Coping Strategies Inventory psychopathology; this association appears stronger for questionnaires. The treating gastroenterologists of women than men. participating children completed the Pediatric Crohn's Disease Activity Index during a clinic visit within a MacMillan HL, Jamieson E, Walsh CA. Reported contact week of completion of the questionnaires. Mean with child protection services among those reporting parent- and child-reported adherence scores fell child physical and sexual abuse: results from a between the "most of the time" and "always" community survey. Child Abuse Negl 2003; categories, although perfect adherence was low. 27(12):1397-408. Among IBD-specific medications (5-ASAs, Abstract: OBJECTIVE: This study uses results from a immunomodulators, steroids), 48% of children and large community survey to examine the relationship 38% of parents reported being always adherent to all between a history of child maltreatment and self- medications. Parent-child concordance was high. reports of contact with Child Protection Services Family dysfunction and poor child coping strategies (CPS). METHODS: The Ontario Health Supplement were associated with worse adherence. The correlation was a province-wide, probability-based survey of between more behavioral/emotional problems and household dwellings in the province of Ontario, lower adherence approached significance. Adherence Canada. A random sample of residents aged 15 and should be monitored in families that lack appropriate older participated in the Ontario Health Supplement child discipline and in children who cope by simply (N=9953). A face-to-face interview included a question wishing stressors would go away. Because these issues about contact with Child Protection Services (CPS), are associated with poor adherence, it has been and the Child Maltreatment History Self-Report, a self- suggested that psychotherapy addressing these areas administered questionnaire, was used to assess history may contribute to improved adherence. of child physical and sexual abuse. RESULTS: Only a very small percentage of respondents with a history of MacMillan HL, Fleming JE, Streiner DL et al. Childhood child abuse reported contact with CPS; 5.1% of those abuse and lifetime psychopathology in a community with a history of physical abuse, and 8.7% of those sample. Am J Psychiatry 2001; 158(11):1878-83. with a history of sexual abuse. Contact with CPS was Abstract: OBJECTIVE: The authors assessed lifetime associated with younger age of respondent for both psychopathology in a general population sample and types of abuse and female gender for physical abuse. In compared the rates of five psychiatric disorder the case of sexual abuse, younger respondents whose categories between those who reported a childhood parental employment classification was in the lower history of either physical or sexual abuse and those socioeconomic group were more likely to have contact who did not. METHOD: A modified version of the with CPS. CONCLUSIONS: Interventions that target only those who come in contact with CPS will not 677
- 686. reach most personsexposed to child abuse. STUDY DESIGN: We identified 100 failed trials of labor and 300 successful trials of labor in women with Macmillan R, McMorris BJ, Kruttschnitt C. Linked lives: a prior cesarean delivery performed at our institution. stability and change in maternal circumstances and Information was collected on >70 potential predictors trajectories of antisocial behavior in children. Child of labor outcomes from the medical records, including Dev 2004; 75(1):205-20. demographic, historical, and past obstetric information, Abstract: Drawing on the notion of linked lives, this as well as information from the index pregnancy. study examined the effects of stability and change in Bivariate analyses comparing women in whom a trial maternal circumstance on developmental trajectories of of labor failed with those whose trial succeeded were antisocial behavior in children 4 to 7 years of age. performed. These initial analyses were used to select Using data from a national sample of young mothers variables for inclusion into our muitivariate predictive and growth curve analysis, the study demonstrated that model. From the same data we trained and tested a early maternal circumstances influences early neural network, using a back-propagation algorithm. antisocial behavior, whereas stability and change in The test characteristics of the multivariate predictive these circumstances both exacerbate and ameliorate model and the neural network were compared. behavior problems. Of particular note, meaningful RESULTS: From the bivariate analysis a history of escape from poverty attenuates antisocial behavior substance abuse (adjusted odds ratio, 0.27; 95% whereas persistence in poverty or long-term movement confidence interval, 0.09-0.80), a successful prior into poverty intensifies such problems. These findings vaginal birth after cesarean delivery (adjusted odds highlight the importance of structural context for ratio, 0.13; 95% confidence interval, 0.05-0.31), parenting practices and the need to consider child cervical dilatation at admission (adjusted odds ratio, development in light of dynamic and changing life- 0.53; 95% confidence interval, 0.31-0.88), and the need course fortunes of parents. for labor augmentation (adjusted odds ratio, 2.15; 95% confidence interval, 1.14-4.06) were ultimately MacNab YC. Hierarchical Bayesian modeling of spatially discovered to be important in predicting the likelihood correlated health service outcome and utilization rates. of the success or failure of a trial of labor. With these Biometrics 2003; 59(2):305-16. variables in the predictive model the sensitivity of the Abstract: We present Bayesian hierarchical spatial derived rule for predicting failure was 77%, the models for spatially correlated small-area health specificity was 65%, and the overall accuracy was service outcome and utilization rates, with a particular 69%. We also built a network using the 4 variables that emphasis on the estimation of both measured and were included in the final multivariate model. We were unmeasured or unknown covariate effects. This unable to achieve the same degree of sensitivity and Bayesian hierarchical model framework enables specificity that we observed with the regression-based simultaneous modeling of fixed covariate effects and predictive model (sensitivity and specificity, 59% and random residual effects. The random effects are 44%). CONCLUSION: In this study a standard modeled via Bayesian prior specifications reflecting multivariate model was better able to predict outcome spatial heterogeneity globally and relative homogeneity in women ttempting a trial of labor. among neighboring areas. The model inference is implemented using Markov chain Monte Carlo Maconochie I, Redhead J. The National Service Framework: methods. Specifically, a hybrid Markov chain Monte paediatric emergency care. Lancet 2005; Carlo algorithm (Neal, 1995, Bayesian Learning for 365(9472):1673-4. Neural Networks; Gustafson, MacNab, and Wen, 2003, Notes: CORPORATE NAME: National Service Statistics and Computing, to appear) is used for Framework posterior sampling of the random effects. To illustrate relevant problems, methods, and techniques, we MacPhee M. Using evidence-based practice to create a present an analysis of regional variation in venous access team: the Venous Access Task Force of intraventricular hemorrhage incidence rates among the Children's Hospital of Denver. J Pediatr Nurs 2002; neonatal intensive care unit patients across Canada. 17(6):450-4. Notes: CORPORATE NAME: Venous Access Task Macones GA, Hausman N, Edelstein R, Stamilio DM, Force Marder SJ. Predicting outcomes of trials of labor in Abstract: The following article is an example of women attempting vaginal birth after cesarean evidence-based practice applied to an institutional delivery: a comparison of multivariate methods with Quality Improvement (QI) project. QI originated in the neural networks. Am J Obstet Gynecol 2001; 1980s and is best associated with the work of W. 184(3):409-13. Deming (1986). It is also known as Continuous Quality Abstract: OBJECTIVE: Our aim was to assess the Improvement, because a major principle of this utility and effectiveness of a neural network for approach is constant improvement of services or predicting the likelihood of success of a trial of labor, products. This improvement process contains other relative to standard multivariate predictive models. critical components: scientific method, employee participation and teamwork, accountable leadership, 678
- 687. appropriate training andongoing education, and client wounds (P <.003) to be associated independently with focus (Demming, 1986). QI has been globally positive drug screens. No statistical differences were successful and has helped transform American observed in ethnic distribution, ISS, RTS, hospital industry, including health care services. The following days, or mortality rate when patients with positive clinically based project illustrates the application of QI screen results were compared with those without concepts and evidence-based practice to enhance evidence of substance use. CONCLUSIONS: Trauma outcomes. victims had evidence of substance use in early teen age years especially in the 14 and 15-year-old age groups. MacQueen G, Nagy T, Santa Barbara J, Raichle C. 'Iraq Toxicology screening disclosed that substance use is Water Treatment Vulnerabilities': a challenge to public associated strongly with gunshot wounds. Substance health ethics. Med Confl Surviv 2004; 20(2):109-19. use, along with poverty, inadequate family support, and Notes: GENERAL NOTE: KIE: 32 refs. peer pressure are factors that influence injury risk. GENERAL NOTE: KIE: KIE Bib: public health; war Interventions to prevent substance use in young Abstract: A formerly classified US document, 'Iraq children may reduce the risk of injury. Water Treatment Vulnerabilities,' provides evidence that ill health was knowingly induced in the population Madden JM, Soumerai SB, Lieu TA, Mandl KD, Zhang F, of Iraq through the ruination of that country's water Ross-Degnan D. Effects of a law against early purification system. We believe that the uncovering of postpartum discharge on newborn follow-up, adverse this document should stimulate the public health events, and HMO expenditures. N Engl J Med 2002; community to clarify principles of public health ethics 347(25):2031-8. and to formulate statements giving voice to these Notes: CORPORATE NAME: Health maintenance principles. We propose here two statements, one organization dealing with the broad issue of public health ethics and Abstract: BACKGROUND: Concern about harm to international relations, and one dealing specifically newborns from early postpartum discharges led to laws with public health ethics and water purification. establishing minimum hospital stays in the mid-1990s. We evaluated the effects of an early-discharge protocol Madan A, Beech DJ, Flint L. Drugs, guns, and kids: the (a hospital stay of one postpartum night plus a home association between substance use and injury caused by visit) in a health maintenance organization (HMO) and interpersonal violence. J Pediatr Surg 2001; 36(3):440- a subsequent state law guaranteeing a 48-hour hospital 2. stay. METHODS: Using interrupted-time-series Abstract: BACKGROUND: Drug and alcohol uses analysis and data on 20,366 mother-infant pairs with have been linked to the frequency of injury events, normal vaginal deliveries, we measured changes in recurrent hospital admission for injury, and length of stay, newborn examinations on the third or interpersonal violence. Data regarding the association fourth day of life, and office visits, emergency of recent substance use and injury type and frequency department visits, and hospital readmissions for in children and young adults are not available. Such newborns. We also examined expenditures for data probably would be valuable in planning hospitalizations and home-based care. RESULTS: The interventions to prevent substance use and reduce the early-discharge program increased the rate of stays of risks of injuries. METHODS: Evidence of substance less than two nights from 29.0 percent to 65.6 percent use was assessed in trauma patients presenting to the (P<0.001). The rate declined to 13.7 percent after the authors' level 1 trauma center over a 6-month interval. state mandate (P<0.001). The rate of newborn Demographic data, mechanisms of injury, revised examinations on the third or fourth day of life trauma scores (RTS), injury severity scores (ISS), increased from 24.5 percent to 64.4 percent with the hospital days, and mortality rate were evaluated. Chi program (P<0.001), then dropped to 53.0 percent after square analysis and 2-tailed, paired t tests were used the mandate (P<0.001)--changes that primarily for statistical analysis. Multivariate logistic regression reflected changes in the rate of home visits. The rate of was utilized to determine the influence of individual nonurgent visits to a health center increased from 33.4 variables. RESULTS: From a total group of 743 percent to 44.7 percent (P<0.001) after the reduced- patients with life-threatening injuries, trauma registry stay program was implemented. There were no records of 186 patients less than 21 years old were significant changes in the rate of emergency eligible for evaluation, and 126 of these had complete department visits (quarterly mean, 1.1 percent) or blood and urine drug assessments completed on rehospitalizations (quarterly mean, 1.5 percent). admission to the trauma center. Forty-two percent (53 Results were similar for a vulnerable subgroup with of 126) patients tested positive for alcohol or drugs. No lower incomes, younger maternal age, a lower level of patients less than 14 years of age (n = 61) had positive education, or some combination of these drug screen results. However, in the cohort of patients characteristics. Average HMO expenditures on hospital aged 14 and 15 (n = 17), 71% tested positive. Also, and home-based services decreased by $90 per delivery 72% of adolescents (age < 18) who were victims of with the early-discharge program and increased by injuries from gunshot wounds had evidence of $100 after the mandate. CONCLUSIONS: Neither substance use. Multivariate analysis showed gunshot policy appears to have affected the health outcomes of 679
- 688. newborns. After themandate, newborns were less vaginal birth or 2-3 days after cesarean birth) decreased likely to be examined as recommended on day 3 or 4. from 52% to 16% for vaginally born infants and from Because of changes in hospital prices, the two policies 87% to 63% for cesarean-born infants (P =.001). had minimal effects on HMO expenditures for hospital Although the legislation mandated coverage for home and home-based services. visits after short stays, only 12.4% of short-stay newborns had early home visits. Overall, 50% of Madhavan S. Fosterage patterns in the age of AIDS: infants had early home or clinic follow-up; compared continuity and change. Soc Sci Med 2004; 58(7):1443- with those who did not receive early follow-up, these 54. infants were more likely to have complete Abstract: An estimated 4 million children, or about immunizations (adjusted odds ratio [OR], 1.09; 95% 10% of the entire South African population, will be confidence interval [CI], 1.03-1.14), urgent care or orphaned by the year 2015. There is growing consensus emergency department visits (adjusted OR, 1.22; 95% that the extended family system is no longer capable of CI, 1.07-1.39), and readmissions (adjusted OR, 2.49; providing for orphans given severe economic 95% CI, 2.02-3.08). CONCLUSIONS: Although constraints. There is, therefore, an urgency to develop implementation of Minnesota's early discharge appropriate interventions to support families and take legislation corresponded with significantly increased care of these children. This article examines some of lengths of stay, very few short-stay infants received the the existing literature on child fosterage and uses it to postdischarge care for which coverage was mandated. highlight understudied aspects of the current situation Our findings indicate, however, that infants at higher of children orphaned through AIDS in South Africa. Of risk for adverse outcomes were appropriately identified particular concern are the points of continuity and to receive early follow-up. change in fosterage patterns before and after the onset of the epidemic in South Africa. I suggest that an Maffei FA, Powers KS, van der Jagt EW. Apparent life- understanding of the short- and long-term threatening events as an indicator of occult abuse. Arch consequences for children orphaned by AIDS in South Pediatr Adolesc Med 2004; 158(4):402; author reply Africa calls for historical contextualisation given that 402-3. child fostering, both voluntarily and involuntarily, has been a feature of black family life since well before the Magee BD. Uterine rupture among women with a prior onset of HIV/AIDS. In addition, I demonstrate the cesarean delivery. N Engl J Med 2002; 346(2):134-7. value of examining kinship, family, and networks in order to fully understand the circumstances of fostering Mahalingam S, Meanger J, Foster PS, Lidbury BA. The viral these children. The paper concludes with a call for manipulation of the host cellular and immune more research on children orphaned by AIDS in South environments to enhance propagation and survival: a Africa that will provide not only more data, but also focus on RNA viruses. J Leukoc Biol 2002; 72(3):429- enrich theoretical approaches to studying patterns of 39. child fosterage in Africa and elsewhere. Abstract: Virus infection presents a significant challenge to host survival. The capacity of the virus to Madhiwalla N. Women's illnesses: life cycle approach. Natl replicate and persist in the host is dependent on the Med J India 2003; 16 Suppl 2:35-8. status of the host antiviral defense mechanisms. The study of antiviral immunity has revealed effective Madlon-Kay DJ, DeFor TA, Egerter S. Newborn length of antiviral host immune responses and enhanced our stay, health care utilization, and the effect of Minnesota knowledge of the diversity of viral immunomodulatory legislation. Arch Pediatr Adolesc Med 2003; strategies that undermine these defences. This review 157(6):579-83. describes the diverse approaches that are used by RNA Abstract: OBJECTIVE: To describe newborn length of viruses to trick or evade immune detection and stay, postdischarge follow-up, and health care response systems. Some of these approaches include utilization in the context of Minnesota's early discharge the specific targeting of the major histocompatibility legislation. DESIGN AND SETTING: Retrospective complex-restricted antigen presentation pathways, study using claims data from a large managed care apoptosis, disruption of cytokine function and organization. PARTICIPANTS: Term newborns born signaling, exploitation of the chemokine system, and from January 1995 through February 1999 (N = 22 interference with humoral immune responses. A 944). OUTCOME MEASURES: Newborn length of detailed insight into interactions of viruses with the stay, home or clinic visits within 1 week of discharge immune system may provide direction in the (early follow-up), immunizations completed by age 3 development of new vaccine strategies and novel months, readmissions within 1 month of discharge, and antiviral compounds. urgent care or emergency department visits within 2 months of discharge. RESULTS: After enactment of Maher J, Macfarlane A. Inequalities in infant mortality: Minnesota's early discharge legislation in 1996, the trends by social class, registration status, mother's age percentage of newborns with short stays (0-1 days after and birthweight, England and Wales, 1976-2000. 680
- 689. Health Stat Q 2004; (24):14-22. decrease the risk of divorce and facilitate marital Abstract: This article examines trends in inequalities in functioning, but the effects were small. Greater infant mortality in England and Wales between 1976 Christian conservatism was modestly associated with and 2000. It describes variations in neonatal, greater endorsement and use of corporal punishment postneonatal and infant mortality by mother's age, with preadolescents. Isolated findings suggested that registration status, father's social class, multiplicity and greater parental religiousness relates to more positive birthweight. Throughout the period, social class parenting and better child adjustment. The scope, differences in mortality were wider in the postneonatal meaningfulness, and potential strength of findings were period than the neonatal period and there was restricted because of reliance on global or single-item considerable variation in infant mortality by age of measures of religious and family domains. To facilitate mother, birthweight and multiplicity within both more conceptually and methodologically sophisticated manual and non-manual groups. research, the authors delineated mechanisms by which the substantive and psychosocial elements of religion Maher VF, Ford J. The heartbreak of parents patriae. could benefit or harm family adjustment. JONAS Healthc Law Ethics Regul 2002; 4(1):18-22. Notes: GENERAL NOTE: KIE: 10 refs. Mahoney G, Wheeden CA, Perales F. Relationship of GENERAL NOTE: KIE: KIE Bib: patient care/minors; preschool special education outcomes to instructional treatment refusal/minors practices and parent-child interaction. Res Dev Disabil 2004; 25(6):539-58. Mahon-Daly P, Andrews GJ. Liminality and breastfeeding: Abstract: Developmental outcomes attained by children women negotiating space and two bodies. Health Place receiving preschool special education services in 2002; 8(2):61-76. relationship to both the general instructional approach Abstract: It is almost universally accepted that used by their teachers and their parents' style of breastfeeding infants is nutritionally superior to bottle- interaction were examined. The sample included 70 feeding. However, despite this medical advice, in many children from 41 Early Childhood Special Education countries breastfeeding rates remain low and in the (ECSE) classrooms. The type of instructional model UK, rates are relatively static. The literature on children received was determined by dividing the breastfeeding has discussed international rates and the sample into three clusters based upon six global ratings broad socio-economic factors influencing these rates. of children's classroom environment: Choice; Through an observational study of a group of Cognitive Problem-Solving; Child-Initiated Learning; breastfeeding and non-breastfeeding women in the Developmental Match; Child-Centered Routines; and United Kingdom, this research utilises contemporary Rewards and Discipline Strategies. Based on this theoretical perspectives on the body, space and rites of analysis, 27 children were classified as receiving passage, and investigates the reasons why some developmental instruction; 15 didactic instruction; and breastfeeding mothers may be in a liminal period, and 28 naturalistic instruction. Observations of parent-child the breastfeeding event itself, at times, a liminal and interaction collected at the beginning and end of the marginalised act. The paper argues that, for the group year were classified along four dimensions using the studied, breastfeeding is sometimes discouraged by its Maternal Behavior Rating Scale: Responsiveness, medicalisation, and that breastmilk and breastfeeding Affect, Achievement Orientation and Directiveness. are often considered by mothers to be embarrassing. Results indicated that the kinds of experiences that Many of the women studied regarded certain public children received varied significantly across the three and private places to be unacceptable places to instructional models. However, there were no breastfeed and claimed to modify their behaviour significant differences in the impact of these accordingly. The paper demonstrates the value of instructional models on children's rate of development. conducting locally based qualitative research into Regression analyses indicated that children's rate of breastfeeding experiences, and of using theoretical development at the end of intervention was perspectives from post-medical geography to interpret significantly related to their parents' style of interaction women's experiences. but was unrelated to the type of instructional model they received. Mahoney A, Pargament KI, Tarakeshwar N, Swank AB. Religion in the home in the 1980s and 1990s: a meta- Mahua C. Children's bill smacks of compromise. Nurs analytic review and conceptual analysis of links Times 2004; 100(28):12-3. between religion, marriage, and parenting. J Fam Psychol 2001; 15(4):559-96. Maida AM, Molina ME, Erazo R. [Munchausen syndrome Abstract: The authors reviewed 94 studies published in by proxy, an unusual presentation]. Rev Med Chil journals since 1980 on religion and marital or parental 2001; 129(8):917-20. functioning. Meta-analytic techniques were used to Abstract: We report a 12 year old girl that first quantify religion-family associations examined in at consulted for fever with bilateral knee arthralgias. A least 3 studies. Greater religiousness appeared to neurological workout was started due to a progressive 681
- 690. gait disturbance, butall results were incongruent with determining whether pornography consumption may or nerve or nerve root lesions, leading to the diagnosis of may not lead to sexually aggressive outcomes. In future a functional paralysis. The patient worsened to the work, it is important not to use an overly simplistic lens point of prostration. Due to the suspicion that the of focus in which pornography exposure is seen as mother was inducing the symptoms, the patient was generally harmful or not. Depending on particular admitted to the hospital, where she improved notably. constellations of personality characteristics, the effects She was discharged walking. The improvement during of pornography may differ considerably among hospital stay confirmed the diagnosis of a Munchausen different teenagers as well as within different cultures. by proxy syndrome, mimicking a disabling The research suggests that particular concerns may be neurological condition. needed for those who are highly frequent consumers of pornography, those who seek out sexually violent Majeed A. Referral of Dr Peter Mansfield to the GMC. BMJ content, and those who also have other risk factors. 2001; 323(7309):356. Malcoe LH, Duran BM, Montgomery JM. Socioeconomic Major EF. [Treatment of psychologically traumatised disparities in intimate partner violence against Native patients in Norway]. Tidsskr Nor Laegeforen 2003; American women: a cross-sectional study. BMC Med 123(19):2709-12. 2004; 2:20. Abstract: BACKGROUND: The Norwegian Abstract: BACKGROUND: Intimate partner violence Directorate of Health and Social Affairs is carrying out (IPV) against women is a global public health problem, a project on various aspects of traumatic stress. The yet data on IPV against Native American women are present survey was carried out in 2001 in order to extremely limited. We conducted a cross-sectional gather more knowledge about these patients within the study of Native American women to determine mental health care system. MATERIAL AND prevalence of lifetime and past-year IPV and partner METHODS: 325 hospitals, outpatient clinics and injury; examine IPV in relation to pregnancy; and district psychiatric centres were asked by questionnaire assess demographic and socioeconomic correlates of to comment on the types of traumatised patients they past-year IPV. METHODS: Participants were recruited treated, their own perceived professional skills, the from a tribally-operated clinic serving low-income diagnoses they used and the therapy they offered, and pregnant and childbearing women in southwest their contact with national and regional specialist units. Oklahoma. A self-administered survey was completed RESULTS: Refugees and victims of sexual abuse were by 312 Native American women (96% response rate) the groups treated by most units; only a few treated attending the clinic from June through August 1997. veterans of UN/NATO peacekeeping forces. Half of Lifetime and past-year IPV were measured using the units reported lack of professional skills in treating modified 18-item Conflict Tactics Scales. A refugees. Only a few units reported changes in socioeconomic index was created based on partner's diagnosis and treatment as a result of advice from the education, public assistance receipt, and poverty level. specialist units. INTERPRETATION: The high RESULTS: More than half (58.7%) of participants frequency of units reporting a need for better skills in reported lifetime physical and/or sexual IPV; 39.1% treating refugees is a challenge to the mental health experienced severe physical IPV; 12.2% reported care system and the specialist units. The results suggest partner-forced sexual activity; and 40.1% reported a need for discussion of the role of the national and lifetime partner-perpetrated injuries. A total of 273 regional specialist units as well as a need for closer women had a spouse or boyfriend during the previous cooperation between psychiatric and primary health 12 months (although all participants were Native care. American, 59.0% of partners were non-Native). Among these women, past-year prevalence was 30.1% Makkar RP. Concerns about research and prevention for physical and/or sexual IPV; 15.8% for severe strategies in Munchausen Syndrome by Proxy (MSBP) physical IPV; 3.3% for forced partner-perpetrated abuse. Child Abuse Negl 2003; 27(9):987-8. sexual activity; and 16.4% for intimate partner injury. Reported IPV prevalence during pregnancy was 9.3%. Malakoff D. Human research. Nigerian families sue Pfizer, Pregnancy was not associated with past-year IPV (odds testing the reach of U.S. law. Science 2001; ratio = 0.9). Past-year IPV prevalence was 42.8% 293(5536):1742. among women scoring low on the socioeconomic index, compared with 10.1% among the reference Malamuth N, Huppin M. Pornography and teenagers: the group. After adjusting for age, relationship status, and importance of individual differences. Adolesc Med household size, low socioeconomic index remained Clin 2005; 16(2):315-26, viii. strongly associated with past-year IPV (odds ratio = Abstract: This article focuses on the effects of exposure 5.0; 95% confidence interval: 2.4, 10.7). to pornography on teenagers, particularly males, and CONCLUSIONS: Native American women in our concentrates on sexually aggressive outcomes and on sample experienced exceptionally high rates of lifetime the characteristics of the individual as crucial in and past-year IPV. Additionally, within this low- income sample, there was strong evidence of 682
- 691. socioeconomic variability inIPV. Further research multiples. The project's integrated package of training should determine prevalence of IPV against Native and parenting education materials is available to other American women from diverse tribes and regions, and regions to assist in such efforts. examine pathways through which socioeconomic disadvantage may increase their IPV risk. Malone RE. Tobacco industry surveillance of public health groups: the case of STAT (Stop Teenage Addiction to Mallett RB. Teledermatology in practice. Clin Exp Dermatol Tobacco) and INFACT (Infant Formula Action 2003; 28(4):356-9. Coalition). Am J Public Health 2002; 92(6):955-60. Abstract: Teledermatology has been the focus of much Abstract: OBJECTIVES: The goal of this study was to interest in recent years. Potential uses include a simple describe how the tobacco industry collects information supporting role for primary care, more accurate triage about public health groups. METHODS: Publicly of dermatology patients or an 'advice only' service available internal tobacco industry documents were reducing the need for dermatology patients to attend reviewed and analyzed using a chronological case outpatient clinics. With the current under-provision of study approach. RESULTS: The industry engaged in dermatology services in the UK and the waiting list aggressive intelligence gathering, used intermediaries targets set by government, teledermatology systems to obtain materials under false pretenses, sent public have been proposed as a possible solution. 'Store and relations spies to the organizations' meetings, and forward' teledermatology systems are easy to set up covertly taped strategy sessions. Other industry and it has been shown that accurate diagnoses can be strategies included publicly minimizing the effects of made using digital images attached to an E-mailed boycotts, painting health advocates as "extreme," history. In an area of geographical isolation a store and identifying and exploiting disagreements, and planning forward teledermatology system has been used to "redirect the funding" of tobacco control successfully to reduce patient waiting times. In organizations to other purposes. CONCLUSIONS: Peterborough we have been using a store and forward Public health advocates often make light of tobacco teledermatology system for over 4 years. Our industry observers, but industry surveillance may be experience has demonstrated that for only a small real, intense, and covert and may obstruct public health number of selected patients was it possible to provide initiatives. an advice-only service, but the majority of patients still need to be seen in the outpatient clinic. Despite the Maloni JA, Albrecht SA, Thomas KK, Halleran J, Jones R. technical simplicity of these systems today there is still Implementing evidence-based practice: reducing risk little evidence that teledermatology will have a for low birth weight through pregnancy smoking significant impact on patient workload in the average cessation. J Obstet Gynecol Neonatal Nurs 2003; dermatology clinic. It must be recognized that 32(5):676-82. teledermatology is potentially a useful communication Abstract: In 1989, the Association of Women's Health, tool for selected patients in primary care but is unlikely Obstetric and Neonatal Nurses (AWHONN) developed to solve waiting list problems or replace the need for a research utilization program to integrate evidence local dermatology services. into practice areas where there were large discrepancies between research evidence and clinical practice. The Mallia P. The case of the Maltese Siamese Twins--when current program, renamed Research-Based Practice moral arguments balance out should parental rights (RBP), uses translational research methods to build come into play. Med Health Care Philos 2002; from evidence such as that in the Cochrane database 5(2):205-9. and to create protocols for integration of research Notes: GENERAL NOTE: KIE: 17 fn. directly into clinical practice. This article describes the GENERAL NOTE: KIE: KIE Bib: patient care/minors development of the sixth project (RBP6), in which an evidence-based protocol to address smoking in Malmstrom PM. A regional approach to promoting pregnancy was integrated into clinical practice. The improved care of multiples. Twin Res 2001; 4(2):67- protocol includes screening women using descriptive 70. statements and integrates the 5 As (ask, advise, assess, Abstract: Live births of multiples in the U.S. rose 35% assist, arrange) into prenatal and postpartum care at from 87,700 in 1988 to 118,295 in 1998. This increase every visit. By integrating smoking cessation presents public health issues due to the elevated health counseling into care, nurses may reduce the risk of low and psychosocial risks that accompany multiple birth. birth weight among pregnant women in both the United However, health and social service providers and States and Canada. educators are poorly prepared to address the specific needs of the multiple birth population. The Twin Mancuso CE, Tanzi MG, Gabay M. Paradoxical reactions to Service Network Project therefore developed regional benzodiazepines: literature review and treatment networks of multiple birth training and resources in options. Pharmacotherapy 2004; 24(9):1177-85. California to address this problem. Results indicate that Abstract: Benzodiazepines frequently are administered these can substantially improve the care available to to patients to induce sedation. Paradoxical reactions to 683
- 692. benzodiazepines, characterized by increased building the social networks of children with DCD. talkativeness, emotional release, excitement, and excessive movement, are relatively uncommon and Mandl KD, Feit S, Larson C, Kohane IS. Newborn screening occur in less than 1% of patients. The exact mechanism program practices in the United States: notification, of paradoxical reactions remains unclear. Most cases research, and consent. Pediatrics 2002; 109(2):269-73. are idiosyncratic; however, some evidence suggests Abstract: OBJECTIVE: To define current practice that these reactions may occur secondary to a genetic among US newborn screening programs for link, history of alcohol abuse, or psychological notification of results, research, and consenting disturbances. This review evaluates the numerous cases procedures. METHODS: A telephone survey of all US of paradoxical reactions to benzodiazepines in adult newborn screening program supervisors. RESULTS: and pediatric patients that have been reported in the All 51 programs participated. All states reported biomedical literature. It also explores the advantages abnormal results to the infant's physician, and some and disadvantages of the various available treatment also reported to the hospital and parents. Cases with options. abnormal results were tracked to different endpoints but usually (92.1%) at least until a follow-up Mandavilli A. The coming epidemic. Nature 2005; appointment was made. A total of 66.6% of programs 436(7050):496-8. can communicate with programs in other states; 9.8% enable families to suppress reporting of results to the Mander R. Care in labour in the event of perinatal death. infant's physician. No state has a mechanism for Pract Midwife 2002; 5(8):10-3. parents to prevent results from entering the medical record. Parents or physicians who request results are Mandich AD, Polatajko HJ, Rodger S. Rites of passage: often authenticated by providing their name (52.9%). understanding participation of children with Many programs (45.1%) report only to physicians and developmental coordination disorder. Hum Mov Sci require just their name (43.5%), an identification 2003; 22(4-5):583-95. number (17.4%), a letter (26.1%), or a parent's Abstract: Children with developmental coordination signature (26.1%). A total of 70.6% retain residual disorder (DCD) experience difficulty participating in blood samples; of these, only 8.3% store them the typical activities of childhood and are known to completely devoid of patient identifiers. A total of have a more sedentary pattern of activities than their 49.0% of programs aggregate data for research. In peers. Little research has been done to investigate the 16.0% of these, the data are publicly available. In impact of these deficits on the lives of children with 24.0%, researchers obtain approval at their own DCD and the importance of their participation in the institution; in 24.0%, researchers obtain approval typical activities of childhood. This qualitative study through the state laboratory Institutional Review explored the impact of the disorder and the importance Board. In 74.5% of programs, parents are notified but of participation for children with DCD from the not asked for consent before collection of the sample; perspective of the parent. Twelve in-depth interviews 19.6% neither notify parents nor obtain consent before were conducted with parents of children with DCD screening. CONCLUSIONS: There is wide variation in who attended a university clinic specializing in using practice among the US newborn screening programs. the Cognitive Orientation to daily Occupational Because the programs collectively manage a Performance (CO-OP) approach, a cognitive-based comprehensive nationwide genomic databank, careful intervention. Findings revealed that incompetence in consideration of how information technology and high- everyday activities had serious negative effects for the throughput genomic analysis are used will be essential children. Conversely, intervention that was focused on to allow progress in clinical care, public health, and enablement at the activity and participation level had a research while protecting individual privacy. significant positive impact on the children's quality of life. Emerging themes highlighted the notion that Mandlawitz MR. The impact of the legal system on performance competency played an important role in educational programming for young children with being accepted by peers and being able "to be part of autism spectrum disorder. J Autism Dev Disord 2002; the group". As well, parents reported that successful 32(5):495-508. participation built confidence in their children and Abstract: Since 1990, State Educational Agency (SEA) allowed them to try other new activities. The World and Local Educational Agency (LEA) policies and Health Organization's International Classification of practices of educational programming for young Functioning, Disability, and Health provides a unique children with autism have evolved in response to the framework for analyzing and understanding the impact due process system and court decisions. This has of the physical disability on the lives of families with become an issue because of an increase in the children with DCD. Results illustrate how intervention identification of children with autism, reclassification that focuses on enabling children to choose their own of children previously reported under other disability functional goals in the area of physical activity has categories, publicity about the competition between important implications for enabling participation and methodologies, parent advocacy for specific methodologies, shortages of qualified personnel, and 684
- 693. the demand fordue process to ensure appropriate disorders requires the use of a variety of tasks that services. A review is made of substantive and differentially challenge these systems. Here we procedural issues presented in due process and court describe a novel battery, the Test of Everyday cases, the legal standards used by hearing officers and Attention for Children (TEA-Ch), comprising nine judges, and a synthesis of the case law. It is subtests adapted from the adult literature. The recommended that school districts consider legal performance of 293 healthy children between the ages standards as programs are designed, that programs fit of 6 and 16 is described together with the relationships the unique needs of the child, that programs ensure to IQ, existing measures of attention, and scholastic appropriate progress educationally and socially, and attainment. This large normative sample also allows us that communication between parents and school to test the fit of the adult model of functionally districts be open and honest so that the due process separable attention systems to the observed patterns of system is used as the last resort. variance in children's performance. A Structural Equation Modelling approach supports this view. A Mani S, Cooper GF. Causal discovery using a Bayesian local three-factor model of sustained and selective attention causal discovery algorithm. Medinfo 2004; 11(Pt and higher-level "executive" control formed a good fit 1):731-5. to the data, even in the youngest children. A single Abstract: This study focused on the development and factor model was rejected. There are behavioural and application of an efficient algorithm to induce causal anatomical grounds to believe that Attention Deficit relationships from observational data. The algorithm, Disorder (ADD) is particularly associated with poor called BLCD, is based on a causal Bayesian network self-sustained attention and behavioural control. The framework. BLCD initially uses heuristic greedy TEA-Ch performance of 24 boys diagnosed with ADD search to derive the Markov Blanket (MB) of a node presented here is consistent with this view. When that serves as the "locality" for the identification of performance levels on WISC-III subtests were taken pair-wise causal relationships. BLCD takes as input a into account, specific deficits in sustained attention dataset and outputs potential causes of the form were apparent while selective attention performance variable X causally influences variable Y. was within the normal range. Identification of the causal factors of diseases and outcomes, can help formulate better management, Mannes M, Roehlkepartain EC, Benson PL. Unleashing the prevention and control strategies for the improvement power of community to strengthen the well-being of of health care. In this study we focused on children, youth, and families: an asset-building investigating factors that may contribute causally to approach. Child Welfare 2005; 84(2):233-50. infant mortality in the United States. We used the U.S. Abstract: Search Institute's decade-plus emphasis on Linked Birth/Infant Death dataset for 1991 with more the elements of positive human development and than four million records and about 200 variables for community approaches to asset building can make a each record. Our sample consisted of 41,155 re-cords meaningful contribution to the field of child welfare. randomly selected from the whole dataset. Each record The institute's framework of developmental assets had maternal, paternal and child factors and the identifies a set of interrelated experiences, outcome at the end of the first year--whether the infant relationships, skills, and values that are associated with survived or not. Using the infant birth and death dataset reduced high-risk behaviors and increased thriving as input, BLCD out-put six purported causal behaviors. Its community-building work emphasizes relationships. Three out of the six relationships seem the human relations and developmental infrastructure plausible. Even though we have not yet discovered a children, youth, and families require for their health clinically novel causal link, we plan to look for novel and well-being. causal pathways using the full sample. Mansky PJ, Liewehr DJ, Steinberg SM et al. Treatment of Manly JT. Advances in research definitions of child metastatic osteosarcoma with the somatostatin analog maltreatment. Child Abuse Negl 2005; 29(5):425-39. OncoLar: significant reduction of insulin-like growth factor-1 serum levels. J Pediatr Hematol Oncol 2002; Manly T, Anderson V, Nimmo-Smith I, Turner A, Watson 24(6):440-6. P, Robertson IH. The differential assessment of Abstract: BACKGROUND: Insulin-like growth factor- children's attention: the Test of Everyday Attention for 1 (IGF-1) has been implicated in the growth and/or Children (TEA-Ch), normative sample and ADHD metastasis of osteosarcoma (OS) and chondrosarcoma performance. J Child Psychol Psychiatry 2001; based on in vitro and experimental animal studies. 42(8):1065-81. STUDY PURPOSE: To determine the degree of Abstract: "Attention" is not a unitary brain process. growth hormone (GH), IGF-1 axis blockade, toxicities, Evidence from adult studies indicates that distinct and antitumor effect of OncoLar (ONC) (Novartis, East neuroanatomical networks perform specific attentional Hanover, NJ, U.S.A.) in OS. DESIGN/METHODS: A operations and that these are vulnerable to selective phase 1 study with ONC enrolled 21 OS patients damage. Accordingly, characterising attentional (median age 19 y) in four cohorts: ONC 60 mg or 90 mg intramuscularly every 4 weeks with/without 685
- 694. tamoxifen (TAM) 20mg oral daily. RESULTS: There with substance use disorders. were no dose-limiting toxicities. Nineteen percent of patients had grade III drug-related toxicities including: Marais S, Kritzinger A. Farm worker injuries on Western 62% of patients showed progressive disease after two Cape fruit farms: the role of the lay health worker. courses (8 wk). Nineteen percent received four courses. Curationis 2005; 28(4):86-92. No clinical responses were observed. At weeks two and Abstract: AIM AND METHOD: An exploratory and eight of therapy, IGF-1 serum levels dropped 46% ( < descriptive study to obtain basic data on the extent, 0.0001, n = 21) and 53% ( = 0.003, n = 10). The nature, sources and severity of injuries sustained on difference of the area under the curve (AUC) minus fruit farms was conducted. The possibility of utilizing baseline AUC (DeltaAUC) for arginine-stimulated GH lay health workers (LHWs) on farms to document serum levels at week two was lower than baseline ( < routine information on injuries was also investigated. 0.01). At weeks two and eight, GH peak values were Descriptive information of all injuries occurring on lower than baseline ( < 0.0001 and = 0.002, selected farms, both occupational and other, needing respectively). CONCLUSIONS: A long-acting some form of treatment, were documented over a one- somatostatin analog was able to lower IGF-1 levels of year period from June 1999 to May 2000. A purposive OS patients. IGF-BP-3 and GH were only transiently non-probability sampling method was used. Forty-eight reduced. Although ONC was well tolerated, no fruit farms with a history of trained LHWs were sustained clinical responses were observed. The purposefully selected. Injuries were documented using pathophysiology of serum versus tissue concentrations a one-page questionnaire. RESULTS: A total of 500 of IGF-1 as well as the interplay of IGFs, IGF-binding injuries were recorded, giving an average of 10.4 proteins, and other growth factors and cytokines in injuries per farm per year. Half of these injuries were osteosarcoma warrants further investigation. A better work-related. Workers aged 20-39 were most at risk. understanding of these processes should lead to a more Injuries sustained were related to routine activities of effective exploitation of these pathways for the targeted fruit farming, occurred mostly in the orchards and therapy of OS. involved cuts, bruises and abrasions to the hands, including the fingers, and the eyes. Most of the non- Manwell LB, Czabala JC, Ignaczak M, Mundt MP. work related injuries occurred in and around the home. Correlates of depression among heavy drinkers in A third of these injuries were sustained by persons < Polish primary care clinics. Int J Psychiatry Med 2004; 20. A large percentage of the non-work related injuries 34(2):165-78. were violence- and alcohol related. Most of the injuries Abstract: OBJECTIVE: Depression and co-morbid required basic primary health care that could be substance abuse disorders are a major public health managed by the LHW. Injury severity caused people to problem. Information is limited for patients attending take time off for one third of the cases. Polish primary care clinics. This article addresses 30- CONCLUSION: A relatively high occupational injury day and lifetime prevalence of major depression in a rate in comparison to high-income countries. heavy drinking population from 12 Polish primary care Occupational Health and Safety legislation needs to be clinics. METHOD: 277 heavy drinkers were institutionalized and adhered to. Alcohol and violence interviewed by a researcher in each clinic. Heavy on farms is a serious public health problem. LHWs drinking was defined as more than 20 drinks per week could potentially play an important role in for males, or more than 13 drinks per week for females, documenting injury data. or consumption of more than four drinks five or more times in the previous 30 days, or two or more positive Maranan P. Training community members for action: replies to the CAGE questions. Criteria from the Washington's Action Training Network. J Health Hum Diagnostic and Statistical Manual were used to assess Serv Adm 2002; 24(4):413-30. lifetime and past 30-day depression. RESULTS: 35% Abstract: The Children's Alliance in Washington State of women and men met criteria for depression in the 30 has established an ambitious goal of building the days prior to the interview. Lifetime rates were 45% "Children's Action Network" (Network), a statewide for women and 52% for men. Men and women with a network of children's advocates who regularly take CAGE score of 4 were at higher risk for both 30-day action to inform public policy related to children and (67%, OR = 3.85 [1.47, 10.08]) and lifetime (78%, OR families. There are currently about 3,000 members in = 3.28 [1.12, 9.66]) depression. Recreational drug users the Network. Policy advocacy training is an integral and patients reporting symptoms of anti-social component of the Network providing advocates with personality disorders were at increased risk for lifetime necessary tips and tools for communicating with depression. Subjects reporting symptoms of a policy-makers. In order to meet key objectives and childhood conduct disorder were at higher risk for 30- overcome significant challenges and barriers, the day depression. CONCLUSIONS: Depression among training program evolved greatly over the last five patients with substance abuse problems is a common years. This article describes some of the challenges problem. The rates are higher than for other countries faced, particularly in reaching specific target and highlight the need for Polish primary care populations, key strategies undertaken, and how the clinicians to routinely screen for depression in patients curriculum developed over time. 686
- 695. Marcovitch H. Learningfrom tragedies: clinical lessons Abstract: The authors examined the from the Climbie report. Qual Saf Health Care 2003; neuropsychological status of 22 preschoolers at risk for 12(2):82-3. attention-deficit/hyperactivity disorder (ADHD) and 50 matched control children, using measures of nonverbal Margolina IA, Kozlovskaia GV, Proselkova ME. [Mental working memory, perceptual and motor inhibition, and development of children in condition of chronic memory for relative time. All tasks included paired physical abuse: methodical aspect]. Zh Nevrol control conditions, which allowed for the isolation of Psikhiatr Im S S Korsakova 2005; 105(9):4-9. discrete executive function constructs. Group Abstract: Mental dysfunction of 130 children aged 0-14 differences were evident on several measures of years with a history of family physical abuse was neuropsychological functioning; however, after studied using a number of known methods adapted for accounting for nonexecutive abilities, no deficits could early aged children including an original scale of be attributed to specific functions targeted by the tasks. mental dysfunction assessment, which has been Performance on executive measures was not related to elaborated in Mental Health Research Center objective indices of activity level or ratings of ADHD (Moscow). A battery of clinico-psychopathological and symptoms. Yet, the fact that at-risk preschoolers were clinico-psychological methods allowed comprehensive highly symptomatic casts doubt on whether executive assessment of mental state, with 95% cases of mental function deficits and/or frontostriatal networks dysfunction being found in the group studied. The most contribute etiologically to early behavioral pronounced were depression spectrum disorders. manifestations of ADHD. Marino R, Villa A, Guerrero S. A community trial of Marks L. Sacred practices in highly religious families: fluoridated powdered milk in Chile. Community Dent Christian, Jewish, Mormon, and Muslim perspectives. Oral Epidemiol 2001; 29(6):435-42. Fam Process 2004; 43(2):217-31. Abstract: OBJECTIVE: To demonstrate the Abstract: Quantitative research examining linkages effectiveness of a dental caries prevention program on between family relationships and religious experience the primary dentition of Chilean rural children, using has increased substantially in recent years. However, fluoridated powdered milk and milk derivatives. related qualitative research, including research that METHODS: Fluoridated milk and milk-cereal was examines the processes and meanings behind recurring given to about 1000 preschool children in Codegua, a religion-family correlations, remains scant. To address rural community located in the 6th Region of Chile, this paucity, a racially diverse sample (N = 24) of using the standard National Complementary Feeding married, highly religious Christian, Jewish, Mormon, Program (PNAC). The daily fluoride dose from and Muslim parents of school-aged children were fluoridated powdered milk was estimated at 0.25 mg interviewed regarding the importance of religious for infants (0-2 years old), 0.5 mg for children aged 2-3 family interactions, rituals, and practices in their years and 0.75 for children aged 3-6 years. Cross- families. Mothers and fathers discussed several sectional samples of children aged 3-6 years were religious practices that were meaningful to them and taken from Codegua (study community) from 1994 to explained why these practices were meaningful. 1999 and from La Punta (control community) from Parents also identified costs and challenges associated 1997 and 1999. RESULTS: Significant reductions with these practices. Interview data are presented in (72%) were observed in the dmfs indices in the 3-6- connection with three themes: (1) "practicing [and year-old groups in Codegua, when comparing 1999 parenting] what you preach," (2) religious practices, with 1994 data. In 1999, children in the study family connection, and family communion, and (3) community showed significantly lower dmfs than costs of family religious practices. The importance of children in the control community (41%). The family clinicians and researchers attending to the proportion of caries-free children in the study influence of religious practice in the lives of highly community increased after 4 years of program religious individuals and families is discussed. implementation (from 22.0% to 48.4%). CONCLUSION: Under Chilean rural conditions, Marks MB, Lawson HA. Co-production dynamics and time fluoridation of powdered milk distributed through the dollar programs in community-based child welfare PNAC is an effective caries prevention alternative for initiatives for hard-to-serve youth and families. Child areas where water fluoridation might not be feasible. Welfare 2005; 84(2):209-32. Abstract: Hard-to-serve youth and families residing in Marjorie V. The mutilated orchid. RCM Midwives 2005; high-poverty communities often have multiple, 8(3):119. interlocking needs. These needs necessitate complex service models. The complex model described in this Marks DJ, Berwid OG, Santra A, Kera EC, Cyrulnik SE, article combines a unique approach to wraparound Halperin JM. Neuropsychological correlates of ADHD services with a coproduction framework and related symptoms in preschoolers. Neuropsychology 2005; theories. The model aims to improve outcomes for 19(4):446-55. vulnerable youth and their families, simultaneously strengthening communities by employing residents and 687
- 696. engaging participants incommunity service. Examples Abstract: The anterior cingulate is a key component of derived from current pilot projects illustrate co- neural networks subserving attention and emotion production's importance for other child welfare regulation, functions often impaired in patients with initiatives. psychosis. The study aimed to examine anterior cingulate volumes and sulcal morphology in a group of Marleau JD. Birth order and fratricide: an evaluation of patients with childhood-onset schizophrenia (COS) Sulloway's hypothesis. Med Sci Law 2005; 45(1):52-6. compared with controls. Brain magnetic resonance Abstract: Sulloway (1996) suggested that older siblings imaging (MRI) scans were obtained in 13 COS and 18 were more likely to be fratricidal than younger ones. matched control children, ages 6-17 years. Volume Our data, based on 113 case studies found in the measures for the anterior cingulate gyrus (ACG) were psychiatric, psychological and criminological literature obtained through manual labeling. A determination of since 1959, confirms his hypothesis. In 72 out of the 92 cingulate sulcal pattern (single or double) was made for cases (78%) where age could be determined, the each hemisphere. The COS group had a reduced aggressor was older than the victim. The same held leftward skew of the double cingulate sulcal pattern, true even when the age of aggressor, sex of aggressor and absence of the normal left>right ACG volume and victim, presence or not of a blood tie, and presence asymmetry. The right ACG was larger in the COS than of one or more victims are taken into account. in controls. The schizophrenic children showed Surprisingly, most of the aggressors in our sample were decreases in all ACG volumes with age, while the under the age of 18 years. Also, first-borns were more controls showed increases or no change. The data often the aggressor than the victim. This result seems suggest that significant cingulate abnormalities may to confirm the Adlerian theory of dethronement. Some result from deviations in progressive suggestions and hypotheses are advanced for future neurodevelopmental processes, beginning before birth research to improve our understanding of this and continuing through childhood and adolescence, in phenomenon. persons who develop schizophrenia. These structural differences may relate to the well-described cognitive Marley JA, Buila S. Crimes against people with mental deficits these children display, and to the cardinal illness: types, perpetrators, and influencing factors. Soc symptoms of schizophrenia. Work 2001; 46(2):115-24. Abstract: The current emphasis on studying why Marques NM, Lira PI, Lima MC et al. Breastfeeding and people with severe mental illness are potentially violent early weaning practices in northeast Brazil: a has overlooked the effect of violence committed longitudinal study. Pediatrics 2001; 108(4):E66. against these individuals. To balance the understanding Abstract: OBJECTIVES: To describe breastfeeding of the person-in-environment conceptualization of practices from 0 to 12 months of age in 4 small towns severe mental illness, the nature, scope, and effect of that are representative of urban northeast Brazil and to crime and victimization should be examined as part of identify factors associated with introduction of other the context in which these individuals live and milk in the first month of life. METHODS: From function. The study reported in this article examined January to August 1998, 364 mothers were interviewed the nature and scope of victimization as experienced by at delivery to ascertain antenatal care; delivery room 234 individuals with a diagnosed major mental illness; practices; and their intentions regarding breastfeeding, what types of victimization experiences occurred pacifiers, and introduction of water, teas, and other during their lifetime; what specific victimization milk. Their perceptions of home support and the experiences these individuals identified as the most advantages of breastfeeding also were assessed. troubling; who the perpetrators for these specific Thereafter, daily information about feeding practices victimization experiences were; and what influence was collected at twice-weekly home visits. When other demographic and clinical characteristics played in milk was started, a second interview was conducted to influencing the risk of victimization among this group. ascertain initial and current breastfeeding problems and The study indicates that social workers should better use of a pacifier. Reasons for starting other milk were assess for experiences of victimization among people investigated using 5-point Likert scales. RESULTS: with mental illness and better understand the effect of Mothers were positive toward breastfeeding, and 99% such experiences on the individual's symptoms and breastfed their new infant. Few intended to breastfeed day-to-day functioning. exclusively, and in the first week 80% gave water/tea and 56% used a pacifier. The median duration of Maroteaux P, Le Merrer M. [Battered or brittle child?]. Arch exclusive breastfeeding was 0 days, and the median age Pediatr 2003; 10(8):679-80. for starting other milk was 24 days. The median duration of breastfeeding was 65 days for mothers who Marquardt RK, Levitt JG, Blanton RE et al. Abnormal started other milk within 1 month and 165 days for development of the anterior cingulate in childhood- other mothers. After adjustment for confounding onset schizophrenia: a preliminary quantitative MRI variables, the main factors associated with introduction study. Psychiatry Res 2005; 138(3):221-33. of other milk within 1 month were pacifier use in the first week (odds ratio [OR], 4.01; 95% confidence 688
- 697. interval [CI]: 2.07-7.78),intention to start other milk in emerges from our study. Most of the mutations of the first month (OR, 3.79; 95% CI: 1.74-8.24), giving uncharged and solvent inaccessible residues and the water/tea in the first week (OR, 3.07; 95% CI: 1.56- truncations must disrupt the basic structure of the 6.03), and leaving the maternity ward before protein. The mutations of charged residues would be breastfeeding was started (OR, 2.59; 95% CI: 1.34- expected to interfere with internal hydrogen bonding 5.04). CONCLUSION: Although breastfeeding is networks, introducing severe incompatible partnering common in this community, it rarely is exclusive and that is caused by poor packing or electrostatic takes place for a relatively short duration. Identification repulsions. of risk factors for early introduction of other milk offers potential avenues for future intervention, Martin PL. Moving toward an international standard in including improvement of breastfeeding support in informed consent: the impact of intersexuality and the antenatal and maternity services. Internet on the standard of care. Duke J Gend Law Policy 2002; 9:135-69. Marsella LT, Savastano L, Saracino V, Del Vecchio R. Notes: GENERAL NOTE: KIE: 310 fn. [Child labour]. Clin Ter 2005; 156(6):273-80. GENERAL NOTE: KIE: KIE Bib: informed Abstract: The authors emphasize the violation of consent/minors; patient care/minors children's and adolescents' rights as a result of the exploitation of child labour. Besides the legal aspect, Martin SG. Children exposed to domestic violence: they pointed out the medical features related to the psychological considerations for health care delicate growing process of the child in the phases of practitioners. Holist Nurs Pract 2002; 16(3):7-15. development and adaptation of the main organs to hard Abstract: This article reviews the psychological impact work. Currently the problem is being supervised by of exposure to domestic violence on child those states that recognize the right for minors to be development. The purpose is to give insight to the protected against any kind of physical, mental, spiritual following questions: How does the experience of and moral risk. family violence affect a child's perception of the world and relationships with others? What type of coping Marsh A. Testing pregnant women and newborns for HIV: style might this same child be likely to develop? What legal and ethical responses to public health efforts to factors help protect a child who has been exposed to prevent pediatric AIDS. Yale J Law Fem 2001; violence in the home? In addition, the article discusses 13(2):195-263. assessment considerations for health care practitioners Notes: GENERAL NOTE: KIE: Marsh, Andrea and recommends areas for future research and public GENERAL NOTE: KIE: 444 fn. policy development. GENERAL NOTE: KIE: KIE Bib: AIDS/testing and screening; public health Martin SL, Mackie L, Kupper LL, Buescher PA, Moracco KE. Physical abuse of women before, during, and after Marsh M. The missing piece. Nurs Stand 2003; 17(25):22-3. pregnancy. JAMA 2001; 285(12):1581-4. Abstract: CONTEXT: Clinicians who care for new Martin MA, Rubio JC, Buchbinder J et al. Molecular mothers and infants need information concerning heterogeneity of myophosphorylase deficiency postpartum physical abuse of women as a foundation (McArdle's disease): a genotype-phenotype correlation on which to develop appropriate clinical screening and study. Ann Neurol 2001; 50(5):574-81. intervention procedures. However, no previous Abstract: We report on 54 Spanish patients with population-based studies have been conducted of McArdle's disease from 40 unrelated families. postpartum physical abuse. OBJECTIVES: To examine Molecular analysis revealed that the most common patterns of physical abuse before, during, and after R49X mutation was present in 70% of patients and pregnancy in a representative statewide sample of 55% of alleles. The G204S mutation was less frequent North Carolina women. DESIGN, SETTING, AND and found in 14.8% of patients and 9% of mutant PARTICIPANTS: Survey of participants in the North alleles. The W797R mutation was observed in 16.5% Carolina Pregnancy Risk Assessment Monitoring of patients, accounting for 13.7% of mutant alleles. System (NC PRAMS). Of the 3542 women invited to Moreover, 78% of mutant alleles among Spanish participate in NC PRAMS between July 1, 1997, and patients can be identified by using polymerase chain December 31, 1998, 75% (n = 2648) responded. MAIN reaction-restriction fragment length polymorphism OUTCOME MEASURES: Prevalence of physical analysis for the R49X, G204S, and W797R mutations, abuse during the 12 months before pregnancy, during which makes noninvasive diagnosis possible through pregnancy, and after infant delivery; injuries and molecular genetic analysis of blood DNA. Six novel medical interventions resulting from postpartum abuse; mutations were found. Three were missense mutations, and patterns of abuse over time in relation to E348K, R601W, and A703V; two nonsense mutations, sociodemographic characteristics and use of well-baby E124X and Q754X; and one single base pair deletion, care. RESULTS: The prevalence of abuse before 533 delA. No clear genotype-phenotype correlation pregnancy was 6.9% (95% confidence interval [CI], 689
- 698. 5.6%-8.2%) compared with6.1% (95% CI, 4.8%- Martinez CR Jr, Forgatch MS. Adjusting to change: linking 7.4%) during pregnancy and 3.2% (95% CI, 2.3%- family structure transitions with parenting and boys' 4.1%) during a mean postpartum period of 3.6 months. adjustment. J Fam Psychol 2002; 16(2):107-17. Abuse during a previous period was strongly predictive Abstract: This study examined links between family of later abuse. Most women who were abused after structure transitions and children's academic, pregnancy (77%) were injured, but only 23% received behavioral, and emotional outcomes in a sample of 238 medical treatment for their injuries. Virtually all divorcing mothers and their sons in Grades 1-3. abused and nonabused women used well-baby care; Multiple methods and agents were used in assessing private physicians were the most common source of family process variables and child outcomes. Findings care. The mean number of well-baby care visits did not suggest that greater accumulations of family transitions differ significantly by maternal patterns of abuse. were associated with poorer academic functioning, CONCLUSION: Since well-baby care use is similar for greater acting-out behavior, and worse emotional abused and nonabused mothers, pediatric practices may adjustment for boys. However, in all three cases, these be important settings for screening women for relationships were mediated by parenting practices: violence. Parental academic skill encouragement mediated the relationship between transitions and academic Martines J, Paul VK, Bhutta ZA et al. Neonatal survival: a functioning, and a factor of more general effective call for action. Lancet 2005; 365(9465):1189-97. parenting practices mediated the relationships between Notes: CORPORATE NAME: Lancet Neonatal transitions and acting out and emotional adjustment. Survival Steering Team Abstract: To achieve the Millennium Development Martinez-Campillo Garcia F, Maura da Fonseca A, Santiago Goal for child survival (MDG-4), neonatal deaths need Oliva J et al. [Vaccine coverage study and intervention to be prevented. Previous papers in this series have with health community agents in a marginal gypsy presented the size of the problem, discussed cost- community of Alicante]. Aten Primaria 2003; effective interventions, and outlined a systematic 31(4):234-8. approach to overcoming health-system constraints to Abstract: OBJEDTIVESn To measure the vaccination scaling up. We address issues related to improving coverage in a pediatric population living in Parque neonatal survival. Countries should not wait to initiate Ansaldo, Montoto, Casa Larga, Cabrera Vicario, San action. Success is possible in low-income countries and Anton and Travesia del Canal and evolution after an without highly developed technology. Effective, low- intervention health program performed by Gypsy cost interventions exist, but are not present in educators specially trained for such intervention. programmes. Specific efforts are needed by safe DESIGN: Descriptive study, pretest-postest without motherhood and child survival programmes. Improved control group. SETTING: Community. Primary health availability of skilled care during childbirth and care. Participants. Four hundred and sixty three family/community-based care through postnatal home marginals Gypsies children younger than 15 years old. visits will benefit mothers and their newborn babies. MEASUREMENTS AND MAIN RESULTS: The Incorporation of management of neonatal illness into project includes an educational program and health the integrated management of childhood illness care actions by means of home visits. Duration of the initiative (IMCI) will improve child survival. project was from 1-10-96 until 1-10-97 and from 1-10- Engagement of the community and promotion of 98 until 1-10-99. Before intervention the vaccine demand for care are crucial. To halve neonatal coverage was for polio, diphtheria and tetanus 41%, mortality between 2000 and 2015 should be one of the pertussis 24% and measles, mumps and rubella 36%. targets of MDG-4. Development, implementation, and After intervention the overall coverage increased 17%. monitoring of national action plans for neonatal The vaccine coverage was for polio, diphtheria and survival is a priority. We estimate the running costs of tetanus 53%, pertussis 45% y measles, mumps and the selected packages at 90% coverage in the 75 rubella 54%. CONCLUSIONS: This study shows up countries with the highest mortality rates to be US4.1 the low vaccine coverage founded and the increase of billion dollars a year, in addition to current overall coverage after the intervention in 17%. We also expenditures of 2.0 billion dollars. About 30% of this conclude of the intervention the necesity of money would be for interventions that have specific collaboration between Gypsies associations, health benefit for the newborn child; the remaining 70% will primary care centers and public health centers to carry also benefit mothers and older children, and out efficacy interventions in marginal population. substantially reduce rates of stillbirths. The cost per neonatal death averted is estimated at 2100 dollars Martinez E. Children's Dental Safety Net--a collaborative (range 1700-3100 dollars). Maternal, neonatal, and initiative of San Diego County's Council of child health receive little funding relative to the large Community Clinics. Compend Contin Educ Dent 2002; numbers of deaths. International donors and leaders of 23(12 Suppl):36-8. developing countries should be held accountable for meeting their commitments and increasing resources. Martino SC, Collins RL, Kanouse DE, Elliott M, Berry SH. 690
- 699. Social cognitive processesmediating the relationship families to rethink the kind of education parents are between exposure to television's sexual content and providing their childrenwith/their own education. For adolescents' sexual behavior. J Pers Soc Psychol 2005; the other ones, it was perceived as a support for 89(6):914-24. behavioral problems. As noticed, some parents stressed Abstract: This study used multiple-group structural a negative influence falling upon their children, which equation modeling to test a model explaining the made them more disobedient on their return home, and association between exposure to televised sexual causing disciplinary procedures harder to be content and initiation of intercourse among an established. The conclusion is that reintegration of the ethnically diverse national sample of 1,292 target children/adolescents is harnessed by violence adolescents. The authors hypothesized, on the basis of happening inside families. social-cognitive theory, that exposure to televised sexual content would influence adolescents' safe-sex Martyn C. Politics as a determinant of health. BMJ 2004; self-efficacy, sex-related outcome expectancies, and 329(7480):1423-4. perceived peer norms regarding sex, and that each of these would, in turn, influence intercourse initiation. Masi G, Millepiedi S, Mucci M, Bertini N, Milantoni L, Findings support a model in which the relationship Arcangeli F. A naturalistic study of referred children between exposure to TV's sexual content and and adolescents with obsessive-compulsive disorder. J intercourse initiation is mediated by safe-sex self- Am Acad Child Adolesc Psychiatry 2005; 44(7):673- efficacy among African Americans and Whites but not 81. among Hispanics. Outcome expectancies and perceived Abstract: OBJECTIVE: To report on clinical features, peer norms may also mediate the link between comorbidity, and response to pharmacotherapy in exposure and intercourse initiation among all 3 children and adolescents with obsessive-compulsive racial/ethnic groups, although evidence of this could disorder (OCD) naturalistically followed and treated not be confirmed. with serotonin reuptake inhibitors (SRIs). METHOD: A consecutive series of 94 patients (65 males, 29 Martins CB, Andrade SM. [Epidemiology of accidents and females, age 13.6 +/- 2.8 years), referred in the period violence against children in a city of Southern Brazil]. January 2001-April 2004, diagnosed with a clinical Rev Lat Am Enfermagem 2005; 13(4):530-7. interview (Diagnostic Interview for Children and Abstract: This study aimed to analyze the Adolescents-Revised), and followed for 10 +/- 6 epidemiological characteristics of accidents and months, were included in the study. RESULTS: violence against children under 15 years old who lived Contamination obsessions and washing rituals were in Londrina, a city in the South of Brazil, in 2001. associated with less impairment than other subtypes of Morbidity data were collected from general hospitals OCD. Aggressive sexual obsessions and checking records and mortality data were obtained from the rituals as well as symmetry obsessions and ordering- Municipal Mortality Information Center. A total of repeating rituals were more frequently comorbid with 8,854 children were studied, which corresponded to an tic disorders. According to the Clinical Global incidence rate of 74.8/1,000 children. Admission and Impressions-Improvement scale (score 1 or 2), 63 fatality rates were 4.2% and 0.2%, respectively. The subjects (67%) were responders to treatment. incidence rate was higher among two-year olds Nonresponders were more severely impaired and had a (109/1,000) and male victims prevailed (60.7%). Other higher number of comorbid disorders, namely, bipolar causes of injuries were the main subtype of external disorder and conduct disorder (p < .05). Forty-seven cause (61.0%), followed by events of undetermined patients (50%) received an SRI monotherapy, whereas intention (30.6%) and by transport-related injuries the other 47 (50%) needed other medications. Patients (7.5%). The head was the most affected body part receiving SRI monotherapy were less severely (34.9%) and superficial injuries were the most frequent impaired; had a later onset of OCD; were at a younger kind of trauma (32.4%). The results contribute to the age at the visit, had higher rates of depression and planning of injury control and prevention actions. anxiety and lower rates of bipolar disorder, attention- deficit/hyperactivity disorder, and conduct disorder (p Martins CS, Ferriani MG. [Reintegration of victimized < .05). CONCLUSIONS: Long-term naturalistic children and adolescents in their parents' view]. Rev prospective studies in pediatric patients with OCD Bras Enferm 2003; 56(6):651-4. might represent an important source of information for Abstract: This study aims at learning, from some everyday care regarding the effectiveness of a aggressor families' point of view, the way reintegration treatment over extended periods of time under routine of child and adolescent victims into their own families clinical conditions. happen, in the city of Ribeirao Preto-SP in 2002. The methodology used is descriptive and qualitative; data Mason PR, Gregson S, Gwanzura L, Cappuccinelli P, were collected through interviews and observation of Rapelli P, Fiori PL. Enzyme immunoassay for participants. Nine families whose children were urogenital trichomoniasis as a marker of unsafe sexual institutionalized were surveyed. Results showed that behaviour. Epidemiol Infect 2001; 126(1):103-9. the institutionalization of children is a way for some 691
- 700. Abstract: Enzyme immunoassay(EIA) was used to dorsolateral prefrontal cortex compared with healthy detect antibodies to Trichomonas vaginalis in sera from participants; 13 of 15 matched patient-comparison Zimbabwe. The EIA showed a sensitivity of 95 and subject pairs displayed a difference in this direction. In 94% when compared with vaginal swab culture among addition, generalized anxiety disorder patients women attending a family planning clinic (FPC) and reporting childhood abuse had lower N- female commercial sex workers (CSW) respectively. acetylaspartate/creatine ratios in the right dorsolateral The specificity was 85 and 77% in the two groups. prefrontal cortex than did nonabused patients. Culture-negative FPC women were sub-divided into Metabolite differences were not detected in other high risk or low risk of exposure to trichomoniasis. The regions. CONCLUSIONS: Generalized anxiety seroprevalence was 10% (6/61) among low risk disorder is associated with asymmetric increases in the women, 21% (10/48) among high risk women and 23% N-acetylaspartate/creatine ratio, a suggested marker of (9/39) among culture negative CSW. The EIA was neuronal viability, in the prefrontal cortex. The positive in 46% (18/39) men with genital discharge but findings also support prior research linking childhood only 5% (2/37) healthy blood donors. None of 31 sera abuse to reduced neuronal viability. from prepubescent children was positive. The EIA may be useful for community surveys of trichomoniasis. Maton KI, Hrabowski FA 3rd. Increasing the number of Because T. vaginalis is a common sexually transmitted African American PhDs in the sciences and disease, the test may indicate behaviour that increases engineering: a strengths-based approach. Am Psychol the risk of STD transmission. 2004; 59(6):547-56. Abstract: Fifty years after Brown v. Board of Mastal MF. Building a caring community. Coordinating the Education, the percentage of African American health care of children with special needs. Healthplan students who receive PhDs in natural science, 2001; 42(5):58, 60-2. technology, engineering, or mathematics (STEM) fields remains disappointingly low. A multifaceted, Mastroianni AC, Kahn JP. Risk and responsibility: ethics, strengths-based approach to intervention and research Grimes v Kennedy Krieger, and public health research that holds great promise for increasing the number of involving children. Am J Public Health 2002; African American students who achieve at the highest 92(7):1073-6. levels academically is described. This work began in Notes: GENERAL NOTE: KIE: 10 refs. 1988 with the development of the Meyerhoff Scholars GENERAL NOTE: KIE: KIE Bib: human Program for undergraduate minority STEM majors at experimentation/informed consent; human the University of Maryland, Baltimore County experimentation/minors; public health (UMBC). If current PhD receipt rates of program Abstract: The legal case of Grimes v. Kennedy Krieger graduates continue, UMBC will in all likelihood Institute, Inc, has raised concerns in the public health become the leading predominantly White research community regarding the acceptable level of baccalaureate-origin university for Black STEM PhDs risk in research involving children, parental authority in the nation. The program is described and outcome for informed consent, and exploitation of research and process findings from its ongoing evaluation are subjects for the benefit of public health. We provide an highlighted. The parenting practices that helped these overview of the case and discuss the impact of the youths to overcome the odds and achieve at the highest court's decision and its possible effect on future levels prior to coming to college are also examined. research protection policies and practices. Matsuda I. Bioethical considerations in neonatal screening: Mathew SJ, Mao X, Coplan JD et al. Dorsolateral prefrontal Japanese experiences. Southeast Asian J Trop Med cortical pathology in generalized anxiety disorder: a Public Health 2003; 34 Suppl 3:46-8. proton magnetic resonance spectroscopic imaging Abstract: Since 1979, at least 13,000 affected babies study. Am J Psychiatry 2004; 161(6):1119-21. have been identified with one of the tested diseases. Abstract: OBJECTIVE: Few neuroimaging studies of The outcome for patients is generally favorable if generalized anxiety disorder have been conducted. The adequate treatment is given. Recently, ethical issues present study used proton magnetic resonance have arisen concerning whether or not written informed spectroscopy to assess concentrations of N- consent should be required, under what conditions the acetylaspartate, often considered a marker of neuronal residual blood spot may be used for research purposes viability, in generalized anxiety disorder patients. other than that originally designed, and whether or not METHOD: N-Acetylaspartate/creatine resonance ratios the test is cost-effective. Mandatory screening seems were measured in the left and right dorsolateral acceptable under certain conditions, but parental prefrontal cortex and hippocampus of 15 medication- education and opportunity for refusal should be part of free generalized anxiety disorder patients and 15 age- the system. Refusal should be documented only after and sex-matched healthy volunteers. RESULTS: an attempt has been made to persuade parents to Generalized anxiety disorder patients had a 16.5% consent. Informed consent is necessary if there is higher N-acetylaspartate/creatine ratio in the right uncertainty about the test's benefit to the child. Parents should be informed of the potential research value of 692
- 701. the samples andassured that research results will not situation. Characteristics of TOPS were investigated be linked to any particular/individual newborn. If both in randomly selected normal school children and identified or coded blood spots are used for research, in boys with a conduct disorder. Four factors appeared IRB review and approval by IRB must occur. The net to underlie the TOPS scores from 652 randomly health care benefit from screening for six disorders in selected boys and girls from grades 1 to 6, these being: Japan was 0.25 billion yen ($2.2 million) per 100,000 teachers' scores for the types of problem situation screened newborns compared to $3.2 million for PKU Being Disadvantaged, Coping with Competition, Social and CH in the US for 100,000 screened newborns. Expectations of Peers, and Teacher Expectations. Because of the high internal consistency of the four Matsumoto T, Yamaguchi A, Asami T, Okada T, Yoshikawa factors, TOPS was abbreviated to a TOPS-Short Form K, Hirayasu Y. Characteristics of self-cutters among (18 instead of 44 items). The four-factor model was male inmates: association with bulimia and cross-validated by means of a second sample of 326 dissociation. Psychiatry Clin Neurosci 2005; boys and girls. A model with only one general problem 59(3):319-26. behaviour factor did not fit the data of both samples. Abstract: It was examined whether bulimia and When the four specific factors were added a dissociation are common in male self-cutters, as has satisfactory fit resulted. Moreover, it was found that in been found in female self-cutters. The subjects were the first sample 52% of the variance was explained by 796 male inmates of a juvenile prison. A self-reporting the general factor, whereas 18% of the variance was questionnaire was used to assess self-cutting, histories explained by the four specific factors together. Thus, of psychoactive substance use, problem behaviors, and the extent to which problem behaviour is situation traumatic life events in the subjects. The Adolescent specific should not be disregarded. In all four types of Dissociative Experience Scale and the Bulimia problem situation, boys showed more inappropriate Investigatory Test of Edinburgh were also used. behaviour than girls. With increasing age, children Subjects were divided into two groups: self-cutting and were rated as being more competent in dealing with the non-cutting. Questionnaire responses and dissociation problem situation Being Disadvantaged. Teachers rated and bulimia assessments were compared between the the four types of problem situation as more problematic groups. Self-cutters began smoking (P < 0.001) and for boys with a conduct disorder (N = 42) than for drinking (P < 0.001) earlier, and more frequently used normal control boys (N = 67). Conduct disordered boys illicit psychoactive drugs (P < 0.001), experienced also differed individually in the number of situational childhood physical abuse (P < 0.001), and reported types that were problematic for them. With respect to suicide attempts (P < 0.001), suicidal ideation (P < clinical implications, the identification of the particular 0.001), and outward violence toward a person (P < social context in which a conduct disordered child 0.001) or object (P < 0.001) than non-cutters. Self- displays his or her inappropriate behaviour may help cutters also scored significantly higher on the bulimia refine treatment goals: more adequate social (P < 0.001) and dissociation tests (P < 0.001). Logistic functioning should be aimed at specifically in those regression analysis demonstrated that suicide attempt situations that are problematic. (odds ratio, 4.311) and suicidal ideation (odds ratio, 2.336) could discriminate between male inmates with Maughan B, Iervolino AC, Collishaw S. Time trends in child and without self-cutting. Male self-cutters showed and adolescent mental disorders. Curr Opin Psychiatry 'multi-impulsive bulimic' tendencies resembling those 2005; 18(4):381-5. of female self-cutters, although to a lesser extent. Abstract: PURPOSE OF REVIEW: 1995 saw the Clinical features of male as opposed to female self- publication of a major review of time trends in cutters were influenced by gender differences. psychosocial disorders of youth across the second half of the twentieth century. It found evidence for Matthys W, Maassen GH, Cuperus JM, van Engeland H. substantial increases in rates of youth crime, alcohol The assessment of the situational specificity of and drug use, depression and suicide in most children's problems behaviour in peer-peer context. J industrialized countries in the decades following the Child Psychol Psychiatry 2001; 42(3):413-20. Second World War, slowing in some instances in the Abstract: In both theory and research the general issue 1980s. Ten years on, we review findings on more of the extent to which children's problem behaviour is recent trends in rates of these and other indicators of generalised across situations, and to what extent it is child and adolescent mental health. RECENT situation specific, has been neglected. In the clinical FINDINGS: Prevalence estimates for autism spectrum assessment of disordered children, too, little attention disorders have increased in recent decades, as has has been paid to the specific situations in which these public and professional awareness of hyperactivity and children display their inappropriate behaviour. In this attention deficits. Trends in adolescent conduct study the Taxonomy of Problematic Social Situations problems, and in alcohol and drug use, appear to reflect (TOPS) (Dodge, McClaskey, & Feldman, 1985) was culture-specific influences. Rates of suicide among employed. This is a questionnaire in which the child's young males, and self-harm among females have risen teacher is asked to rate the likelihood of a child in many countries in recent years; trends in emotional responding in an inappropriate manner in a specific disorders are more varied, but there is little evidence 693
- 702. for any risein rates of anorexia nervosa. Although compared with controls. Performance on the Starry some contributors to these trends have been identified, Night, a test demanding alerting and sensory-orienting much remains to be learned about the key risks but not executive attention function, was significantly involved. SUMMARY: Monitoring time trends in child associated with lesion size in the alerting and sensory- and adolescent mental health is essential for service orienting networks but not the executive attention planning; knowledge of changing trends can also network. Furthermore, earlier age at lesion acquisition provide important pointers to potential risk factors. was significantly associated with poorer attention Current data sources allow relatively reliable tracking function even when lesion size was controlled. These of trends in some areas, but remain severely limited in findings support the theory of dissociable networks of others. Further research is needed to understand the attention and add to evidence from studies of children mechanisms underlying recently identified trends in with diffuse and focal brain damage that early insults child and adolescent mental health. are associated with worse long-term outcomes in many domains of neuropsychological function. In addition, Maughan B, Rowe R, Messer J, Goodman R, Meltzer H. these results may provide clues towards the Conduct disorder and oppositional defiant disorder in a understanding of mechanisms underlying attention in national sample: developmental epidemiology. J Child children. Psychol Psychiatry 2004; 45(3):609-21. Abstract: BACKGROUND: Despite an expanding Maxeiner H. Demonstration and interpretation of bridging epidemiological evidence base, uncertainties remain vein ruptures in cases of infantile subdural bleedings. J over key aspects of the epidemiology of the 'antisocial' Forensic Sci 2001; 46(1):85-93. disorders in childhood and adolescence. METHODS: Abstract: Report of two cases of lethal infantile We used cross-sectional data on a nationally subdural bleedings (SDB). Bridging vein (BV) ruptures representative sample of 10,438 5-15-year-olds drawn were directly proven as the source of the (minimal) from the 1999 British Child Mental Health Survey to SDB by a postmortem X-ray. In the controversial examine age trends, gender ratios and patterns of discussion concerning the causes of infantile SDB, comorbidity in DSM-IV Conduct Disorder (CD) and proof of the occurrence of several BV ruptures is seen Oppositional Defiant Disorder (ODD). RESULTS: CD as an important sign of a trauma of significant degree. was significantly more common in boys than girls, and Although infantile SDB undoubtedly can result from increased in prevalence with age. Among children who accidental as well as intentional injuries, and therefore, met diagnostic criteria for CD, status violations and the SDB itself does not allow far-reaching conclusions other non-aggressive conduct problems increased with as to the cause of injury, the presence of several BV age, while aggressive symptoms became less common. ruptures combined with an SDB of insignificant Gender differences in ODD varied by reporter. volume, in an infant dead or in a deep coma on clinical Estimates of age trends in ODD depended heavily on presentation, is not compatible with the supposition of treatment of overlaps with CD. Following DSM-IV a minor fall as the cause. We have not observed such guidelines (where ODD is not diagnosed in the findings as the result of a minor accidental event for presence of CD), rates of ODD fell with age; if that more than 15 years. constraint was released, clinically significant rates of oppositionality persisted at similar levels from early Maxeiner H. [Evaluation of subdural hemorrhage in infants childhood to middle adolescence. CD and ODD after alleged minor trauma]. Unfallchirurg 2001; showed high levels of overlap, and both diagnoses 104(7):569-76. showed substantial comorbidity with other non- Abstract: QUESTIONING: Recently the discussion antisocial disorders. CONCLUSIONS: Results from concerning the causes of infantile subdural bleedings this large-scale study confirm and extend previous (SDB) has become quite controversial. The wide- findings in the epidemiology of the disruptive spread interpretation that most of these cases are the behaviour disorders. result of abuse, especially by the shaken-baby- syndrome, was doubted, and the role of (even minor) Max JE, Robin DA, Taylor HG et al. Attention function accidental events was emphasized. METHODS: This after childhood stroke. J Int Neuropsychol Soc 2004; situation should be analyzed basing on the official 10(7):976-86. statistics of the causes of death in the city of Berlin Abstract: We investigated attentional outcome after (1978-1998) and the autopsy material of our institute childhood stroke and orthopedic diagnosis in medical (1978-1999). RESULTS: In this period, approximately controls. Twenty-nine children with focal stroke 440.000 children lived their first year of life in our city. lesions and individually matched children with Only 80 violent deaths of infants (up to 1 year old) clubfoot or scoliosis were studied with standardized were recorded in the official statistics, including 27 attention and neuroimaging assessments. Stroke lesions deaths due to blunt forces, with 24 lethal head injuries were quite varied in location and commonly involved as the main group. Only two cases were attributed to regions implicated in Posner's model of attention "falls under unclear conditions"; all other accidental networks. Children with stroke lesions performed cases were the results of traffic accidents or falls from significantly more poorly regarding attention function a height. No death due to an undoubted minor fall was 694
- 703. recorded, nor wasany in our autopsy material. We subdural hemorrhages should be kept from another: a) investigated 10 cases of infantile SDB, all without skull patients suffering a moderate head injury from a minor fractures and gross brain injuries. Only 1 victim had a accident which results in a subdural bleeding (from a SDB of a significant volume; in all other cases only small intracranial lesion) often do not deteriorate soon small amounts of blood were present in the subdural after the impact, develop a hemorrhage of significant space. Bridging vein ruptures were directly volume, respond well to therapy and have a good demonstrated in 8 cases and were bilaterally in most prognosis. b) cases with a history of no or only of an instances; recently their detection has been simplified insignificant trauma, infants dead or nearly dead on by postmortem x-ray using contrast material. All 10 clinical presentation, often a poor outcome in cases of cases were interpreted as typical acceleration- survival. There is typically no significant subdural deceleration injuries (as in shaking), although only in 2 bleeding despite multiple bridging vein ruptures in the cases a confession of this procedure could be obtained. majority of these cases: the subdural hemorrhage is CONCLUSION: Comparing cases of accidental and here only a visible sign of a much more serious and non-accidental SDB in the literature, infantile SDB general cerebral alteration, resulting in a rapid increase obviously cannot be looked at as a homogeneous of intracranial pressure (often complicated by entity: two quite different types should be kept respiratory arrest) which prevents a signifant bleeding separate: the patients suffering from an accidental SDB into the subdural space. This combination of findings is due to a minor fall mostly do not deteriorate typically found in victims of massive events (car immediately after the trauma, develop SDB of some occupants in high-velocity crashes) and not compatible volume, up to a space-occupying mass lesion, and have with a supposition of a minor fall causing this. often a good prognosis. A lethal outcome is extremely uncommon; we have not observed a single case of an May PA, Gossage JP. Estimating the prevalence of fetal infantile lethal SDB resulting from such a minor injury alcohol syndrome. A summary. Alcohol Res Health for more than 20 years. The source of the SDB in those 2001; 25(3):159-67. cases currently is unknown in most instances. The Abstract: Since the late 1970s, many studies have second group of infantile SDB includes the well-known reported on the prevalence of fetal alcohol syndrome group of shaken-baby-syndrome: no adequate history, (FAS), alcohol-related birth defects (ARBD), and infants dead or nearly dead on clinical presentation, alcohol-related neurodevelopmental disorders often a poor outcome if the event is survived, typically (ARND). The three main types of research methods no significant volume of SDB, and--according to our used in these studies are passive surveillance, clinic- experiences--in all cases BV ruptures. This based studies, and active case ascertainment. This combination of several BV ruptures with no significant article describes each of these methods, including their subdural bleeding is not compatible with a supposition strengths and weaknesses, and summarizes the of a minor fall causing this. estimated prevalence of FAS produced by each of these approaches. The maternal risk factors associated with Maxeiner H. [A postmortem view on "pure" subdural FAS and other alcohol-related anomalies include hemorrhages in infants and toddlers]. Klin Padiatr advanced maternal age, low socioeconomic status, 2002; 214(1):30-6. frequent binge drinking, family and friends with Abstract: In the last years, the discussion concerning drinking problems, and poor social and psychological the causes of infantile subdural hemorrhages became indicators. Overall, the available literature points to a controversial. Many authors still suppose that child prevalence rate of FAS of 0.5 to 2 cases per 1,000 abuse is the predominant cause of such cases. On the births in the United States during the 1980s and 1990s. other hand, reports presenting series of accidental cases were published, and the fear of an overdiagnosis of the May WE. "Jodie" and "Mary": separating the Maltese twins. shaken baby syndrome has been expressed. Our Natl Cathol Bioeth Q 2001; 1(3):407-16. autopsy material concerning all lethal head injuries of Notes: GENERAL NOTE: KIE: May, William E infants and toddlers from 2 decades was reviewed. 17 GENERAL NOTE: KIE: 32 fn. of these 64 cases were characterized by the following: GENERAL NOTE: KIE: KIE Bib: patient care/minors history of no trauma or only an insignificant event; children found dead or apnoic or in coma; no skull Maybloom B, Champion Z. Development and fractures; no focal brain injury; ruptures of several implementation of a multi-centre information system bridging veins but only minimal subdural bleeding. 11 for paediatric and infant critical care. Intensive Crit victims were infants (1st year of life) and either 3 were Care Nurs 2003; 19(6):326-41. 2 years resp. 3 - 6 years old; 50 % off all lethal head Abstract: BACKGROUND: With no UK collective injuries of infants were of this type, while only 25 % information system, a need existed to establish an resp. 10 % of the following age groups. None of these integrated information system for public and private 17 cases was a result of a minor accident witnessed by sector hospitals providing paediatric and infant critical unrelated persons. Abuse could be ascertained with a care services. A lack of information in the past made it high degree of probability in most cases and remained difficult for those procuring, providing and monitoring quite likely in the others. Two different types of 695
- 704. services to makeinformed, evidence-based decisions men (70%, or 7 of 10) recommended a leave of 1 to 3 using reliable integrated data. OBJECTIVES: To months, and all women preferred a 3-month maternity develop and implement a collective multi-purpose or child care leave of absence. During surgical practice, information system for paediatric and infant critical only 12% (2/17) of men but 64% (7/11) of women care that was easily adaptable to any UK infant or have taken time off for either childbearing or child paediatric critical care setting. Information outputs had care. Half of the respondents (21/42) have a formal to fulfil policy requirements and meet the needs of leave of absence policy at work, 52% (11/21) of which stakeholders. METHOD: Two minimum datasets, are paid leave programs. Although the workweek of corresponding data definitions, survey forms and a user our practicing graduates is 69 +/- 16 hours for men and database were developed through a process of 64 +/- 12 hours for women, 62% (26/42) spend more consultation by utilising an information partnership. than 20 hours per week parenting. More than 80% Design, content, development and implementation (27/32) would consider a part-time surgical practice for issues were identified, discussed and resolved through more parenting involvement; one third of the a co-ordinated collaborative process. RESULTS: Data responders suggested that 30 hours a week constitutes a collection was implemented in all London and reasonable part-time practice, one third preferred fewer Brighton National Health Service (NHS) general and than 30 hours, and one third favored more than 30 cardio-thoracic paediatric intensive care (PIC) units, hours per week. Data are presented as mean +/- SD. several private PIC units and one NHS tertiary referral CONCLUSIONS: Childbearing and child care may neonatal unit (NNU) 24 months from project start. have an enormous impact on one's decision to pursue a CONCLUSIONS: The development of universal career in surgery. To attract and retain the best integrated information systems for defined settings of candidates for future surgeons, formal policies on the care is achievable within reasonable timeframes; availability of child care services in the residency however, successful development and implementation program and the workplace should be studied and requires working within an information partnership to implemented. Furthermore, national studies are needed maximise co-ordination, co-operation and to define appropriate, acceptable workweeks for part- collaboration. Those collecting and using data must be time or flexible practices and the duration of leaves of identified and involved in all aspects of development absence for childbearing or child care. from project start. Financial and manpower resources must be well planned. Datasets should be as small as Mayor S. Report calls for clinical networks to improve possible in order to make the collection of complete babies' survival. BMJ 2003; 326(7391):680. and valid data realistically achievable. When considering service-based information needs, Mayor S. WHO report shows public health impact of considerable thought should be given to a multi- violence. BMJ 2002; 325(7367):731. purpose; multi-use approach based on the most refined minimum dataset possible. Maziak W. Smoking in Syria: profile of a developing Arab country. Int J Tuberc Lung Dis 2002; 6(3):183-91. Mayer KL, Ho HS, Goodnight JE Jr. Childbearing and child Abstract: One of the main obstacles to tobacco control care in surgery. Arch Surg 2001; 136(6):649-55. in the Middle East lies in the shortage of reliable, Abstract: HYPOTHESIS: The responsibility for standardised data on the spread and patterns of tobacco childbearing and child care has a major effect on use in society. In Syria, a project aiming at drawing an general surgical residency and subsequent surgical epidemiological map of the tobacco epidemic in this practice. METHODS: A survey of all graduates from a country was started 4 years ago. Overall, nine studies university general surgical training program between have resulted, with a total of 6780 participants. The 1989 and 2000. RESULTS: Twenty-seven women and crude prevalence of current smoking among adults in 44 men completed general surgical training at our Syria, based on combined information from all studies, university during the period, and 42 (59%) responded is 48% and 9% for males and females, respectively. to our survey. The age at completion of the residency The prevalence of current smoking among high school was 34.0 +/- 2.2 years for men and 33.9 +/- 2.8 years adolescents is 16% and 7% for boys and girls, for women. During residency, 64% (14/22) of the men respectively, and was strongly associated with parental and 15% (3/20) of the women had children. At the time and sibling smoking. High school students from of the survey, 21 (95%) of the men and 8 (40%) of the families with parents and/or siblings who smoked were women had children. Most residents (24 [57%] of 42) 4.4 times more likely to be current smokers than those relied on their spouse for child care. During surgical from non-smoking families. The biggest influx of new practice, 18 (43%) indicated that they rely on their smokers among males in Syria is occurring in the early spouse; 19 (45%) use day care, home care, or both; and twenties, but an earlier pattern can occur among youths (8%) of 26 are unsatisfied with their current child care with low academic performance or socioeconomic arrangement. During training, 38% (5/13) of men and status. Smoking in women, evaluated by data from 67% (2/3) of women took time off for maternity leave, physicians, tends to start later than in men and paternity leave, or child care. Two of 3 surgeons would continues to increase with age. Women's smoking in like to have had more time off during residency; most 696
- 705. Syria is relatedto their level of social liberalisation. 'region of interest' approaches usually adopted, and Data show that active smoking is associated with an variable inclusion criteria for subjects across the autism increased risk of respiratory diseases among smokers, spectrum. Moreover, despite a consensus that autism and that exposure to environmental tobacco smoke probably affects widely distributed brain regions, the (ETS) is associated with an increased risk of issue of anatomical connectivity has received little respiratory symptoms in children. Knowledge about the attention. Therefore, we planned a fully automated harmful effects of smoking and the desire to quit are voxel-based whole brain volumetric analysis in disproportionate to the rate of successful cessation. The children with autism and normal IQ. We predicted that evidence collected indicates possible avenues for brain structural changes would be similar to those tobacco control in Syria, including price increases, previously shown in adults with autism spectrum smoking cessation programmes, restriction of disorder and that a correlation analysis would suggest adolescents' access to cigarettes, and intensive structural dysconnectivity. We included 17 stringently prevention work among women. diagnosed children with autism and 17 age-matched controls. All children had IQ >80. Using Brain Mazzoni CM. The rights of the embryo and the foetus in Activation and Morphological Mapping (BAMM) private law: the Italian experience. Law Hum Genome software, we measured global brain and tissue class Rev 2002; (17):83-97. volumes and mapped regional grey and white matter Notes: GENERAL NOTE: KIE: KIE Bib: embryo; differences across the whole brain. With the embryo and fetal research; personhood expectation that volumes of interconnected regions correlate positively, we carried out a preliminary Mbassa Menick D, Ngoh F. [Psychological mistreatment of exploration of 'connectivity' in autism by comparing children with sickle cell disease in Cameroon: the nature of inter-regional grey matter volume description and analysis of 1 case]. Med Trop (Mars) correlations with control. Children with autism had a 2001; 61(2):163-8. significant reduction in total grey matter volume and Abstract: Psychological maltreatment of a children significant increase in CSF volume. They had with sickle-cell disease is a form of parental significant localized grey matter reductions within dysfunction provoked by a crisis situation. In most fronto-striatal and parietal networks similar to findings cases, this type of child abuse involves a relatively in our previous study, and additional decreases in harmonious family going through a period of ventral and superior temporal grey matter. White adaptation that jeopardizes its internal equilibrium. The matter was reduced in the cerebellum, left internal weakest components of the family, i.e., the children, capsule and fornices. Correlation analysis revealed become the scapegoats for the crisis. After a brief significantly more numerous and more positive grey description of this disorder, the authors analyze the matter volumetric correlations in controls compared different causes that lead to eruption of intra-familial with children with autism. Thus, using similar violence. Several cultural, social, and economic factors diagnostic criteria and image analysis methods in combine to trigger the maltreatment to which hapless otherwise healthy populations with an autistic spectrum children with sickle-cell disease fall victim. Special disorder from different countries, cultures and age legislation to provide appropriate child care is the only groups, we report a number of consistent findings. alternative to prevent these situations from becoming Taken together, our data suggest abnormalities in the chronic subject only to the socio-economic conditions anatomy and connectivity of limbic-striatal 'social' of the parents and prevailing ethos. brain systems which may contribute to the brain metabolic differences and behavioural phenotype in McAliley LG, Daly BJ. Baby Grace. Hastings Cent Rep autism. 2002; 32(1):12; discussion 13-5. Notes: GENERAL NOTE: KIE: KIE Bib: allowing to McBeth J, Morris S, Benjamin S, Silman AJ, Macfarlane GJ. die/infants; treatment refusal/minors Associations between adverse events in childhood and chronic widespread pain in adulthood: are they McAlonan GM, Cheung V, Cheung C et al. Mapping the explained by differential recall? J Rheumatol 2001; brain in autism. A voxel-based MRI study of 28(10):2305-9. volumetric differences and intercorrelations in autism. Abstract: OBJECTIVE: Clinic based studies suggest Brain 2005; 128(Pt 2):268-76. that adverse events in childhood may predispose to Abstract: Autism is a disorder of neurodevelopment chronic pain in adult life. These have been conducted resulting in pervasive abnormalities in social on highly selected groups, and it is unknown whether interaction and communication, repetitive behaviours these relationships hold in the general population and and restricted interests. There is evidence for functional to what extent the increased rate of adverse childhood abnormalities and metabolic dysconnectivity in 'social events in persons with pain is an artefact of differential brain' circuitry in this condition, but its structural basis reporting. We examined the hypothesis that chronic has proved difficult to establish reliably. Explanations widespread pain was associated with reports of adverse for this include replication difficulties inherent in experiences in childhood and whether any observed relationships could be explained by differential recall. 697
- 706. METHODS: A crosssectional population based McBurney PG, Simpson KN, Darden PM. Potential cost screening survey was conducted. Subjects completed a savings of decreased emergency department visits questionnaire that included assessments of pain and through increased continuity in a pediatric medical psychological state. In total, 296 subjects who had home. Ambul Pediatr 2004; 4(3):204-8. demonstrated psychological distress were randomly Abstract: PURPOSE: To determine the potential cost selected and had a detailed interview, which included savings of decreased emergency department (ED) visits an assessment of 14 adverse childhood experiences. resulting from increased continuity of care provided in Medical records relating to childhood were also a pediatric medical home. METHODS: An economic examined for those subjects. RESULTS: The modeling study comparing the cost of ED visits prevalence of self-reported adverse childhood associated with average continuity of care versus the experiences was greatest in adult subjects with current cost of ED visits associated with a 10% point increase chronic widespread pain. Exposure to illness in family in continuity was performed. This model's premise is members, parental loss, operations, and abuse were all that increased continuity will decrease care in the ED. associated with increased, but nonsignificant, odds of Parameters of the model included average continuity of having chronic widespread pain versus those without care and expected use of the ED by pediatric patients such exposures. However the only statistically as well as the relationship between these two variables. significant association was with childhood Parameters were estimated from the literature. Average hospitalizations. From medical record information the continuity, as measured by the Continuity of Care associations of hospitalizations (OR 5.1, 95% CI 2.0- Index by Bice and Boxerman, was determined to be 13.0) and operations (OR 3.0, 95% CI 1.2-7.2) with 40%. Average ED use was estimated to be 0.68 pain previously noted were partly explained by visits/child per year. Continuity of care was stratified differential recall between subjects with and without into low, medium, and high levels. The Medical pain: hospitalizations, OR 2.2, 95% CI 0.9-5.5; University of South Carolina's ED charges were used. operations, OR 1.2, 95% CI 0.5-3.4. CONCLUSION: An average pediatric practice was estimated to contain Although several reported adverse events in childhood 2000 patients. RESULTS: Two hypothetical practices were observed to be associated with chronic of 2000 patients each were created to represent widespread pain in adulthood, only reports of pediatric medical homes: practice 1 received 40% hospitalizations were significantly associated. continuity and practice 2 received 50%. The model's Validation of self-reported exposures suggests that outcome was measured in terms of expected ED there was differential recall of past events among those charges per practice averted over a 1-year period. with and without pain, and this differential recall Increasing continuity of care by 10% points yielded a explained the association between hospitalizations and decline in expected ED visits from 1362 to 1290 per current chronic pain. Such differential recall may practice: 19,905 US dollars was saved. explain other observations of an association between CONCLUSION: Continuity of care can yield many reports of adverse childhood events and chronic pain in benefits, including cost savings from decreased charges adulthood. associated with less frequent ED use. McBurnett K, Kerckhoff C, Capasso L et al. Antisocial McCabe KM, Hough R, Wood PA, Yeh M. Childhood and personality, substance abuse, and exposure to parental adolescent onset conduct disorder: a test of the violence in males referred for domestic violence. developmental taxonomy. J Abnorm Child Psychol Violence Vict 2001; 16(5):491-506. 2001; 29(4):305-16. Abstract: This study investigated whether childhood Abstract: Hypotheses generated by a developmental disruptive behavior (hyperactivity, oppositional- taxonomy that distinguishes between childhood and defiance, conduct problems) plus adult psychopathic adolescent onset conduct disorders were tested. adjustment are associated with domestic violence. Hypotheses predicted that (1) individual and familial Adult males (n = 66) in diversion programs completed factors would be more strongly related to childhood the Wender Utah Rating Scale (WURS), MMPI onset conduct disorder, whereas ethnic minority status Psychopathic Deviate scale (PD), Conflict Tactics and exposure to deviant peers would be more strongly Scales representing themselves and their parents, and related to adolescent onset conduct disorder and (2) substance use measures. Substance use and lifespan individuals with childhood onset disorder would be antisocial personality (measured by high WURS and more likely to commit violent and victim oriented PD scores) were robust predictors of verbal and offenses than individuals with adolescent onset conduct moderate physical domestic abuse. Violence in the disorder. The first hypothesis was strongly supported family of origin was associated with abuse when tested and the second hypothesis was partially supported. alone, but failed to exhibit unique association with Implications for early identification of youth at risk for abuse when other predictors were taken into account. chronic offending are discussed. The possibility that antisocial batterers respond to contingencies by moderating physical harm, while McCabe KM, Lansing AE, Garland A, Hough R. Gender persisting at psychological harm, is discussed. differences in psychopathology, functional impairment, and familial risk factors among adjudicated 698
- 707. delinquents. J AmAcad Child Adolesc Psychiatry may improve mothers' confidence in the adequacy of 2002; 41(7):860-7. their milk supply. Abstract: OBJECTIVE: To test the hypotheses that female juvenile delinquents would have higher rates of McClelland GM, Elkington KS, Teplin LA, Abram KM. psychological symptoms, DSM-IVpsychiatric and Multiple substance use disorders in juvenile detainees. substance use disorders, functional impairment, and J Am Acad Child Adolesc Psychiatry 2004; familial risk factors than male juvenile delinquents. 43(10):1215-24. METHOD: A stratified random sample of adjudicated Abstract: OBJECTIVE: To estimate the 6-month delinquents (n = 513 males, n = 112 females) was prevalence of multiple substance use disorders (SUDs) drawn from San Diego County administrative among juvenile detainees by demographic subgroups databases. Of those sampled youths who could be (sex, race/ethnicity, age). METHOD: Participants were located, 65.7% completed interviews. Psychological a randomly selected sample of 1,829 African symptoms, DSM-lVdiagnoses, and familial risk factors American, non-Hispanic white, and Hispanic detainees were assessed between October 1997 and January (1,172 males, 657 females, aged 10 to 18). Patterns and 1999. RESULTS: Female delinquents scored higher on prevalence of DSM-III-R multiple SUDs were assessed parent and self-report measures of psychological using the Diagnostic Interview Schedule for Children symptoms and had higher rates of DSM-IVmental Version 2.3. The authors used two-tailed F and t tests disorders than did male delinquents. Girls also with an alpha of .05 to examine combinations of SUDs experienced greater incidences of physical, emotional, by sex, race/ethnicity, and age. RESULTS: Nearly half and sexual abuse; physical neglect; and family history of the detainees had one or more SUDs; more than of mental illness than their male counterparts. No 21% had two or more SUDs. The most prevalent gender differences were found on parental ratings of combination of SUDs was alcohol and marijuana use youth functional impairment, substance use disorders, disorders (17.25% females, 19.42% males). Among comorbidity, or parental history of antisocial behavior. detainees with any SUD, almost half had multiple CONCLUSIONS: Findings indicated that female SUDs. Among detainees with alcohol use disorder, adjudicated delinquents have significantly higher rates more than 80% also had one or more drug use of psychopathology, maltreatment history, and familial disorders. Among detainees with a drug use disorder, risk factors than males and suggest that the mental approximately 50% also had an alcohol use disorder. health needs of girls in juvenile justice deserve CONCLUSIONS: Among detained youths with any increased attention. SUD, multiple SUDs are the rule, not the exception. Substance abuse treatments need to target detainees McCarter-Spaulding DE, Kearney MH. Parenting self- with multiple SUDs who, upon release, return to efficacy and perception of insufficient breast milk. J communities where services are often unavailable. Obstet Gynecol Neonatal Nurs 2001; 30(5):515-22. Clinicians can help ensure continuity of care by Abstract: OBJECTIVE: Insufficient breast milk is a working with juvenile courts and detention centers. major reason why mothers give up breastfeeding and may be related to low levels of maternal confidence. McCloskey KA, Raphael DN. Adult perpetrator gender This study explored the relationship between parenting asymmetries in child sexual assault victim selection: self-efficacy (PES) and perception of insufficient results from the 2000 National Incident-Based Report breast milk. DESIGN: Cross-sectional descriptive System. J Child Sex Abus 2005; 14(4):1-24. correlational study. SETTING: Four private primary Abstract: Data from the 2000 National Incident-Based care pediatric practices in the northern United States. Reporting System (NIBRS) show that while males PARTICIPANTS: Sixty breastfeeding mothers of make up about nine out of every 10 adult sexual assault infants ages 1 to 11 weeks. PROCEDURES: Mothers perpetrators, totaling about 26,878 incidents within the were recruited during well-baby pediatric visits. They reporting period, females account for about one out of returned completed questionnaires by mail. Data were 10 perpetrators, totaling about 1,162 incidents. Male analyzed using descriptive statistics, t tests, and sexual assault perpetrators offend against child victims multiple regression analysis. MAIN OUTCOME about 25% of the time and predominantly choose MEASURE: The Perception of Insufficient Milk (PIM) female child victims, whereas female perpetrators questionnaire, an investigator-developed instrument. offend against child victims about 40% of the time and RESULTS: There was a significant correlation (r = choose child victims of both genders equally. Male .487, p < .01) between the self-efficacy and perceived perpetrators offend against adolescent victims about insufficient milk scores. Regression analysis revealed 40% of the time, and once again tend to choose female that 23% of the variance in PIM was explained by PES, adolescent victims. Female perpetrators offend against after maternal age, education, and parity had been adolescent victims a comparable amount of time (about taken into account. CONCLUSIONS: Although further 45%), and for forcible offenses (rape, sodomy, sexual research is needed to refine the measurement of assault with an object, and forcible fondling) choose perceived insufficient milk and differentiate adolescent victims of both genders equally, while for breastfeeding self-efficacy from general parenting self- non-forcible offenses (non-forcible incest and statutory efficacy, nursing interventions to enhance self-efficacy rape) they tend to choose predominantly male victims. 699
- 708. Finally, adult malesexual assault perpetrators choose Today Int Midwife 2002; (62):25. adult victims about 36% of the time while female perpetrators choose adult victims only 16% of the time. McCullough LB. A framework for the ethically justified Implications for professionals are discussed, including clinical management of intersex conditions. Adv Exp recommendations to aid in correct identification of Med Biol 2002; 511:149-65; discussion 165-73. adult perpetrators and child/adolescent victims of sexual assault. McDermott BM, Jaffa T. Eating disorders in children and adolescents: an update. Curr Opin Psychiatry 2005; McCloskey LA, Stuewig J. The quality of peer relationships 18(4):407-10. among children exposed to family violence. Dev Abstract: PURPOSE OF REVIEW: Children and Psychopathol 2001; 13(1):83-96. adolescents with eating disorders frequently present to Abstract: Three hundred sixty-three school-aged child mental health and paediatric services and have children from maritally violent and nonviolent families significant morbidity, psychosocial impairment and were interviewed about their friendship networks, mortality. Efforts to treat these individuals have been frequency of social contact, the interpersonal quality of hampered by a poor evidence base for effective their friendships, and hostile attributional biases. interventions. This article reviews research published Mothers answered items from the Child Behavior during 2004 with a primary focus on this challenging Checklist about peer conflict. Children did not differ on clinical area. RECENT FINDINGS: Research the number of friends they claimed or their frequency published during 2004 has replicated past of contact with peers. However, children exposed to epidemiological findings and expanded our marital violence reported feeling more lonely and understanding of the relationship of family meal having more conflict with a close friend. Their mothers structure and disordered eating. Research has provided also reported them as having more problems with assistance in the well known clinical conundrums of peers. In addition, children with punitive mothers had excessive exercising in anorexia nervosa and predicting more conflict with a best friend. Residing in a shelter when return of menses will occur. There has also been added further to children's feelings of loneliness, with clarification of adolescent bingeing. Potential advances one third having no best friend. Children's attributional include a new, noninvasive method of measuring body biases were unrelated to the quality of their peer composition and investigations in adolescents on relations or any other index of peer functioning. leptin, neuro and gastrointestinal peptides. Importantly, Results are discussed in terms of an attachment further evidence of the effectiveness of family therapy framework. Findings confirm that it is important to for anorexia nervosa and short-term benefits from examine the quality of relationships to determine how intervention programs have been published. children at risk fare in their social lives. SUMMARY: The research base that will influence clinical practice in child and adolescent eating McCoy ML. Factors impacting the assessment of maternal disorders is increasing. More research is required in all culpability in cases of alleged fetal abuse. J Drug Educ areas of intervention. 2003; 33(3):275-88. Abstract: These studies explored attitudes toward McDonald EM, Solomon B, Shields W et al. Evaluation of maternal culpability in cases of alleged fetal abuse. In kiosk-based tailoring to promote household safety experiment one, general culpability for the use of behaviors in an urban pediatric primary care practice. various substances during pregnancy was assessed as Patient Educ Couns 2005; 58(2):168-81. well as the impact of other potentially relevant factors. Abstract: We tested a kiosk-based tailoring One hundred and twenty students completed the intervention with a sample of 144 parents of young survey. Participants overwhelmingly supported treating children using a two-group randomized controlled drug use by pregnant women as a criminal offense. design to evaluate the kiosk. Intervention group parents With regard to the assessment of more specific (n = 70) answered 50 questions at a practice-based questions, the lack of consensus regarding what factors kiosk and they and their child's physician received effect culpability is striking. Experiment two examined immediate feedback reports of their injury prevention the possible impact of the mothers' race (White or needs. Four weeks later, both control (n = 74) and Black) and social class (Poor or Middle class) on the intervention parents completed a telephone interview. assessment of culpability. One hundred and sixty-four Safety knowledge, beliefs, and practices were community members responded to a survey sent to compared at follow-up. Compared to control group randomly selected persons in upstate South Carolina. parents, intervention group parents were more The results indicate that at least in response to a brief, knowledgeable about the inappropriateness of young written, case scenario, neither race nor social class children riding in the front seat of a car (16% versus make a large impact on participants' sanction 5%, p < 0.05), less likely to believe that teaching a recommendations. child to mind you is the best way to prevent injuries (64% versus 86%, p < 0.05), and more likely to report McCracken L. A freedom chain of women. Midwifery that they "have syrup of ipecac" (34% versus 9%, p < 700
- 709. 0.001) and "knowhow to use" it (24% versus 4%, p < low TB incidence, frequently among groups whose 0.002). This study provides further support for the use drug use or other illegal activities complicate control of tailored communication to address the prevention of efforts. TB programs should consider the use of injuries to young children but calls for continued network analysis as a supplement to routine contact investigation in the area. investigations to identify unrecognized patterns of M. tuberculosis transmission. McDougle CJ, Stigler KA, Posey DJ. Treatment of aggression in children and adolescents with autism and McEvoy M, Lee C, O'Neill A et al. Are there universal conduct disorder. J Clin Psychiatry 2003; 64 Suppl parenting concepts among culturally diverse families in 4:16-25. an inner-city pediatric clinic? J Pediatr Health Care Abstract: The optimal clinical management of 2005; 19(3):142-50. aggression in children and adolescents involves both Abstract: INTRODUCTION: Cultural competence is behavioral and pharmacologic intervention strategies. necessary in providing care to culturally diverse This article reviews medication treatments for families. Numerous studies have emphasized youngsters with autistic disorder and conduct disorder, similarities and differences between predetermined conditions for which the pharmacologic management cultural groups, yet few have studied groups across of aggression is often necessary. Efficacy results and cultures. This project aimed to investigate parenting associated adverse effects from selected clinical trials concepts, which in this context pertains to philosophy of most classes of psychotropic medications are of parenting and child care practices across cultures. discussed. While preliminary progress has been made METHOD: Using a grounded theory approach, in the development of medication treatments for these ethnographic interviews of 46 families representing 27 serious disorders of youth, additional controlled countries were taped, transcribed, and analyzed. research and longitudinal studies are needed to better RESULTS: Similarities in parenting concepts were understand the efficacy and tolerability of currently found among families. Teaching values and respect and available compounds within each diagnostic group. the need for strict discipline were important. A sense of community, family, and spirituality/religion was McDowell BM. Volunteering--a community partnership. J strong. Television was viewed as educational and Spec Pediatr Nurs 2002; 7(3):121-2. parents anticipated opportunities for jobs and higher education for their children. Parents were more McElroy PD, Rothenberg RB, Varghese R et al. A network- inclined to use medical treatments than home remedies informed approach to investigating a tuberculosis for acute illnesses, which may have been linked to the outbreak: implications for enhancing contact finding that their providers had a strong influence. investigations. Int J Tuberc Lung Dis 2003; 7(12 Suppl Parents feared children playing alone outdoors; 3):S486-93. distrusted nonfamily babysitters; and felt conflicted Abstract: BACKGROUND: To elucidate networks of between a desire for cultural preservation versus Mycobacterium tuberculosis transmission, it may be assimilation. DISCUSSION: Universal concepts in appropriate to characterize the types of relationships parenting philosophies and practices exist among among tuberculosis (TB) cases and their contacts (with culturally diverse families. Providers may approach and without latent TB infection) in addition to relying anticipatory guidance by addressing global parental on traditional efforts to distinguish 'close' from 'casual' concerns that transcend culture in order to relieve time contacts. SETTING: A TB outbreak in a US low constraints and the overwhelming task of being incidence state. OBJECTIVE: To evaluate whether knowledgeable about all cultures. social network analysis can provide insights into transmission settings that might otherwise go McFarlane A, Clark CR, Bryant RA et al. The impact of unrecognized by routine practices. DESIGN: All adult early life stress on psychophysiological, personality outbreak-associated cases (n = 19) and a convenience and behavioral measures in 740 non-clinical subjects. J sample of their contacts with and without latent TB Integr Neurosci 2005; 4(1):27-40. infection (LTBI) (n = 26) were re-interviewed in 2001 Abstract: Early Life Stress (ELS) has been associated using a structured questionnaire. Network analysis with a range of adverse outcomes in adults, including software was used to create diagrams illustrating abnormalities in electrical brain activity [1], personality important persons within the outbreak network, as well dimensions [40], increased vulnerability to substance as types of activities TB cases engaged in with their abuse and depression [14]. The present study seeks to contacts. RESULTS: Drug use and drug sharing were quantify these proposed effects in a large sample of more commonly reported among cases and their non-clinical subjects. Data for the study was obtained infected contacts than among contacts without LTBI. from The Brain Resource International Database (six TB cases central to the outbreak network used crack laboratories: two in USA, two in Europe, two in cocaine, uncovering the need to focus control efforts on Australia). This study analyzed scalp specific sites and persons involved in illicit drug use. electrophysiological data (EEG eyes open, closed and CONCLUSION: Outbreaks occur even in areas with target auditory oddball data) and personality (NEO- FFI), history of addictive substance use and ELS) data 701
- 710. that was acquiredfrom 740 healthy volunteers. The McGeary J. The costs of penance. Time 2002; 159(12):53-4. ELS measures were collected via a self-report measure and covered a broad range of events from childhood McGee R, Williams S, Nada-Raja S. Is cigarette smoking sexual and physical abuse, to first-hand experience of associated with suicidal ideation among young people? traumatizing accidents and sustained domestic conflict Am J Psychiatry 2005; 162(3):619-20. [41]. Analysis of covariance, controlling for age and Abstract: OBJECTIVE: The authors examined the gender, compared EEG data from subjects exposed to association between suicidal ideation in early ELS with those who were unexposed. ELS was adulthood and daily tobacco smoking in a community associated with significantly decreased power across sample of adolescents. METHOD: Participants were the EEG spectrum. The between group differences enrolled in a longitudinal study of health and were strongest in the eyes closed paradigm, where development. The factors of disadvantage, subjects who experienced ELS showed significantly impulsiveness, stress, depressed mood, tobacco reduced beta (F1,405=12.37, p=.000), theta smoking, other substance use, and parental attachment (F1,405=20.48, p=.000), alpha (F1,405=9.65, p=.002) were included in multivariate modelling of suicidal and delta power (F1,450=36.22, p=.000). ELS exposed ideation. RESULTS: Data on tobacco use were subjects also showed a significantly higher alpha peak available for 764 participants. Early tobacco smoking frequency (F1,405=6.39, p=.012) in the eyes closed was significantly predictive of later suicidal ideation, paradigm. Analysis of covariance on ERP components but there was no longer a significant relationship when revealed that subjects who experienced ELS had high levels of stress and depression and low levels of significantly decreased N2 amplitude (F1,405=7.73, parental attachment in adolescence were included in p=.006). Analyses of variance conducted on measures the multivariate model. CONCLUSIONS: Tobacco of personality revealed that subjects who experienced smoking in adolescence does not appear to elevate the ELS had significantly higher levels of neuroticism risk of later suicidal ideation. (F1,264=13.39, p=.000) and openness (F1,264=17.11, p=.000), but lower levels of conscientiousness, than McGillicuddy NB, Rychtarik RG, Morsheimer ET. controls (F1,264=4.08, p=.044). The number of ELS Psychometric evaluation of the parent situation events experienced was shown to be a significant inventory: a role-play measure of coping in parents of predictor of scores on the DASS questionnaire [27], substance-using adolescents. Psychol Assess 2004; which rates subjects on symptoms of depression 16(4):386-90. (F3,688=16.44, p=.000, R2=.07), anxiety Abstract: This article reports on the generalizability, (F3,688=14.32, p=.000, R2=.06) and stress reliability, and construct validity of the Parent Situation (F3,688=20.02, p=.000, R2=.08). Each additional early Inventory (PSI), a role-play measure of coping skills in life stressor was associated with an increase in these parents experiencing problems from an adolescent's scores independent of age, gender and the type of drug and alcohol use. Generalizability was robust (.80) stressor. Furthermore, the number of ELS experiences and alternate form and test-retest reliability were among smokers was also found to be a positive satisfactory. PSI skillfulness was negatively related to predictor of the nicotine dependency score (Faegstrom the parent's own substance use and to the adolescent's Test For Nicotine Dependence, [19]) (F3,104=10.99, alcohol use. The PSI shows promise as a reliable and p=.000, R2=.24), independent of age, gender and type potentially valid measure of coping in this population of stressor. In conclusion, we highlight the impact of a and has direct implications for developing and history of ELS showed significant effects on brain evaluating skill-based parent training programs. function (EEG and ERP activity), personality dimensions and nicotine dependence. McGinn D. Father fixit. Newsweek 2002; 139(19):42-3. McGarvey TP, Haen C. Intervention strategies for treating McGlade MS, Saha S, Dahlstrom ME. The Latina paradox: traumatized siblings on a pediatric inpatient unit. Am J an opportunity for restructuring prenatal care delivery. Orthopsychiatry 2005; 75(3):395-408. Am J Public Health 2004; 94(12):2062-5. Abstract: This article examines the course of treatment Abstract: Latina mothers in the United States enjoy for 2 traumatized siblings in an acute inpatient child surprisingly favorable birth outcomes despite their psychiatric unit following severe physical abuse by social disadvantages. This "Latina paradox" is their mother. In treating these 2 boys, the authors used particularly evident among Mexican-born women. The intervention strategies that can be applied to the social and cultural factors that contribute to this treatment of other traumatized siblings in institutional paradox are maintained by community networks-- settings. Issues of self-worth, survivor guilt, and informal systems of prenatal care that are composed of conflictual sibling dynamics are illustrated as they family, friends, community members, and lay health relate to the treatment. In addition, transference- workers. This informal system confers protective countertransference dynamics are examined. factors that provide a behavioral context for healthy births. US-born Latinas are losing this protection, McGeary D. Editorial board's eye view. Emerg Nurse 2003; although it could be maintained with the support of 11(2):9. 702
- 711. community-based informal caresystems. We oppositional defiant disorder contributed to risk for recommend steps to harness the benefits of informal depression and anxiety. ADHD was not a significant systems of prenatal care in Latino communities to meet risk factor for substance use disorders when male sex, the increasing needs of pregnant Latina women. disruptive behavior disorders, and socioeconomic status were controlled. CONCLUSIONS: Adult ADHD McGoodwin L, McKeown T. Poisoning trends and the is associated with significant lifetime psychiatric importance of educating patients about poison comorbidity that is not explained by clinical referral prevention. J Okla State Med Assoc 2004; 97(3):127- bias. 30. Abstract: Medical professionals are recognized as a McGreevy D. Risks and benefits of the single versus the vital link in communities for education and treatment triple MMR vaccine: how can health professionals of poisoning exposures. The Oklahoma Poison Control reassure parents? J R Soc Health 2005; 125(2):84-6. Center (OPCC) is a resource for medical professionals Abstract: Measles, mumps and rubella (MMR) are all as well as the public. Nationally and in Oklahoma, preventable but infectious diseases caused by viruses. among all age groups, analgesics are responsible for A particular study by Wakefield et al suggests that the most fatalities. Trends in common exposures in the there are potentially adverse effects of having the triple age 5 and younger age group and the 13 through 19 age MMR vaccine. This has been reported widely by the group, an acetaminophen protocol, information about media and has caused alarm to parents of young the poison center and HIPPA privacy regulations, children, probably contributing to the decline in its poison prevention tips and where to obtain educational uptake. In order to provide the context for the debate materials are outlined. National Poison Prevention regarding the single versus the triple vaccine, this paper Week, March 21-27, 2004, is an excellent time to briefly appraises firstly, the Wakefield et al research educate all age groups about poison prevention paper that has led to public health concerns and techniques and what to do when there is a poisoning secondly, a more rigorous research study (Madsen et emergency. Board certified toxicologists, pharmacists al) that contradicts the findings; the paper then explores and registered nurses are available 24 hours a day, 7 the risks and benefits of the single and the triple MMR days a week by calling 1-800-222-1222. vaccine programmes, finally providing a short discussion on factors that might influence the decision- McGough JJ, Smalley SL, McCracken JT et al. Psychiatric making process by parents when faced with the comorbidity in adult attention deficit hyperactivity dilemma of not having their child vaccinated, or opting disorder: findings from multiplex families. Am J for either the single or triple vaccination programme. Psychiatry 2005; 162(9):1621-7. Abstract: OBJECTIVE: Patterns of psychiatric McHaffie HE, Fowlie PW, Hume R, Laing IA, Lloyd DJ, comorbidity were assessed in adults with and without Lyon AJ. Consent to autopsy for neonates. Arch Dis attention deficit hyperactivity disorder (ADHD) Child Fetal Neonatal Ed 2001; 85(1):F4-7. identified through a genetic study of families Abstract: OBJECTIVES: To determine parents' views containing multiple children with ADHD. METHOD: on autopsy after treatment withdrawal. DESIGN: Face Lifetime ADHD and comorbid psychopathology were to face interviews with 59 sets of bereaved parents (108 assessed in 435 parents of children with ADHD. Rates individual parents) for whose 62 babies there had been and mean ages at onset of comorbid psychopathology discussion of treatment withdrawal. RESULTS: All were compared in parents with lifetime ADHD, parents except one couple were asked for permission for with persistent ADHD, and those without ADHD. Age- postmortem examination; 38% refused. The main adjusted rates of comorbidity were compared with reasons for declining were concerns about Kaplan-Meier survival curves. Logistic regression was disfigurement, a wish to have the child left in peace, used to assess additional risk factors for conditions and a feeling that an autopsy was unnecessary because more frequent in ADHD subjects. RESULTS: The the parents had no unanswered questions. The parents with ADHD were significantly more likely to diagnosis, the age of the child, and the approach of the be unskilled workers and less likely to have a college consultant appeared to influence consent rates. Of degree. ADHD subjects had more lifetime those who agreed to autopsies, 92% were given the psychopathology; 87% had at least one and 56% had at results by the neonatologist concerned. Whether or not least two other psychiatric disorders, compared with they had agreed to the procedure, at 13 months no 64% and 27%, respectively, in non-ADHD subjects. parent expressed regrets about their decision. ADHD was associated with greater disruptive CONCLUSIONS: Autopsy rates in the East of behavior, substance use, and mood and anxiety Scotland stand at 62%. Parents' perceptions are an disorders and with earlier onset of major depression, important element in consent to postmortem dysthymia, oppositional defiant disorder, and conduct examination. disorder. Group differences based on Kaplan-Meier age-corrected risks were consistent with those for raw McHaffie HE, Laing IA, Parker M, McMillan J. Deciding frequency distributions. Male sex added risk for for imperilled newborns: medical authority or parental disruptive behavior disorders. Female sex and 703
- 712. autonomy? J MedEthics 2001; 27(2):104-9. Abstract: OBJECTIVE: This article provides a clinical Notes: GENERAL NOTE: KIE: McHaffie, Hazel E; perspective on the combined impacts on children of Laing, Ian A; Parker, Michael; McMillan, John spousal violence in the home and the absence of GENERAL NOTE: KIE: 13 refs. attuned parental thought that accompanies it. GENERAL NOTE: KIE: KIE Bib: allowing to METHODS: This article takes the form of a die/infants commentary, drawing on clinical case studies and Abstract: The ethical issues around decision making on research literature to illustrate the child's experience of behalf of infants have been illuminated by two "unthinking," nonreflective parental states of mind, empirical research studies carried out in Scotland. In- from the point of witnessing violence through to depth interviews with 176 medical and nursing staff contact arrangements post-separation. Parallel and with 108 parents of babies for whom there was dynamics and impacts are discussed with caregiving discussion of treatment withholding/withdrawal, and legislative systems. RESULTS: The article generated a wealth of data on both the decision making suggests that "unthinking" states of mind in parents can process and the management of cases. Both staff and be as damaging for a child as the overt witnessing and parents believe that parents should be involved in experiencing of violence. CONCLUSIONS: The treatment limitation decisions on behalf of their babies. prevention or early overturning of unthinking states of However, whilst many doctors and nurses consider the mind, in and out of the home, greatly influences the ultimate responsibility too great for families to carry, nature of a child's recovery from domestic violence. the majority of parents wish to be the final arbiters. We offer explanations for the differences in perception McKay MM, Atkins MS, Hawkins T, Brown C, Lynn CJ. found in the two groups. The results of these empirical Inner-city African American parental involvement in studies provide both aids to ethical reflection and children's schooling: racial socialization and social guidance for clinicians dealing with these vulnerable support from the parent community. Am J Community families. They demonstrate the value of empirical data Psychol 2003; 32(1-2):107-14. in the philosophical debate. Abstract: Parents (n = 161) and teachers (n = 18) from an urban elementary school serving primarily African McHugh K. Neuroimaging in non-accidental head injury: if, American children completed questionnaires regarding when, why and how. Clin Radiol 2005; 60(7):826-7; racial socialization, social support, and involvement in author reply 827-8. activities that support youth educational achievement at home and school. Parental reports of racism awareness, McInnes RJ, Stone DH. The process of implementing a and contact with school staff were significantly community-based peer breast-feeding support correlated with parent reports of at-home involvement programme: the Glasgow experience. Midwifery 2001; and at-school involvement. Parent reports of social 17(1):65-73. support from the parent community were significantly Abstract: AIM: to document the process of related to at-home involvement only. Relative to implementing and maintaining a community-based teacher reports, parents reported more formal contacts peer-support programme. DESIGN AND SETTING: a with school staff, and higher levels of racism community-based study located in a socio- awareness, religiosity, and African American cultural economically disadvantaged housing estate on the pride. Teachers and parents agreed on school climate outskirts of Glasgow. PARTICIPANTS: pregnant and parental levels of at-home and at-school women residing in a target postcode area. involvement. The results suggest that racial INTERVENTION: a programme of peer counselling socialization processes are related to parent and support for breast feeding, comprising antenatal involvement in children's schooling and that increased and postnatal home visits over a period of three years. efforts are needed to bridge a cultural gap between IMPLICATIONS FOR PRACTICE: peer support may parents and teachers in inner-city communities. provide an acceptable and appropriate role model for breast-feeding mothers. However, further research is McKee TE, Harvey E, Danforth JS, Ulaszek WR, Friedman required on other influential factors such as the social JL. The relation between parental coping styles and network and the impact of this programme on the peer parent-child interactions before and after treatment for supporter. CONCLUSIONS: despite a low prevalence children with ADHD and oppositional behavior. J Clin of breast feeding, initiating and maintaining peer Child Adolesc Psychol 2004; 33(1):158-68. breast-feeding support was possible. Peer support Abstract: This study examined the relation between appeared to be acceptable to mothers and health parental coping styles, discipline, and child behavior professionals. Study mothers spoke enthusiastically of before and after participating in a parent training the intervention and mentioned increased confidence program for parents of children with Attention- and self-esteem. Deficit/Hyperactivity Disorder (ADHD) and oppositional behavior. For mothers, use of more McIntosh JE. Thought in the face of violence: a child's need. maladaptive and less adaptive coping styles was related Child Abuse Negl 2002; 26(3):229-41. to more self-reported lax and overreactive discipline, more observed coercive parenting, and more observed 704
- 713. child misbehavior priorto parent training. No adolescents: is there evidence of specificity? J Child significant relations were found for mothers following Psychol Psychiatry 2003; 44(1):107-33. parent training after controlling for pretreatment Abstract: Research on the relations between specific variables. For fathers, use of more maladaptive and less stressors and specific psychological outcomes among adaptive coping styles was related to self-reported lax children and adolescents is reviewed. Specificity, the discipline before and after parent training. Contrary to notion that particular risk factors are uniquely related prediction, fathers who reported less seeking support to particular outcomes is discussed from a theoretical and adaptive-focused coping showed the most perspective, and models of specificity are described. improvement in their children's behavior. Most results Several domains of stressors are examined from a remained significant after controlling for self-reported specificity framework (e.g., exposure to violence, depression. Implications for improving parent training abuse, and divorce/marital conflict) in relation to research and programs were discussed. broad-band outcomes of internalizing and externalizing symptoms. Studies that tested for specificity conducted McKeever P, Miller KL. Mothering children who have within the past 15 years are examined, and definitional disabilities: a Bourdieusian interpretation of maternal problems are highlighted. Little evidence for specificity practices. Soc Sci Med 2004; 59(6):1177-91. was found. Methodological problems in the literature Abstract: In the last three decades, mothers of children and the lack of theory-driven specificity research are who have chronic illnesses or disabilities have been discussed, and directions for future research are studied extensively. With some notable exceptions, identified. most research has overlooked the socio-political context of disability and has interpreted maternal McMurray A. Domestic violence: conceptual and practice behaviours and feelings in negative or issues. Contemp Nurse 2005; 18(3):219-32. psychopathological terms. In this paper we report the Abstract: This article analyses the conceptual issues results of using Pierre Bourdieu's central concepts to surrounding domestic violence against women, reanalyse three independent qualitative studies focused including the lack of clarity in identifying accurate on mothers' accounts of raising children with severe prevalence rates, and the affect of domestic violence on disabling conditions. We illustrate the logic of mothers' other family members. Research conducted in Australia practices and conclude that they represent strategic and overseas provides an evidence base for the manipulations of accessible bodily, cultural and contention that violence against women is a serious symbolic capital consistent with the 'rules of the game' problem for healthcare and society, and should be across multiple fields. Mothers struggled to establish addressed comprehensively in both the healthcare and and maintain the personhood and value of their socio-legal context to protect the woman and the children, and to obtain resources within a broader family. It is argued that solutions to the problem rely context of body normativeness, exclusion and inequity. on knowledge and understanding of gender relations, This Bourdieusian rendering of the logic of maternal cultural factors, the psychology of intimate partner practices has important implications for research and attachments and the socio-legal system, particularly for paediatric practices. separating couples. Recommendations for best practice in helping victims of violence are provided. McKenzie B, Bacon B. Parent education after separation: results from a multi-site study on best practices. Can J McNally RJ, Clancy SA, Schacter DL. Directed forgetting of Commun Ment Health 2002; (4 Suppl):73-88. trauma cues in adults reporting repressed or recovered Abstract: Although parent education after separation in memories of childhood sexual abuse. J Abnorm Canada is relatively new, most provinces and territories Psychol 2001; 110(1):151-6. now have some type of program that provides Abstract: An item-cuing directed forgetting task was separating parents with information on their children's used to investigate whether women reporting repressed needs, co-parenting options, and strategies for (n = 13) or recovered (n = 13) memories of childhood improving communication. A 1999-2000 survey of sexual abuse (CSA) exhibit an avoidant encoding style parents in 10 such program sites throughout Canada: (and resultant impaired memory) for trauma cues (a) demonstrates a high level of parent satisfaction with relative to women reporting no CSA experience (n = the programs, (b) chronicles benefits related to reduced 15). All participants viewed intermixed trauma (e.g., conflict and improved child well-being 3 to 4 months molested), positive (e.g., confident), and categorized following program attendance, and (c) identifies neutral (e.g., mailbox) words on a computer screen and several implications for best practices. Results of this were instructed either to remember or to forget each study suggest that parent education is but one program word. The results provided no support for the within a network of services needed to support both hypothesis that people reporting either repressed or parents and children after separation. recovered memories of CSA are especially adept at forgetting words related to trauma. These groups McMahon SD, Grant KE, Compas BE, Thurm AE, Ey S. recalled words they were instructed to remember more Stress and psychopathology in children and often than words they were instructed to forget regardless of whether they were trauma related. 705
- 714. McNaughton DB. Nursehome visits to maternal-child turn to if they were the child in the story. RESULTS: clients: a review of intervention research. Public Health Consistency in the data indicated that the children Nurs 2004; 21(3):207-19. could reliably discriminate between different Abstract: Home visiting has been considered a relationships in terms of the support functions they promising strategy for addressing the multiple needs of serve. Pets were often ranked higher than certain kinds families at risk. Research reviews are a valuable of human relationship, and they featured prominently resource for researchers, policymakers, and as providers of comfort, esteem support and confidants practitioners who develop and support new home- for a secret. Confidence in these findings is gained visiting interventions. This review examines 13 through pets not being nominated for functions they research studies published between the years of 1980 could not realistically perform. and 2000 that test the effectiveness of home-visiting interventions using professional nurses as home McPhee J, Stewart C. Recent developments in law. J Bioeth visitors. Findings indicate that a wide range of client Inq 2005; 2(2):63-8. problems are addressed during home visits using a Notes: GENERAL NOTE: KIE: KIE Bib: bioethics variety of nursing interventions. Missing from most of the reports is a clear theoretical link between the client McPhee J, Stewart C. Recent developments in law. J Bioeth problem addressed, the nursing intervention, and target Inq 2005; 2(1):4-9. outcomes. About half of the studies were successful in Notes: GENERAL NOTE: KIE: KIE Bib: bioethics achieving desired outcomes. Future research should be directed by middle-range practice theory, clearly McPherson ML, Lairson DR, Smith EO, Brody BA, explicate the nursing intervention being tested, use Jefferson LS. Noncompliance with medical follow-up power analysis to determine sample size, and report after pediatric intensive care. Pediatrics 2002; reliability and validity of dependent variable measures 109(6):e94. with culturally diverse samples. Abstract: OBJECTIVES: To describe the medical follow-up ordered, the health care utilization, the McNeil-Haber FM. Ethical considerations in the use of appointment compliance, and the risk factors nonerotic touch in psychotherapy with children. Ethics associated with noncompliance in patients who are Behav 2004; 14(2):123-40. discharged after a pediatric intensive care unit (PICU) Notes: GENERAL NOTE: KIE: 35 refs. stay. METHODS: A prospective, analytic, cohort study GENERAL NOTE: KIE: KIE Bib: patient care/minors; of 111 critically ill children, age 1 day to 16 years, who professional patient relationship were admitted to a 30-bed PICU in an urban, tertiary- Abstract: Although touch frequently occurs in care, pediatric teaching hospital compared children psychotherapy with children, there is little written on who were compliant with medical follow-up with those the ethical considerations of therapeutic touch. Because who were not. The main outcomes measured were physical contact does occur, therapists must consider if, emergent and unscheduled physician visits during the how, and when it is used, for both their clients' safety first 6 weeks after hospital discharge; compliance with and their own. In this review, I further develop the ordered medical follow-up after hospital discharge; and issues suggested by Aquino and Lee (2000) in the use comparisons of socioeconomic, demographic, and of nurturing touch in therapy by considering many medical need factors between compliant and types of touch that occur in psychotherapy with noncompliant children. Discharge orders for follow-up children; the possible positive role of touch; clients' appointments with general pediatricians and perception of touch in therapy; considerations related subspecialists were collected from the chart at hospital to the therapist, the child's safety, and any history of discharge. Patients were contacted after hospital abuse in the child's and family's background; and other discharge to determine whether and when they received practical considerations. I list guidelines. medical follow-up; 28% were found to be noncompliant. Risk factors associated with McNicholas J, Collis GM. Children's representations of pets noncompliance were evaluated. Emergent and in their social networks. Child Care Health Dev 2001; unscheduled physician visits were tracked during the 27(3):279-94. first 6 weeks after hospital discharge. RESULTS:Lack Abstract: OBJECTIVES: To develop a child-friendly of follow-up orders at hospital discharge did not affect methodology to study children's representations of the frequency of emergent visits. Children fell into 2 social support available from their personal groups: those who were 100% compliant and those relationships; and to examine children's representations with < or =67% compliance. No socioeconomic or of support from their pets compared to support from demographic risk factors could be identified between human relationships. DESIGN: Participants were 22 the 2 groups. Compared with the 100% compliant year-3 primary school children aged 7-8 years. They patients, patients who were compliant with < or =67% were asked to list all the people and animals important of appointments were more severely ill, as defined by to them and then to select a 'top 10' of most special higher peak pediatric risk of mortality scores during relationships. Using a story-based methodology, their PICU stay (11.5 vs 8.4), longer PICU length of children were asked who from their 'top 10' they would 706
- 715. stays (10.1 daysvs 4.6 days), and longer hospital deviation]) was significantly higher than SNAP for length of stays (25.5 days vs 14 days). Most predictive survivors (13 +/- 6.1). However, this difference of noncompliance was the number of medical diminished steadily and by DOL 10 was no longer appointments ordered by physicians. Patients with 3 or statistically significant (12.7 +/- 4.9 vs 10.0 +/- 4.8). more appointments were less likely to be compliant On each NICU day, at all ranges of SNAP scores, there with follow-up. After hospital discharge, children were were at least as many infants who would ultimately more likely to visit a primary care physician compared survive as would die. Consequently, the positive with a subspecialist (95% vs 82%). When patients were predictive value of any SNAP value for subsequent ordered to see a specialist, scheduled appointments mortality was <0.5 on all NICU days. Prediction were much better attended than the recommended profiles were obtained for 230 ventilated infants appointments (92% vs 67%). CONCLUSIONS: Lack reflecting over 11 000 intuitions obtained on 2867 of ordered medical follow-up did not affect emergent patient days. One hundred fifty-seven (81%) of 192 visits. In this group of critically ill children, a survivor profiles displayed consistent accurate significant percentage (28%) did not receive timely prediction profiles-at least 90% of their NICU medical follow-up. No socioeconomic or demographic ventilation days were characterized by 100% prediction risk factors were identified in noncompliant children. of survival. Twenty-five (13%) of 192 surviving However, severity of illness (higher peak pediatric risk infants survived somewhat unexpectedly; that is, after of mortality score, longer PICU stay, and longer at least 1 day characterized by at least 1 estimate of hospital stay) and the number of follow-up "death." Thirty-three (60%) of the 55 nonsurvivors died appointments ordered were predictors of before DOL 10. Eighty-two percent of the prediction noncompliance. Potential exists for implementing profiles for these early dying infants were strategies to improve compliance in identified homogeneous, dismal, and accurate. Twenty-two populations. (40%) of the 55 nonsurvivors died after DOL 10. Seventeen (78%) of these 22 late-dying infants were McQuoid-Mason D. Parental refusal of blood transfusions predicted to live by many observers on many hospital for minor children solely on religious grounds--the days. Sixty-one (30%) of 230 profiled patients had at doctor's dilemma resolved. S Afr Med J 2005; least 1 NICU day characterized by at least 1 prediction 95(1):29-30. of death; 26/61 (43%) of these patients were Notes: GENERAL NOTE: KIE: KIE Bib: treatment incorrectly predicted; that is, they survived. Seventeen refusal/minors infants who were predicted to die during but survived nonetheless were assessed neurologically at 1 year. Meacham J. Sex and the church. A case for change. Fourteen (82%) of these 17 were not neurologically Newsweek 2002; 139(18):22-32. normal-8 were clearly abnormal, 1 suspicious, and 5 had died. CONCLUSIONS: If absolute certainty about Meadow W, Frain L, Ren Y, Lee G, Soneji S, Lantos J. mortality is the only criterion that can justify a decision Serial assessment of mortality in the neonatal intensive to withhold or withdraw life-sustaining treatment in the care unit by algorithm and intuition: certainty, NICU, these data would make such decisions difficult uncertainty, and informed consent. Pediatrics 2002; on the first day of life, and increasingly problematic 109(5):878-86. thereafter. However, if we acknowledge that medicine Notes: GENERAL NOTE: KIE: 40 refs. is inevitably an inexact science and that clinical GENERAL NOTE: KIE: KIE Bib: allowing to predictions can never be perfect, we can ask the more die/infants; patient care/minors interesting question of whether good but less-than- Abstract: OBJECTIVES: Does predictive power for perfect predictions of imprecise but ethically relevant outcomes of neonatal intensive care unit (NICU) clinical outcomes can still be useful. We think that they patients get better with time? Or does it get worse? We can-and that they must. determined the predictive power of Score for Neonatal Acute Physiology (SNAP) scores and clinical intuitions Meadows LM, Thurston WE, Lackner S. Whealth study: as a function of day of life (DOL) for newborn infants women's reports of childhood abuse. Health Care admitted to our NICU. METHODS: We identified 369 Women Int 2001; 22(5):439-54. infants admitted to our NICU during 1996-1997 who Abstract: Most samples of adult women will contain a required mechanical ventilation. We calculated SNAP significant proportion who have been or are currently scores on DOL 1, 3, 4, 5, 7, 10, 14, 21, 28, and weekly in abusive relationships. While past research has linked thereafter until either death or extubation. We also childhood abuse of girls to adult health concerns, little asked nurses, residents, fellows, and attendings on each is known about the process through which women day of mechanical ventilation: "Do you think this child retrospectively reconcile these experiences. This article is going to live to go home to their family, or die before reports on data collected in an ongoing project on hospital discharge?" RESULTS: Two thousand twenty- midlife women's health. Twenty-seven of 50 urban, eight SNAP scores were calculated for 285 infants. On middle-class participants in this phase of the project DOL 1, SNAP for nonsurvivors (24 +/- 8.7 [standard reported childhood abuse experiences. In the analysis, several aspects of these experiences were identified: 707
- 716. definitions of abuse;recontextualizing abuse; Meel BL. Incidence and patterns of violent and/or traumatic responsibility for abuse; abuse avoidance; and deaths between 1993 and 1999 in the Transkei region experiences of multiple abuse. The women's discourse of South Africa. J Trauma 2004; 57(1):125-9. reflected a number of ideologies that provide a context Abstract: BACKGROUND: Incidence and patterns of in which women negotiate their understandings of violent and/or traumatic deaths among 4,525 victims these childhood experiences. This article provides over a 7-year period in the Transkei region of South insight into our understanding of abuse. It addresses the Africa were investigated. METHOD: Retrospective fundamental issue of promoting a worldview that review and analysis was performed of all medicolegal precludes child abuse while leaving adult survivors autopsies (n = 6,181) between January 1993 and with options for "moving on." December 1999, of which 4,525 were violent or traumatic deaths. RESULTS: During the 7-year period Meadows M. Drug research and children. FDA Consum (January 1993-December 1999), violent and/or 2003; 37(1):12-7. traumatic deaths in the Transkei region accounted for an average annual rate of 162 per 100,000 of the Mechanic D. Disadvantage, inequality, and social policy. population. The common causes of deaths per 100,000 Health Aff (Millwood) 2002; 21(2):48-59. of population per year were as follows: motor vehicle Abstract: Eliminating disparities in health is a primary collisions, 63; firearm injuries, 43; stab wounds, 32; goal of the federal government and many states. Our and blunt trauma, 24. Male subjects outnumbered overarching objective should be to improve population female subjects by a 3.3:1 ratio. The murder rate in health for all groups to the maximum extent. Ironically, female subjects was 18 per 100,000 population. The enhancing population health and even the health of the murder rate in this area increased from 94 per 100,000 disadvantaged can conflict with efforts to reduce in 1993 to 121 in 1999. Nearly 50% of the violent disparities. This paper presents data showing that and/or traumatic deaths occurred in the 21- to 40-year interventions that offer some of the largest possible age group. There has been an increase in nontraumatic gains for the disadvantaged may also increase deaths such as hanging (1.5 times) and poisoning (5 disparities, and it examines policies that offer the times). CONCLUSION: The average annual incidence potential to decrease disparities while improving of violent and/or traumatic deaths in the Transkei population health. Enhancement of educational region of South Africa is 162 per 100,000 population. attainment and access to health services and income Firearm-related deaths, at 43 per 100,000 of the support for those in greatest need appear to be population per year, have contributed substantially to particularly important pathways to improved this high incidence. This is a major cause of concern. population health. Meel BL. Mortality of children in the Transkei region of Medora NP, Wilson S, Larson JH. Attitudes toward South Africa. Am J Forensic Med Pathol 2003; parenting strategies, potential for child abuse, and 24(2):141-7. parental satisfaction of ethnically diverse low-income Abstract: This study attempted to unfold, perhaps for U.S. mothers. J Soc Psychol 2001; 141(3):335-48. the first time, the problem of childhood mortality Abstract: Among a sample of 176 low-income mothers resulting from trauma in the Eastern Cape Province of from 3 ethnic groups in the United States, the authors South Africa. This study was carried out in the Umtata investigated ethnic differences in attitudes toward and Ngqeleni magisterial districts, which have a preferred parenting strategies, or styles; ethnic combined population of about 400,000. Most people differences in the potential for child abuse; and the there have very few resources and have historically relationship between parenting strategies, the potential relied on money repatriated by migrant workers. In the for child abuse, and parental satisfaction. They Transkei region, unemployment is at a very high level: distributed the Maternal Reactions to Child's Deviant 48.5%. Assault on children is very common in this Behavior subscale (K. M. Rickard, W. Graziano, & R. region, and this may result in death. The aim of this Forehand, 1984), a shortened version of the Child study was to establish the state of deaths resulting from Abuse Potential Inventory (CAPI; J. S. Milner & R. C. pediatric trauma, and to formulate recommendations Wimberley, 1979), and a Parental Satisfaction Scale that could probably help prevent or reduce these (N. P Medora, S. M. Wilson, & J. Larson, 1996) to the deaths. The objective was to gather epidemiologic participants. The results indicated no significant ethnic information on the victims of pediatric trauma. The differences in preferred parenting styles. Mothers from study was designed as a descriptive study, using all 3 ethnic groups ranked praise and reasoning as the reviews of traumatic deaths in pediatric age groups 1st and 2nd preferred parenting strategies. There were during the period January 1993 to December 1999. no ethnic differences in the perceived potential for This study was carried out on cases that were brought child abuse. Parental satisfaction was negatively related to the medicolegal laboratory at Umtata General to 2 of the CAPI subscales--Loneliness and Problems. Hospital, Umtata, in the Transkei region of the Eastern The parenting strategy reasoning was positively Cape Province, South Africa. There were 6181 correlated with parental satisfaction. autopsies conducted from 1993 to 1999. All the medicolegal autopsies were divided into two groups: 708
- 717. pediatric (15 yearsof age or younger) and adult (older vitreoretinal surgery for treatment of pre-macular than 15 years). Of the autopsies, 89.4% (n = 5587) hemorrhagic cyst in eyes of patients suffering from were in the adult group, and 10.6% (n = 594) were in Terson's syndrome and shaken baby syndrome. the pediatric group. Of the pediatric deaths, 64% (n = PATIENTS AND METHODS: Between November 383) were related to trauma. The highest numbers were 1995 and May 2003 seven eyes of six children in the 11- to 15-year (n = 146, 38%) and the 6- to 10- underwent vitrectomy for pre-macular hemorrhagic year (n = 135, 34%) age groups. Of the children who cyst. Patients' age ranged from 5 months to 17 years. died of trauma, 112 (28%) were aged 0 to 5 years. Indication for vitreoretinal surgery was pre-macular Unintentional injuries from motor vehicle accidents hemorrhagic cyst in eyes with Terson's syndrome (n=5) were the leading cause of death (59%), whereas and shaken baby syndrome (n=2). During vitrectomy, intentional injuries (41%) were associated with murder. rhexis of internal limiting membrane was performed. Nearly a quarter (22%) of pediatric traumatic deaths Four children received intensive orthoptic treatment were due to penetrating injuries: stab (12%) and postoperatively. RESULTS: All eyes in our series gunshot (10%) wounds. Most of the pediatric deaths showed a submembranous localization of pre-macular occurred during the festive months of December, hemorrhagic cyst. The results of electron microscopic January, and April; the death toll during these months examination showed that the excised anterior walls was three to four times higher than in the rest of the contain internal limiting membrane. In all eyes year. It was concluded that 64% of pediatric deaths in improvement of the anatomic situation and of visual the Transkei region were the result of trauma. This acuity was achieved. Duration of follow-up ranged represents 1 pediatric trauma death for every 10 adult from 6 months to 5 years. CONCLUSIONS: trauma deaths. Forty-one percent of the child trauma Vitrectomy for hemorrhagic macular cyst in children is deaths were due to intentional injuries, usually murder. a safe and effective alternative to observation, offering It is recommended that the government set targets and visual rehabilitation, especially if amblyopia has put into place strategies for the reduction of pediatric developed or if both eyes are affected. If a hemorrhagic deaths due to trauma. The different deaths so called macular cyst is encountered, its complete removal is "rule of reversal" could be considered as an indicator of recommended to prevent development of proliferative social health. vitreoretinopathy. Mehta PD, Neale MC, Flay BR. Squeezing interval change Meller K, Passero C. The cold truth. Pediatr Nurs 2004; from ordinal panel data: latent growth curves with 30(1):41-2. ordinal outcomes. Psychol Methods 2004; 9(3):301-33. Abstract: A didactic on latent growth curve modeling Mellins CA, Smith R, O'Driscoll P et al. High rates of for ordinal outcomes is presented. The conceptual behavioral problems in perinatally HIV-infected aspects of modeling growth with ordinal variables and children are not linked to HIV disease. Pediatrics 2003; the notion of threshold invariance are illustrated 111(2):384-93. graphically using a hypothetical example. The ordinal Notes: CORPORATE NAME: NIH growth model is described in terms of 3 nested models: NIAID/NICHD/NIDA-Sponsored Women and Infant (a) multivariate normality of the underlying continuous Transmission Study Group latent variables (yt) and its relationship with the Abstract: OBJECTIVE: Descriptive studies and clinical observed ordinal response pattern (Yt), (b) threshold reports have suggested that human immunodeficiency invariance over time, and (c) growth model for the virus (HIV)-positive children are at risk for behavioral continuous latent variable on a common scale. problems. Inadequate control groups and sample sizes Algebraic implications of the model restrictions are have limited the ability of investigators to consider derived, and practical aspects of fitting ordinal growth multiple influences that place HIV-positive children at models are discussed with the help of an empirical risk for poor behavioral outcomes. We examined the example and Mx script (M. C. Neale, S. M. Boker, G. unique and combined influences of HIV, prenatal drug Xie, & H. H. Maes, 1999). The necessary conditions exposure, and environmental factors on behavior in for the identification of growth models with ordinal children who were perinatally exposed to HIV. data and the methodological implications of the model METHODS: Participants included 307 children who of threshold invariance are discussed. were born to HIV-positive mothers (96 HIV infected and 211 seroreverters) and enrolled in a natural history, Meier P, Schmitz F, Wiedemann P. Vitrectomy for pre- longitudinal study of women to infant HIV macular hemorrhagic cyst in children and young adults. transmission. Caregivers completed parent behavioral Graefes Arch Clin Exp Ophthalmol 2005; 243(8):824- rating scales, beginning when the children were 3 years 8. old. Data were also collected on prenatal drug Abstract: BACKGROUND: A pre-macular exposure; child age, gender, and ethnicity; caregiver accumulation of blood is termed a hemorrhagic relationship to child; and birth complications. macular cyst and may be found both in eyes with RESULTS: Multivariate analyses comparing the HIV- Terson's syndrome and in shaken baby syndrome. In infected children with perinatally exposed but this study, we report on our experience and results of uninfected children from similar backgrounds failed to 709
- 718. find an associationbetween either HIV status or Menick DM. [Sexual abuse at schools in Cameroon: results prenatal drug exposure and poor behavioral outcomes. of a survey-action program in Yaounde]. Med Trop The strongest correlates of increased behavioral (Mars) 2002; 62(1):58-62. symptoms were demographic characteristics. Abstract: The purpose of this questionnaire-based CONCLUSIONS: This study suggests that although a study was to determine the incidence of sexual abuse in high prevalence of behavioral problems does exist schools in Yaounde, Cameroon, to assess the extent of among HIV-infected children, neither HIV infection teacher involvement in such acts and to provide nor prenatal drug exposure is the underlying cause. children an opportunity to come forward with their Rather, other biological and environmental factors are experiences. The author hypothesized that the number likely contributors toward poor behavioral outcomes. of sexual abuse victims was increasing and that the most frequent abusers were teachers, school staff, and Melton GB. Mandated reporting: a policy without reason. classmates. To check this hypothesis, a total of 1710 Child Abuse Negl 2005; 29(1):9-18. questionnaires were sent to 10 public and private secondary schools between January 4 and April 30, Menard CB, Bandeen-Roche KJ, Chilcoat HD. 1999. The response rate was 98.7%. A total of 269 Epidemiology of multiple childhood traumatic events: students reported being sexual abused before the age of child abuse, parental psychopathology, and other 16 for an overall incidence of 15.9%. There were 74 family-level stressors. Soc Psychiatry Psychiatr boys (27.5%) and 195 girls (72.5%) with a mean age Epidemiol 2004; 39(11):857-65. 11.6 years (range 4 to 15 years) at the time of abuse. Abstract: BACKGROUND: Multiple family-level Sexual abuse involved rape in 38.7% of cases, fondling childhood stressors are common and are correlated. It in 54.6% and pornographic scenes in 6.7%. Of the 274 is unknown if clusters of commonly co-occurring sexual abusers identified, 86.5% were men and 13.5% stressors are identifiable. The study was designed to were women. Sexual abuse took place within the explore family-level stressor clustering in the general family in 31.4% of cases and outside the family setting population, to estimate the prevalence of exposure 68.6%. Sexual abuse occurred in a school setting in classes, and to examine the correlation of approximately 15% of cases and involved classmates in sociodemographic characteristics with class approximately 30%. The alleged extrafamilial abusers prevalence. METHOD: Data were collected from an were teachers in 7.9% of cases and tutors in 7.6%. epidemiological sample and analyzed using latent class Survey data supports the working hypothesis of this regression. RESULTS: A six-class solution was study and warrants implementation of a program to identified. Classes were characterized by low risk prevent sexual abuse in schools. (prevalence=23%), universal high risk (7 %), family conflict (11 %), household substance problems (22 %), Menikoff J. The involuntary research subject. Camb Q non-nuclear family structure (24 %), parent's mental Healthc Ethics 2004; 13(4):338-45. illness (13 %). CONCLUSIONS: Class prevalence Notes: GENERAL NOTE: KIE: 20 refs. varied with race and welfare status, not gender. GENERAL NOTE: KIE: KIE Bib: genetic screening; Interventions for childhood stressors are person- human experimentation/informed consent; human focused; the analytic approach may uniquely inform experimentation/minors resource allocation. Mercer J. Coercive restraint therapies: a dangerous Menick DM. [Problems of child sexual abuse in Africa or alternative mental health intervention. MedGenMed the imbroglio of a double paradox: the example of 2005; 7(3):6. Cameroon]. Child Abuse Negl 2001; 25(1):109-21. Abstract: Physicians caring for adopted or foster Abstract: OBJECTIVE: This study has investigated the children should be aware of the use of coercive prevalence of sexual abuse cases in Cameroon (Africa) restraint therapy (CRT) practices by parents and mental and approached the way these cases are solved. health practitioners. CRT is defined as a mental health METHOD: 405 medical certificates have been intervention involving physical restraint and is used in reviewed within a three years period. RESULTS: Over adoptive or foster families with the intention of 405 medical certificates, 19 cases of sexual abuse have increasing emotional attachment to parents. Coercive been identified. All the victims were girls. The great restraint therapy parenting (CRTP) is a set of child care majority of them were aged 10-14 (57.9%) and 15-19 practices adjuvant to CRT. CRT and CRTP have been (31.6%). The sexual assaults have been perpetrated out associated with child deaths and poor growth. of the family. CONCLUSION: The results show Examination of the CRT literature shows a conflict evidence of sexual abuse cases in Africa. Friendly with accepted practice, an unusual theoretic basis, and adjustments by private contracts and family an absence of empirical support. Nevertheless, CRT interventions with financial amends for the parents of appears to be increasing in popularity. This article the victims are often preferred to the court of justice, discusses possible reasons for the increase, and offers because of poverty, cultural pressures and judicial suggestions for professional responses to the CRT injunctions. problem. 710
- 719. Mercer JA. TheProtestant child, adolescent, and family. and hospitalizations (IRR, 0.57; CI, 0.36-0.92; P = Child Adolesc Psychiatr Clin N Am 2004; 13(1):161- 0.02). Death of a parent with HIV was associated with 81, ix. a threefold increase in mortality among HIV-negative Abstract: This article addresses Protestant Christianity children < 10 years old (hazard ratio, 2.9; CI, 1.1-8.1; P as an often-overlooked but significant factor in clinical = 0.04). Of 134 bacterial isolates from family members work with children and adolescents. Noting the wide before cotrimoxazole treatment, 89 (66%) were range of beliefs and practices among Protestants, the resistant to cotrimoxazole; of 75 recovered during article identifies key tenets of Protestant faith that cotrimoxazole treatment, 54 (72%) were resistant (P = shape the worldviews of children, adolescents, and 0.41). INTERPRETATION: Cotrimoxazole their families. Clinical implications of these beliefs are prophylaxis taken by persons with HIV was associated explored, with particular attention to three potentially with decreased morbidity and mortality among family psychopathologic features: the religious legitimation of members. Antimicrobial resistance among diarrheal child maltreatment; paranormal, direct experiences of pathogens infecting family members did not increase. the divine through unusual perceptions such as trance Concerns regarding the spread of bacterial resistance states or visions deemed normal within their religious should not impede implementation of cotrimoxazole context but that may also evidence serious pathology; programs. and sexuality issues of particular significance for adolescents. Research suggests that Protestant beliefs Mermin J, Lule J, Ekwaru JP et al. Effect of co-trimoxazole also constitute resources for clinical work because they prophylaxis on morbidity, mortality, CD4-cell count, appear to be protective factors in relation to depression, and viral load in HIV infection in rural Uganda. Lancet avoidance of high-risk behaviors, and other measures 2004; 364(9443):1428-34. of resiliency among adolescents. Clinicians who do not Abstract: BACKGROUND: Prophylaxis with co- take the Protestant Christian family's religious/spiritual trimoxazole (trimethoprim-sulphamethoxazole) is worldview into consideration in case formulation risk recommended for people with HIV infection or AIDS misunderstanding or alienating them from treatment. but is rarely used in Africa. We assessed the effect of The article concludes with suggestions for such prophylaxis on morbidity, mortality, CD4-cell collaboration. count, and viral load among people with HIV infection living in rural Uganda, an area with high rates of Merk T. Beyond the burns. Managing the pain & bacterial resistance to co-trimoxazole. METHODS: consequences of pediatric burns. JEMS 2001; 26(9):66- Between April, 2001, and March, 2003, we enrolled, 75; quiz 76-7. and followed up with weekly home visits, 509 individuals with HIV-1 infection and their 1522 HIV- Mermin J, Lule J, Ekwaru JP et al. Cotrimoxazole negative household members. After 5 months of prophylaxis by HIV-infected persons in Uganda follow-up, HIV-positive participants were offered daily reduces morbidity and mortality among HIV- co-trimoxazole prophylaxis (800 mg trimethoprim, 160 uninfected family members. AIDS 2005; 19(10):1035- mg sulphamethoxazole) and followed up for a further 42. 1.5 years. We assessed rates of malaria, diarrhoea, Abstract: BACKGROUND: The effect of hospital admission, and death. FINDINGS: Co- cotrimoxazole prophylaxis taken by persons with HIV trimoxazole was well tolerated with rare (<2% per on community health and antimicrobial resistance is person-year) adverse reactions. Even though rates of unknown. OBJECTIVE: To assess the effect of resistance in diarrhoeal pathogens were high (76%), cotrimoxazole prophylaxis taken by persons with HIV co-trimoxazole prophylaxis was associated with a 46% on morbidity, mortality, and antimicrobial resistance of reduction in mortality (hazard ratio 0.54 [95% CI 0.35- diarrheal pathogens infecting their HIV-negative 0.84], p=0.006) and lower rates of malaria family members. DESIGN: Prospective cohort in rural (multivariate incidence rate ratio 0.28 [0.19-0.40], Uganda. METHODS: A total of 879 persons with HIV p<0.0001), diarrhoea (0.65 [0.53-0.81], p<0.0001), and and 2771 HIV-negative family members received hospital admission (0.69 [0.48-0.98], p=0.04). The weekly home-visits. After 5 months, persons with HIV annual rate of decline in CD4-cell count was less received daily cotrimoxazole prophylaxis and during prophylaxis than before (77 vs 203 cells per households were followed for an average of 17 microL, p<0.0001), and the annual rate of increase in additional months. FINDINGS: During the study, 224 viral load was lower (0.08 vs 0.90 log(10) copies per participants with HIV (25%) and 29 household mL, p=0.01). INTERPRETATION: Daily co- members (1%) died. Mortality among HIV-negative trimoxazole prophylaxis was associated with reduced family members < 10 years old was 63% less during morbidity and mortality and had beneficial effects on the cotrimoxazole period than before [hazard ratio, CD4-cell count and viral load. Co-trimoxazole 0.37; 95% confidence interval (CI), 0.14-0.95; P = prophylaxis is a readily available, effective intervention 0.04]. Malaria among family members was less for people with HIV infection in Africa. common during cotrimoxazole treatment [incidence rate ratio (IRR), 0.62; CI, 0.53-0.74; P < 0.0001], as Merry S, McDowell H, Hetrick S, Bir J, Muller N. were diarrhea (IRR, 0.59; CI, 0.45-0.76; P = 0.0001), Psychological and/or educational interventions for the 711
- 720. prevention of depressionin children and adolescents. assessed using funnel plots. MAIN RESULTS: Studies Cochrane Database Syst Rev 2004; (1):CD003380. were divided into those that compared intervention Abstract: BACKGROUND: Depression is the fourth with an active comparison or placebo (i.e. a control most important disease in the estimation of the burden condition that resembles the intervention being of disease Murray 1996 and is a common problem with investigated but which lacks the elements thought to be prevalence rates estimated to be as high as 8% in active in preventing depression) and those that used a young people. Depression in young people is "wait-list" or no intervention comparison group. Only associated with poor academic performance, social two studies fell into the former category and neither dysfunction, substance abuse, suicide attempts, and showed effectiveness although one study was completed suicide (NHMRC 1997). This has inadequately powered to show a difference and in the precipitated the development of programmes aimed at other the "placebo" contained active therapeutic preventing the onset of depression. This review elements, reducing the ability to demonstrate a evaluates evidence for the effectiveness of these difference from intervention. Psychological prevention programmes. OBJECTIVES: To determine interventions were effective compared with non- whether psychological and/or educational interventions intervention immediately after the programmes were (both universal and targeted) are effective in reducing delivered with a significant reduction in scores on risk of depressive disorder by reducing depressive depression rating scales for targeted (standardised symptoms immediately after intervention or by mean difference (SMD) of -0.26 and a 95% confidence preventing the onset of depressive disorder in children interval (CI) of -0.40 to -0.13 ) but not universal and adolescents over the next one to three years. interventions (SMD -0.21, 95% CI -0.48, 0.06), with a SEARCH STRATEGY: The Cochrane Depression, significant effect maintained on pooling data (SMD - Anxiety and Neurosis Group trials register (August 0.26, 95% CI -0.36, -0.15). While small effect sizes 2002), MEDLINE (1966 to December Week 3 2002), were reported, these were associated with a significant EMBASE (1980 to January Week 2 2003), PsychInfo reduction in depressive episodes. The overall risk (1886 to January Week 2 2003) and ERIC (1985 to difference after intervention translates to "numbers December 2002) were searched. In addition, needed to treat" (NNT) of 10.The most effective study conference abstracts, the reference lists of included is the targeted programme by Clarke (Clarke 2001) studies, and other reviews were searched and experts in where the initial effect size of -0.46 is associated with the field were contacted. SELECTION CRITERIA: an initial risk difference of -0.22 and NNT 5. There Each identified study was assessed for possible was no evidence of effectiveness for educational inclusion by two independent reviewers based on the interventions. Reports of effectiveness for boys and methods sections. The determinants for inclusion were girls were contradictory. The quality of many studies that the trial include a psychological and/or educational was poor, and only two studies made allocation prevention programme for young people aged 5 to 19 concealment explicit. Sensitivity analysis of only high years-old, who did not meet DSM or ICD criteria for quality studies did not alter the results significantly. depression and/or did not fall into the clinical range on The only analysis in which there was significant standardised, validated, and reliable rating scales of statistical heterogeneity was the sub-group analysis by depression. DATA COLLECTION AND ANALYSIS: gender where there was variability in the response to The methodological quality of the included trials was different programmes for both girls and boys.For the assessed by two independent reviewers according to a most part funnel plots indicate findings are robust for list of pre-determined criteria, which were based on short term effects with no publication bias evident. quality ratings devised by Moncrieff and colleagues There are too few studies to comment on whether there (Moncrieff 2001). Outcome data was extracted and is publication bias for studies reporting long-term (12- entered into Revman 4.2. Means and standard 36 month) follow-up. REVIEWER'S CONCLUSIONS: deviations for continuous outcomes and number of Although there is insufficient evidence to warrant the events for dichotomous outcomes were extracted where introduction of depression prevention programmes available. For trials where the required data were not currently, results to date indicate that further study reported or could not be calculated, further details were would be worthwhile. There is a need to compare requested from first authors. If no further details were interventions with a placebo or some sort of active provided, the trial was included in the review and comparison so that study participants do not know described, but not included in the meta-analysis. whether they are in the intervention group or not, to Results were presented for each type of intervention: investigate the impact of booster sessions to see if targeted or universal interventions; and educational or effectiveness immediately after intervention can be psychological interventions and if data were provided, prolonged, ideally for a year or longer, and to consider by gender. Where possible data were combined in practical implementation of prevention programmes meta-analyses to give a treatment effect across all when choosing target populations. Until now most trials.Sensitivity analysis were conducted on studies studies have focussed on psychological interventions. rated as "adequate" or "high" quality, that is with a The potential effectiveness of educational interventions score over 22, based on the scale by Moncrieff et al has not been fully investigated. Given the gender (Moncrieff 2001). The presence of publication bias was differences in prevalence, and the change in these that 712
- 721. occurs in adolescencewith a disproportionate increase a higher prevalence in the mothers of children born in prevalence rates for girls, it is likely that girls and with isolated OFCs (cases). CONCLUSIONS: Some boys will respond differently to interventions. maternal diseases are risk factors for the pathogenesis Although differences have been reported in studies in of isolated OFCs. It is worth considering the prevention this review the findings are contradictory and a more of possible harmful effects of influenza by vaccination definitive delineation of gender specific responses to during the expected epidemic period. interventions would be helpful. Mettner J. Champion of children. Minn Med 2003; 86(3):8- Merskey H. Abuse and ACTH response to corticotropin- 12. releasing factor. Am J Psychiatry 2002; 159(1):157; author reply 157-8. Metzger X. [Data aggregation in measuring inequalities and inequities in the health of populations]. Rev Panam Mertin P, Mohr PB. Incidence and correlates of posttrauma Salud Publica 2002; 12(6):445-53. symptoms in children from backgrounds of domestic Abstract: OBJECTIVES: To compare how different violence. Violence Vict 2002; 17(5):555-67. degrees of data aggregation influence the measurement Abstract: In recent years, evidence has emerged of the of health inequalities and health inequities within a presence of posttrauma symptoms in children from population, and to assess the appropriateness of those backgrounds of domestic violence. The present study different degrees of data aggregation in performing examined the incidence and correlates of posttrauma studies on inequalities and inequities. METHODS: As symptoms in 56 children of mothers who had been an example, we used data on the infant mortality rate in residents in women's shelters in Adelaide, South Costa Rica in 1973 and in 1984 and calculated Australia. The most frequently endorsed symptoms measurements that are frequently used to quantify among this sample of children were being troubled by inequalities and inequities. RESULTS: According to distressing thoughts, conscious avoidance, our results, the inequality measures presented (except hypervigilance, and sleep difficulties. Twenty percent for those that were derived using regression models) of children met the criteria for a diagnosis of are not sensitive to data aggregation by socioeconomic posttraumatic stress disorder (PTSD). Children meeting groups. However, when geographic areas are full PTSD criteria scored significantly higher on compared, more disaggregation of the data results in measures of anxiety, depression, and dissociation. the measures indicating greater inequality. Results support the use of a posttrauma framework for CONCLUSIONS: Our results show that some understanding the effects on children of living with measures can vary widely depending on the level of domestic violence. data aggregation. It is thus crucial to know how to select these measures and also how to aggregate the Metneki J, Puho E, Czeizel AE. Maternal diseases and data in a way that is consistent with the objectives of isolated orofacial clefts in Hungary. Birth Defects Res each study. A Clin Mol Teratol 2005; 73(9):617-23. Abstract: BACKGROUND: Isolated orofacial clefts Meyer-Bahlburg HF. Child-adult sexual contact: (OFCs) are likely to be caused by gene-environment terminology. Arch Sex Behav 2002; 31(2):157. interaction; therefore, the objective of the current study was to evaluate the possible association between all Meyers LA, Pourbohloul B, Newman ME, Skowronski DM, maternal diseases during pregnancy and isolated cleft Brunham RC. Network theory and SARS: predicting lip with or without cleft palate (CL+/-CP) and posterior outbreak diversity. J Theor Biol 2005; 232(1):71-81. cleft palate (PCP) in the offspring. METHODS: The Abstract: Many infectious diseases spread through database of the large population-based Hungarian populations via the networks formed by physical Case-Control Surveillance of Congenital contacts among individuals. The patterns of these Abnormalities, 1980-1996, was evaluated. The contacts tend to be highly heterogeneous. Traditional database includes 1374 cases with isolated CL+/- CP "compartmental" modeling in epidemiology, however, and 601 with PCP, plus 38,151 matched population assumes that population groups are fully mixed, that is, controls (without defects) and 20,868 patient controls every individual has an equal chance of spreading the with other defects. Data collection was based on disease to every other. Applications of compartmental prospective medical records, retrospective maternal models to Severe Acute Respiratory Syndrome (SARS) data via a self-reported questionnaire, and home visits resulted in estimates of the fundamental quantity called of nonresponding families. RESULTS: An increased the basic reproductive number R0--the number of new risk for isolated CL+/- CP was found for children born cases of SARS resulting from a single initial case-- to mothers with influenza, common cold, orofacial above one, implying that, without public health herpes, and gastroenteritis during pregnancy. Risk for intervention, most outbreaks should spark large-scale isolated PCP was increased in children of mothers with epidemics. Here we compare these predictions to the influenza, sinusitis, and bronchitis. Among chronic early epidemiology of SARS. We apply the methods of maternal diseases, epilepsy and angina pectoris showed contact network epidemiology to illustrate that for a 713
- 722. single value ofR0, any two outbreaks, even in the distinguishing bipolar from attention- same setting, may have very different epidemiological deficit/hyperactivity disorder subjects. outcomes. We offer quantitative insight into the CONCLUSIONS: While there was a significant heterogeneity of SARS outbreaks worldwide, and heterogeneity in estimates between studies, a consistent illustrate the utility of this approach for assessing pattern of elevations in inattention/hyperactivity, public health strategies. depression/anxiety, and aggression was identified. Michalowski S. Reversal of fortune--Re A (Conjoined Middeldorp S, Peters M. [Diagnostic image (177). A lifeless Twins) and beyond: who should make treatment infant. Shaken baby syndrome]. Ned Tijdschr decisions on behalf of young children? Health Law J Geneeskd 2004; 148(23):1168; author reply 1168. 2001; 9:149-69. Notes: GENERAL NOTE: KIE: 74 fn. Mifflin P. Protection of children born with severe GENERAL NOTE: KIE: KIE Bib: informed disabilities. Part 1: The legal framework. Pract consent/minors Midwife 2001; 4(1):30-1. Michalowski S. Sanctity of life--are some lives more sacred Mifflin P. Protection of children born with severe than others? Leg Stud (Soc Leg Scholars) 2002; disabilities. Part 2: Some relevant cases and their 22(3):377-97. implications. Pract Midwife 2001; 4(2):30-1. Notes: GENERAL NOTE: KIE: 105 fn. GENERAL NOTE: KIE: KIE Bib: allowing to Mifflin PC. Jodie and Mary. Ethical and legal implications die/infants; allowing to die/legal aspects; patient of separating conjoined twins. Pract Midwife 2001; care/minors 4(7):48-9. Abstract: Court decisions concerning the life and death of patients become more and more frequent in the Mijanovich T, Weitzman BC. Which "broken windows" context of medical practice. One of the most matter? School, neighborhood, and family controversial decisions in this area in recent years has characteristics associated with youths' feelings of been the decision of the Court of Appeal in Re A unsafety. J Urban Health 2003; 80(3):400-15. (Conjoined Twins: Medical Treatment), authorising the Abstract: Young people's fears of victimization and separation of conjoined twins. This paper will argue feelings of unsafety constitute a serious and pervasive that the decision was flawed both on legal and moral public health problem and appear to be associated with grounds and that its potential implications for future different factors than actual victimization. Our analysis cases are more far-reaching than the judgment itself of a population-based telephone survey of youths aged suggests. 10-18 years in five economically distressed cities and their suburbs reveals that a substantial minority of Mick E, Biederman J, Pandina G, Faraone SV. A youths feel unsafe on any given day, and that an even preliminary meta-analysis of the child behavior greater number feel unsafe in school. While some checklist in pediatric bipolar disorder. Biol Psychiatry traditional predictors of victimization (such as low 2003; 53(11):1021-7. socioeconomic status) were associated with feeling Abstract: BACKGROUND: A possible explanation for unsafe, perceived school disorder was the major factor the ongoing controversy surrounding pediatric bipolar associated with such feelings. Disorderliness may thus disorder is that differences in assessment be the school's version of "broken windows," which methodologies lead to conflicting results. One way to serve to signal to students a lack of consistent adult address methodological differences in assessment concern and oversight that can leave them feeling across studies is to use a single standardized unsafe. We suggest that fixing the broken windows of assessment of psychopathology to calibrate the school disorderliness may have a significant, positive findings reported in different studies. To this end, we impact on adolescents' feelings of safety. conducted a meta-analysis of several studies that have employed the Child Behavior Checklist in the Mikropoulos TA, Strouboulis V. Factors that influence assessment of children with a diagnosis of bipolar presence in educational virtual environments. disorder. METHODS: MEDLINE was searched for all Cyberpsychol Behav 2004; 7(5):582-91. publications that utilized the Child Behavior Checklist Abstract: The present article is a part of a project for in addition to structured diagnostic interviews to assess the measurement of presence in educational virtual pediatric bipolar disorder. Random effects models were environments (VEs), since presence is correlated with used to calculate combined estimates of Child Behavior higher levels of cognitive performance and emotional Checklist clinical subscales. RESULTS: Children with development, factors that contribute to knowledge bipolar disorder had scaled scores of >70 in the construction. The aim of our study was to investigate Aggression, Attention Problems, and the sense of presence of 12-year-old pupils within an Anxious/Depressed subscales of the Child Behavior educational VE representing an ancient Greek house Checklist. The Child Behavior Checklist was useful in through a sense of embodiment and the ability to 714
- 723. handle task performance,while using various sexual abuse take place in larger social and political peripheral devices. This is the first report on presence contexts that include concerns about the family, gender measurement with children, based on the indication relations, sexuality and sexual behavior, the "science that children and adults may apply very unrelated wars," and the role of government. Conflicting claims criteria. Our results showed statistically significant about practice issues related to child sexual abuse differences on the level of tiredness and ease of use in require that social work practitioners be taught to using six different input devices. The combination of critically examine how the moral and political beliefs the keyboard and mouse and the keyboard on its own of researchers might influence the kinds of questions were the least tedious and easiest input devices, giving they ask and how they interpret and frame their a sense of presence as stated by the pupils. research findings. Environmental richness and the high level of interactivity within the VE resulted in a high degree of Milgrom P, Garcia RI, Ismail A, Katz RV, Weintraub JA. presence for almost all the pupils. The majority of them Improving America's access to care: The National felt a sense of presence whilst driving the avatar, Institute of Dental and Craniofacial Research addresses indicating that presence is significantly correlated with oral health disparities. J Am Dent Assoc 2004; pupils' degree of association with their virtual bodies. 135(10):1389-96. All the pupils felt a sense of presence when wearing Abstract: BACKGROUND AND OVERVIEW: The the head-mounted display. Our findings are in line with National Institute of Dental and Craniofacial Research, those of other researchers and show evidence of or NIDCR, in 2001 sponsored the establishment of personal, social and environmental presence. Centers for Research to Reduce Oral Health Disparities. The centers are based at Boston University; Milazzo AS Jr, Herlong JR, Li JS, Sanders SP, Barrington New York University; the University of Michigan; the M, Bengur AR. Real-time transmission of pediatric University of Washington; and the University of echocardiograms using a single ISDN line. Comput California, San Francisco. Reflecting the importance of Biol Med 2002; 32(5):379-88. research to reduce disparities, the centers, along with Abstract: We tested the adequacy of a related grants, represent one of the largest financial videoconferencing system using a single integrated commitments ever made by the NIDCR. The centers systems digital network (ISDN) line (128 kilobits per are sponsored in part by the National Center on second) for the remote diagnosis of children with Minority Health and Health Disparities, or NCMHHD. suspected congenital heart disease (CHD). Real-time Each of the five centers has forged partnerships that echocardiogram interpretation was compared to include ties with dental societies, state and local health subsequent videotape review in 401 studies with agencies, community and migrant health centers, concordance in 383 (95.5%) studies. A new diagnosis American Indian tribal nations and institutions that of CHD was made in 98 studies. Immediate patient serve other diverse patient populations. transfer was arranged based upon a real-time diagnosis CONCLUSIONS AND CLINICAL IMPLICATIONS: in five studies. In 300 studies, a normal diagnosis This network is attempting to address the needs of obviated further evaluation. A single ISDN line is communities with poor oral health. A major part of the adequate for transmission of pediatric echocardiograms effort of these new centers is to build community and it allows for remote management of patients with networks and establish long-term relationships. Center CHD. investigators also recognize that solutions to these vexing problems must be built on an understanding of Mildred J. Claimsmakers in the child sexual abuse "wars": the social, economic, racial, educational, political and who are they and what do they want? Soc Work 2003; behavioral factors that affect most health care issues. 48(4):492-503. Abstract: The research findings described in this article Miller BD. Female-selective abortion in Asia: patterns, are based on in-depth interviews with 40 people who policies, and debates. Am Anthropol 2001; helped bring concerns about child sexual abuse to 103(4):1083-95. audiences in the Western world. The results of this Notes: GENERAL NOTE: KIE: Miller, Barbara D study suggest that significant differences of opinion GENERAL NOTE: KIE: 80 refs. and perspective exist both within and between the two GENERAL NOTE: KIE: KIE Bib: abortion/foreign widely recognized camps of opinion that have countries; sex determination developed around this issue. From respondents' Abstract: Since the early 1980s, the use of sex-selective descriptions of their own and others' viewpoints, a abortion increased in many Asian contexts. Estimates continuum model of eight positions on issues related to indicate that several million female fetuses were child sexual abuse was developed and is described in aborted in the last two decades of the twentieth this article. Using a social constructionist framework, century. This article takes a currently unusual approach the author suggests that debates about child sexual for a cultural anthropologist in pursuing cross-national abuse, although framed primarily as empirical issues, comparisons of trends in sex-selective abortion. The may reflect moral and political, as well as scientific, risks involved in such an approach are taken in the disagreements. Debates about issues related to child hope that it will yield insights not gained through 715
- 724. localized analysis. Afterreviewing the available enter a futuristic world in which they become evidence on female-selective abortion, I discuss "reconstructors," members of an elite scientific unit features of Asian culture that support strong son charged with recovering lost medical knowledge about preference. Next I review the related issues of analgesic drugs. Two of the four episodes have been increased technological availability for prenatal sex evaluated through a comprehensive review process selection and national policies about sex selection. involving middle school students, teachers, Last, I consider several positions on female-selective neuroscience researchers, and clinicians. Analysis of abortion and how cultural anthropology may contribute the pretest and posttest scores demonstrated significant to understanding the global context and consequences knowledge gain that validly can be attributed to use of of prenatal gender discrimination. the game. These data provide evidence that science content can be transmitted through innovative online Miller-Johnson S, Coie JD, Maumary-Gremaud A, Bierman techniques without sacrificing compelling content or K. Peer rejection and aggression and early starter effective pedagogical strategies. models of conduct disorder. J Abnorm Child Psychol 2002; 30(3):217-30. Miller-Loncar C, Lester BM, Seifer R et al. Predictors of Notes: CORPORATE NAME: Conduct Problems motor development in children prenatally exposed to Prevention Research Group cocaine. Neurotoxicol Teratol 2005; 27(2):213-20. Abstract: Peer rejection and aggression in the early Abstract: The current study examined the pattern of school years were examined for their relevance to early motor development across the first 18 months of life in starting conduct problems. The sample of 657 boys and infants with in utero exposure to cocaine to determine girls from 4 geographical locations was followed from how prenatal drug effects and level of exposure relates 1st through 4th grades. Peer rejection in 1st grade to motor development. Motor development was added incrementally to the prediction of early starting examined at 1, 4, 12, and 18 months of age (corrected conduct problems in 3rd and 4th grades, over and for prematurity). Infants were divided into cocaine above the effects of aggression. Peer rejection and exposed (n=392) and comparison (n=776) groups. aggression in 1st grade were also associated with the Exposure status was determined by meconium assay impulsive and emotionally reactive behaviors found in and maternal self-report with alcohol, marijuana, older samples. Being rejected by peers subsequent to tobacco, and opiates present in both groups. Motor 1st grade marginally added to the prediction of early skills were assessed at 1 month using the NICU starting conduct problems in 3rd and 4th grades, Network Neurobehavioral Scale (NNNS), at 4 months controlling for 1st grade ADHD symptoms and using the posture and fine motor assessment of infants aggression. Furthermore, peer rejection partially (PFMAI), at 12 months using the Bayley Scales of mediated the predictive relation between early ADHD Infant Development-Second Edition (BSID-II), and at symptoms and subsequent conduct problems. These 18 months using the Peabody Developmental Motor results support the hypothesis that the experience of Scales (PDMS). Examiners masked to exposure status peer rejection in the early school years adds to the risk performed all assessments. Motor scores were for early starting conduct problems. converted to standard (z) scores, and hierarchical linear modeling (HLM) was used to examine the change in Miller L, France D, Clemetson L et al. Sins of the fathers. motor skills from 1 to 18 months of age. Infants with Newsweek 2002; 139(9):42-9, 51-2. exposure to cocaine showed low motor skills at their initial status of 1 month but displayed significant Miller L, Schweingruber H, Oliver R, Mayes J, Smith D. increases over time. Both higher and lower levels of Teaching neuroscience through Web adventures: tobacco use related to poorer motor performance on adolescents reconstruct the history and science of average. Heavy cocaine use related to poorer motor opioids. Neuroscientist 2002; 8(1):16-21. performance as compared to no use, but there were no Abstract: New technological and cultural developments effects of level of cocaine use on change in motor surrounding adolescents' use of the World Wide Web skills. offer an opportunity for turning aspects of the Internet gaming phenomenon to the advantage of neuroscience Miller M. Fractures during physical therapy. Pediatr Radiol education. Specifically, an experimental project to 2002; 32(7):536-7. transmit aspects of problem-based learning and the National Science Standards through an interactive Web Miller TR, Fisher DA, Cohen MA. Costs of juvenile adventure is reported here. The Reconstructors is an violence: policy implications. Pediatrics 2001; episodic Web-based adventure series entitled 107(1):E3. Medicinal Mysteries from History. It is funded by the National Institute on Drug Abuse, and the first series Miller VA, Drotar D, Burant C, Kodish E. Clinician-parent focuses on opioids. It was created with the input of communication during informed consent for pediatric middle school students and teachers. Through the use leukemia trials. J Pediatr Psychol 2005; 30(3):219-29. of multimedia technologies, middle school students Abstract: OBJECTIVE: To address the need to 716
- 725. describe informed consentin pediatric settings and to maximum vision is to be restored. From January 2000 identify barriers to parent understanding, this study through February 2003, 468 victims of terror were assessed how aspects of clinician-parent examined in one of two major hospitals in Jerusalem communication during the informed consent that treat ocular injuries; 40 (8.5%) of these patients conference (ICC) relate to parent understanding of suffered from PET. METHODS: We conducted in our informed consent and parent perception of the impact hospital a retrospective chart review of 109 consecutive of the ICC on their anxiety and control. METHODS: patients with PET from January 2000 to February Parents of 127 children with newly diagnosed leukemia 2003; 40 (36.7%) cases were caused by terrorism. Data who were eligible for clinical trials were the were collected on demographic characteristics; type, participants. The study used comprehensive methods cause and extent of injury; and visual acuity (VA) on including both observational and self-report assessment admission and at discharge. The terror victims were methods. RESULTS: Structural equation modeling hospitalized in intensive care, surgical, and demonstrated that parent race and socioeconomic status ophthalmology wards. RESULTS: Of the patients (SES) were powerful predictors of clinician-parent admitted after terrorist attacks, 64% were male. Arab communication, parent anxiety and control as a result patients comprised 20% of those admitted. Ninety-five of the ICC, and parent understanding. Clinician percent of the terror victims with PET required surgery information giving and partnership building predicted (20% for enucleation, 30% for retinal detachment, and parent participation during the ICC. CONCLUSIONS: the remaining 45% for other causes). Eighty-two These findings may be used to design interventions that percent of these victims presented with a visual acuity increase the effectiveness of the ICC by identifying > or = 20/200 in the injured eye (versus 63% in patients specific elements of the conference that influence admitted with ocular trauma from other causes), and parent affect and understanding. 44% remained blind at discharge (versus 28% from other causes). CONCLUSIONS: Terror victims have Mimasaka S, Hashiyada M, Nata M, Funayama M. more severe ocular injuries than do other patients with Correlation between serum IL-6 levels and death: PET Ophthalmic nurses must make a special effort to usefulness in diagnosis of "traumatic shock"? Tohoku J attend to these patients in wards other than the Exp Med 2001; 193(4):319-24. ophthalmology wards and to coordinate their in- Abstract: Interleukin-6 (IL-6) has been considered as hospital care and follow-up treatments with hospital an important mediator of inflammation. Clinically it is personnel in intensive care and surgical wards. a well-known marker of the severity of injury following major trauma. In this study, the levels of IL- Miner MH, Munns R. Isolation and normlessness: attitudinal 6 in body serum were applied to a traumatic death comparisons of adolescent sex offenders, juvenile index. Of ninety victims 55 were men and 35 women, offenders, and nondelinquents. Int J Offender Ther with a mean age of 53.4+/- 19 (S.D.) years. The cases Comp Criminol 2005; 49(5):491-504. were classified as traumatic deaths (38 cases), non- Abstract: The authors explored attitudinal differences traumatic deaths other than natural causes of deaths (36 among adolescent male sex offenders, juvenile cases), and deaths due to natural causes (16 cases). All delinquents, and nondelinquent youth based on three samples were collected within 2 days after death. The variables drawn from integrated delinquency theory: mean values of IL-6 levels of the traumatic, non- conventional attitudes, normlessness, and social traumatic and disease groups were 8608.97, 2205.65, isolation. Consistent with previous juvenile and 3266.64 pg/ml, respectively. Some cases in non- delinquency studies, the results indicate no differences traumatic and disease cases were beyond 10 000 pg/ml, among the three groups on conventional attitudes. With however, the mean value of the traumatic group was respect to normlessness, both the sex offenders and statistically higher than that of the other two groups. juvenile delinquent groups demonstrated more school Even though several cases had high levels of IL-6 in normlessness than did nondelinquent youths, and spite of instantaneous death, the results showed that IL- adolescent sex offenders showed greater peer 6 levels are helpful in the diagnosis of traumatic shock. normlessness than did either nondelinquent youths or juvenile delinquents. Examination of perceived social Mimran S, Rotem R. Ocular trauma under the shadow of isolation among the three groups indicates that sex terror. Insight 2005; 30(3):10-2. offenders consistently perceived themselves as more Abstract: OBJECTIVES: To determine the prevalence isolated than other youths with their families, in their and severity of penetrating eye trauma (PET) in victims school, and among their peers. These results suggest of terror attacks in Jerusalem and to determine their that interpersonal factors, in addition to a lack of social specific in-hospital needs; and to evaluate the role of controls and normlessness, are associated with sexually the ophthalmic nurse in helping to treat these patients inappropriate behavior. in wards other than the ophthalmology ward and to determine how the ophthalmic nurse can coordinate Minkoff H, McCalla S. Uterine rupture among women with care of the patients with other hospital personnel. a prior cesarean delivery. N Engl J Med 2002; BACKGROUND: PET is a common cause of 346(2):134-7. significant visual loss. Early treatment is mandatory if 717
- 726. Minkovitz CS, HughartN, Strobino D et al. A practice- with someone at the practice (OR, 0.95 [95% CI, 0.56 based intervention to enhance quality of care in the first to 1.63] and OR, 2.82 [95% CI, 1.57 to 5.08]). 3 years of life: the Healthy Steps for Young Children CONCLUSION: Universal, practice-based Program. JAMA 2003; 290(23):3081-91. interventions can enhance quality of care for families Abstract: CONTEXT: There is growing concern of young children and can improve selected parenting regarding the quality of health care available in the practices. United States for young children, and specific limitations have been noted in developmental and Minns RA, Busuttil A. Patterns of presentation of the shaken behavioral services provided for children in the first 3 baby syndrome: four types of inflicted brain injury years of life. OBJECTIVE: To determine the impact of predominate. BMJ 2004; 328(7442):766. the Healthy Steps for Young Children Program on quality of early childhood health care and parenting Mintz Y, Shapira SC, Pikarsky AJ et al. The experience of practices. DESIGN, SETTING, AND one institution dealing with terror: the El Aqsa Intifada PARTICIPANTS: Prospective controlled clinical trial riots. Isr Med Assoc J 2002; 4(7):554-6. enrolling participants between September 1996 and Abstract: BACKGROUND: During a period of 13 November 1998 at 6 randomization and 9 quasi- months--1 October 2000 to 31 October 2001--586 experimental sites across the United States. Participants terror assault casualties were treated in the trauma unit were 5565 children enrolled at birth and followed up and emergency department of Hadassah University through age 3 years. INTERVENTION: Incorporation Hospital (Ein Kerem campus); 27% (n = 158) were of developmental specialists and enhanced hospitalized and the rest were discharged within 24 developmental services into pediatric care in hours. OBJECTIVES: To analyze the special participants' first 3 years of life. MAIN OUTCOME requirements of a large number of victims who MEASURES: Quality of care was operationalized received treatment during a short period. METHODS: across 4 domains: effectiveness (eg, families received Data were attained from the main admitting office and > or =4 Healthy Steps-related services or discussed >6 the trauma registry records. Factors analyzed included anticipatory guidance topics), patient-centeredness (eg, age, gender, mechanism of injury, anatomic site of families were satisfied with care provided), timeliness injury, Injury Severity Score, and length of stay. (eg, children received timely well-child visits and RESULTS: Males comprised 81% of the hospitalized vaccinations), and efficiency (eg, families remained at patients. The majority of the injuries (70%) were due to the practice for > or =20 months). Parenting outcomes gunshot wounds and 31% of the hospitalized patients included response to child misbehavior (eg, use of were severely injured (ISS > or = 16). Twelve patients severe discipline) and practices to promote child died, yielding a mortality rate of 7.5%. development and safety (eg, mothers at risk for CONCLUSION: The nature of the injuries was more depression discussed their sadness with someone at the complex and severe than trauma of other etiologies, as practice). RESULTS: Of the 5565 enrolled families, noted by the mean length of stay (10.2 vs. 7.2 days), 3737 (67.2%) responded to an interview at 30 to 33 mean intensive care unit stay (2.8 vs. 0.9 days), and months (usual care, 1716 families; Healthy Steps, 2021 mean operations per patient (0.7 vs. 0.5). The mean families). Families who participated in the Healthy insurance cost for each hospitalized terror casualty was Steps Program had greater odds of receiving 4 or more also higher than for other trauma etiologies (US$ 3,200 Healthy Steps-related services (for randomization and vs. 2,500). quasi-experimental sites, respectively: odds ratio [OR], 16.90 [95% confidence interval [CI], 12.78 to 22.34] Mirsal H, Kalyoncu A, Pektas O, Tan D, Beyazyurek M. and OR, 23.05 [95% CI, 17.38 to 30.58]), of discussing Childhood trauma in alcoholics. Alcohol Alcohol 2004; more than 6 anticipatory guidance topics (OR, 8.56 39(2):126-9. [95% CI, 6.47 to 11.32] and OR, 12.31 [95% CI, 9.35 Abstract: AIMS: Many studies have been conducted to to 16.19]), of being highly satisfied with care provided evaluate the relationship between childhood trauma (eg, someone in the practice went out of the way for and alcoholism. In this study 80 alcoholics were chosen them) (OR, 2.06 [95% CI, 1.64 to 2.58] and OR, 2.11 according to their hospitalization order. The control [95% CI, 1.72 to 2.59]), of receiving timely well-child group consisted of 60 subjects, with no history of visits and vaccinations (eg, age-appropriate 1-month alcohol use, matched with the patient group in age and visit) (OR, 1.98 [95% CI, 1.08 to 3.62] and OR, 2.11 sex. METHODS: A sociodemographic and clinical data [95% CI, 1.16 to 3.85]), and of remaining at the form, a questionnaire focusing on traumatic life practice for 20 months or longer (OR, 2.02 [95% CI, experiences in childhood and The Childhood Trauma 1.61 to 2.55] and OR, 1.75 [95% CI, 1.43 to 2.15]). Questionnaire, Hamilton Depression Rating Scale, and They also had reduced odds of using severe discipline Hamilton Anxiety Rating Scale were applied to both (eg, slapping in face or spanking with object) (OR, groups. RESULTS: Significant differences were found 0.82 [95% CI, 0.54 to 1.26] and OR, 0.67 [95% CI, between the two groups on traumatic life experiences 0.46 to 0.97]). Among mothers considered at risk for in childhood. Results suggested that childhood trauma depression, those who participated in the Healthy Steps positively correlates with anxiety and affective Program had greater odds of discussing their sadness 718
- 727. symptoms among alcoholics.CONCLUSIONS: identified by the researchers throw snowball sampling. Further studies are needed concerning this issue. Earlier results of an unstable childhood and a poor social situation from studies that used other sampling Mitka M. Hospital study offers hope of changing lives prone methods were replicated. The drug users had an earlier to violence. JAMA 2002; 287(5):576-7. nicotine and alcohol debut, and perceived themselves as unloved, physically abused children that were afraid Moag-Stahlberg A, Miles A, Marcello M. What kids say of their parents during childhood. In addition, they do and what parents think kids are doing: The depression, suicide attempts and convictions were more ADAF/Knowledge Networks 2003 Family Nutrition common among the drug users. and Physical Activity Study. J Am Diet Assoc 2003; 103(11):1541-6. Moghtaderi A, Rahimi-Movaghar V, Safdari M. Notes: CORPORATE NAME: ADAF/Knowledge Spontaneous brain rupture: a complication of untreated Networks 2003 Family Nutrition and Physical Activity hydrocephalus. Clin Neurol Neurosurg 2005; Study 108(1):48-51. Abstract: A case of infantile hydrocephalus with Moe MC, Westerlund U, Varghese M, Berg-Johnsen J, secondary spontaneous brain rupture is reported. As far Svensson M, Langmoen IA. Development of neuronal as the authors' knowledge, this is the first case of networks from single stem cells harvested from the spontaneous brain and ventricular rupture secondary to adult human brain. Neurosurgery 2005; 56(6):1182-8; high-pressure hydrocephalus. It is a case of infantile discussion 1188-90. hydrocephalus occurring due to the expansility of an Abstract: OBJECTIVE: It was long held as an axiom infantile skull, which is normally not seen these days, that new neurons are not produced in the adult human and is a fatal sequela of untreated hydrocephalus. This brain. More recent studies, however, have identified rare complication occurs with the rupture of thinnest multipotent cells whose progeny express glial or part of the ependymal layer of the ventricle, cerebral neuronal markers. This discovery may lead to new tissue, meningeal membranes, bone and scalp. therapeutic strategies against central nervous system disorders by transplanting stem cells that have been Mohan P. Inequities in coverage of preventive child health propagated in vitro. Still, it is not known whether stem interventions: the rural drinking water supply program cells from the adult human brain retain the potential to and the universal immunization program in Rajasthan, mature into neurons that integrate and communicate in India. Am J Public Health 2005; 95(2):241-4. a network. METHODS: We cultured cells from the Abstract: OBJECTIVES: I assessed whether the Rural ventricular wall of the adult human brain as Drinking Water Supply Program (RDWSP) and the monoclonal neurospheres. After two passages, the Universal Immunization Program (UIP) have achieved neurospheres were dissociated and the cells were equitable coverage in Rajasthan, India, and explored allowed to differentiate. After 4 weeks of maturation, program characteristics that affect equitable coverage the cells were studied by immunocytochemistry, of preventive health interventions. METHODS: A total confocal microscopy, and whole-cell patch-clamp. of 2460 children presenting at 12 primary health RESULTS: We show that monoclonal stem cells facilities in one district of Rajasthan were enrolled and harvested from the ventricular wall of the adult human classified into economic quartiles based on possession brain develop into mature neurons with functional of assets. Immunization coverage and prime source of glutamate receptors and glutamatergic nerve terminals. drinking water were compared across quartiles. By patching pairs of cells simultaneously, we also RESULTS: A higher access to piped water by present direct evidence for synaptic communication wealthier families (P< .001) was compensated by between neurons developed from the same monoclonal higher access to hand pumps by poorer families cell. CONCLUSION: Neural stem cells harvested from (P<.001), resulting in equal access to a safe source the adult human brain retain the potential to mature (P=.9). Immunization coverage was inequitable, into fully differentiated neurons that integrate and favoring the wealthier children (P<.001). communicate by synapses. This opens a possible future CONCLUSIONS: The RDWSP has achieved equitable scenario of autotransplantation, in which stem cells are coverage, while UIP coverage remains highly harvested from small biopsies of the ventricular wall inequitable. Programs can make coverage more and propagated in vitro before transplantation. equitable by formulating explicit objectives to ensure physical access to all, promoting the intervention's Moen C, Ohlund LS. Negative memories of childhood and demand by the poor, and enhancing the support and current drug use. Nord J Psychiatry 2003; 57(4):303-8. monitoring of frontline workers who deliver these Abstract: Data on drug abuse and memories of the interventions. childhood were collected through a self-report questionnaire from a group of current drug users and a Mohatt GV, Rasmus SM, Thomas L, Allen J, Hazel K, group of non-using controls. Both samples were Hensel C. "Tied together like a woven hat:" Protective unidentified as groups by the society and were pathways to Alaska native sobriety. Harm Reduct J 719
- 728. 2004; 1(1):10. is overwhelming evidence that harsh interventions are Abstract: BACKGROUND: The People Awakening damaging to children, both emotionally and physically. Project (1RO1 AA 11446-03) had two purposes, The effects of such trauma may be compounded when completed in Phase I and Phase II of the project. The a child has preexisting learning difficulties. When purpose of Phase I was to complete a qualitative study; schools respond to these challenges using harsh the research objective was discovery oriented with the methods, children can be further traumatized. The specific aim of identification of protective and recovery authors review principles of childhood factors in Alaska Native sobriety. Results were used to neurodevelopment, describe a model to understand develop a heuristic model of protective and recovery children in context, and discuss how exposure to factors, and measures based on these factors. The certain noxious sensory experiences can affect research objective of Phase II was to pilot these children's responses to threat or perceived threat. They measures and provide initial validity data. METHODS: also describe implications for school nurses. Phase I utilized a life history methodology. People Awakening interviewed a convenience sample of 101 Moineau G, Plint A. Tibial fractures possibly linked to use Alaska Natives who had either recovered from of a baby stationary activity center. Pediatr Emerg Care alcoholism (n = 58) or never had a drinking problem (n 2005; 21(3):181-3. = 43). This later group included both lifetime abstainers (LAs) and non-problem drinkers (NPs). Life Molczan KA. Triaging pediatric orthopedic injuries. J Emerg histories were transcribed and analyzed using grounded Nurs 2001; 27(3):297-300. theory and consensual data analytic procedures within a participatory action research framework. Analyses Molinari E, Selvini M, Lenzini F. Sexual abuse and eating were utilized to generate heuristic models of protection disorders: clinical cases. Eat Weight Disord 2003; and recovery from alcohol abuse among Alaska 8(4):253-62. Natives. RESULTS: Analyses generated a heuristic Abstract: The aim of this analysis of five clinical cases model of protective factors from alcohol abuse. The is to show how an experience of sexual abuse can resulting multilevel and multi-factorial model describes contribute towards increasing individual vulnerability interactive and reciprocal influences of (a) individual, and become one of several factors that come together family, and community characteristics; (b) trauma and to aggravate and complicate the symptoms the individual and contextual response to trauma, (c) characterising eating disorders. It is also intended to experimental substance use and the person's social enhance the importance of a "multifactorial" model for environment; and (d) reflective processes associated approaching this kind of psychopathology. with a turning point, or a life decision regarding sobriety. The importance of cultural factors mediating Mollen CJ, Fein JA, Localio AR, Durbin DR. all these protective processes is emphasized. For NPs, Characterization of interpersonal violence events the resilience process drew from personal stores of involving young adolescent girls vs events involving self-confidence, self-efficacy, and self-mastery that young adolescent boys. Arch Pediatr Adolesc Med derived from ability to successfully maneuver within 2004; 158(6):545-50. stressful or potentially traumatizing environments. In Abstract: BACKGROUND: Multiple studies have contrast, for many LAs, efficacy was instead described demonstrated that girls are engaging in interpersonal in more socially embedded terms better understood as violence. However, little is known about the potentially communal mastery. One style of mastery is more unique aspects of violent events involving girls. associated with individualistic orientations, the other OBJECTIVES: To describe characteristics of with more collectivistic. Future research is needed interpersonal violence events in preadolescents and regarding the generalizeability of this group difference. young adolescents and to determine if events involving CONCLUSIONS: Results suggest that preventative any girl are different than those involving only boys. interventions should focus on intervening DESIGN: A cross-sectional survey of 8- to 14-year-old simultaneously at the community, family, and patients who were being evaluated at an urban individual levels to build resilience and protective children's hospital emergency department for injuries factors at each level. Of particular importance is the caused by interpersonal violence was conducted building of reflexivity along with other cognitive between September 2000 and August 2001. The survey processes that allow the individual to think through asked the patient to describe details about event problems and to reach a life decision to not abuse circumstances, opponents, weapon use, and injury alcohol. severity. RESULTS: We enrolled 190 patients into the study; 58 (31%) were girls. Seventy-four events (39%) Mohr WK, Anderson JA. Reconsidering punitive and harsh had a girl involved, 156 (82%) occurred on a weekday, discipline. J Sch Nurs 2002; 18(6):346-52. 127 (67%) were classified as fights, 140 (74%) were Abstract: Corporal punishment and other harsh with a known opponent, and 93 (49%) occurred at interventions continue to be widespread despite the fact school. Events involving girls were more likely than that the leading theories or models of behavioral events involving all boys to occur at home (relative risk management do not support their effectiveness. There 720
- 729. [RR], 1.6; 95%confidence interval [CI], 1.0-2.5). Both Monagle P, Robb B, Driscoll S, Bowes G. Organ retention boys and girls reported "being disrespected" and following paediatric and perinatal autopsy: where to "teasing" as popular reasons for a fight. Events from here? J Paediatr Child Health 2002; 38(4):405-8. involving girls were more commonly related to a "recurrence of a previous fight" (RR, 6.4; 95% CI, 1.9- Mondaini N, Ponchietti R, Gontero P et al. Penile length is 21.5), were more likely to end because of adult normal in most men seeking penile lengthening intervention (RR, 1.7; 95% CI, 1.1-2.6), and have a procedures. Int J Impot Res 2002; 14(4):283-6. family member try to physically break up the fight Abstract: Concerns over penile size and a desire for a (RR, 3.7; 95% CI, 1.5-9.1). CONCLUSION: Violent longer penis are common in the male population. The events involving preadolescent and early adolescent number of male patients seeking an andrological girls are more likely to be in response to a previous consultation for the problem of 'short penis' is event and to involve the home environment and family increasing. We looked at the numbers of patients member intervention. Health care professionals should presenting to a University andrology clinic over a 2-y screen violently injured girls for safety concerns and period and correlated their perceived penis size with retaliation plans and consider engaging the family in the accepted norms. Sixty-seven patients were efforts to prevent future events. evaluated with a median age of 27 (range 16-55) complaining of 'short penis' and requesting surgical Molnar BE, Roberts AL, Browne A, Gardener H, Buka SL. correction. Clinical history, including the IIEF-5 What girls need: recommendations for preventing questionnaire and an accurate physical examination violence among urban girls in the US. Soc Sci Med were obtained. Data concerning measures of penile 2005; 60(10):2191-204. length and circumference were recorded in both the Abstract: The last decade saw increases in arrests of flaccid and fully stretched states and compared to the girls for violent behavior and a corresponding concern normal reference range as previously described in the that girls' involvement in violence was increasing in the nomogram we recently published (Eur Urol 2001; 39: USA. However, there are few empirical studies of the 183-186.). All patients were also asked to estimate the dynamics of violence by girls, leaving providers of length of a normal sized penis.Fourty-four (65.7%) violence prevention programs and policy-makers complained of a short penis only while flaccid, 22 without evidence on which to base gender-appropriate patients (32.8%%) while both flaccid and erect, and prevention strategies. To address this gap, qualitative only one patient (1.5%) was worried only by the erect interviews were conducted with a diverse sample of 61 length of the penis. Fifteen (22.4%) also complained urban girls aged 11-17. Findings were compared with about their penile circumference. Fifty-seven (85%) quantitative interviews from the prospective cohort of patients thought a 'normal' penile length should range 961 girls from whom these respondents were drawn, from 10 to 17 cm (median value of 12 cm). Ten from the Project on Human Development in Chicago patients (15%) were not able to estimate 'normal' penile Neighborhoods. Mixed-method techniques were size. No patient was found to have a penile length employed. Qualitative data were analyzed for girls' under the 2.5 percentile according to our nomogram. recommendations for preventing involvement in Forty-two (62.7%) subjects recalled the problem violence. Data from the larger cohort were used to test starting in childhood, when they felt that their penis these recommendations quantitatively. Due to study was smaller than their friends'. In 25 patients (37.3%) design, in the qualitative sample, 36 girls (64%) were the problem started in the teenage years after seeing involved in recent violence, most often with or against erotic images. Our data show that most men who seek other girls. Pro-social behavior was common among penile lengthening surgery overestimate 'normal' penile both violent and nonviolent girls. In the overall cohort length. In our series, none of the patients could be sample, 24.9% of girls reported violent perpetration classified as having a severely short penis according to and 97% reported pro-social activities. Eight themes our nomogram and none had any anatomical penile regarding staying safe and preventing violence abnormality. Most found the use of a nomgram to show emerged from the qualitative interviews: girls stayed them how they compared with other men helpful. We safe by staying home, avoiding dangerous people, suggest that documentation of such a demonstration staying busy with after-school activities, remaining should be made for any man seeking an opinion on calm when confronted, using escorts, and fighting back penile lengthening surgery. if attacked. Girls' protective influences included: empathic parental involvement, positive relationships Monsen RB. Adopting children. J Pediatr Nurs 2004; with peers and older youth, and involvement in safe 19(3):214-5. and constructive activities. These findings emphasize that safety in community, school, and family settings is Monsen RB. Advocating for children. J Pediatr Nurs 2004; critical for girls in avoiding violence and other risky 19(5):364-5. behaviors. Violence prevention programs should focus on enhancing girls' relationships with mothers, older Monsen RB. Children hearing. J Pediatr Nurs 2003; girls, and friends their age. 18(6):421-2. 721
- 730. Monsen RB. Drawingthe pain. J Pediatr Nurs 2003; violence can be understood in terms of "stories told" 18(4):284-5. and "stories lived." When stories told (e.g., the experience of torture and organized violence) are in Monteiro C, Trindade E, Monteiro F et al. Blood group- contradiction to stories lived, a situation of ambiguity antigen profile predicted by molecular biology in and uncertainty is created. The meaning-providing Munchausen syndrome by proxy. J Lab Clin Med contexts for making sense of the family history of 2004; 144(6):319. violence and exile can be more or less coherent or contradictory, and might result in a strengthened Monteiro Caran EM, Dias CG, Seber A, Petrilli AS. Clinical relationship or confusion, powerlessness, and action aspects and treatment of pain in children and paralysis. Clinicians can help traumatized families deal adolescents with cancer. Pediatr Blood Cancer 2005; with their past histories of violence by paying attention 45(7):925-32. to such ambiguities and contradictions. Abstract: BACKGROUND: The aim of this study was to characterize the clinical aspects and the treatment of Montgomery E, Foldspang A. Seeking asylum in Denmark: mild to severe pain in Brazilian children and refugee children's mental health and exposure to adolescents with cancer. We evaluated the importance violence. Eur J Public Health 2005; 15(3):233-7. of classifying patients according to the phase of cancer Abstract: AIMS: The aim of this study was to compare treatment (diagnosis, treatment, recurrence, and end-of- profiles of present mental health and previous exposure life palliative care) and the opioid-related side effects. to violence among refugee children from the Middle METHODS: An institutional prospective study of 184 East, whose asylum seeking families either did or did episodes of pain in children and adolescents with not obtain permission to stay in Denmark. METHODS: cancer was conducted. Pain was classified according to Shortly after arrival in Denmark, the parents of 311 its cause, physiopathology and intensity. Treatment Middle-Eastern children answered a structured was based on the WHO guidelines for cancer pain interview on their children's exposure to organized relief. RESULTS: Pain scales were completed by 77% violence and their mental health. The families were of the patients. Numerical scales were used by 49% of followed-up as concerns receipt of a residence permit. them. Morphine was given in 111 episodes for 2,758 RESULTS: At arrival in Denmark, the children's patient days. Morphine doses had to be escalated when patterns of previous exposure to violence and present it was given to patients during end-of-life palliative mental health was generally similar irrespective of the care. Opioids were well tolerated with no severe side family getting a residence permit, as was the case for effects. Psychological dependence on morphine was 90 families (60.4%) with 190 children (61.1%). In both found in 2% (2/111) of the cases. Pain control was groups an overwhelming majority, eight to nine out of satisfactory in 97% of the episodes. CONCLUSIONS: 10 children, had been exposed to conditions of war and The WHO guidelines for cancer pain relief were had stayed in a refugee camp, and seven out of 10 had effective in controlling pain in children and adolescents witnessed violence. Half of the children had a tortured with cancer. Despite their low socioeconomic level, parent. Considerably more children of families who did patients were able to quantify their pain using rating not get a residence permit had lost a parent (30.6% scales. versus 13.7%; P<0.001). In both groups about two- thirds suffered from anxiety and about 30% from sleep Montgomery E. Tortured families: a Coordinated problems, and children whose families did not later on Management of Meaning analysis. Fam Process 2004; get a residence permit more often appeared sad or 43(3):349-71. miserable (43.8% versus 27.9%; P<0.005). Abstract: Torture is known to affect both the individual CONCLUSIONS: The asylum-granting decision and the family. The aim of the present study was to process seems to have divided the children into two reach a better understanding of the significance of groups with only superficial disparity as concerns their communication and information about parental previous exposure to violence and their present mental exposure to violence in torture-surviving families. The health. There seems to be good reason to systematically theoretical background is Social Constructionism and integrate evidence on the children of refugee families Coordinated Management of Meaning (CMM). In- in the treatment of applications for permission to stay. depth interviews were carried out with 14 members of 3 Middle Eastern refugee families living in Denmark in Montgomery E, Foldspang A. Traumatic experience and which the father had been exposed to torture. The 3 sleep disturbance in refugee children from the Middle families experienced their life stories and situations as East. Eur J Public Health 2001; 11(1):18-22. refugees in very different ways, ranging from Abstract: BACKGROUND: Sleep disturbance is meaninglessness, discontinuance, and alienation to a frequently reported in children after traumatic sense of community, solidarity, and openness. experiences associated with organised violence. The Communications about past events were related to such aim of this study was to identify specific traumatic risk meaning-providing contexts. The way in which parents indicators and modifying factors for sleep disturbance talk with their children about torture and organized among recently arrived refugee children from the Middle East. METHODS: The study group comprises 722
- 731. 311, 3-15 yearold refugee children from the Middle Ann Emerg Med 2002; 39(4):404-12. East. On arrival in Denmark, their parents participated Abstract: Practice guidelines and performance in a structured interview about their childrens' health measures are critical elements of an effective quality and history of exile and eventual exposure to war, improvement process for emergency medical services organised violence and human rights violation. for children (EMSC). Practice guidelines address the RESULTS: A family history of violence (grandparent's clinical management of individual patients, and violent death before the birth of the child or parental performance measures assess the quality of care exposure to torture) as well as a stressful present family delivered to a population. The public and private situation (father scolds the child more than previously) sectors have invested considerable resources in were the strongest predictors of prevalent sleep developing practice guidelines and performance disturbance in the children. Arriving in Denmark with measures to improve the quality of health care services. both parents rather than one was a modifying factor, so As organizations continue development efforts, health the effect of traumatic experience on sleep patterns care professionals who are actively involved in later in childhood was mediated through parental emergency care must collaborate to develop guidelines presence and behaviour. CONCLUSION: This study that address the unique physiologic, psychologic, and indicates that the family environment is of primary cultural needs of children. The Emergency Medical importance for childhood sleep disturbance following Services for Children Managed Care Task Force traumatic experiences connected with war and other recommended the development of a series of white organised violence. papers to focus on issues related to practice guidelines and performance measures in EMSC. The Maternal Montigny F, Lacharite C. Perceived parental efficacy: and Child Health Bureau, Health Resources and concept analysis. J Adv Nurs 2005; 49(4):387-96. Services Administration, the National Highway Traffic Abstract: AIMS: This paper describes a concept Safety Administration, and the Robert Wood Johnson analysis carried out to remove some of the ambiguity Foundation jointly sponsored the project. The paper surrounding the conceptual meaning of perceived was developed by a panel selected from a pool of parental efficacy and to distinguish it from related experts in managed care, quality improvement, and concepts such as parental confidence and parental emergency medical services. After a review of the competence. BACKGROUND: Constructing parental literature, the panelists met to discuss critical issues efficacy is a crucial step for family members after the related to practice guidelines and performance birth of their first child. For some authors, perceived measures in EMSC. The panelists developed parental efficacy is a motor for adequate parental recommendations that can serve as resources for practices. Confusion about the definition and managed care organizations, health care providers, measurement of this concept has hindered both professional associations, and governmental policy psychology and nursing practice and research. Concept makers. The panel recognized the lack of nationally delineation and concept clarification are required in recognized pediatric emergency care guidelines and order to further the development of the concept of performance measures and called for immediate action perceived parental efficacy. METHODS: A literature in these areas. search using a variety of online databases yielded 113 articles between the years 1980 and 2000. The final Mooney JF 3rd, Cramer KE. Lower extremity compartment sample (n=60) consisted of 30 articles from two syndrome in infants associated with child abuse: a disciplines: nursing and psychology. A content analysis report of two cases. J Orthop Trauma 2004; 18(5):320- of the literature was done using Rodger's evolutionary 2. concept analysis method. FINDINGS: Content analysis Abstract: Compartment syndrome associated with child of the literature yielded four contributors to perceived abuse is unreported in the literature. We describe two parental efficacy: positive enactive mastery cases secondary to lower extremity fractures resulting experiences, vicarious experiences, verbal persuasion from child abuse. The diagnosis and management of and an appropriate physiological and affective state. compartment syndrome are reviewed. Orthopaedic Perceived parental efficacy can thus be defined as surgeons involved in the care of pediatric patients must 'beliefs or judgements a parent holds of their be aware of this potentially devastating complication, capabilities to organize and execute a set of tasks and must be prepared for timely management. related to parenting a child'. CONCLUSION: This conceptual analysis has allowed perceived parental Moore C, Dunkelberg E, Chivers L, O'Berg J, Waldinger RJ. efficacy to be distinguished from parental confidence The role of shame and guilt in male aggression toward and parental competence. Both nursing and psychology partners. J Am Psychoanal Assoc 2004; 52(2):480-1. research, practice and education will benefit from a more precise and delineated concept. Moore KA, Coker K, DuBuisson AB, Swett B, Edwards WH. Implementing potentially better practices for Moody-Williams JD, Krug S, O'Connor R, Shook JE, Athey improving family-centered care in neonatal intensive JL, Holleran RS. Practice guidelines and performance care units: successes and challenges. Pediatrics 2003; measures in emergency medical services for children. 723
- 732. 111(4 Pt 2):e450-60. After controlling for language, demographics, health Abstract: OBJECTIVE: Multidisciplinary teams from status, socio-economic characteristics, and mothers' 11 medical center neonatal intensive care units prenatal care use, infants of US-born MA mothers had collaborated in a quality improvement project with a rates of use similar to WNH. However, even after focus on family-centered care. METHODS: Through a controlling for the study variables, infants of Mexico- process of self-analysis, literature review, born mothers were less likely (OR = .83) to use the benchmarking site visits, and expert consultation, 10 developmental clinic. Hispanics continued to lag potentially better practice (PBP) areas were defined. behind in the use of services compared with WNHs. Improvement activities in 4 of the 10 areas are given as The disparity is not a function of ethnicity, but appears examples of successes and challenges that individual attributable to demographic and socio-economic centers encountered. The 4 areas are vision and characteristics. Infants who had a CHN visit were philosophy, unit culture, family participation in care, significantly more likely (OR = 2.51) to use the and families as advisors. RESULTS: Centers were at developmental clinic than those without a nurse visit. different places for all of the PBPs at the beginning and Infants whose mothers had inadequate prenatal care throughout the collaboration. Seven centers developed were less likely to use these follow-up services even or revised their vision or philosophy of care statements after controlling for study variables. CONCLUSIONS: about family-centered care. Incorporating the vision Infants whose mothers had inadequate prenatal care and philosophy of care into performance appraisals, should be targeted for more intense CHN visits. Infants hiring of new personnel, and changing unit culture to a of mothers born in Mexico may need additional more family-centered practice were more challenging support/assistance in using the developmental clinic. than developing the statements. Full parent participation in care requires unrestricted access to the Moores A, Pace NA. Children's rights in Europe. Eur J neonatal intensive care unit. The shift from considering Anaesthesiol 2005; 22(4):245-8. parents to be "visitors" to being partners in caring for their child was more difficult for centers with restricted Moosajee M. Violence--a noxious cocktail of genes and the visitation policies. All centers developed, expanded, or environment. J R Soc Med 2003; 96(5):211-4. started plans for establishing family advisory councils. The experience of 2 centers is described. Moraczewski AS. Against the separation of Jodie and Mary. CONCLUSIONS: Family-centered care is more of a Ethics Medics 2001; 26(6):1-2. journey than a destination. Collaborating centers in this Notes: GENERAL NOTE: KIE: Moraczewski, Albert project found themselves at different places in that S journey. Through perseverance in implementing the GENERAL NOTE: KIE: KIE Bib: patient care/minors PBPs, all have moved further along the path. Morad Y, Avni I, Capra L et al. Shaken baby syndrome Moore PD, Bay RC, Balcazar H, Coonrod DV, Brady J, without intracranial hemorrhage on initial computed Russ R. Use of home visit and developmental clinic tomography. J AAPOS 2004; 8(6):521-7. services by high risk Mexican-American and white Abstract: OBJECTIVE: We sought to describe the non-Hispanic infants. Matern Child Health J 2005; unique characteristics of children diagnosed with 9(1):35-47. shaken baby syndrome (SBS) despite the absence of Abstract: OBJECTIVE: To investigate whether US- intracranial hemorrhage on cranial computerized born infants of mothers of Mexican descent who were tomography (CT) on hospital admission. METHODS: enrolled in Arizona's Newborn Intensive Care Program Using an international e-mail-based listserv for (NICP) received follow-up services (developmental professionals with an interest in child abuse, we clinic and community health nurse [(CHN)] home identified and reviewed the charts of children visits) at the rates similar to White non-Hispanic hospitalized in different medical centers who were (WNH) infants. Socio-economic and health status diagnosed with SBS although CT disclosed no signs of characteristics were controlled using stepped intracranial bleeding. Children with normal imaging regressions in order to assess the impact of each on were not included. RESULTS: Eight cases were service use. METHODS: This population-based study identified. All children had cerebral edema in CT, used retrospective data from the NICP administrative which was severe on 7/8 cases (88%). All of these database that were linked to birth certificates for years children had extensive retinal hemorrhage. The 1994-1998. The study population was limited to prognosis was poor; 5/8 infants died (63% mortality), Arizona-born infants; it included 7442 infants of WNH and the rest had permanent neurologic damage. mothers, 2612 infants of US-born Mexican American CONCLUSION: The diagnosis of SBS can be (MA) mothers and 2872 infants of Mexico-born established even when CT at presentation does not mothers. Four service use indicators were used in the demonstrate intracranial hemorrhage. We hypothesize analysis. RESULTS: Both Hispanic infant subgroups that rapidly developing cerebral edema may cause were less likely to have a CHN visit by 6 months and increased intracranial pressure and tamponade that by 1 year, and to average fewer CHN visits. A smaller prevents the accumulation of intracranial blood. The percent attended the developmental clinic by age one. 724
- 733. prognosis in thesecases is grave. legal ramifications of their clinical diagnoses. As the legal arena is currently revising laws concerning rights Morad Y, Kim YM, Mian M, Huyer D, Capra L, Levin AV. of sexual consent among the mentally retarded, it is Nonophthalmologist accuracy in diagnosing retinal essential that determinations of mental competency hemorrhages in the shaken baby syndrome. J Pediatr follow national standards in order to delineate clearly 2003; 142(4):431-4. any instance of sexual abuse. Clinical documentation Abstract: Nonophthalmologists did not attempt to of sexual abuse and sexually transmitted disease is an (36%) or were "unable to" (19%) examine the fundus important part of a routine examination since many in 72 children with shaken baby syndrome. When the such individuals are indeed sexually active. Legal retina was examined, nonophthalmologists were codes adjudicating sexual abuse cases of the mentally accurate in recognizing the absence or presence of retarded often offer scant protection and vague retinal hemorrhage in 87%. However, false-negative terminology. Thus, medical documentation and examinations occurred in 13%. Ophthalmology physician competency rulings form a solid foundation consultation should be an integral part of the evaluation for future work toward legal recourse for the abused. of children with suspected abuse. Moreno JD. "Of uncertain viability." The new federal rules Moraes LR, Cancio JA, Cairncross S, Huttly S. Impact of for fetal and neonatal research. Hastings Cent Rep drainage and sewerage on diarrhoea in poor urban 2002; 32(5):47-8. areas in Salvador, Brazil. Trans R Soc Trop Med Hyg Notes: GENERAL NOTE: KIE: 3 refs. 2003; 97(2):153-8. GENERAL NOTE: KIE: KIE Bib: embryo and fetal Abstract: A longitudinal prospective study of the effect research; human experimentation/minors; human of drainage and sewerage systems on diarrhoea in experimentation/regulation children aged < 5 years was conducted in 9 poor urban areas of the city of Salvador (population 2.44 million) Moreno L, Sanchez JL, Manas S et al. Tools for acquisition, in north-east Brazil in 1989-90. Due to complex processing and knowledge-based diagnostic of the political and administrative reasons, 3 areas had electroencephalogram and visual evoked potentials. J benefited from drainage improvements, 3 from both Med Syst 2001; 25(3):177-94. drainage and sewerage improvements, and 3 from Abstract: The objective of our research is to develop neither. An extensive questionnaire was applied to computer-based tools to automate the clinical collect information on each child and on the conditions evaluation of the electroencephalogram (EEG) and of the household, and mothers recorded diarrhoea visual evoked potentials (VEP). This paper describes a episodes in their children aged < 5 years daily for 1 set of solutions to support all the aspects regarding the year, using calendars. Fortnightly home visits were standard procedures of the diagnosis in made to collect the data. The incidence of diarrhoea in neurophysiology, including: (1) acquisition and real- children in neighbourhoods with drainage was less than time processing and compression of EEG and VEP two-thirds, and in neighbourhoods with drainage and signals, (2) real-time brain mapping of spectral powers, sewerage less than one-third, of the incidence in (3) classifier design, (4) automatic detection of neighbourhoods with neither. After controlling for morphologies through supervised neural networks. (5) potential confounders, the proportion of children with signal analysis through fuzzy modelling, and (6) a 'frequent diarrhoea' showed the same significant trend knowledge based approach to classifier design. across the study groups. Though the groups were not exactly comparable, more than one child was Moriyama M, Suwa T, Kabuto M, Fukushima T. monitored per household, and it was not possible to Participatory assessment of the environment from rotate fieldworkers between study groups, the study children's viewpoints: development of a method and its provides evidence that community sanitation can have trial. Tohoku J Exp Med 2001; 193(2):141-51. an impact on diarrhoeal disease, even without measures Abstract: To understand the actual viewpoints of to promote hygiene behaviour. children about daily life and the environment, the authors, adopting a participatory strategy, visited 21 Morano JP. Sexual Abuse of the Mentally Retarded Patient: classes of Japanese school children, improved in a Medical and Legal Analysis for the Primary Care stepwise process their ways of question-asking, and Physician. Prim Care Companion J Clin Psychiatry developed "WIFY"(what is important for you); a set of 2001; 3(3):126-35. interactive questions composed of a basic question and Abstract: The primary care physician has a vital role in three accompanying instructions. In applying WIFY, documenting and preventing sexual abuse among the 59 fourth graders, 22 in Nagasaki, Japan and 37 in mentally retarded populations in our community. Since Beijing, China, reported their viewpoints in each of the current national trend is to integrate citizens with classroom settings. In both settings, when children mental retardation into the community away from were allowed to communicate with each other by the institutionalized care, it is essential that all physicians use of WIFY answering sheet, spontaneous exchanges have a basic understanding of the unique medical and arose and continued. WIFY itself is supposed to bring 725
- 734. out and enhancemutual collaboration and spontaneous education is more important than statutory mandate. networking. In this instance, WIFY functioned as a communication tool. When answering sheets were Morrongiello BA, Kiriakou S. Mothers' home-safety collected and obtained responses were analyzed as practices for preventing six types of childhood injuries: cases, a rather materialistic view was suggested among what do they do, and why? J Pediatr Psychol 2004; Japanese children and a more disciplined view, which 29(4):285-97. put much value on school and home, was suggested Abstract: OBJECTIVE: To identify determinants of among Chinese children. Further studies are needed to mothers' home-safety practices for preventing six types confirm the changing environmental views of children of common injuries to children (burns, poisoning, from the collaborative research framework. drowning, cuts, strangulation/suffocation/choking, and falls). METHODS: Home interviews were conducted Mork M. [Medical problems and needs of follow-up in a with mothers of children 19-24 and 25-30 months old group of children with mild cerebral palsy]. Tidsskr about home-safety practices. For each of 30 safety Nor Laegeforen 2001; 121(13):1566-9. precautions to prevent these six types of injuries, Abstract: BACKGROUND: There is no specialized mothers indicated whether or not they engaged in the health service for routine follow-up for ambulatory practice, and explained why. RESULTS: Regression children with cerebral palsy in Rogaland county. Our analyses revealed both common and unique aim was to investigate the kind of medical problems determinants of mothers' home-safety practices to these children had and whether these problems were prevent these six types of home injuries. For burns, discovered by the health services. MATERIAL AND cuts, and falls, beliefs that child characteristics and METHODS: 37 children with cerebral palsy born parent characteristics elevated the child's risk of injury 1987-1992 were investigated. They were all were the key determinants of the mother's engaging in independent walkers without mental retardation at the precautionary measures. For drowning, poisoning, and time of selection. The majority had spastic hemiplegia suffocation/strangulation/choking, health beliefs also or spastic diplegia. Their parents were interviewed and contributed to predict mothers' practices, including the children underwent a neurological examination. beliefs about potential injury severity and extent of RESULTS: Orthopedic problems such as scoliosis, hip effort required to implement precautionary measures. abnormalities, tight tendons and muscles, and leg CONCLUSIONS: The factors that motivated mothers length discrepancy were not discovered by the local to engage in precautionary measures at home varied health service. The children had a high incidence of depending on the type of injury. Intervention programs epilepsy, visual disorders and minor speech problems. to enhance maternal home-safety practices will need to Minor learning difficulties were frequent. target different factors depending on the type of injury INTERPRETATION: Children with mild cerebral to be addressed. palsy have specific problems and need the attention of neuropediatricians in order to establish the primary and Morrow AL, Guerrero ML. From bioactive substances to secondary problems involved. research on breast-feeding promotion. Adv Exp Med Biol 2001; 501:447-55. Morrill AC, Dai J, Dunn S, Sung I, Smith K. Child custody Abstract: Despite known health benefits, exclusive and visitation decisions when the father has perpetrated breast-feeding for at least 4 months is uncommon in violence against the mother. Violence Against Women many countries. In Mexico, most mothers initiate 2005; 11(8):1076-107. breast-feeding but few breast-feed exclusively. Abstract: This research evaluated the effectiveness of OBJECTIVE: The objective was to examine the statutes mandating a presumption against custody to a effectiveness of home visits by lay peer counselors to perpetrator of domestic violence (DV) and judicial increase exclusive breast-feeding among mothers in a education about DV. Across six states, the authors periurban area of Mexico. METHODS: An examined 393 custody and/or visitation orders where ethnographic assessment conducted in 1994 that the father perpetrated DV against the mother and identified key maternal beliefs, practices, and needs surveyed 60 judges who entered those orders. With the was used to guide educational strategies. Lay presumption, more orders gave legal and physical counselors were recruited from the same community custody to the mother and imposed a structured and trained by La Leche League. From March 1995 schedule and restrictive conditions on fathers' visits, through September 1996, pregnant women were except where there was also a "friendly parent" identified by community census and invited to provision and a presumption for joint custody. The participate. Women were enrolled into a randomized, presumption is effective only as part of a consistent controlled study of 3 groups: no intervention (control), statutory scheme. Although 86% of judges had 3 visits, and 6 visits during pregnancy and early received DV education, they scored no better in postpartum. Data collection was performed by a social knowledge or attitudes. More of their orders gave worker apart from the counselors. Exclusive breast- mothers sole physical custody, and knowledge was feeding was defined by WHO criteria. RESULTS: The associated with maternal custody, yet fewer structured study enrolled 130 women; 52 were in the 3-visit or restricted fathers' visitation. Quality of DV group, 44 in the 6-visit group, and 34 in the control 726
- 735. group. Study groupsdid not differ in the maternal giving rise to a number of health/well-being-related characteristics or initiation of breast-feeding (96%). At themes. The paper concludes that using a range of 3 months postpartum, exclusive breast-feeding was methods, including visual methods, has helped to practiced by only 12% of controls vs. 52% in the 3- explore quality of life issues for children that are visit group and 67% in the 6-visit group (P < 0.001, log usually neglected in studies of young people's health- rank test). In the first 3 months, significantly (P = related behaviours. 0.037) fewer intervention than control infants had an episode of diarrhea (11% vs. 26%, respectively). Morton JB, Munakata Y. Active versus latent Intervention effectiveness was independent of maternal representations: a neural network model of factors or birth hospital. CONCLUSIONS: This unique perseveration, dissociation, and decalage. Dev experimental study demonstrated a dramatic increase in Psychobiol 2002; 40(3):255-65. exclusive breast-feeding and a significant reduction in Abstract: Children of different ages often perseverate, infant illness in an urban community through well- repeating previous behaviors when they are no longer designed maternal support including early intervention appropriate, despite appearing to know what they and repeated contact. should be doing. Using neural network models, we explore an account of these phenomena based on a Morrow OI, Sweat MD, Morrow RH. The matalisi: pathway distinction between active memory (subserved by the to early sexual initiation among the youth of Mpigi, prefrontal cortex) and latent memory (subserved by Uganda. AIDS Behav 2004; 8(4):365-78. posterior cortex). The models demonstrate how (a) Abstract: This paper describes the role and personal perseveration occurs when an active memory of characteristics of the "matalisi,'' a previously currently relevant knowledge is insufficiently strong to unreported phenomenon uncovered during a study of overcome a latent bias established by previous youth sexual behavior in Uganda. The "matalisi,'' a go- experience, (b) apparent dissociations between between, played a central role in sexual relationships of children's knowledge and action may reflect most youth in Mpigi, Uganda. The first phase of the differences in the amount of conflict between active study was an ethnographic inquiry of youth (ages 10- and latent memories that children need to resolve in the 16) sexual behavior. During this phase it became tasks, and (c) differences in when children master evident that matalisis were used in most courtships and formally similar tasks (decalage) may result from initial sexual liaisons. The second phase included a differences in the strength of children's initial biases. sociometric investigation of youth networks and a mini The models help to clarify how prefrontal development survey of youth who had been matalisis. Among youth may lead to advances in flexible thinking. interviewed, 47.3% of males (105/222) and 14.1% of females (42/298) had experienced sexual intercourse. Morton JB, Munakata Y. What's the difference? Contrasting For 88%, participating as someone's matalisi preceded modular and neural network approaches to first coitus. By understanding the role of the matalisi, understanding developmental variability. J Dev Behav interventions may be developed to improve sex Pediatr 2005; 26(2):128-39. education and more effectively address sexual Abstract: Understanding why development differs behaviors that lead to unwanted pregnancies, STIs, and across individuals is an important challenge for HIV infection. developmental theory. This paper evaluates two approaches to developmental variability observed in Morrow V. Using qualitative methods to elicit young domains such as language processing and across people's perspectives on their environments: some populations such as typically developing children, ideas for community health initiatives. Health Educ children with developmental disorders, and typical Res 2001; 16(3):255-68. adults. Modular accounts attribute developmental Abstract: This paper describes qualitative methods variability to delay, damage, or dysfunction in discrete used in a research project for the former Health underlying structures. Neural network approaches Education Authority, exploring Putnam's concept of attribute developmental variability to emergent effects 'social capital' in relation to children and young of graded variations in an interactive, developing people's well-being and health. Putnam's system. The authors conclude that neural network conceptualization of social capital consists of the approaches offer more formal and parsimonious following features: trust, reciprocal support, civic accounts of the nature and sources of developmental engagement, community identity and social networks, variability. and the premise is that levels of social capital in a community have an important effect on people's well- Moskalewicz J, Zulewska-Sak J. [Alcohol drinking in the being. Research was carried out with 102 children aged time of political transition in Poland. Report of the between 12 and 15 in two relatively deprived parts of a National Health Programme ]. Przegl Epidemiol 2003; town in southeast England. The paper describes the 57(4):713-23. research setting, methods, consent process and ethical Abstract: The National Health Programme was adopted issues that arose. It explores how the methods in Poland in the mid-1990s. It consists of 18 targets generated different forms of interconnected data, 727
- 736. including target 4that calls for diminishing alcohol familial risk for substance abuse and antisocial consumption and changing its structure as well as behaviors. limiting health harms associated with alcohol. The programme is being monitored on bi-annual basis. The Moss HB, Lynch KG, Hardie TL, Baron DA. Family monitoring covers a level of alcohol consumption and functioning and peer affiliation in children of fathers associated harm including trends in mortality and with antisocial personality disorder and substance morbidity as well as in road accidents in 1990-2001 dependence: associations with problem behaviors. Am period. During the period in point, particularly in the J Psychiatry 2002; 159(4):607-14. beginning of the transition alcohol consumption Abstract: OBJECTIVE: Family functioning and peer increased at least by one third reaching 10-11 litres of influences are theoretically linked to child pure ethanol per capita, mostly due to sudden psychopathology. This study quantified the functional disruption of the alcohol control system and high tide status of families with fathers with substance of unrecorded supply. Currently, the consumption is dependence with or without comorbid antisocial estimated to be 9.5-10.0 litres with 30% share of the personality disorder and evaluated the peer unrecorded. During last decade recorded morbidity due environments of preadolescent offspring. The authors to mental disorders associated with alcohol increased examined associations between the child's by 80% and 60% respectively in out- and in-patient psychopathology, paternal substance system while mortality rates almost doubled. Male dependence/antisocial personality disorder status, and mortality due to liver diseases increased by 50% while measures of family and peer environments. METHOD: that of women remained relatively flat. In last few Families with the presence or absence of paternal years, alcohol related mortality tended to decline substance dependence were subdivided into those with slightly parallel to consumption trends. Significant and without paternal antisocial personality disorder. improvement has been achieved in prevention of Grouped families were contrasted on measures of drunken diving. The number of deaths in alcohol family functioning, the child's peer affiliation, and the related road accidents decreased two fold while a rate child's problem behaviors. Regression analysis of drunken crashes per 1000 vehicles dropped three determined the influence of these factors on the child's times. psychopathology. RESULTS: Families with paternal substance dependence functioned worse than normal Moss HB, Lynch KG, Hardie TL. Affiliation with deviant comparison families. However, families with paternal peers among children of substance dependent fathers substance dependence and antisocial personality from pre-adolescence into adolescence: associations disorder (N=34) did not differ markedly from those with problem behaviors. Drug Alcohol Depend 2003; with substance dependence without antisocial 71(2):117-25. personality disorder (N=84). The children of fathers Abstract: OBJECTIVE: Affiliation with delinquent with both substance dependence and antisocial peers has been shown to be a major risk factor for the personality disorder had greater affiliation with deviant development of antisocial and substance abuse peers than those with substance dependence without behaviors in adolescence. However, little data are antisocial personality disorder and comparison families available concerning the developmental trajectories of (N=104). CONCLUSIONS: Children of fathers with deviant peer affiliation. METHOD: In this study, we substance dependence and antisocial personality have prospectively examined the density of deviant disorder demonstrated higher externalizing and peers among the social networks of children of drug internalizing psychopathology than those with dependent fathers at age 10, and at 2 and 5 year follow- substance dependence but not antisocial personality ups, and compared them with those of controls. disorder and those without either condition. Paternal Measures of internalizing and externalizing substance dependence/antisocial personality disorder psychopathology were employed as time varying status and the child's affiliation with deviant peers were covariates, while socioeconomic status (SES) was used most robustly associated with the child's as a time invariant covariate. A pattern mixture psychopathology. Research is needed to develop analysis of missing data was conducted. RESULTS: interventions that effectively address parental risk and Using mixed effects models, we found significant main healthy peer relations. effects of time, group, externalizing psychopathology, and to lesser extent, SES on the magnitude of Moura AT, Reichenheim ME. [Are we really detecting affiliation with deviant peers. Greater deviant peer violence in families of children visiting our health affiliation among the high-risk children was found at services? The experience of a public health service in each time point. Externalizing psychopathology Rio de Janeiro, Brazil]. Cad Saude Publica 2005; augmented the magnitude of deviant peer affiliation in 21(4):1124-33. both high-risk and comparison children. Abstract: Domestic violence, particularly in childhood, CONCLUSION: Offspring of drug dependent fathers is a growing public health concern. Information on have heightened affiliation with deviant peers from morbidity is mostly underreported due to constraints in pre-adolescence through mid-adolescence. This social case detection. This paper analyzes the frequency of developmental process may be a component of the events measured actively by outpatient services as 728
- 737. compared to spontaneousreports. Information on funded, longitudinal investigation and describes child violence was assessed for 245 families from April to problems, service use, and predictors of service use for June 2001 using the Conflict Tactics Scales: Parent- 506 children of 252 mothers diagnosed with serious Child Version (CTSPC) and the Revised Conflict mental illness. Mothers are primarily poor, minority Tactics Scales (CTS2). Cases referred to the Social women from urban areas. A multilevel-model approach Work Department provided the caseload for the active is used to examine service use for multiple siblings in a search period (12 months). There was a high family. More than one third of children had received prevalence of physical violence in the couple, with services (from school or mental health agencies) in serious events occurring in 17.0% of the families. In their lifetimes. Service use was predicted by child relation to children, cases of "minor" physical demographic characteristics (being male, non-African aggression were reported in 46.0% of families and American, and older), social context variables (more serious cases in 9.9%. The spontaneously identified negative life events, less financial satisfaction, and prevalence was 3.3%. This case study demonstrates the more parenting dissatisfaction), and maternal missed opportunities for detection and calls attention to psychiatric variables (positively by high levels of case the need to review the approach to domestic violence management receipt and affective diagnoses, by health services. negatively by maternal substance abuse history). In a subsample of "target children," mothers' rating of child Mouradian WE, Schaad DC, Kim S et al. Addressing behavior problems additionally predicted service use. disparities in children's oral health: a dental-medical Implications of results for research and intervention are partnership to train family practice residents. J Dent discussed. Educ 2003; 67(8):886-95. Abstract: Providing oral health care to rural Moya FR, Lally KP. Evidence-based management of infants populations in the United States is a major challenge. with congenital diaphragmatic hernia. Semin Perinatol Lack of community water fluoridation, dental 2005; 29(2):112-7. workforce shortages, and geographical barriers all Abstract: The mortality rate associated with congenital aggravate oral health and access problems in the diaphragmatic hernia (CDH) varies widely between largely rural Northwest. Children from low-income and centers and remains relatively high despite widespread minority families and children with special needs are at use of new therapeutic modalities. Many of these have particular risk. Family-centered disease prevention been implemented without properly controlled studies. strategies are needed to reduce oral health disparities in Over the past 10 to 15 years, only 9 randomized trials children. Oral health promotion can take place in a enrolling a total of approximately 250 infants with primary care practitioner's office, but medical providers CDH have been published. The limited evidence often lack relevant training. In this project, dental, available suggests that better outcomes are observed by medical, and educational faculty at a large academic delivering infants with CDH at experienced centers, by health center partnered to provide evidence-based, delaying surgical repair until hemodynamic and culturally competent pediatric oral health training to respiratory stability is achieved, and by the judicious family medicine residents in five community-based utilization of nonaggressive mechanical ventilation and training programs. The curriculum targets children permissive hypercapnea. Other therapeutic modalities, birth to five years and covers dental development, the such as high frequency oscillatory ventilation, inhaled caries process, dental emergencies, and oral health in nitric oxide, and ECMO, may provide additional children with special needs. Outcome measures include advantages for selected infants. There is a dire need to changes in knowledge, attitudes, and self-efficacy; establish networks of centers that manage enough preliminary results are presented. The program also infants with CDH, to conduct appropriately sized partnered with local dentists to ensure a referral randomized trials that can answer some of the critical network for children with identified disease at the questions about the management and long-term family medicine training sites. Pediatric dentistry outcome of these infants. residents assisted in didactic and hands-on training of family medicine residents. Future topics for oral health Mueller M, Wagner CL, Annibale DJ, Hulsey TC, Knapp training of family physicians are suggested. RG, Almeida JS. Predicting extubation outcome in preterm newborns: a comparison of neural networks Mowbray CT, Lewandowski L, Bybee D, Oyserman D. with clinical expertise and statistical modeling. Pediatr Children of mothers diagnosed with serious mental Res 2004; 56(1):11-8. illness: patterns and predictors of service use. Ment Abstract: Even though ventilator technology and Health Serv Res 2004; 6(3):167-83. monitoring of premature infants has improved Abstract: Children who have a parent diagnosed with a immensely over the past decades, there are still no mental illness are at risk of psychiatric and behavioral standards for weaning and determining optimal problems; yet, these children do not necessarily receive extubation time for those infants. Approximately 30% needed services. Research has investigated correlates of intubated preterm infants will fail attempted of child mental health service use, but not for these extubation, requiring reintubation and resuming of high-risk children. This study is part of an NIMH- mechanical ventilation. A machine-learning approach 729
- 738. using artificial neuralnetworks (ANNs) to aid in relative to those in the top 20% of earnings. This extubation decision making is hereby proposed. Using translates into the loss of 11 million YLLs and 17.4 expert opinion, 51 variables were identified as being million HALYs each year. Compared with persons relevant for the decision of whether to extubate an living above the poverty threshold, those living below infant who is on mechanical ventilation. The data on the poverty threshold live an average of 3.2 million 183 premature infants, born between 1999 and 2002, fewer HALYs per year-a difference of 8.5 HALYs per were collected by review of medical charts. The ANN individual between age 18 and death. The income- extubation model was compared with alternative associated burden of disease appears to be a leading statistical modeling using multivariate logistic cause of morbidity and mortality in the US. regression and also with the clinician's own predictive insight using sensitivity analysis and receiver operating Mueser KT, Salyers MP, Rosenberg SD et al. Interpersonal characteristic curves. The optimal ANN model used 13 trauma and posttraumatic stress disorder in patients parameters and achieved an area under the receiver with severe mental illness: demographic, clinical, and operating characteristic curve of 0.87 (out-of-sample health correlates. Schizophr Bull 2004; 30(1):45-57. validation), comparing favorably with multivariate Notes: CORPORATE NAME: 5 Site Health and Risk logistic regression. It also compared well with the Study Research Committee clinician's expertise, which raises the possibility of Abstract: This study's purpose was to evaluate the being useful as an automated alert tool. Because an prevalence and correlates of posttraumatic stress ANN learns directly from previous data obtained in the disorder (PTSD) in persons with severe mental illness. institution where it is to be used, this makes it Standardized assessments of interpersonal trauma and particularly amenable for application to evidence-based PTSD were conducted in 782 patients with severe medicine. Given the variety of practices and equipment mental illness receiving services in one of five being used in different hospitals, this may be inpatient and outpatient treatment settings. Analyses particularly relevant in the context of caring for examined the prevalence of PTSD and the preterm newborns who are on mechanical ventilation. demographic, clinical, and health correlates of PTSD diagnosis. The overall rate of current PTSD in the Mueller M, Wagner CL, Annibale DJ, Hulsey TC, Knapp sample was 34.8 percent. For demographic RG, Almeida JS. Web-based prediction of extubation characteristics, the prevalence of PTSD was higher in outcome in premature infants on mechanical patients who were younger, white, homeless, and ventilation using an artificial neural network. AMIA unemployed. For clinical and health variables, PTSD Annu Symp Proc 2003; 945. was more common in patients with major mood Abstract: The web-based implementation of a decision- disorders (compared to schizophrenia or support tool for the prediction of extubation outcome in schizoaffective disorders), alcohol use disorder, more mechanically ventilated premature infants enables the recent psychiatric hospitalizations, more health integration of advanced and computationally intensive problems, more visits to doctors for health problems, modeling approaches with easy-usage, no maintenance and more nonpsychiatric hospitalizations over the past requirements and wide availability. Accordingly, the year. The results support prior research documenting artificial neural network predictive tool developed the high rates of PTSD in patients with severe mental provides decision-support in determining whether to illness and suggest that PTSD may contribute to extubate a premature infant to clinicians in NICUs substance abuse, psychiatric and medical comorbidity, anywhere with access to the Internet. and psychiatric and health service utilization. Muennig P, Franks P, Jia H, Lubetkin E, Gold MR. The Mujkic A, Vuletic G, Kozaric-Kovacic D. Evaluation of income-associated burden of disease in the United community based intervention for the protection of States. Soc Sci Med 2005; 61(9):2018-26. children from small arms and explosive devices during Abstract: In this study, we estimate the total burden of the war: observational study. Croat Med J 2002; disease associated with income in the US. We calculate 43(4):390-5. the relationships between income and life expectancy, Abstract: AIM: To evaluate the influence of a health-adjusted life expectancy, annual years of life community-based intervention aimed at reducing the lost (YLLs), and health adjusted life years risk of unintentional injuries caused by small arms and (HALYs).We used the 2000 US Medical Expenditure explosive devices accessible to children during the Panel Survey to derive quality of life estimates by 1991-1995 war in Croatia. METHOD: From May 5 to income and age, the 1990-1992 US National Health June 15 in 1994 and 1995, we performed a cross- Interview Survey linked to National Death Index data sectional survey on exposure of the children in Croatia through the end of 1995 to derive mortality risks by to different small arms and explosive devices, using income and by age, and 2000 US mortality data from specially prepared questionnaires. The survey was the National Center for Health Statistics to derive conducted in Dubrovnik-Neretva and Karlovac current mortality estimates for the US population by counties, where community-based intervention was age-group. The bottom 80% of adult income earners' carried out, and Lika-Senj and Sisak-Moslavina life expectancy is 4.3 years and 5.8 HALYs shorter counties, where only national intervention was 730
- 739. implemented. The sampleincluded a total of 5,317 particularly women referred to drug abuse treatment by parents and 2,581 children. The response rate was 98%. child welfare due to prenatal drug use. Seventy-one All participants were asked to give answers according such women who used drugs during pregnancy were to current situation. RESULTS: Approximately a third randomly assigned to either receive three MI sessions of children in the counties without community-based or to watch two educational videos and participate in a intervention and a fifth in the counties with home visit. Treatment retention group attendance and community-based intervention could access small arms random urine analysis results were evaluated in these and explosive devices at home. Boys were more women during the first 8 weeks of treatment. No exposed than girls (p=0.001). In the communities with differences were found between the two conditions on community-based intervention, children were less these variables. Possible reasons for these negative exposed to the devices, such as small-arms, hand findings are discussed, as are ideas for future research grenades, and explosives, which were the main cause with coerced populations. of injuries. In 1994, parents in counties without community-based intervention handled weapons in Mulvihill A, Buncic JR. Vertical sensory nystagmus front of their children in 45% cases vs 31% of those in associated with intraocular haemorrhages in the shaken the counties with community-based intervention baby syndrome. Eye 2004; 18(5):545-6. (p<0.001). In 1995, the percentages were 44 and 32, respectively (p<0.001). CONCLUSION: Although it is Munjanja SP. Ethics in reproductive health: clinical issues in impossible to quantify the exact amount of risk Zimbabwe. Cent Afr J Med 2001; 47(6):159-63. reduction due to health intervention alone, community- Notes: GENERAL NOTE: KIE: 14 refs. based intervention reduced the exposure of children to GENERAL NOTE: KIE: KIE Bib: reproduction weapons. Abstract: Reproductive health can present health practitioners with ethical problems because of the Mukadam S, Gilles EE. Unusual inflicted hot oil burns in a complex interaction between cultural practices, the 7-year-old. Burns 2003; 29(1):83-6. laws of the country and individual personal Abstract: Pediatric burn injuries occur not infrequently preferences. In particular, the problems of pregnancy, as the result of abuse. While the majority of these burns sexually transmitted infections, family planning, sexual are inflicted scald burns, those due to contact or violence, and domestic abuse require a good contact/scald mechanisms may present diagnostic knowledge of the laws of the country and the culture in challenges. A child with unusual combined contact and which they operate. The practitioner should at all times scald burns caused by a metal spatula heated in hot respect the patient's autonomy and serve their best cooking oil is described. The odd pattern of healed interests, whilst keeping in mind the legitimate interest injury limited the initial diagnosis to inflicted healing of their partners, spouses, parents or guardians. burns. Despite the initial lack of disclosure, an inflicted etiology was supported by clearly delineated margins, Munoz Cobos F, Martin Carretero ML, Vivancos Escobar D, macular lesions with hyper-pigmented rims and Blanca Barba F, Rodriguez Carrion T, Ruiz Ramos M. variegated central regions. Additional findings of [Improving care for victims of domestic violence. numerous adult bites and bruises provided adjunctive Impact of a priority intervention]. Aten Primaria 2001; support for an inflicted etiology. Aspects of this case 28(4):241-8. are atypical for the usual demographics of a burn Abstract: OBJECTIVE: To evaluate the impact of a victim. This case extends the known presentations of priority intervention in the care given to women who inflicted contact/scald burns. are victims of domestic violence and their children. DESIGN: Non-randomised intervention study. Mulholland H. Child protection. The nurse's role. Nurs SETTING: Urban health centre. PATIENTS: Women Times 2003; 99(18):20-4. and children living at a reception centre for families suffering domestic violence and who had clinical Mulholland H. Nurses can make sure it never happens again. records opened at the health centre. Pre-intervention Nurs Times 2003; 99(5):10-1. group (December 1997-July 1999): 36 women, 70 children. Post-intervention group (August 1999-June Mullins SM, Suarez M, Ondersma SJ, Page MC. The impact 2000): 35 women and 41 children.Interventions. of motivational interviewing on substance abuse Allocation to a single family doctor and paediatrician. treatment retention: a randomized control trial of Elimination of bureaucratic obstacles and prioritised women involved with child welfare. J Subst Abuse care. Social/family assessment by the social worker. Treat 2004; 27(1):51-8. Preferential inclusion in programmes: Women: family Abstract: Previous studies have supported the efficacy planning, hepatitis B vaccination, pregnancy control, of Motivational Interviewing (MI) in increasing early diagnosis of breast cancer (women > 50), same treatment engagement and retention among people with for cervical cancer. Children: child health (< 5) substance abuse disorders. However, few studies have (priority activities: psychomotor development and assessed the impact of MI with coerced populations, somatometry) and vaccinations. This intervention 731
- 740. started in August1999. MEASUREMENTS AND inequality, working-class power, and social capital and MAIN RESULTS: Measurement of the impact of the life expectancy, self-rated health, low birth weight, and intervention: bivariant analysis through Chi2 test for age- and cause-specific mortality in 16 wealthy qualitative variables and Student's t test and U Mann- countries. Of all the health outcomes, the five variables Whitney test for quantitative variables (alpha 0.05) in related to birth and infant survival and nonintentional the pre- and post-intervention groups. Statistically injuries had the most consistent association with significant differences in participation were detected economic inequality and working-class power (in between the pre- and post-intervention groups in the particular with strength of the welfare state) and, less following activities: number of visits to programmes so, with social capital indicators. Rates of low birth (0.49, SD 0.95; 1.01, SD 1.24, respectively), social and weight and infant deaths from all causes were lower in family assessment (83%/100%), family planning countries with more "left" (e.g., socialist, social (14%/51.4%), hepatitis B vaccination (19%/48.7%), democratic, labor) votes, more left members of early cervical cancer diagnosis (0/25.7%), child health parliament, more years of social democratic (33.4%/70%), vaccinations (26.34%/64%), somametric government, more women in government, and various assessment (25%/100%) and psychomotor indicators of strength of the welfare state, as well as development assessment (41.6%/94%). low economic inequality, as measured in a variety of CONCLUSIONS: Prioritised intervention in families ways. Similar associations were observed for injury that are victims of domestic violence improves their mortality, underscoring the crucial role of unions and participation in preventive activities. labor parties in promoting workplace safety. Overall, social capital shows weaker associations with Munro VE. Square pegs in round holes: the dilemma of population health indicators than do economic conjoined twins and individual rights. Soc Leg Stud inequality and working-class power. The popularity of 2001; 10(4):459-82. social capital and exclusion of class-related political Notes: GENERAL NOTE: KIE: Munro, Vanessa E and welfare state indicators does not seem to be GENERAL NOTE: KIE: 33 refs. 7 fn. justified on empirical grounds. GENERAL NOTE: KIE: KIE Bib: patient care/minors; personhood Munzarova M. Towards the abolition of man: the voice of Abstract: The judgment in the English Court of Appeal disabled persons cannot be ignored. Bull Med Ethics case of Re A (Conjoined Twins: Surgical Separation) 2002; (174):13-21. highlights forcefully the highly individualistic and Notes: GENERAL NOTE: KIE: 21 refs. abstract assumptions that commonly shape the GENERAL NOTE: KIE: KIE Bib: bioethics; deployment of rights discourse in liberal legal euthanasia adjudication. Forced by the all-or-nothing nature of this discourse into a dilemma between perceiving of the Munzer SR, Smith FO. Limited property rights in umbilical twins as separate right-bearers or perceiving of the cord blood for transplantation and research. J Pediatr stronger twin, Jodie, as the singular right-bearer and of Hematol Oncol 2001; 23(4):203-7. Mary, her weaker sibling, as a non-legal entity, the court chose the former option. Perceiving of the twins Muram D. Evidence-based medicine (EBM) in pediatric and as distinct and equal legal persons forced the court to adolescent gynecology. J Pediatr Adolesc Gynecol employ a balancing of incommensurate interests, 2003; 16(2):63-4. implicitly accepting a utilitarian analysis within the strongly deontological confines of law and medicine. Murphy C. Is Saint Pat's for sale? Plus six other burning The implications of this turn towards utilitarianism are questions. Fortune 2002; 145(10):32. significant. Within the confines of this article, it will be argued, however, that these implications are avoidable Murphy EK. Withdrawing consent after a procedure has if the law concedes a more flexible approach to the begun. AORN J 2003; 78(1):116-8, 121. dominant notion of the distinct and autonomous right- bearer. Murphy JF. Flawed expert witnesses: the breaking of the profession's china. Ir Med J 2003; 96(2):36. Muntaner C, Lynch JW, Hillemeier M et al. Economic inequality, working-class power, social capital, and Murphy S. Non accidental injury vs staphylococcal scalded cause-specific mortality in wealthy countries. Int J skin syndrome. A case study. Emerg Nurse 2001; Health Serv 2002; 32(4):629-56. 9(1):26-30. Abstract: This study tests two propositions from Navarro's critique of the social capital literature: that Murray K. Children in need. Nurs Stand 2001; 16(6):12. social capital's importance has been exaggerated and that class-related political factors, absent from social Murray L, Woolgar M, Murray J, Cooper P. Self-exclusion epidemiology and public health, might be key from health care in women at high risk for postpartum determinants of population health. The authors estimate depression. J Public Health Med 2003; 25(2):131-7. cross-sectional associations between economic 732
- 741. Abstract: BACKGROUND: Asignificant proportion of very instrumental in both decreasing and preventing women who are vulnerable to postnatal depression bullying behaviors. refuse to engage in treatment programmes. Little is known about them, other than some general Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, demographic characteristics. In particular, their access Costello EJ. Obesity and psychiatric disorder: to health care and their own and their infants' health developmental trajectories. Pediatrics 2003; 111(4 Pt outcomes are uncharted. METHODS: We conducted a 1):851-9. nested cohort case-control study, using data from Abstract: OBJECTIVES: To identify age-related computerized health systems, and general practitioner trajectories of obesity from childhood into adolescence, (GP) and maternity records, to identify the and to test the association of these trajectories with the characteristics, health service contacts, and maternal development of psychiatric disorders (conduct and infant health outcomes for primiparous antenatal disorder, oppositional defiant disorder, attention- clinic attenders at high risk for postnatal depression deficit/hyperactivity disorder, substance abuse, who either refused (self-exclusion group) or else depression, and anxiety). METHODS: White children agreed (take-up group) to receive additional Health (N = 991) 9 to 16 years old from the Great Smoky Visiting support in pregnancy and the first 2 months Mountains Study, a representative sample of rural postpartum. RESULTS: Women excluding themselves youth, were evaluated annually over an 8-year period from Health Visitor support were younger and less for height, weight, psychiatric disorder, and highly educated than women willing to take up the vulnerabilities for psychiatric disorder. Longitudinal support. They were less likely to attend midwifery, GP analyses on the repeated measures data were conducted and routine Health Visitor appointments, but were using developmental trajectory models and generalized more likely to book in late and to attend accident and estimating equation models. RESULTS: Obesity was 3 emergency department (A&E). Their infants had to 4 times more common than expected from national poorer outcome in terms of gestation, birthweight and rates using Centers for Disease Control and Prevention breastfeeding. Differences between the groups still 2000 criteria. Four developmental trajectories of obtained when age and education were taken into obesity were found: no obesity (73%), chronic obesity account for midwifery contacts, A&E attendance and (15%), childhood obesity (5%), and adolescent obesity gestation; the difference in the initiation of breast (7%). Only chronic obesity was associated with feeding was attenuated, but not wholly explained, by psychiatric disorder: oppositional defiant disorder in age and education. CONCLUSION: A subgroup of boys and girls and depressive disorders in boys. psychologically vulnerable child-bearing women are at CONCLUSIONS: In a general population sample particular risk for poor access to health care and studied longitudinally, chronic obesity was associated adverse infant outcome. Barriers to take-up of services with psychopathology. need to be understood in order better to deliver care. Myer L, Abdool Karim SS, Lombard C, Wilkinson D. Murray PE. Exposure to possible risk is unethical. Arch Treatment of maternal syphilis in rural South Africa: Pediatr Adolesc Med 2002; 156(1):87; author reply 88. effect of multiple doses of benzathine penicillin on pregnancy loss. Trop Med Int Health 2004; Muscari ME. Identifying victims and perpetrators of 9(11):1216-21. violence. Forensic techniques for primary care settings. Abstract: OBJECTIVES: Despite few data, the Adv Nurse Pract 2004; 12(4):83-6, 98. treatment of syphilis in pregnant women using a single dose of benzathine penicillin is the standard of care in Muscari ME. Sticks and stones: the NP's role with bullies many resource-poor settings. We examined the effect and victims. J Pediatr Health Care 2002; 16(1):22-8. of various doses of benzathine penicillin on pregnancy Abstract: Bullying is a worldwide problem that can loss among women with a positive Rapid Plasma create negative lifelong consequences for both bullies Reagin (RPR) test result in a rural South African and victims. Victims of bullies can suffer from low district. METHODS: All pregnant women making their self-esteem, depression, and anxiety, all problems that first antenatal care visit during pregnancy were may carry into adulthood. The academic progress of screened for syphilis using the RPR test. Those testing victims may be impaired, and they may find positive were counselled to receive three weekly doses themselves isolated because their peers fear losing of benzathine penicillin, and received a partner status or being bullied themselves. Bullies may develop notification card. Pregnancy outcomes were conduct disorders and delinquent behaviors during determined from facility records or home visits where their teen years, as well as serious antisocial and necessary. RESULTS: Of 8917 women screened, 1043 criminal behavior in adulthood. The majority of bullies (12%) had reactive syphilis serology; of those with titre remain bullies throughout their lives, cherishing the data available, 30% had titres of 1:8 or greater. While power and control over others that their behavior 41% (n = 430) of women received all three doses as evokes. Nurse practitioners play a critical role in the counselled, 30% (n = 312) received only one dose, and identification of both bullies and victims and can be 20% (n = 207) did not return to the clinic to receive treatment. Among the 947 women with pregnancy 733
- 742. outcome data available,there were 17 miscarriages and years of use. 48 perinatal deaths observed. There was a strong trend towards reduced risk of pregnancy loss among women Nainan OV, Armstrong GL, Han XH, Williams I, Bell BP, receiving multiple doses of penicillin (adjusted OR for Margolis HS. Hepatitis a molecular epidemiology in perinatal mortality for each additional dose received, the United States, 1996-1997: sources of infection and 0.63; 95% CI, 0.48-0.84). CONCLUSIONS: While this implications of vaccination policy. J Infect Dis 2005; association requires further investigation, these results 191(6):957-63. suggest that there may be substantial benefit to Abstract: BACKGROUND: The genetic relatedness of providing multiple doses of benzathine penicillin to hepatitis A virus (HAV) isolates was determined to treat maternal syphilis in this setting. identify possible infection sources for case patients in the Sentinel Counties Study of Acute Viral Hepatitis. Myers JE. Examination of liability considerations for METHODS: A 315-nucleotide segment of the VP1-P2 professionals in child protection. Child Abuse Negl region of the HAV genome was amplified and 2002; 26(10):1007-9. sequenced from serum of case patients and analyzed together with risk-factor data. RESULTS: Of 508 Myers JE. Keep the lifeboat afloat. Child Abuse Negl 2002; HAV-RNA-positive case patients, 449 (88.4%) were 26(6-7):561-7. interviewed, and 255 (50.1%) reported >/=1 risk factor. Some 123 unique nucleotide sequence patterns Naciones Unidas. Asamblea General. Los derechos del niño: (UNSPs) were identified--77 (62.6%) from only 1 case Resolución aprobada por la Asamblea General. New patient and the rest in 2-99 persons. Among York: Naciones Unidas, 2003:17. international travelers, a single person was more often infected with a single type of UNSP (17/54 [31.5%]), Nagelkerke NJ, Jha P, de Vlas SJ et al. Modelling compared with other case patients (48/393 [12.2%]; HIV/AIDS epidemics in Botswana and India: impact of P<.001). UNSPs from travelers to Mexico (33/37 interventions to prevent transmission. Bull World [89.2%]) clustered with those from Hispanic children Health Organ 2002; 80(2):89-96. (47/49 [95.9%]). Of 119 men who had sex with men, Abstract: OBJECTIVE: To describe a dynamic 96 (80.7%) had the same or similar UNSPs, which compartmental simulation model for Botswana and were also found in 37 men and 10 women with no India, developed to identify the best strategies for identified infection source. CONCLUSION: HAV is preventing spread of HIV/AIDS. METHODS: The often transmitted within networks of persons with following interventions were considered: a behavioural similar risk factors, which may be the infection source intervention focused on female sex workers; a for others in the community. conventional programme for the treatment of sexually transmitted infections; a programme for the prevention Nair MK. Child abuse. Indian Pediatr 2004; 41(4):319-20. of mother-to-child transmission; an antiretroviral treatment programme for the entire population, based Nandi S, Kumar R, Ray P, Vohra H, Ganguly NK. Group A on a single regimen; and an antiretroviral treatment streptococcal sore throat in a periurban population of programme for sex workers only, also based on a northern India: a one-year prospective study. Bull single regimen. FINDINGS: The interventions directed World Health Organ 2001; 79(6):528-33. at sex workers as well as those dealing with sexually Abstract: OBJECTIVE: To estimate the incidence and transmitted infections showed promise for long-term risk factors of group A streptococcus (GAS) sore throat prevention of human immunodeficiency virus (HIV) among school-aged children living in a periurban slum infection, although their relative ranking was uncertain. area of Chandigarh, North India. METHODS: A total In India, a sex worker intervention would drive the of 536 children aged 5-15 years from 261 families epidemic to extinction. In Botswana none of the identified by a systematic random selection method interventions alone would achieve this, although the were enrolled in the study. Episodes of sore throat were prevalence of HIV would be reduced by almost 50%. recorded through fortnightly home visits over a one- Mother-to-child transmission programmes could year period. The local vernacular (Hindi) terms gala reduce HIV transmission to infants, but would have no kharab (bad throat) and khansi jukam (cough and cold) impact on the epidemic itself. In the long run, were used to identify symptoms of sore throat, and interventions targeting sexual transmission would be throat swab specimens were collected from children even more effective in reducing the number of HIV- who had these symptoms on the day of the home visit. infected children than mother-to-child transmission Bacterial culture was carried out and the isolation of programmes. Antiretroviral therapy would prevent GAS was confirmed using group-A-specific antiserum. transmission in the short term, but eventually its effects FINDINGS: The incidences of sore throat and GAS would wane because of the development of drug sore throat were, respectively, 7.05 and 0.95 episodes resistance. CONCLUSION: Depending on the country per child-year. The incidence was higher in the and how the antiretroviral therapy was targeted, 25- following situations: among 11-year-olds, during the 100% of HIV cases would be drug- resistant after 30 winter (November to January) and rainy (August) 734
- 743. months (a bimodalpeak), among children living in METHOD: Abuse history, affective environment in the houses where there was no separate room for the family-of-origin, dissociation, and abuse potential were kitchen, and in homes that included a tobacco smoker. assessed in a sample of 76 mothers with elementary CONCLUSION: The results show that the incidence of school-age children. RESULTS: Predictions were GAS sore throat was related to age, season, and indoor supported. Affective Family Environment moderated air pollution. the relation between abuse history and dissociation, with abuse history relating to greater dissociation Nansel TR, Craig W, Overpeck MD, Saluja G, Ruan WJ. primarily when the family environment was Cross-national consistency in the relationship between conflictual, uncohesive and unexpressive. Further, bullying behaviors and psychosocial adjustment. Arch dissociation significantly mediated the relation between Pediatr Adolesc Med 2004; 158(8):730-6. abuse history and abuse potential (Z = 2.19, p < .05). Notes: CORPORATE NAME: Health Behaviour in CONCLUSIONS: Dissociation's strong association School-aged Children Bullying Analyses Working with abuse potential may partially explain why only Group some abused children later perpetuate the cycle of Abstract: OBJECTIVE: To determine whether the abuse, as those who are not dissociative into adulthood relationship between bullying and psychosocial are likely to have lower abuse potential, in contrast to adjustment is consistent across countries by standard those displaying elevated dissociation. The extent of measures and methods. DESIGN: Cross-sectional self- the dissociation may depend on the affective family report surveys were obtained from nationally environment in which the abuse took place. representative samples of students in 25 countries. Involvement in bullying, as bully, victim, or both bully Narayanasamy A, Owens J. A critical incident study of and victim, was assessed. SETTING: Surveys were nurses' responses to the spiritual needs of their patients. conducted at public and private schools throughout the J Adv Nurs 2001; 33(4):446-55. participating countries. PARTICIPANTS: Participants Notes: GENERAL NOTE: KIE: 35 refs. included all consenting students in sampled GENERAL NOTE: KIE: KIE Bib: patient care; classrooms, for a total of 113 200 students at average professional patient relationship ages of 11.5, 13.5, and 15.5 years. MAIN OUTCOME Abstract: AIMS OF STUDY: The aims of the study MEASURES: Psychosocial adjustment dimensions were to carry out a critical incident study to: (1) assessed included health problems, emotional Describe what nurses consider to be spiritual needs; (2) adjustment, school adjustment, relationships with Explore how nurses respond to the spiritual needs of classmates, alcohol use, and weapon carrying. their patients; (3) Typify nurses' involvement in RESULTS: Involvement in bullying varied spiritual dimensions of care; (4) Describe the effect of dramatically across countries, ranging from 9% to 54% nurses' intervention related to spiritual care. of youth. However, across all countries, involvement in BACKGROUND: In the caring professions a focus on bullying was associated with poorer psychosocial individuals as bio-psychological-spiritual beings is adjustment (P<.05). In all or nearly all countries, gaining recognition and this notion is based on the bullies, victims, and bully-victims reported greater premise that there should be a balance of mind, body health problems and poorer emotional and social and spirit for the maintenance of health in a person adjustment. Victims and bully-victims consistently (Stoll 1979). Emerging research highlights the reported poorer relationships with classmates, whereas importance of spiritual care in nursing and suggests bullies and bully-victims reported greater alcohol use that there is scope for improving this dimension of care and weapon carrying. CONCLUSIONS: The in order to improve the quality of life for many association of bullying with poorer psychosocial patients. However, there is very little evidence about adjustment is remarkably similar across countries. how nurses respond to the spiritual needs of their Bullying is a critical issue for the health of youth patients. Therefore the purpose of this study was to internationally. map by critical incident techniques how nurses construct and respond to patients' spiritual needs in a Narang DS, Contreras JM. The relationships of dissociation variety of clinical settings. METHODS: Critical and affective family environment with the incidents were obtained from 115 nurses. The data intergenerational cycle of child abuse. Child Abuse from these incidents were subjected to content analysis Negl 2005; 29(6):683-99. and categories were developed and described. The Abstract: OBJECTIVE: The purpose was to test a emerging categories were subjected to peer reviews to model that may explain how physically abused children ensure reliability and validity of findings. FINDINGS: become physically abusive parents. It was predicted The findings suggest that there is confusion over the that when the family's affective environment is notion of spirituality and the nurse's role related to uncohesive, unexpressive, and conflictual, a history of spiritual care. A variety of approaches to spiritual care abuse experiences would be associated with elevated emerged in this study from the critical incidents dissociation. It was hypothesized that dissociation derived from nurse respondents. These were would mediate between a childhood history of abuse categorized as 'personal', 'procedural', 'culturalisit' or and the current potential to be physically abusive. 'evangelical'. There was an overwhelming consensus 735
- 744. that patients' faithand trust in nurses produces a CASE REPORT: We present a case of Menkes disease positive effect on patients and families, and nurses complicated by progressive macrocephaly following themselves derived satisfaction from the experience of the development of massive subdural haematomas. giving spiritual care. In this respect, spiritual care These lesions associated with femoral metaphyseal interventions promote a sense of well-being in nurses spurs could be confused with nonaccidental injury such as well as being a valuable part of total patient care. as that seen in the shaken baby syndrome. CONCLUSION: The study concluded that there is DISCUSSION: This case emphasises that Menkes scope for developing an ideal model of spiritual care disease, like glutaric aciduria type 1, should be using the critical incident data from this study. included in the differential diagnosis of unexplained subdural haematomas and neurological deficits in Narbona J, Crespo N. [Developmental amnesias]. Rev infants. Neurol 2002; 34 Suppl 1:S110-4. Abstract: OBJECTIVE: The literature on clinical and Navaie-Waliser M, Misener M, Mersman C, Lincoln P. physiophatologic characteristics of the spectrum of Evaluating the needs of children with asthma in home memory disorders in childhood is reviewed in this care: the vital role of nurses as caregivers and article. DEVELOPMENT: There are only a few educators. Public Health Nurs 2004; 21(4):306-15. detailed reports of permanent specific memory Abstract: To date, few evaluations have examined disorders in children. Early anoxo ischaemic issues specific to children's asthma management in bihippocampal injuries can cause a selective permanent their homes. This study examined the characteristics, impairment of episodic daily life memory with risk factors, and needs of children with asthma, and the preservation of semantic learning and general impact of home health nurses on improving intelligence; this dissociation has been related to partial parents'/family caregivers' knowledge about asthma hippocampal damage whilst the entorhinal, triggers and management. The medical records of parahippocampal and prefrontal cortices, which are children, </=19 years, residing in New York City, who critical to systematized memorizing and work memory, were admitted to home care with asthma in 1999 (n = keep normal. Biological psychiatry research has shown 1,007) were reviewed retrospectively to collect a wide that early childhood amnesias after psychological range of data. The majority of children with asthma in maltreatment or abuse could be related to damage in home care were </=5 years, male, racial/ethnic neuronal systems which support memory, caused by minorities, and hospital referred. Approximately one in glutamatergic cascade. Both severe bilateral four children with asthma suffered from additional hippocampal sclerosis (also mediated by toxic comorbidities. Home environmental triggers included neurotransmitters) in early malignant epilepsies, and dust/dust mites, animal dander, mold, massive bilateral damage of mesial temporal lobes due perfumes/detergents, and cigarette smoke. Notable to herpex virus encephalitis or Reye's syndrome, cause psychosocial triggers were family tensions, physical severe amnesic deficits, frequently accompanied by activity, anxiety/stress, and friends/peer pressure. Most absence of any language development and autism with parents/family caregivers had inadequate knowledge features of Kluver-Bucy syndrome. There are also on about recognition of asthma attacks and its triggers and record some examples of Korsakoff's syndrome in management. Discharge assessments suggested that children with midfossa tumors. CONCLUSIONS: All home health nurses can help improve caregivers' types of classical amnesias described in adults have knowledge about asthma management. Children with been observed in children. Developmental amnesias are asthma in home care have diverse needs, receive few probably more frequent than currently presumed. It nurse home visits, and have parents/family caregivers must be paid special attention to selective in need of more intensive education on asthma autobiographical memory impairments in individuals symptom recognition and management. who underwent a partial bihippocampal damage in perinatal or early postnatal periods; they are to be Navarro V, Borrell C, Benach J et al. The importance of the distinguished from, although it may coexist with, other political and the social in explaining mortality clinical situations such as attention deficit disorder or differentials among the countries of the OECD, 1950- semantic pragmatic disorder. 1998. Int J Health Serv 2003; 33(3):419-94. Abstract: This article analyzes (within the conceptual Nassogne MC, Sharrard M, Hertz-Pannier L et al. Massive frame defined in the previous article) the impact of subdural haematomas in Menkes disease mimicking political variables such as time of government by shaken baby syndrome. Childs Nerv Syst 2002; political parties (social democratic, Christian 18(12):729-31. democratic or conservative, liberal, and ex-dictatorial Abstract: INTRODUCTION: Menkes disease is an X- that have governed the OECD countries during the linked inherited disorder of intestinal copper absorption 1950-1998 period) and their electoral support on (1) resulting in copper deficiency. Cardinal features redistributional policies in the labor market and in the include hair abnormalities, facial dysmorphism, severe welfare state; (2) the income inequalities measured by neurological impairment, hypothermia, arterial Theil and Gini indexes; and (3) health indicators, such anomalies, bone abnormalities and a fatal outcome. as infant mortality and life expectancy. This analysis is 736
- 745. carried out statisticallyby a bivariate and a multivariate unprotected sexual contact with multiple partners (risk analysis (a pooled cross-sectional study). Both analyses of sexually transmitted diseases, of an unwanted show that political variables play an important role in pregnancy), substance abuse, delinquency, school defining how public and social policies determine the failure or suicide. Professionals who deal with levels of inequalities and affect the level of infant adolescents should be aware of the devastating medical mortality. In general, political parties more committed and psychosocial sequelae of sexual abuse and should to redistributional policies, such as social democratic be able to recognize it, incorporating questions parties, are the most successful in reducing inequalities regarding victimization into the psycho-social or sexual and improving infant mortality. Less evidence exists, history. A medical examination, including an external however, on effects on life expectancy. The article also anogenital inspection and in selected cases a pelvic quantifies statistically the relationship between the examination, should always be performed. It is political and the policy variables and between these important to acknowledge that normal anogenital variables and the dependent variables--that is, the findings do not exclude sexual abuse and that a health indicators. multidisciplinary medical-psychosocial evaluation is mandatory. Navratil F. [Genital infections in prepubertal girls]. Ther Umsch 2002; 59(9):475-9. Needlman R, Toker KH, Dreyer BP, Klass P, Mendelsohn Abstract: Vulvitis and vulvovaginitis are the most AL. Effectiveness of a primary care intervention to common gynecologic complaint in prepubertal girls. support reading aloud: a multicenter evaluation. Ambul The frequently observed therapeutic failures are due Pediatr 2005; 5(4):209-15. mainly to lack of knowledge of the characteristics of Abstract: OBJECTIVE: Failure to read at grade level this age group, of age and development in appropriate predicts life-long economic and social disability. Early diagnostic procedures and of therapeutic measures exposure to reading aloud may prevent reading similar to those in the adult female patient. Prepubertal problems. This study seeks to determine whether girls are anatomically, physiologically and behaviorally institution of Reach Out and Read (ROR) programs is at relative risk for vulvovaginitis. Symptoms include associated with increased reading aloud in a national pruritus, genital pain, "vulvar dysuria" and discharge. sample. DESIGN: Before-after intervention study: History taking and a general pediatric examination are separate convenience samples were studied before and mandatory, thereafter an age appropriate careful after institution of ROR programs at multiple sites. anogenital examination should follow. It requires time, PARTICIPANTS AND SETTING: A convenience patience and knowledge of the different non sample of parents of children age 6-72 months seeking traumatizing examination techniques. The findings in routine health care at 19 clinical sites in 10 states. girls with vulvovaginitis are variable and erythema, INTERVENTIONS: The ROR model incorporates excoriations and discharge can be found. The genital anticipatory guidance about reading aloud and inspection and the use of microscopy and distribution of free picture books at health supervision microbiologic studies are helpful in planning an visits from 6 months through 5 years as well as reading appropriate therapy. The majority of vulvovaginal aloud in the waiting room. MAIN OUTCOME infections in children are nonspecific but they can also MEASURES: Parents were interviewed about their be caused by specific organisms and are mostly attitudes and practices related to reading aloud, using bacterial. Yeast infections are not found in otherwise questions drawn from validated instruments. healthy prepubertal girls. The therapeutic approach RESULTS: The sample included 1647 subjects (730 consists of improved anogenital hygiene, sitz/tub baths intervention, 917 comparison). After controlling for and use of non irritating soaps. However if an multiple potential confounding factors, significant abnormal population of bacteria is present associations were found between exposure to ROR and antimicrobial therapy should be considered. reading aloud as a favorite parenting activity (Adjusted Reassurance and a review of preventive methods are Odds Ratio [AOR] 1.6, P < .001); reading aloud at crucial in the management of girls with vulvovaginitis. bedtime (Adjusted Odds Ratio [AOR*rsqb; 1.5, P < .001); reading aloud 3 or more days per week (AOR Navratil F. [Sexual abuse in adolescence: patient assessment, 1.8, P < .001); and ownership of > or = 10 picture necessity and meaning of the physical examination]. books (AOR 1.6, P < .001). CONCLUSIONS: In a Gynakol Geburtshilfliche Rundsch 2003; 43(3):146-51. national sample, implementation of ROR programs was Abstract: The objective of this paper is to report on the associated with increased parental support for reading characteristics of sexual abuse in adolescence, on the aloud. This study provides evidence of the medical evaluation and interpretation of findings and effectiveness of a primary care intervention strategy to on the necessity of a multidisciplinary intervention. promote reading aloud to young children. Sexual abuse is a common problem affecting children and adolescents, males and females of any age or Neggers Y, Goldenberg R, Cliver S, Hauth J. Effects of socio-economic class. 10-22% of adolescents are domestic violence on preterm birth and low birth victims of sexual abuse. They engage more frequently weight. Acta Obstet Gynecol Scand 2004; 83(5):455- in risk-taking behaviours, such as early sexual activity, 60. 737
- 746. Abstract: BACKGROUND: Domesticviolence is Nelson S. Your body tells the truth. Ment Health Today increasingly recognized as a potentially modifiable risk 2003; 20-3. factor for adverse pregnancy outcomes. This study was conducted to evaluate the relationship between abuse Nemeth L, O'Briain DS, Puri P. Demonstration of neuronal during pregnancy or within the last year and low birth networks in the human upper urinary tract using weight and preterm birth. METHODS: From 1997 to confocal laser scanning microscopy. J Urol 2001; 2001, 3149 low income, relatively low-risk pregnant 166(1):255-8. women (82% African-American) participated in this Abstract: PURPOSE: To our knowledge innervation of prospective study. The Abuse Assessment Screen, a the upper urinary tract and its role in motility and validated screening tool, which assesses emotional, sensation are not clearly understood. The whole mount physical or sexual abuse, injuries due to physical abuse preparation technique provides 3-dimensional (D) and physical abuse in the index pregnancy, was filled morphology of the innervation and its relationship of out by 3103 women. RESULTS: Of the women branching and interconnecting nerve fibers to each screened, 26.6% reported emotional abuse, 18.7% other and to the neighboring tissues. Confocal laser reported physical abuse in the past year and 10.3% scanning microscopy provides dramatic optical women reported being beaten, bruised, threatened with advantages for detecting 3-D structures in thick a weapon or being permanently injured. Abuse during specimens. We investigated the distribution and pregnancy was reported by 5.9% of the women. Low morphology of the neuronal structures in the human birth weight and preterm birth occurred in 10.9% and upper urinary tract using the whole mount preparation 10.2% of the pregnant women, respectively. Logistic technique and confocal laser scanning microscopy. regression analyzes indicated that injury due to MATERIALS AND METHODS: Whole mount physical abuse within the past year was significantly preparations of the human renal pelvis and ureter were associated with both preterm birth [adjusted odds ratio stained by standard immunohistochemical method (AOR) = 1.6, 95% confidence interval (CI) = 1.1-2.3] using various neuronal markers (protein gene product and low birth weight (AOR = 1.8, 95% CI = 1.3-2.5) 9.5, neuron specific enolase and neurofilament). The 3- after adjusting for other covariates. The mean birth D architecture of the specimens was investigated with weight of infants born to women who were injured due the help of confocal laser scanning microscopy. to physical abuse was significantly lower (-75.2 g, p = RESULTS: We detected 2 mesh-like neuronal 0.04) than the mean birth weight of infants of women networks or plexus in the human upper urinary tract. who were not injured. CONCLUSION: These results The first and more prominent plexus was located in the indicate that in our population, injuries resulting from submucosa between the lamina propria and tunica physical abuse are associated with both low birth muscularis, and the second neuronal network was weight and preterm birth. found between the smooth muscle fibers of the ureteral wall. There were frequent interconnections between the Nelms BC. Emotional abuse: helping prevent the problem. J 2 networks in the ureteral wall. CONCLUSIONS: To Pediatr Health Care 2001; 15(3):103-4. our knowledge our study shows for the first time that there are 2 well formed mesh-like neuronal plexus in Nelson CA. Can we develop a neurobiological model of the human upper urinary tract. Our findings suggest human social-emotional development? Integrative that the autonomic nervous system of the human upper thoughts on the effects of separation on parent-child urinary tract may have a significant role in the interactions. Ann N Y Acad Sci 2003; 1008:48-54. propagation, coordination and modulation of Abstract: After summarizing the main points raised in ureteropelvic peristalsis. articles by Kaslow et al. and Plotsk, a number of questions that derive from these authors' work are Nemets B, Witztum E, Kotler M. [False memory syndrome: listed. Additional questions are then posed, the answers state of the art]. Harefuah 2002; 141(8):726-30, 760. to which will likely facilitate one's ability to translate Abstract: The review describes the heated dispute on animal models of child psychopathology into human the present state of recovered traumatic memories. terms. After summarizing the various advantages and There are two main schools concerning the status of disadvantages to models using mice, rats, and recovered memories of child abuse. One school monkeys, several examples of recent research that have believes in their authenticity unconditionally. Those attempted to meld animal models with human studies who oppose the authenticity claim False Memory are described. Syndrome's existence. They describe it as "a serious form of psychopathology characterized by strongly Nelson EA. Category D: unknown whether ill treatment is believed pseudomemories of childhood sexual abuse" cause. Arch Dis Child 2003; 88(7):645. and "condition in which a person's identity and interpersonal relationships are centered around a Nelson L. Quashed convictions reignite row over British cot memory of traumatic experience which is objectively deaths. Nature 2004; 427(6973):384. false but in which the person strongly believes". This review presents the allegations of both sides involved in the dispute, with updates of scientific and judicial 738
- 747. references and relevantrecommendations to care used drugs and had problems related to drug use. takers. Newman BS, Dannenfelser PL. Children's protective Neto MT. Regionalization, networks and neonatal transport. services and law enforcement: fostering partnerships in J Matern Fetal Neonatal Med 2002; 11(2):140. investigations of child abuse. J Child Sex Abus 2005; 14(2):97-111. Neufeld S, Wright SM, Gaut J. Not raising a "bubble kid": Abstract: Although collaboration in child abuse farm parents' attitudes and practices regarding the investigations has been emphasized since 1974, employment, training and supervision of their children. barriers, including role conflicts and organizational J Rural Health 2002; 18(1):57-66. differences, have often been reported. This study Abstract: This article explores farm parents' attitudes describes the process of collaboration based on the and practices regarding the employment, training and perceptions of investigators working with a Child supervision of their children among a sample of 24 Advocacy Center. Telephone interviews were farm couples from southeastern Washington state. The conducted with 290 child protective service workers goal was to gain a greater understanding of parental and law enforcement officers from 28 child advocacy attitudes and practices in order to devise appropriate centers in 20 different states. Respondents identified and meaningful efforts to improve the safety of barriers to the process of collaboration such as conflicts children and adolescents involved in farm work. over case control and facilitators including co-housing Demographic data regarding the farm families and their and cross-training. Conditions that should contribute to farm safety practices were collected through a short successful collaboration are discussed. questionnaire, and parental attitudes and practices regarding the employment, training and supervision of Newman JD, Sheehan KM, Powell EC. Screening for their children were explored through open-ended, semi- intimate-partner violence in the pediatric emergency structured interviews. The results suggest that farm department. Pediatr Emerg Care 2005; 21(2):79-83. parents have developed a logical and consistent set of Abstract: OBJECTIVE: The aims of this study were to beliefs and attitudes regarding the employment, determine the annual prevalence of intimate-partner training, and supervision of their children that is based violence (IPV) in an urban pediatric emergency in part on the belief that farm work is highly beneficial department (ED) among mothers seeking care for their to their children's development. Safety interventions to children, to examine the associations between IPV and reduce childhood farm injuries will have to family socioeconomic characteristics, triage time, and acknowledge farm work as important and beneficial for child's diagnosis, and to describe perceptions and children in order to maintain legitimacy and credibility. preferences for IPV screening. METHODS: A Nevertheless, because farm parents' practices regarding confidential 15-item survey was completed by 451 their children's employment reflect cultural beliefs and women caretakers who were unaccompanied by a male values regarding children and child-rearing, some partner in an urban pediatric ED associated with a recommended safety guidelines will be difficult to children's hospital. Women were enrolled during 4- implement. hour time blocks selected to represent ED use patterns during June and July 2002. Survey questions addressed Newcomb MD, Locke TF. Childhood adversity and poor experiences of IPV (physical or sexual violence and mothering: consequences of polydrug abuse use as a perception of safety) in the preceding year and moderator. Addict Behav 2005; 30(5):1061-4. preferences for IPV screening. We also collected Abstract: Drug abuse consequences have been typically information about the women's socioeconomic examined as a direct or main effect on various later characteristics and the child's triage time and diagnosis. outcomes. Drug abuse may also serve as a consequence RESULTS: Fifty women reported IPV, an annual that alters (moderates) critical developmental prevalence of 11%. Compared with white women, the trajectories. This study examined the relationship relative risk of IPV among black women was 1.1 (95% between childhood adversity factors (parent alcohol confidence interval [CI], 1.0-1.2) and among Hispanic and drug-related problems, childhood maltreatment) women was 1.1 (95% CI, 1.0-1.2). Compared with and future parenting practices through an analysis of women who completed college, the relative risk of the moderating effects of polydrug problems. Data women who had not completed high school was 5.8 from a community sample of mothers was divided into (95% CI, 2.0-26.4). We observed no association with two groups based on the median split level of polydrug poverty. Women who reported IPV more often sought problems (alcohol, marijuana, cocaine) that they care for their child in the evening (4-12 pm, chi2, P < reported (low, N=123; high, N=114). Confirmatory 0.01); there was no association with the child's factor models (CFAs) were developed for the two diagnosis. Most (75%) stated that IPV screening in the groups and compared with multiple group analyses pediatric ED was appropriate. CONCLUSIONS: The (MGAs). Results revealed that mothers who had annual prevalence of IPV in a pediatric ED is 11%. As parents with alcohol or drug-related problems were socioeconomic and visit characteristics are imprecise in more likely to become poor parents, if they themselves identifying women at risk, screening should include all women. Screening for IPV in the pediatric ED is 739
- 748. acceptable to women. an overall agreement of 67% (K = 0.29). Ten (29%) of 35 initial TST-negative reactions boosted, nine of Newport DJ, Heim C, Bonsall R, Miller AH, Nemeroff CB. whom were BCG-vaccinated subjects. Boosting Pituitary-adrenal responses to standard and low-dose occurred in eight (67%) of 12 subjects who were dexamethasone suppression tests in adult survivors of initially QFT-positive/TST-negative. Compared to the child abuse. Biol Psychiatry 2004; 55(1):10-20. second TST, initial QFT had a relative post-test Abstract: BACKGROUND: Previous studies indicate probability of 76% (95% CI 0.58-0.95); boosting that adverse childhood events are associated with accounted for 8/16 (50%) of initial testing persistent changes in corticotropin-releasing factor discordances. CONCLUSION: Positive QFT in the neuronal systems. Our aim was to determine whether setting of negative TST frequently anticipates a TST altered glucocorticoid feedback mediates the boost. This finding helps explain discordance between neuroendocrine sequelae of childhood trauma. the two tests and may provide an alternative to serial METHODS: Standard and low-dose dexamethasone TST testing. suppression tests (DST) were performed in women with a history of child abuse (n=19), child abuse and Nguyen T, Malley R, Inkelis S, Kuppermann N. Comparison major depression (n=16), major depression and no of prediction models for adverse outcome in pediatric childhood trauma (n=10), and no history of mental meningococcal disease using artificial neural network illness or childhood trauma (n=19). Secondary analysis and logistic regression analyses. J Clin Epidemiol with posttraumatic stress disorder (PTSD) as the 2002; 55(7):687-95. organizing diagnosis was also conducted. RESULTS: Abstract: The objective of this study was to compare In the low-dose DST, depressed women with a history artificial neural network (ANN) and multivariable of abuse exhibited greater cortisol suppression than any logistic regression analyses for prediction modeling of comparator group and greater corticotropin suppression adverse outcome in pediatric meningococcal disease. than healthy volunteers or nondepressed abuse We analyzed a previously constructed database of survivors. There were no differences between children younger than 20 years of age with nondepressed abuse survivors and healthy volunteers in meningococcal disease at four pediatric referral the low-dose DST or between any subject groups in the hospitals from 1985-1996. Patients were randomly standard DST. The PTSD analysis produced similar divided into derivation and validation datasets. Adverse results. CONCLUSIONS: Cortisol supersuppression is outcome was defined as death or limb amputation. evident in psychiatrically ill trauma survivors, but not ANN and multivariable logistic regression models in nondepressed abuse survivors, indicating that were developed using the derivation set, and were enhanced glucocorticoid feedback is not an invariable tested on the validation set. Eight variables associated consequence of childhood trauma but is more related to with adverse outcome in previous studies of the resultant psychiatric illness in traumatized meningococcal disease were considered in both the individuals. ANN and logistic regression analyses. Accuracies of these models were then compared. There were 381 Newton R. Neurological networks. Dev Med Child Neurol patients with meningococcal disease in the database, of 2002; 44(12):795. whom 50 had adverse outcomes. When applied to the validation data set, the sensitivities for both the ANN Ney JP, Joseph KR, Mitchell MH. Late subdural hygromas and logistic regressions models were 75% and the from birth trauma. Neurology 2005; 65(4):517. specificities were both 91%. There were no significant differences in any of the performance parameters Nguyen M, Perry S, Parsonnet J. QuantiFERON-TB predicts between the two models. ANN analysis is an effective tuberculin skin test boosting in U.S. foreign-born. Int J tool for developing prediction models for adverse Tuberc Lung Dis 2005; 9(9):985-91. outcome of meningococcal disease in children, and has Abstract: SETTING: Santa Clara County, Northern similar accuracy as logistic regression modeling. With California. OBJECTIVE: To characterize agreement of larger, more complete databases, and with advanced tuberculin skin test (TST) and QuantiFERON-TB ANN algorithms, this technology may become (QFT) with repeated testing. DESIGN: Fifty-two increasingly useful for real-time prediction of patient subjects participating in an ongoing prospective study outcome. of infectious disease transmission were tested by TST and QFT at two home visits 3 months apart. Boosting Ngwena C. Access to health care services as a justiciable was defined as reclassification of TST from negative to socio-economic right under the South African positive. Agreement and reproducibility of TST and constitution. Med Law Int 2003; 6(1):13-23. QFT were assessed using kappa and McNemar Notes: GENERAL NOTE: KIE: 43 fn. statistics. RESULTS: Of 48 individuals completing all GENERAL NOTE: KIE: KIE Bib: AIDS; health tests, 75% were foreign-born (92% Latin America) and care/foreign countries; health care/rights 58% were BCG-vaccinated. Initial TST and QFT were Abstract: This commentary describes and analyses the positive in 13 (27%) and 21 (44%), respectively, with decision of the Constitutional Court of South Africa in Minister of Health and Others v Treatment Action 740
- 749. Campaign and Otherswhere the South African Abstract: Women and men who meet criteria for government was found to have violated the right of psychiatric disorder are likely to be parents. Many go access to health care under the Constitution. Section undiagnosed and untreated, putting themselves and 27(1) guarantees everyone the right of access to health their children at risk of poor outcomes. Adults with care services. Section 27(2) imposes on the state a duty mental illness may fear disclosing their status as to take reasonable measures within its available parents; providers may not ask. Practices can be resources to achieve the progressive realisation of this modified to promote the well being of parents with right. To the extent that government was unreasonably mental illness and their children. delaying access to patently affordable life-saving therapy for the prevention of mother-to-child Nicklas TA, Baranowski T, Baranowski JC, Cullen K, transmission of HIV to a class of persons that was Rittenberry L, Olvera N. Family and child-care largely vulnerable and indigent, it is submitted that the provider influences on preschool children's fruit, juice, case was correctly decided. However, there is little and vegetable consumption. Nutr Rev 2001; 59(7):224- doubt that the decision, and in particular the 35. prescriptive nature of the remedy granted by the Court Abstract: Children's intakes of fruit, juice, and and its budgetary implications, do no sit easily with a vegetables (FJV) do not meet the recommended traditional notion of separation of powers between the minimum of five daily servings, placing them at judiciary on the one hand, and the executive and increased risk for development of cancer and other Parliament on the other. At the same time, it must be diseases. Because children's food preferences and accepted that the remedy and its budgetary implications practices are initiated early in life (e.g., 2-5 years of are an inevitable consequence of the inclusion of age), early dietary intervention programs may have justiciable socio-economic rights in the Bill of Rights. immediate nutritional benefit, as well as reduce chronic The principles that were applied by the Court in disease risk when learned healthful habits and determining the case were largely drawn from preferences are carried into adulthood. Families and jurisprudence developed by organs under treaty bodies, child-care settings are important social environments and in particular the Committee on Economic, Social within which food-related behaviors among young and Cultural Rights. children are developed. FJV preferences, the primary predictor of FJV consumption in children, are Nicholas SW, Abrams EJ. Boarder babies with AIDS in influenced by availability, variety, and repeated harlem: lessons in applied public health. Am J Public exposure. Caregivers (parents and child-care providers) Health 2002; 92(2):163-5. can influence children's eating practices by controlling availability and accessibility of foods, meal structure, Nichols LA. The infant caring process among Cherokee food modeling, food socialization practices, and food- mothers. J Holist Nurs 2004; 22(3):226-53. related parenting style. Much remains to be learned Abstract: The purpose of this study was to identify the about how these influences and practices affect the social process of infant care among Cherokee mothers. development of FJV preferences and consumption Nineteen informants, who had an infant less than 2 early in life. years of age, were interviewed. The data were analyzed using the technique of constant comparative analysis. Nicklin S, Spencer SA. Recruitment failure in early neonatal A social process of Indian infant care among Cherokee research. Arch Dis Child Fetal Neonatal Ed 2004; mothers was identified. Eight concepts emerged from 89(3):F281. data analysis. The first and principal concept, being a Cherokee mother, describes the functions of being an Nicolaidis C. The Voices of survivors documentary: using Indian mother in Cherokee society. The other seven patient narrative to educate physicians about domestic concepts describe the patterns of cultural care the violence. J Gen Intern Med 2002; 17(2):117-24. mothers provided to their infants. These included Abstract: This article describes a method of developing accommodating everyday infant care, accommodating physician education materials using analysis of health perspectives, building a care-providing domestic violence patient experiences and patients' consortium, living spiritually, merging the infant into descriptions of their experiences. The process began Indian culture, using noncoercive discipline techniques, with interviews of 21 domestic violence survivors, and vigilantly watching for the natural unfolding of the focusing on what they wanted to teach physicians. infant. Trustworthiness and credibility of the generated Qualitative analysis of these interviews identified 4 theory were evaluated through multiple measures. main themes regarding what survivors wanted physicians to understand about life in an abusive Nicholson J, Biebel K. Commentary on "Community mental relationship: that domestic violence is universal, that it health care for women with severe mental illness who is more than just physical assaults, that it is all about are parents" - The tragedy of missed opportunities: of power and control, and that it affects the entire family. missed opportunities: What providers can do. Because what survivors wanted from physicians Community Ment Health J 2002; 38(2):167-72. differed depending on where they were in their abusive 741
- 750. relationships, recommendations weredeveloped for some of the children to be infected with Chlamydia each of 5 common situations: when a patient may not trachomatis. Therefore, the risk for sexually abused yet recognize the abuse, when s/he may not be ready or children to be infected with Chlamydia trachomatis or able to disclose the abuse, when s/he chooses to remain Neisseria gonorrhoeae is very low, depending on the in an abusive relationship, when s/he is seeking care kind of abuse and the perpetrator's possible risk for an acute assault, and when s/he has left the behaviour, age, and gender. As a conclusion, only relationship but not yet healed. Interview excerpts children with a clear indication should be tested for representing each of the identified themes are used to these sexually transmitted diseases. create a 30-minute educational documentary. A written companion guide covers the traditional aspects of Nievas F, Justicia F. Development of memory structures for domestic violence education. In teaching about homographs using pathfinder network representations. domestic violence or other health problems where it is Span J Psychol 2003; 6(1):12-27. difficult for physicians to understand their patients Abstract: Some studies with children have shown that intuitively, an educator's most important role may be to there is no semantic priming at short stimulus onset direct learners to listen to the experience and wisdom asynchrony (SOA) in lexical decision and naming tasks of patients. for homographs. The predictions of spreading activation theories might explain this missing effect. Nicoletti A. A role for the nurse practitioner. J Pediatr There may be differences in children's and adults' Adolesc Gynecol 2001; 14(2):101-2. memory structures. We have explored this hypothesis. The development of memory structure representations Nielsen LA, Mikkelsen SJ, Charles AV. [Chlamydia for homographs was measured by a Pathfinder trachomatis and Neisseria gonorrhoeae infections in algorithm. In Experiment 1, the three dependent sexually abused children in Jutland]. Ugeskr Laeger variables were: the number of links in the network, 2002; 164(49):5806-9. closeness measures (C), and distances between nodes. Abstract: INTRODUCTION: At the Department of Results revealed developmental differences in network Forensic Medicine, University of Aarhus, Denmark, structure representations in adults and children. In examinations are performed of children who are Experiment 2, results revealed that these differences suspected of having been sexually abused. The medical were not due to the cohort effect. In Experiment 3, the forensic investigation aims at documenting sexual relationship between associative strength, as measured abuse if there are any physical findings. The presence by associative norms, and distances, as measured by of certain sexually transmitted diseases, which cannot Pathfinder algorithm, was explored. The results of be explained otherwise, may be such documentation. these three experiments and empirical research from This article focuses on Chlamydia trachomatis and semantic priming experiments show that these Neisseria gonorrhoeae, and the risk for the sexually differences in memory structure representations could abused child to contract these diseases. MATERIAL be one of the sources of the missing semantic priming AND METHODS: Retrospectively, we went through effect in children. the Institute's files from 1996 to 2000 concerning child abuse. Information about age, sex, cultures for Nilsson C, Horgby K, Borres MP. [Increasing number of Chlamydia trachomatis and for Neisseria gonorrhoeae, child abuse cases in Sweden--in accordance with and the results of these cultures was registered. If the reality?]. Lakartidningen 2001; 98(19):2298-301. child had been cultured, the suspected perpetrator's age Abstract: The number of police reports on child assault and gender were registered as well. The children were shows an increasing trend during the last two decades all between 0 and 15 years of age, and in all cases the in Sweden. The purpose of this article is to present suspicion of sexual abuse had led to reporting to the possible explanations. Increased awareness of child police. RESULTS: 295 girls and 41 boys were abuse, legislative reforms, changes in attitudes toward examined in the period from 1996 to 2000. A total of corporal punishment and violence in general, and 100 cultures for Chlamydia trachomatis and 105 changed routines within schools can explain the cultures for Neisseria gonorrhoeae were performed. increasing trend in police reporting. An actual increase Among the 111 children who were examined for in the rate of child abuse is possible but less likely. Chlamydia trachomatis and/or Neisseria gonorrhoeae Reports of increasingly violent behavior among young there were no positive results. In 102 cases the people must be taken seriously. suspected perpetrator was known to be one or more men, and only in one case it was a women. The mean Nishida A, Sugiyama S, Aoki S, Kuroda S. Characteristics age of the suspected perpetrators was 35.4 years. and outcomes of school refusal in Hiroshima, Japan: DISCUSSION: The prevalence of Neisseria proposals for network therapy. Acta Med Okayama gonorrhoeae and Chlamydia trachomatis should reflect 2004; 58(5):241-9. the prevalence in the group of perpetrators. Neisseria Abstract: The authors conducted a study on children gonorrhoeae is uncommon outside Copenhagen, the undergoing treatment at major school refusal treatment capital of Denmark, whereas Chlamydia trachomatis is centers in Hiroshima Prefecture. On the whole, school quite common. On this background, we had expected 742
- 751. refusal in theprefecture was found to peak between 13 conflicting tasks imposed on the physician. and 14 years of age. By age group, the main reason for Complementary to pediatric exclusion of genuine school refusal in elementary school group was parent- disease, psychopathological assessment is required to child relationship with separation anxiety. Given exclude other sources of deviant illness behaviour. additional problems such as neglect at home and Factious disorder shares particular features (active complicated social situations in their schools, junior violation of the child, false report of history, high school students were found to present diverse aggravated symptom presentation and increased symptoms from introversion and self-analysis to doctor-hopping, difficulties in conforming maternal extroversion, neglect of studies, and delinquency. report in biomedical data) with other Among high school students, there were more cases psychopathological entities (child abuse, simulation, suffering withdrawal and schizophrenia spectrum dissociative disorders, somatoform disorders including disorders. The major task regarding treatment seems to hypochondria, variants of maternal overprotection and lie in how to treat complex cases combining different infantilization, psychosis or delusion in the mother). problems. We summarized herein the studies we have Criteria for differentiation are presented. Three carried out and propose a model for a network therapy concepts on the psychopathological etiology of system based on functional liaisons between treatment factitious disorder by proxy are relevant: In some centers. With this system, a child psychiatric medical cases, it may be conceived as secondary manifestation facility plays the part of a liaison center for the overall of a primary psychopathological entity or personality network system. disorder. Learning theory emphasises operant rewards received from vicarious sick role. Attachment theory Nixon RD, Sweeney L, Erickson DB, Touyz SW. Parent- provides possible explanations concerning the child interaction therapy: a comparison of standard and traumatic impact on the child, early sources of abbreviated treatments for oppositional defiant psychopathology in the fabricating mother and risks for preschoolers. J Consult Clin Psychol 2003; 71(2):251- intergenerational transmission of factitious disorders. 60. Abstract: Families of 54 behaviorally disturbed Nokes DJ, Okiro EA, Ngama M et al. Respiratory syncytial preschool-aged children (3 to 5 years) were randomly virus epidemiology in a birth cohort from Kilifi district, assigned to 1 of 3 treatment conditions: standard Kenya: infection during the first year of life. J Infect parent-child interaction therapy (PCIT; STD); modified Dis 2004; 190(10):1828-32. PCIT that used didactic videotapes, telephone Abstract: We report estimates of incidence of consultations, and face-to-face sessions to abbreviate respiratory syncytial virus (RSV) infection during the treatment; and a no-treatment waitlist control group first year of life for a birth cohort from rural, coastal (WL). Twenty-one nondisturbed preschoolers were Kenya. A total of 338 recruits born between 21 January recruited as a social validation comparison condition. 2002 and 30 May 2002 were monitored for symptoms Posttreatment assessment indicated significant of respiratory infection by home visits and hospital differences in parent-reported externalizing behavior in referrals. Nasal washings were screened by use of children, and parental stress and discipline practices immunofluorescence. From 311 child-years of from both treatment groups on most measures observation (cyo), 133 RSV infections were found, of compared with the WL group. Clinical significance which 48 were lower respiratory tract infections testing suggested a superior effect for the STD (LRTIs) and 31 were severe LRTIs, resulting in 4 immediately after intervention, but by 6-month follow- hospital admissions. There were 121 primary RSV up, the two groups were comparable. The findings infections (248 cyo), of which 45 were LRTIs and 30 indicate that abbreviated PCIT may be of benefit for were severe LRTIs, resulting in 4 hospital admissions; families with young conduct problem children. there was no association with age. RSV contributed significantly to total LRTI disease in this vaccine-target Noeker M. [Factitious disorder and factitious disorder by group. proxy]. Prax Kinderpsychol Kinderpsychiatr 2004; 53(7):449-67. Noland JS, Singer LT, Short EJ et al. Prenatal drug exposure Abstract: Similar to the adult patient, a child or and selective attention in preschoolers. Neurotoxicol adolescent may actively feign or produce artificial Teratol 2005; 27(3):429-38. symptoms (synonymous: Munchausen syndrome). The Abstract: Deficits in sustained attention and more frequent case is that the child suffers from being impulsivity have previously been demonstrated in an object of symptom fabrication induced by a close preschoolers prenatally exposed to cocaine. We person caring for the child, regularly the mother assessed an additional component of attention, (Munchausen syndrome by proxy). This review focuses selective attention, in a large, poly-substance cocaine- on psychopathological aspects of the clinically more exposed cohort of 4 year olds and their at-risk relevant factitious disorder by proxy. Typical comparison group. Employing postpartum maternal behaviour and personality characteristics are presented report and biological assay, we assigned children to that can be taken as clinical warning signs. Doctor- overlapping exposed and complementary control mother-interaction is affectively challenging due to groups for maternal use of cocaine, alcohol, marijuana, 743
- 752. and cigarettes. Maternalpregnancy use of cocaine and differed greatly at intake, we compared their outcomes use of cigarettes were both associated with increased at 12 months and then examined the effects of the commission errors, indicative of inferior selective intervention separately for these two groups. attention. Severity of maternal use of marijuana during Participants were randomly assigned to the intervention pregnancy was positively correlated with omission or control group and were interviewed during the last errors, suggesting impaired sustained attention. trimester of pregnancy and at 2, 6, and 12 months after Substance exposure effects were independent of birth. The effects of the program varied by maternal postpartum psychological distress, birth race/ethnicity. For African Americans, the program mother cognitive functioning, current caregiver was associated with better maternal documentation of functioning, other substance exposures and child infant immunizations, more developmentally concurrent verbal IQ. appropriate parenting expectations, and higher 12- month infant mental development scores. For Mexican Nooraudah AR, Mohd Sham K, Zahari N, Fauziah K. Non- Americans, the program had positive effects on accidental fatal head injury in small children--a clinico- maternal daily living skills and on the play materials pathological correlation. Med J Malaysia 2004; subscale of the Home Observation for the 59(2):160-5. Measurement of the Environment assessment. This Abstract: Non-accidental head injury leading to study, along with previous research, suggests that home massive intracranial trauma has been identified as a visits by a nurse-health advocate team can improve leading cause of death in small children. In a typical maternal and infant outcomes even for inner-city, low- case, a child usually below the age of one year is income, minority families. Effective programs must be violently shaken, leading to rupture of the connecting culturally sensitive, intensive, and adequately staffed veins between the dura mater and the brain substance and financed. with variable degrees of bleeding into the subdural space resulting in increased intracranial pressure. The Norris DM. Forensic consultation and the clergy sexual accompanying venous thrombosis affecting the vessels abuse crisis. J Am Acad Psychiatry Law 2003; of the brain substance leads to cerebral hypoxia and 31(2):154-7. cellular death. In this study conducted throughout the year 1999, all children below the age of 3 years who Norris JW. Roy Meadow. Lancet 2005; 366(9484):451. were admitted to Hospital Kuala Lumpur and had died due to non-accidental injuries were included. Novins DK, King M, Stone LS. Developing a plan for Postmortems, including histopathological studies, were measuring outcomes in model systems of care for conducted to determine the most likely mechanisms of American Indian and Alaska Native children and the injuries. Ten cases were identified for the whole youth. Am Indian Alsk Native Ment Health Res 2004; year. In 2 cases, both below one year of age, the 11(2):88-98. features presented showed evidence of violent shaking Abstract: The Circles of Care initiative emphasized the of the infants. In 6 other cases whose average age was importance of developing an outcomes measurement 13 (range 4-24) months, there were evidences of direct plan that was consonant with the model system of care trauma and violent shaking. In the last two cases, aged as well as community values and priorities. This 24 and 33 months respectively, there was only analysis suggests that the Circles of Care grantees evidence of direct trauma on the heads without being achieved this key programmatic objective, but that a shaken. This study shows that death due to intracranial major constraint was the tendency of funders, including trauma caused by shaking with or without direct impact the Substance Abuse and Mental Health Services is the most frequent cause of mortality in abused Administration (the funder of Circles of Care), to children. Death due to direct impact between the head mandate their own outcomes measurement plans. and another object is a less frequent occurrence. Funders are encouraged to balance their needs for commonality of measures across programs for their Norr KF, Crittenden KS, Lehrer EL et al. Maternal and own evaluation purposes with the needs of service infant outcomes at one year for a nurse-health advocate providers to utilize measures that meet their unique home visiting program serving African Americans and programmatic and community contexts. Mexican Americans. Public Health Nurs 2003; 20(3):190-203. Novins DK, LeMaster PL, Jumper Thurman P, Plested B. Abstract: This article describes the outcomes at 1 year Describing community needs: examples from the for a randomized clinical trial of Resources, Education Circles of Care initiative. Am Indian Alsk Native Ment and Care in the Home-Futures: a program to reduce Health Res 2004; 11(2):42-58. infant mortality through home visits by a team of Abstract: The assessment of community needs was one trained community residents led by a nurse. Low- of the key foundations of the Circles of Care planning income, inner-city pregnant women who self-identified effort. Grantees identified a range of needs at the child, as African American or Mexican American were adolescent, family, programmatic, and community recruited in two university prenatal clinics in Chicago. levels. This information, along with an emphasis on the Because African Americans and Mexican Americans 744
- 753. importance of eachcommunity's history and culture, parent neglect/abuse, abandonment, mental illness, served as an important guide for each program as they substance abuse, teen mother, or death of a parent. developed their model systems of care. While most grandparents considered their health to be satisfactory, the grandparents, ages thirty to sixty Nowinski CV, Minshew NJ, Luna B, Takarae Y, Sweeney reported a greater number of health concerns. The PSI JA. Oculomotor studies of cerebellar function in identified life stress greater than parenting stress. In autism. Psychiatry Res 2005; 137(1-2):11-9. conclusion, additional research is needed to identify Abstract: Histopathological, neuroimaging and genetic life stresses that add to the parenting burden, and findings indicate cerebellar abnormalities in autism, but grandparents' needs to continue parenting. the extent of neurophysiological dysfunction associated with those findings has not been systematically Nurcombe B. The future of child and adolescent mental examined. Suppression of intrusive saccades (square health. World Psychiatry 2005; 4(3):157. wave jerks) and the ability to sustain eccentric gaze, two phenomena requiring intact cerebellar function, Nurse J. Screening for domestic violence. Cultural shift is were examined in 52 high-functioning individuals with needed. BMJ 2002; 325(7377):1417; author reply autism and 52 age- and IQ-matched healthy subjects 1417. during visual fixation of static central and peripheral targets. Rates of intrusive saccades were not increased Nwomeh BC, Waller AL, Caniano DA, Kelleher KJ. in autism during visual fixation, and foveopetal ocular Informed consent for emergency surgery in infants and drift was also not increased when subjects held an children. J Pediatr Surg 2005; 40(8):1320-5. eccentric gaze. The absence of gross disturbances of Abstract: The informed consent process for emergency visual fixation associated with cerebellar disease in surgery in children poses a challenge for pediatric individuals with autism, such as increased square wave surgeons because the child and his/her surrogates jerk rates and foveopetal drift when holding eccentric (usually parents) must make medical decisions in a gaze, indicates that the functional integrity of relatively short period. The unique circumstances of a cerebellar--brainstem networks devoted to oculomotor surgical emergency create potential barriers to control is preserved in autism despite reported achieving the central goals of the informed consent anatomic variations. However, increased amplitude of process, respect for patient autonomy and beneficence. intrusive saccades and reduced latency of target The purpose of this review is to provide a practical refixation after intrusive saccades were observed in guide for pediatric surgeons on the informed consent individuals with autism, especially when subjects process as it applies to emergency surgery in pediatric maintained fixation of remembered target locations patients. We will also discuss innovative methods of without sensory guidance. The atypical metrics of preoperative education that can be adopted in the intrusive saccades that were observed may be emergency setting and highlight areas in which further attributable to faulty functional connectivity in cortico- research might help to improve this important aspect of cerebellar networks. surgical care. Nowlan WJ. Ethics and genetics. N Engl J Med 2003; Nyambedha EO, Wandibba S, Aagaard-Hansen J. Policy 349(19):1870-2; author reply 1870-2. implications of the inadequate support systems for Notes: GENERAL NOTE: KIE: 3 refs. orphans in western Kenya. Health Policy 2001; GENERAL NOTE: KIE: KIE Bib: confidentiality/legal 58(1):83-96. aspects; genetic screening Abstract: This paper describes the support systems available for orphans in a rural Luo community in Nullis-Kapp C. The knowledge is there to achieve Nyang'oma sub-location in Bondo District of Western development goals, but is the will? Bull World Health Kenya. Qualitative data were collected through in- Organ 2004; 82(10):804-6. depth interviews with orphaned children and their caretakers as well as key informants, and through focus Nunn PE. A study examining the health perceptions and group discussions with orphaned children, widows and parenting stressors of parenting African-American community elders. Quantitative data were obtained by grandparents. ABNF J 2002; 13(5):99-102. questionnaires administered to 100 caretakers of Abstract: The objectives of this study of African- orphaned children. The most serious problem was American, parenting grandparents were to examine the inability of the orphan households to afford school antecedents to grandparent parenting, the grandparents' fees, although lack of food, medicare and clothing were perception of their health status, and their assessment also prominent. The traditional, kinship-based support of parenting stress. Thirty-one subjects completed a systems made a major contribution to catering for the demographic questionnaire, two questions from the orphans though the resources were far from enough. Short form-36-Health Survey, and the Parenting Stress Various community-based groups in the area did not Index (PSI). Results indicated that the grandparents contribute significantly. The problem is getting parented minor grandchildren because of biological desperate due to a combination of an exponentially 745
- 754. increasing prevalence oforphans, poor socio-economic illness in an environment of domestic violence. Holist conditions and decline of the traditional support Nurs Pract 2002; 16(3):16-23. systems. For health planners and policy makers there Abstract: This case study of a young, African are two major concerns. In the short term, a big and American mother with chronic mental illness rapidly growing group of children are without adequate demonstrates the impact of domestic violence on a access to health services, while in the long term, the vulnerable population. The client was economically negative consequences for (in particular the girl) disadvantaged, socially isolated, stigmatized, and orphans' schooling pose a serious threat to the health of victimized by repeated abuse from her live-in male their future children. Based on the study findings, two partner of 7 years. With this overlay of violence in the recommendations are made: that the responsible parties home, the client experienced a downward trajectory in address the issue of education for orphans rapidly and health, self-esteem, economic status, personal freedom, sufficiently and with due consideration of their food social relationships, and legal standing. Using a public security and medicare; and that potential community health model in the context of an urban nursing center, resources such as kinship networks and community an advanced practice nurse provided case management groups are mobilised in order to assist in achieving the and outreach services for the client. goal. O'Connor LA, Morgenstern J, Gibson F, Nakashian M. O'Brien D. Borderline viability resuscitation cases. Med "Nothing about me without me": leading the way to Etika Bioet 2002; 9(3-4):6-10. collaborative relationships with families. Child Welfare Notes: GENERAL NOTE: KIE: 11 refs. 2005; 84(2):153-70. GENERAL NOTE: KIE: KIE Bib: allowing to Abstract: This article discusses the National Center on die/infants; allowing to die/religious aspects; Addiction and Substance Abuse's CASA Safe Haven, resuscitation orders an evidence-based, community-driven intervention Abstract: Decisions on whether to resuscitate severely program for children and families in child welfare premature infants are especially difficult in "borderline whose lives have been adversely affected by substance viability" cases--those where the probability of survival abuse, and for staff in the agencies that work with is slim, and where, if survival is possible, multiple co- them. CASA Safe Haven builds collaborative morbidities and severe disabilities are likely. The 2000 relationships that feature a blend of multidisciplinary International Guidelines on Cardiopulmonary teams that share responsibility for helping families; Resuscitation are comprehensive, yet leave open some family group conferencing, in which families are equal of the more difficult ethical questions that must be and welcome participants in designing and driving a addressed by decision-makers. This paper recommends service plan; and the influence of family court to hold evidence-based, clinical ethical guidelines for neonatal families and service providers accountable for resuscitation, drawing on one large Catholic health progress. CASA Safe Haven is a framework for system's approach, arguing from the perspective of the collaboration. Catholic moral tradition and the Ethical and Religious Directives for Catholic Health Care Services (the ERD O'Connor M. Reading between the lines in Beijing. Putting are policy for all of Catholic health care in the U.S.). birth on the agenda: justice, equality and maternity The paper presumes that there is an inherent dignity of care. Pract Midwife 2002; 5(6):28-30. the human person to be respected and protected regardless of the nature of the person's health problem O'Connor T. Collaboration is essential to improve health or social status. But it also presumes and argues that outcomes for children. Nurs N Z 2003; 9(3):29. treatments can be justified only by a proportionate benefit to the patient. In maintaining a holistic view of O'Donnell L, Stueve A, Agronick G, Wilson-Simmons R, the human person, two extremes are avoided: a Duran R, Jeanbaptiste V. Saving Sex for Later: an "vitalistic" approach where life is preserved at all costs; evaluation of a parent education intervention. Perspect and the "easy" alternative of euthanasia. Several Sex Reprod Health 2005; 37(4):166-73. principles of medicine, theology, ethics and Anglo- Abstract: CONTEXT: Initiation of sexual intercourse American common law are applied to three categories prior to high school is prevalent among inner-city black of preterm infants, each of which calls for a different and Hispanic youths, and has multiple negative health basic response: Category I - infants with a confirmed and social consequences. A promising strategy for gestational age of < 23-0/7 weeks; Category II - infants addressing early adolescent sexual activity is parent with a confirmed gestational age between 23-0/7 and education that addresses normal pubertal changes and 25-0/7 weeks; and Category III - infants with a the challenges of becoming a teenager. METHODS: A gestational age > 25-0/7 weeks. Studies show that 2003-2005 randomized trial to test the effectiveness of survival rates and outcomes vary dramatically for these Saving Sex for Later, a parent education program three groups, even with the availability of the latest presented on three audio CDs, enrolled 846 families technologies. with fifth- and sixth-grade students in seven New York City schools. Parent and youth surveys were conducted O'Brien SM. Staying alive: a client with chronic mental 746
- 755. at baseline andthree months postintervention. development or of extensive research. There is a lack Multivariate logistic and linear regression analyses of knowledge, both in the general community and by were performed to assess relationships between youth health professionals, of the nature of the risks and parent outcomes and treatment condition. associated with heavy alcohol consumption during RESULTS: At follow-up, parents in the intervention pregnancy and the factors that increase this risk. This group were significantly more likely than controls to paper reviews the literature surrounding FAS with the score high on indexes of communication with children aim of providing the reader an understanding of the about targeted risk behaviors, self-efficacy to discuss diagnostic features and epidemiology of FAS and of pubertal development and sexuality, and perceived the developmental sequelae associated with this influence over youths' behaviors (odds ratios, 1.9-2.5). syndrome. Youths in the intervention condition were more likely than controls to report high family support, and O'Leary D, Jyringi D, Sedler M. Childhood conduct reported more family rules and fewer behavioral risks. problems, stages of Alzheimer's disease, and physical Family support and rules partially mediate the aggression against caregivers. Int J Geriatr Psychiatry relationship between treatment condition and 2005; 20(5):401-5. behavioral risks. CONCLUSION: Saving Sex for Later Abstract: OBJECTIVE: To assess the prevalence of is a promising intervention for promoting youths' physical aggression against caregivers by Alzheimer's sexual abstinence. The intervention may also be patients. METHOD: One hundred and ninety-eight effective in enhancing positive parenting practices individuals with dementia, primarily Alzheimer's among parents who are typically difficult to reach disease (AD) were evaluated with the Cohen-Mansfield because of economic hardship, full schedules and Agitation Inventory, the Mini Mental Status complicated lives. Examination, two measures of Activities of Daily Living, portions of the Conflict Tactics Scale to O'Dononvan O. The conjoined twins. Transcript of the measure physical aggression against partner, questions speeches given at the BAFS annual dinner on 28 about conduct problems during childhood/adolescence February 2002. British Academy of Forensic Sciences. of the patients, and chart records of delusion and Med Sci Law 2002; 42(4):280-4. paranoia. RESULTS: 25% of the patients engaged in physical aggression against their caregivers in the past O'Dorisio MS, Hauger M, O'Dorisio TM. Age-dependent year, and 33% of the patients engaged in some act of levels of plasma neuropeptides in normal children. physical aggression against any individual in the past Regul Pept 2002; 109(1-3):189-92. two weeks. Physical aggression against a caregiver was Abstract: Several neuropeptides are secreted in high more likely in the middle (34%) than the early stage of amounts in pediatric tumors such as neuroblastoma and AD (4%). Physical aggression against a partner and have been used as markers of residual or recurrent agitation were more likely if the patient had a history disease. Plasma levels of neuropeptides might be of symptoms of conduct disorder. Delusions and expected to change during development, but have not paranoia were both associated with general physical been determined in normal children. We have obtained aggression and general verbal aggression but not fresh plasma from cord blood of six full-term infants physical aggression against a caretaker. and from peripheral blood in 41 healthy children, ages CONCLUSIONS: 25% of Alzheimer's disease and 1 month to 21 years. Levels of six neuropeptides, Multi-Infarct dementia patients engaged in acts of vasoactive intestinal peptide (VIP), somatostatin, physical aggression against their caregivers. The rate of gastrin releasing peptide (GRP), substance P, aggression seen in this clinical sample was much pancreastatin and neuropeptide Y (NPY) were higher than the rate of physical aggression in a measured by radioimmunoassay along with insulin-like community sample of the elderly. growth factor-1 (IGF-1) whose plasma levels are known to vary during development. A child with O'Leary SG, Vidair HB. Marital adjustment, child-rearing neuroblastoma was treated with the somatostatin disagreements, and overreactive parenting: predicting analogue, octreotide, and the effect on plasma child behavior problems. J Fam Psychol 2005; neuropeptides quantified. Octreotide doses of 2-3 19(2):208-16. microg/kg daily resulted in a 40-60% decrease in Abstract: Using structural equation modeling, the plasma levels of IGF-1, pancreastatin and GRP. These authors evaluated the hypothesis that the relation results are the first publication of plasma neuropeptide between marital adjustment and children's behavior levels in normal children. problems is mediated by child-rearing disagreements, whose effects are mediated by parents' overreactive O'Leary CM. Fetal alcohol syndrome: diagnosis, discipline. In a community sample, fully or partially epidemiology, and developmental outcomes. J Paediatr mediated models of internalizing and externalizing Child Health 2004; 40(1-2):2-7. behavior problems of 3- to 7-year-old boys (N = 99) Abstract: In Australia the issue of fetal alcohol and girls (N = 104) were supported for mothers and syndrome (FAS) has not been the subject of policy fathers in 7 of 8 cases. Child-rearing disagreements always mediated the relation of marital adjustment and 747
- 756. child behavior problems,and overreactive discipline southwest border hospital's in-house asthma was a final mediator in 3 cases. More variance was educational program. DATA SOURCES: (1) accounted for in mothers' than fathers' ratings. For "Increasing the Knowledge Base of Asthmatics and mothers' ratings, the most variance was accounted for Their Families through Asthma Clubs along the in boys' externalizing and girls' internalizing behavior Southwest Border." (2) American Lung Association. problems. (3) National Institutes of Health, National Heart, Lung and Blood Institute. (4) Referrals from a southwest O'Neill DJ. Electronic tagging of people with dementia. border hospital. CONCLUSIONS: Only two of 23 Tagging should be reserved for babies, convicted patients referred for asthma follow-up were readmitted criminals, and animals. BMJ 2003; 326(7383):281. to hospital and/or emergency care during the following Notes: GENERAL NOTE: KIE: 5 refs. year. Large group teaching pretest-posttest score means GENERAL NOTE: KIE: KIE Bib: behavior control; for 3,429 fourth and fifth grade students revealed a patient care/drugs 23% increase in asthma knowledge. Small follow-up groups of students received in-depth asthma education. O'Neill M. Ohio's patient-physician privilege: whether IMPLICATIONS FOR PRACTICE: Effectiveness of planned parenthood is a protected party. J Law Health hospital inpatient asthma education combined with 2002-2003; 17(2):297-325. outpatient family follow-up was supported. An additional finding was that southwest border families O'Shaughnessy RJ. Violent adolescent sexual offenders. are more receptive to visits arranged with a school Child Adolesc Psychiatr Clin N Am 2002; 11(4):749- nurse in their children's school than to home visits from 65. primary care clinic nurses. Abstract: The past 20 years have brought a significant increase in the general knowledge about adolescent Oermann MH, Lowery NF, Thornley J. Evaluation of Web offenders and sexual offenders and the potential harm sites on management of pain in children. Pain Manag that they cause to victims. Currently, however, we are Nurs 2003; 4(3):99-105. left with perhaps more questions than answers in Abstract: Increasingly, consumers access the Internet several important areas. We have concluded that there for information about their health problems and is no single cause or etiologic agent common to all treatments and to learn more about their health care. sexual offenders. Sexual offenders are by nature a Although Web sites can be valuable resources, the complex and a heterogeneous group, and sexual information may not be accurate or current. The offending is likely caused by multiple causation and purpose of this project was to evaluate the quality of interactive factors. Awareness has spread as to the Web sites for parents on the management of children's necessity of providing appropriate assessment and pain. The Health Information Technology Institute treatment facilities for adolescents. The limited criteria were used to evaluate 40 Web sites identified outcome studies indicate a lower recidivism rate for from two search engines: MSN and Google. After the adolescent offenders than adult offenders. This may evaluation process was completed, the readability of reflect a better prognosis for adolescent offenders who the sites was determined. Of the 40 sites, 29 (72.5%) have not had years of reinforcement of deviant sexual provided useful information for parents searching to arousal patterns and whose personality traits are more educate themselves about pain management. Other malleable than those of adult offenders. Further sites advertised the pain management services of their research is needed in the area of subclassification of facility or were not relevant for patient education. The sexual offenders, controlled treatment studies, and reading levels of the Web sites ranged from grade 7.7 prospective longitudinal studies to determine more to 12; the mean reading grade level of the 40 sites was accurate risk assessment. 10.8, too high for many consumers. This article discusses the role of the nurse in evaluating health Web Oberklaid F. Child advocacy and the Queen's representative; sites and teaching patients how best to use the Web for an unlikely link. Arch Dis Child 2003; 88(11):980. their health information. Oberle A. [Possibilities and limitations of children's Oh KJ, Shin YJ, Moon KJ, Hudson JL, Rapee RM. Child- physicians in exposing of child abuse]. rearing practices and psychological disorders in Kinderkrankenschwester 2002; 21(8):345-8. children: cross-cultural comparison of Korea and Australia. Yonsei Med J 2002; 43(4):411-9. Ochsner AK, Alexander JL, Davis A. Increasing awareness Abstract: The present study was designed to explore of asthma and asthma resources in communities on the cultural differences in the relationship between southwest border. J Am Acad Nurse Pract 2002; parenting behaviors and psychological adjustment of 14(5):225-30, 232, 234. the child. Mother-son interaction behaviors of 37 Abstract: PURPOSE: To provide outpatient asthma Korean boys (11 with Anxiety Disorder, 10 with education for children and families along the southwest Externalizing Disorders and 16 Non-clinical boys) and border of the U.S. and to study the effectiveness of a 54 Australian boys (20 with Anxiety Disorder, 17 with Externalizing Disorders and 17 Non-clinical boys) 748
- 757. between the agesof 7 and 15 were compared in terms psychopathology) and adolescent psychopathology was of parental negativity and involvement. The results examined in a sample of 665 13-17 year-old indicated that Korean mothers displayed more overall adolescents and their parents. Results indicated that negativity and lower overall involvement than adolescents who had parents diagnosed with alcohol Australian mothers. Furthermore, anxiety diagnosis dependence only did not significantly differ from was associated with low maternal involvement in the adolescents who had parents with no psychopathology Korean subjects, while in the Australian subjects, high in regard to any of the measures of psychological maternal involvement was associated with clinical symptomatology (substance use, conduct disorder, and status in the child. depression) or clinical diagnoses (alcohol dependence, marijuana dependence, conduct disorder, or Ohan JL, Johnston C. Gender appropriateness of symptom depression) assessed. In contrast, adolescents who had criteria for attention-deficit/hyperactivity disorder, parents diagnosed with alcohol dependence and either oppositional-defiant disorder, and conduct disorder. comorbid drug dependence or depression were more Child Psychiatry Hum Dev 2005; 35(4):359-81. likely to exhibit higher levels of psychological Abstract: We examined the gender appropriateness of symptomatology. In addition, adolescents who had the DSM-IV symptoms of attention- parents diagnosed with alcohol dependence, deficit/hyperactivity disorder (ADHD), oppositional depression, and drug dependence were most likely to defiant disorder (ODD), and conduct disorder (CD). In exhibit psychological problems. These findings Study 1, 100 mothers (35 of children with and 65 of underscore the importance of considering parental children without ADHD) rated how gender-typical and comorbid psychopathology when examining the problematic they saw DSM-IV symptoms of ADHD, relationship between parental alcoholism and offspring ODD, and CD; feminine descriptions of ADHD, ODD, adjustment. and CD behaviors that we created; and relationally and overtly aggressive behaviors. Mothers rated the DSM- Ohnishi T, Moriguchi Y, Matsuda H et al. The neural IV symptoms and overt aggression as boy-descriptive, network for the mirror system and mentalizing in and the feminine items that we created and relational normally developed children: an fMRI study. aggression as girl-descriptive. Mothers saw the Neuroreport 2004; 15(9):1483-7. feminine items as less problematic than the masculine Abstract: We performed fMRI measurements in normal items. In Study 2, for 80 girls (40 with and 40 without children to clarify which cortical areas are commonly ADHD), mothers' ratings on the feminine items were involved in the mirror system (MS) and mentalizing, related to the corresponding DSM-IV symptoms, and which areas are specific for mentalizing, and whether to general psychopathology and impairment. Most children have the same neural networks for MS and correlations were significant and support the construct mentalizing as adults. Normal children had the same validity of the feminine items. neural networks for the MS and mentalizing as adults. Common activations were found in the superior Ohanaka EC. Discharge against medical advice. Trop Doct temporal sulcus and the fusiform gyri, whereas 2002; 32(3):149-51. mentalizing specific activation was found in the medial Abstract: An audit of surgical patients who requested prefrontal, temporal pole and the inferior parietal discharge against medical advice over a 5 year period cortices. We suggest that mentalizing might evolve (July 1996-July 2001) at the University of from a capacity to detect the motion of agents and to BeninTeaching Hospital showed that 78 patients (66 infer intentions. Further, mentalizing might require males and 12 females) were involved.The age range self-perspectives. was 3 days to 85 years (mean 37.86 years).The 21-40 age group was the most involved.Trauma in general Ojeda SR, Heger S. New thoughts on female precocious accounted for the most common clinical condition that puberty. J Pediatr Endocrinol Metab 2001; 14(3):245- caused a patient to discharge against medical advice 56. (64 or 82%), while fracture involving the long bones Abstract: Much effort has been devoted in recent years was the most common condition (37 or 47.4%). The to unravel the neuroendocrine mechanisms responsible plausible reasons for this practice have been outlined for the initiation of mammalian puberty. The concept including measures that may help to reduce discharge that has emerged is that puberty results from the against medical advice in a developing country. unfolding of a centrally originated process involving the concerted influence of neuronal systems that utilize Ohannessian CM, Hesselbrock VM, Kramer J et al. The excitatory and inhibitory amino acids as transmitters relationship between parental alcoholism and and astroglial networks that produce growth factors adolescent psychopathology: a systematic examination able to affect LHRH secretion. We discuss the idea that of parental comorbid psychopathology. J Abnorm an isolated alteration of each of these components may Child Psychol 2004; 32(5):519-33. result in the precocious activation of pulsatile LHRH Abstract: The relationship between parental alcohol release, and thus lead to idiopathic sexual precocity. dependence (with and without comorbid According to this notion, such a premature activation of LHRH neuronal function would be neither 749
- 758. associated with structuraldamage of the prospectively (March 2000- March 2002) from neuroendocrine brain system, nor related to a consecutive patients undertaking DAMA. RESULTS: generalized activation of the neuronal-glial Prevalence rate of DAMA was 1.2%, comprising 202 mechanisms underlying the onset of puberty. On the of 16,440 discharges, of which 95 (47.0%) were contrary, localized activation of discrete cellular neonates. Neonatal jaundice, gross congenital subsets functionally connected to LHRH neurons anomalies and severe birth asphyxia among neonates, would suffice to promote an increase in LHRH release and bronchopneumonia, gastroenteritis, malaria and of sufficient magnitude and duration to initiate the malignancies among infant and older children,were the pubertal process. commonest diagnoses. Twenty (9.9%) cases were critically ill and 53(26.2%) were partially improved at Okabayashi H, Liang J, Krause N, Akiyama H, Sugisawa H. discharge. Perceived improvement of illness, Mental health among older adults in Japan: do sources preference for outpatient care, financial constraints, of social support and negative interaction make a high cost of hospital services, dissatisfaction and difference? Soc Sci Med 2004; 59(11):2259-70. disagreements with care, were the commonest reasons Abstract: This study addresses the question of whether for DAMA. CONCLUSION: DAMA is of social support and interpersonal strain from different multifactorial aetiology, involving clinically sources (i.e., spouse, children, and other relatives and heterogeneous patients who may be critically ill or friends) have differential impact on mental health. Data partially recovered. Socioeconomic, quality and cost of for this research came from a national probability health care are implicated. This study recommends sample of 2200 persons aged 60 and over in Japan. some control measures. Structural equation models were evaluated within the context of two types of social networks: (a) persons Olafson E. Attachment theory and child abuse:some who had a spouse and children (n=1299), and (b) those cautions. J Child Sex Abus 2002; 11(1):125-9. with children only (n=677). Between these two networks, the links among social support, negative Olatawura MO. Mental health care for children: the needs of relations, and mental health were contrasted. The African countries. World Psychiatry 2005; 4(3):159. effects of various sources of social support and negative interactions on mental health vary depending Olauson A. The Agrenska centre: a socioeconomic case on the specific dimension of mental health as well as study of rare diseases. Pharmacoeconomics 2002; 20 the nature of social networks. Among older Japanese Suppl 3:73-5. who are married with children, social support from Abstract: The Agrenska Centre in Gothenburg, spouse has a greater association with positive well- Sweden, provides support services to children with being than social support from children and others. disabilities and their families; these services include a However, cognitive functioning is uncorrelated with all unique programme of family activities, respite services, sources of positive and negative social exchanges. In education, information projects, and research. contrast, among those without a spouse, only greater Participants in their programmes have noted how their support from children is significantly correlated with experiences at the Agrenska Centre differed from their higher positive well-being, less distress, and less experiences with the healthcare system in other parts of cognitive impairment. Sweden. The Department of Economics at the University of Gothenburg conducted a study to Okasha A. Focus on psychiatry in Egypt. Br J Psychiatry evaluate whether the benefits of the Agrenska approach 2004; 185:266-72. might also extend to healthcare savings. There was, in fact, nearly a three-fold decrease in direct and indirect Okonkwo JE, Ibeh CC. Female sexual assault in Nigeria. Int healthcare costs for families using the Agrenska Centre J Gynaecol Obstet 2003; 83(3):325-6. versus those utilising only routine support services. The implication is that society and governments can ill Okoromah CN, Egri-Qkwaji MT. Profile of and control afford not to seek new ways to organise support measures for paediatric discharges against medical networks for patients with rare disorders. advice. Niger Postgrad Med J 2004; 11(1):21-5. Abstract: BACKGROUND: Children are minors in Olds DL, Robinson J, O'Brien R et al. Home visiting by health decision- making and discharges against medical paraprofessionals and by nurses: a randomized, advice (DAMA) may portend adverse health, social controlled trial. Pediatrics 2002; 110(3):486-96. and psychological consequences . This study was Abstract: OBJECTIVE: To examine the effectiveness aimed at ascertaining the prevalence rate and the of home visiting by paraprofessionals and by nurses as determining clinical, sociodemographic factors as well separate means of improving maternal and child health as caregivers' perceptions associated with paediatric when both types of visitors are trained in a program DAMA with the view of proferring possible control model that has demonstrated effectiveness when measures. DESIGN: Pre-tested administered delivered by nurses. METHODS: A randomized, questionnaires were used to collect relevant data controlled trial was conducted in public- and private- 750
- 759. care settings inDenver, Colorado. One thousand one CONCLUSIONS: When trained in a model program of hundred seventy-eight consecutive pregnant women prenatal and infancy home visiting, paraprofessionals with no previous live births who were eligible for produced small effects that rarely achieved statistical or Medicaid or who had no private health insurance were clinical significance; the absence of statistical invited to participate. Seven hundred thirty-five women significance for some outcomes is probably attributable were randomized to control, paraprofessional, or nurse to limited statistical power to detect small effects. conditions. Nurses completed an average of 6.5 home Nurses produced significant effects on a wide range of visits during pregnancy and 21 visits from birth to the maternal and child outcomes. children's second birthdays. Paraprofessionals completed an average of 6.3 home visits during Oleke C, Blystad A, Rekdal OB. "When the obvious brother pregnancy and 16 visits from birth to the children's is not there": political and cultural contexts of the second birthdays. The main outcomes consisted of orphan challenge in northern Uganda. Soc Sci Med changes in women's urine cotinine over the course of 2005; 61(12):2628-38. pregnancy; women's use of ancillary services during Abstract: It is estimated that two million of Uganda's pregnancy; subsequent pregnancies and births, children today are orphaned primarily due to AIDS. educational achievement, workforce participation, and While recognising the immense impact of HIV/AIDS use of welfare; mother-infant responsive interaction; on the present orphan problem, this article calls for a families' home environments; infants' emotional broader historic and cultural contextualisation to reach vulnerability in response to fear stimuli and low an understanding of the vastness of the orphan emotional vitality in response to joy and anger stimuli; challenge. The study on which the article is based was and children's language and mental development, carried out among the Langi in Lira District, northern temperament, and behavioral problems. RESULTS: Uganda, with a prime focus on the situation of orphans Paraprofessional-visited mother-child pairs in which within the extended family system. The data were the mother had low psychological resources interacted collected through ethnographic fieldwork (8 months); with one another more responsively than their control- in-depth interviews with community leaders (21), group counterparts (99.45 vs 97.54 standard score heads of households (45) and orphans (35); through points). There were no other statistically significant focus group discussions (5) with adult men and women paraprofessional effects. In contrast to their control- caring for orphans, community leaders and with group counterparts, nurse-visited smokers had greater orphans; and also through documentary review. A reductions in cotinine levels from intake to the end of survey was conducted in 402 households. The findings pregnancy (259.0 vs 12.32 ng/mL); by the study child's reveal a transition over the past 30 years from a second birthday, women visited by nurses had fewer situation dominated by 'purposeful' voluntary exchange subsequent pregnancies (29% vs 41%) and births (12% of non-orphaned children to one dominated by 'crisis vs 19%); they delayed subsequent pregnancies for fostering' of orphans. Sixty-three percent of the longer intervals; and during the second year after the households caring for orphans were found to be no birth of their first child, they worked more than women longer headed by resourceful paternal kin in a manner in the control group (6.83 vs 5.65 months). Nurse- deemed culturally appropriate by the patrilineal Langi visited mother-child pairs interacted with one another society, but rather by marginalised widows, more responsively than those in the control group grandmothers or other single women receiving little (100.31 vs 98.99 standard score points). At 6 months of support from the paternal clan. This transition is partly age, nurse-visited infants, in contrast to their control- linked to an abrupt discontinuation of the Langi 'widow group counterparts, were less likely to exhibit inheritance' (laku) practice. It is argued that the emotional vulnerability in response to fear stimuli consequential transformations in fostering practices in (16% vs 25%) and nurse-visited infants born to women northern Uganda must be historically situated through a with low psychological resources were less likely to focus on the effects of armed conflicts and uprooting of exhibit low emotional vitality in response to joy and the local pastoral and cotton-based economy, which anger stimuli (24% vs 40% and 13% vs 33%). At 21 have occurred since the late 1970s. These processes months, nurse-visited children born to women with low jointly produced dramatic economic marginalisation psychological resources were less likely to exhibit with highly disturbing consequences for orphans and language delays (7% vs 18%); and at 24 months, they their caretakers. exhibited superior mental development (90.18 vs 86.20 Mental Development Index scores) than their control- Olesen PJ, Nagy Z, Westerberg H, Klingberg T. Combined group counterparts. There were no statistically analysis of DTI and fMRI data reveals a joint significant program effects for the nurses on women's maturation of white and grey matter in a fronto-parietal use of ancillary prenatal services, educational network. Brain Res Cogn Brain Res 2003; 18(1):48-57. achievement, use of welfare, or their children's Abstract: The aim of this study was to explore whether temperament or behavior problems. For most outcomes there are networks of regions where maturation of on which either visitor produced significant effects, the white matter and changes in brain activity show similar paraprofessionals typically had effects that were about developmental trends during childhood. In a previous half the size of those produced by nurses. study, we showed that during childhood, grey matter 751
- 760. activity increases infrontal and parietal regions. We Abstract: This article examines the individual hypothesized that this would be mediated by components of bipolar disorder in children and the maturation of white matter. Twenty-three healthy behaviors that can escalate as a result of misdiagnosis children aged 8-18 years were investigated. Brain and treatment. The brain/behavior relationship in activity was measured using the blood oxygen level- bipolar disorders can be affected by genetics, dependent (BOLD) contrast with functional magnetic developmental failure, or environmental influences, resonance imaging (fMRI) during performance of a which can cause an onset of dramatic mood swings and working memory (WM) task. White matter dysfunctional behavior. School is often the site where microstructure was investigated using diffusion tensor mental health disorders are observed when comparing imaging (DTI). Based on the DTI data, we calculated behaviors with other children. Assessing the emotional, fractional anisotropy (FA), an indicator of myelination academic, and health needs of a student with a bipolar and axon thickness. Prior to scanning, WM score was disorder is a critical step in designing effective evaluated. WM score correlated independently with FA interventions and school accommodations. Without values and BOLD response in several regions. FA appropriate medical, psychological, pharmaceutical, values and BOLD response were extracted for each and academic interventions, a child is at risk for subject from the peak voxels of these regions. The FA uncontrolled mania, depression, substance abuse, or values were used as covariates in an additional BOLD suicide. The school nurse is part of the analysis to find brain regions where FA values and multidisciplinary team and plays a key role in BOLD response correlated. Conversely, the BOLD facilitating case management to potentially reverse this response values were used as covariates in an possible negative trajectory. Successful case additional FA analysis. In several cortical and sub- management provides children with bipolar disorder cortical regions, there were positive correlations the opportunity to reach their academic potential. between maturation of white matter and increased brain activity. Specifically, and consistent with our Olson SL, Ceballo R, Park C. Early problem behavior hypothesis, we found that FA values in fronto-parietal among children from low-income, mother-headed white matter correlated with BOLD response in closely families: a multiple risk perspective. J Clin Child located grey matter in the superior frontal sulcus and Adolesc Psychol 2002; 31(4):419-30. inferior parietal lobe, areas that could form a functional Abstract: Examined proximal and contextual factors network underlying working memory function. most strongly related to externalizing behavior among young children growing up in low-income, mother- Olesen T. [Chlamydia among children and adolescents]. headed families. Participants were 50 low-income Ugeskr Laeger 2005; 167(47):4482-3; author reply single mothers and their preschool-age children who 4483. were visited twice in the home setting. Measures of proximal (low levels of supportive parenting, high Olivan-Gonzalvo G. [Prevalence of hepatitis B, hepatitis C, levels of punitive disciplinary practices, low levels of HIV and latent tuberculosis infection and syphilis in a maternal emotional well-being) and contextual (low population of immigrant children at high social risk]. maternal support, high levels of family stress) risk were Enferm Infecc Microbiol Clin 2004; 22(4):250. assessed in relation to maternal reports of child externalizing behavior and an index of negative child Oliveira RG, Marcon SS. [Infantile and juvenile sexual behavior during a clean-up task. Child defiance during exploration: causes, consequences and relevant aspects the clean-up task was highly associated with punitive for health professionals]. Rev Gaucha Enferm 2005; maternal control in the same situation but had no other 26(3):345-57. direct correlates. However, multiple risk factors Abstract: This article brings a literature revision about representing both proximal and contextual variables the infantile and juvenile sexual exploration. It were associated with variations in children's behavior approaches the subject of sexual exploration in the problem scores. Mothers of children with high national context by adopting, as crossed theme, behavior problem scores reported lower feelings of different forms of violence, particularly the gender self-efficacy in handling child care and emotional kind. It presents the causes and consequences of this stressors, more frequent use of punitive child kind of violence for the individuals' health. From disciplinary practices, and lower feelings of satisfaction reports on some experiences, it points out and discusses with the quality of their supportive resources than relevant aspects of the performance of health others. Maternal self-evaluations of coping efficacy professionals when facing the problem. mediated the relation between perceived support and child behavior problems, suggesting that constructs of Oliver-Vazquez M. [The ethics of public health]. P R Health personal control are important to represent in future Sci J 2003; 22(1):21-2. studies of highly stressed parents. Olson PM, Pacheco MR. Bipolar disorder in school-age Omar HA. Child and adolescent prostitution. J Pediatr children. J Sch Nurs 2005; 21(3):152-7. Adolesc Gynecol 2002; 15(5):329-30. 752
- 761. Omer H. Helpingparents deal with children's acute Observational case report. METHODS: Retrospective disciplinary problems without escalation: the principle study in an institutional clinical practice of two of nonviolent resistance. Fam Process 2001; 40(1):53- families in whom the probands had inferior half 66. keratoconjunctivitis and additional signs of child abuse. Abstract: There are two kinds of escalation between RESULTS: Two unrelated infants presented with parents and children with acute discipline problems: (a) bilateral, asymmetrical, external eye disease affecting complementary escalation, in which parental giving-in the lower half of the cornea and conjunctiva. One eye leads to a progressive increase in the child's demands, had perforated. All eyes recovered quickly while the and (b) reciprocal escalation, in which hostility begets patients were in the hospital with no specific treatment. hostility. Extant programs for helping parents deal with There were other signs of child abuse detected by children with such problems focus mainly on one kind further studies on the patients, and in one case, the of escalation to the neglect of the other. The systematic younger sibling was the subject of severely damaging use of Gandhi's principle of "nonviolent resistance" physical abuse. CONCLUSIONS: Inflicted corneal allows for a parental attitude that counters both kinds injuries are nonspecific, and unexplained of escalation. An intervention is described, which keratoconjunctivitis, especially in the lower half of the allows parents to put this principle into practice. conjunctiva and cornea in infants should alert the clinician to the possibility child abuse, but, by itself Omigbodun OO. Psychosocial issues in a child and cannot be taken as being pathognomonic of abuse. adolescent psychiatric clinic population in Nigeria. Soc Psychiatry Psychiatr Epidemiol 2004; 39(8):667-72. Onyskiw JE. Health and use of health services of children Abstract: BACKGROUND: Psychosocial issues and exposed to violence in their families. Can J Public interventions play a very important role in the Health 2002; 93(6):416-20. aetiology, course and prognosis of several child Abstract: OBJECTIVE: To obtain baseline data on the psychiatric disorders. Psychosocial problems in a child health status and use of health services of children and adolescent psychiatric clinic population in Nigeria exposed to violence in their families. METHOD: The were documented as a preliminary step towards the study used data from the first cycle of the National planning and development of this new facility. Longitudinal Survey of Children and Youth (1994/95). METHODS: A standardised assessment procedure was According to parental reports, 8.6% of children (n = integrated into the routine at the clinic when services 1,648; representing 329,657 children) aged 2 to 11 commenced. Psychosocial stressors and life events years witnessed some violence in their families. They were measured using the interview method so that in- were compared to children who were reported to have depth information could be obtained. RESULTS: Over never witnessed any violence at home. FINDINGS: the 3-year period of study, 79 (62.2%) of the 127 new Children exposed to domestic violence had lower referrals to the clinic had significant psychosocial health status and more conditions or health problems stressors in the year preceding presentation. Problems which limited their participation in normal age-related with primary support, such as separation from parents activities than children in non-violent families. Despite to live with relatives, disruption of the family, this, they had no more contacts with family abandonment by mother, psychiatric illness in a parent practitioners in the previous year and even fewer and sexual/physical abuse, occurred in 50 (39.4%) of contacts with pediatricians than comparison children. the subjects. Problems with social environment They did, however, have more contacts with "other occurred in 11 (8.7 %), 39 (30.7 %) had educational medical doctors," public health nurses, child welfare problems, 5 (3.9%) had economic problems and 15 workers, and other therapists than comparison children. (11.8%) of the children had "other" psychosocial In addition, more child witnesses regularly used stressors. Significantly more children and adolescents prescription medication than children not exposed to with disruptive behaviour disorders and disorders like violence at home. CONCLUSION: These baseline enuresis, separation anxiety and suicidal behaviour had findings suggest that exposure to domestic violence has psychosocial stressors when compared to children with an adverse impact on children's health and use of health psychotic conditions, autistic disorder and epilepsy services. As future cycles become available, these (chi(2) = 9.6; p = 0.048). CONCLUSIONS: The children will be followed to determine the long-term importance of the psychosocial diagnostic dimension in impact on these outcomes. routine practice is illustrated in this study. Some psychosocial factors identified are cultural practices. Oona M, Kalda R, Lember M, Maaroos HI. Family doctors' The effects of these practices on child mental health involvement with families in Estonia. BMC Fam Pract require further study. 2004; 5:24. Abstract: BACKGROUND: Family doctors should Ong T, Hodgkins P, Marsh C, Taylor D. Blinding care for individuals in the context of their family. keratoconjunctivitis and child abuse. Am J Ophthalmol Family has a powerful influence on health and illness 2005; 139(1):190-1. and family interventions have been shown to improve Abstract: PURPOSE: To report an unusual, blinding health outcomes for a variety of health problems. The inflicted eye injury in young children. DESIGN: aim of the study was to investigate the Estonian family 753
- 762. doctors' (FD) attitudesto the patients' family-related Contemporary Society 2002; (44):31-50. issues in their work: to explore the degree of FDs Notes: GENERAL NOTE: KIE: 63 fn. involvement in family matters, their preparedness for GENERAL NOTE: KIE: KIE Bib: confidentiality/legal management of family-related issues and their self- aspects; patient care/minors assessment of the ability to manage different family- related problems. METHODS: A random sample (n = Opperman S, Alant E. The coping responses of the 236) of all FDs in Estonia was investigated using a adolescent siblings of children with severe disabilities. postal questionnaire. Altogether 151 FDs responded to Disabil Rehabil 2003; 25(9):441-54. the questionnaire (response rate 64%), while five of Abstract: PURPOSE: There is a paucity of literature them were excluded as they did not actually work as conducted on adolescents' perceptions of their siblings FDs. RESULTS: Of the respondents, 90% thought that with severe disabilities. The period of adolescence is in managing the health problems of patients FDs characterized by personal and emotional conflicts should communicate and cooperate with family resulting from teenagers' search towards self-identity members. Although most of the family doctors agreed and autonomy and exploration of the boundaries of that modifying of the health damaging risk factors parental support. The study attempts to describe the (smoking, alcohol and drug abuse) of their patients and coping responses of these adolescent siblings in their families is their task, one third of them felt that dealing adjustment to the family stressor of having a sibling with these problems is ineffective, or perceived with a disability; and the adolescents' available coping themselves as poorly prepared or having too little time resources. METHOD: This study is qualitative in for such activities. Of the respondents, 58% (n = 83) nature and open-ended, structured interviews were were of the opinion that they could modify also conducted with 19 adolescents between the ages of 12 relationship problems. CONCLUSIONS: Estonian and 15 years who had a sibling with severe disabilities. family doctors are favourably disposed to involvement The interviews were then analysed according to in family-related problems, however, they need some categories using an editing analysis style. RESULTS: additional training, especially in the field of The results indicated that the subjects reported limited relationship management. family interaction and were often reticent in expressing their feelings about their sibling with a disability. In Oosterlaan J, Geurts HM, Knol DL, Sergeant JA. Low basal addition, they expressed guilt feelings regarding their salivary cortisol is associated with teacher-reported siblings with disabilities. Furthermore, siblings of symptoms of conduct disorder. Psychiatry Res 2005; children with severe disabilities received limited 134(1):1-10. information and guidance regarding their sibling's Abstract: Cortisol has been implicated in disability. CONCLUSION: The need for professional psychobiological explanations of antisocial behavior. support to facilitate adolescents' coping with the This study measured basal salivary cortisol in a sample disability and its consequences as well as the of 25 children (age range 6 to 12 years) selected to vary establishment of strong support networks for these in levels of antisocial behavior. Regression analyses adolescents became evident. were used to predict cortisol concentrations from parent- and teacher-reported symptoms. Parent- Oransky I. Vincent J. Fontana. Lancet 2005; 366(9487):710. reported symptoms did not predict basal cortisol. Teacher-reported conduct disorder (CD) symptoms Orekhova EV, Stroganova TA, Posikera IN. Alpha activity explained 38% of the variance in the cortisol as an index of cortical inhibition during sustained concentrations, with high symptom severity associated internally controlled attention in infants. Clin with low cortisol. When a distinction was made Neurophysiol 2001; 112(5):740-9. between aggressive and non-aggressive CD symptoms, Abstract: OBJECTIVES: The study examined the aggressive CD symptoms were more clearly related to suggestion that infant ability to maintain attention in low cortisol than non-aggressive CD symptoms. In anticipatory task and to sustain interference is related contrast to previous research, no evidence was found to the active inhibitory processes in cortical neural for a mediating role of anxiety symptoms in the networks. METHODS: The extent of selective EEG relationship between CD and cortisol. The results synchronization in the alpha range has been taken as a support biologically based models of antisocial measure of cortical inhibition. EEG was registered in behavior in children that involve reduced autonomic 60 infants aged 8-11 months during: (1) attention to an activity. object in the visual field (externally controlled attention); (2) anticipation of the person in the peek-a- Oppenheimer M. Who lives? Who dies? The utility of Peter boo game (internally controlled attention). RESULTS: Singer. Christ Century 2002; 119(14):24-9. The infants who demonstrated longer periods of Notes: GENERAL NOTE: KIE: KIE Bib: ethicists and anticipatory attention had higher absolute spectral ethics committees amplitude in the broad frequency range under both experimental conditions. It was suggested that the Oppenheimer S. Confronting child abuse. J Halacha effect of 'overall' EEG synchronization is related to 754
- 763. some stable individual differences in Ornoy A. The impact of intrauterine exposure versus psychophysiological traits. To control for the effect of postnatal environment in neurodevelopmental toxicity: overall EEG synchronization the relation between long-term neurobehavioral studies in children at risk relative alpha amplitudes in 6.4-10 Hz range and the for developmental disorders. Toxicol Lett 2003; 140- duration of internally controlled attention was 141:171-81. analyzed. The infants with longer compared to shorter Abstract: Various investigators have shown that anticipatory attention spans had relatively higher 6.8 enriched environment may positively affect the early Hz alpha synchronization at posterior parietal sites brain development of experimental animals. under this experimental condition. CONCLUSIONS: It Environment was also shown to positively affect the was suggested that alpha synchronization over development of young children born to mothers of low posterior parietal cortex reflects an active inhibition of socio-economic class (low SES). It is unknown, certain parietal networks involved in maintaining however, to what extent can an enriched environment attention to peripheral visual field rather than merely improve the developmental outcome of children born an 'idle' state of this cortical area. Such an inhibition with slight brain damage. We studied the development appears to allow infants to avoid interference of of preschool and early school age children born to concurrent visual stimulation at the periphery of the heroin dependent parents raised at home or adopted in visual field. comparison to children suffering only from environmental deprivation (low parental SES) and to Orfali K. Parental role in medical decision-making: fact or controls. They were examined by several professionals, fiction? A comparative study of ethical dilemmas in using standard, age appropriate, neurological and French and American neonatal intensive care units. Soc psychological tests. Similar evaluations were Sci Med 2004; 58(10):2009-22. performed on a group of early school age children born Abstract: Neonatal intensive care has been studied to mothers with pregestational or with gestational from an epidemiological, ethical, medical and even diabetes and on a group of children born prematurely, sociological perspective, but little is known about the with a birth weight of less than 1500 g using various impact of parental involvement in decision-making, developmental tests. Young children born to heroin especially in critical cases. We rely here on a dependent mothers and fathers raised at home and comparative, case-based approach to study the parental children of low SES had, in comparison to controls, role in decision-making within two technologically lower intellectual skills and a higher rate of inattention. identical but culturally and institutionally different This persisted at school age, too. Children born to contexts: France and the United States. These contexts heroin dependent mothers adopted at a young age and rely on two opposed models of decision-making: hence being raised in a good environment had normal parental autonomy in the United States and medical intellectual function but a high rate of inattention and paternalism in France. This paternalism model behavioral problems. We also examined the school age excludes parents from the decision-making process. children for possible presence of ADHD and found a We investigate whether parental involvement leads to high rate of ADHD among all children born to heroin different outcomes from exclusively medically dependent parents including those adopted, as well as determined decisions or whether "technological in the children with low parental SES. Similar findings imperatives" outplay all other factors to shape a unique, regarding the strong positive influence of an enriched 'medically optimal' outcome. Using empirical data environment were observed in children born to diabetic generated from extensive ethnographic fieldwork, in- mothers, where the intellectual abilities of the children depth interviews with 60 clinicians and 71 parents and were directly related with parental education. The chart review over a year in two neonatal intensive care cognitive abilities of the children born prematurely units (one in France and one in the US), we analyze the were also strongly associated with parental education factors that can explain the observed differences in and not with the degree of perinatal complications. In decision-making in medically identical cases. Parental conclusion, in all groups of children at high risk for involvement and the legal context play a less role than developmental problems was found that the physicians' differential use of certainty versus environment has a strong influence on their intellectual uncertainty in prognosis, a conclusion that corroborates abilities but not on motor skills or attention span. A the fact that medical control over ethical dilemmas good environment (high parental SES) may remains even in the context of autonomy. French significantly improve the outcome. physicians do not ask parents permission to withdraw care (as expected in a paternalistic context); but Ornoy A, Segal J, Bar-Hamburger R, Greenbaum C. symmetrically, American neonatologists (despite the Developmental outcome of school-age children born to prevailing autonomy model) tend not to ask permission mothers with heroin dependency: importance of to continue. The study provides an analysis of the environmental factors. Dev Med Child Neurol 2001; making of "ethics", with an emphasis on how decisions 43(10):668-75. are conceptualized as ethical dilemmas. The final Abstract: Development of children aged 5 to 12 years conclusion is that the ongoing medical authority on born to mothers with heroin dependency raised at home ethics remains the key issue. or adopted was studied in comparison with: (1) 755
- 764. children with environmentaldeprivation alone (i.e. low hospital discharge, on completion of the domiciliary parental socioeconomic status [SES] and evidence of care programme and after 1 y, and in the CG at the neglect), (2) children born to fathers with heroin corresponding points in time, which were during dependency fathers, and (3) control individuals of hospitalization, at hospital discharge and after 1 y. No average SES. One hundred and sixty children (84 statistical differences were observed between the males and 76 females; average age at examination 8 groups in emotional well-being, except that mothers in years) were evaluated between 1998 and 1999. All the EDG had a lower level of situational anxiety at the were attending mainstream schools. All participants time of hospital discharge compared with CG mothers were examined by a paediatrician and a psychologist whose infants remained in hospital. One year after the using standard neurological and psychological age- birth, the EDG mothers said they had felt better appropriate tests, as well as tests and questionnaires to prepared to take responsibility for the care of their assess learning ability and attention span. The Conners babies after completion of the domiciliary care and Achenbach questionnaires and the Pollack Taper programme, in contrast to CG mothers. However, no test were used to assess possible presence of attention- statistical differences were observed in the recollection deficit-hyperactivity disorder (ADHD). Mothers were of anxiety, confidence in handling the baby and periods assessed for ADHD using Wender's questionnaire. of mental imbalance. No statistical difference was Children born to parents with heroin dependency raised observed in breastfeeding rates between the groups. at home and those of low SES exhibited intellectual Fathers in the EDG group tended to perceive their impairment both on verbal and performance skills. babies as being healthier, compared with CG fathers. They also had impaired reading and arithmetic skills. CONCLUSION: Early discharge of preterm infants Children born to mothers with heroin dependency but followed by domiciliary nursing care did not seem to who were adopted at a young age had normal have any major effect on the parents' anxiety and their intellectual and learning abilities, except for some assessment of infant health. reduced function on the performance Wechsler Intelligence Scale for Children-Revised. We found a Osman M, Kebede Y, Anberbir S. Magnitude and pattern of high rate of ADHD among all children born to parents injuries in north Gondar administrative zone, northwest with heroin dependency, including those adopted, as Ethiopia. Ethiop Med J 2003; 41(3):213-20. well as in children with low parental SES. The highest Abstract: A prospective study was carried out between rate of ADHD was in children born to mothers with April and July 2000 in North Gondar administrative heroin dependency raised at home, being twice that zone, Northwest Ethiopia, to assess the magnitude, observed in the other groups. Mothers of these groups pattern, outcome and burden of injuries. All trauma of children also had a high rate of ADHD. victims presenting to twenty health institutions were included. Of 37026 patients registered, 1982 (5.4%) Orr RD. Clinical ethics case consultation. Ethics Med 2002; presented with injury as main complaint. Trauma 18(2):33-4. constituted about 46% of surgical patients, which Notes: GENERAL NOTE: KIE: KIE Bib: treatment shows a significant burden to the institutions. Seventy refusal/minors three percent of the injured patients were males. The Abstract: Question: Should we seek a court order to use leading cause of injury was assault (48.5%) followed blood products and/or extra-corporeal membrane by fall down injury (18.6%) and road traffic injuries oxygenation (ECMO) on this critically ill child of (14.7%). Of the vehicle related injuries, 59.6% were Jehovah's Witness parents? caused by commercial vehicles. Admission was required in 15.2% of the injured patients. An average Ortenstrand A, Winbladh B, Nordstrom G, Waldenstrom U. of 4.2 hours was required for initial outpatient Early discharge of preterm infants followed by management. The average hospital stay for the domiciliary nursing care: parents' anxiety, assessment admitted patients was twelve and half days. In this and of infant health and breastfeeding. Acta Paediatr 2001; other parts of Ethiopia, injury prevention efforts should 90(10):1190-5. focus on assault, falls and transport safety with special Abstract: The aim of this study was to evaluate the attention to commercial vehicles. A community-based effect of early discharge of preterm infants, followed study is also recommended to explore the burden of by domiciliary nursing care, on the parents' anxiety, trauma on the general community. their assessment of infant health and breastfeeding. Seventy-five families including 88 preterm infants who Osterhoudt KC. A toddler with recurrent episodes of were physiologically stable but in need of further unresponsiveness. Pediatr Emerg Care 2004; special care, such as gavage feeding, were allocated to 20(3):195-7. an early discharge group (EDG) that was offered home visits (n = 40), or to a control group offered standard Overstreet K, Mannino FL, Benirschke K. The role of neonatal care (CG) (n = 35). Seventy families (37 in placental pathology in the evaluation of interpersonal the EDG and 33 in the CG) completed the study to the violence: a case of abdominal gunshot wound in a 27- 1-y follow-up. Data were collected by means of week gravid uterus. J Perinatol 2002; 22(8):675-8. questionnaires on three occasions: in the EDG, at 756
- 765. Abstract: We presenta 17-year-old G1P0 Asian mothers have serious mental health problems: American woman with a previously undiagnosed parenting as a proximal mediator. J Adolesc 2005; pregnancy who sustained an intra-abdominal gunshot 28(4):443-63. wound at 27 weeks' gestation. Within 2 hours of the Abstract: Maternal mental health (MMH) problems are traumatic event, the victim was taken emergently to the associated with lack of confidence in one's parenting, operating room for exploratory laparotomy. Findings overly lax or too harsh discipline, and child academic included a gravid uterus with two entrance wounds and underperformance. We asked if parenting mediates the two small exit wounds with active bleeding from the effect of MMH problems on academic outcomes even right broad ligament. The fetus was bradycardic but among mothers with serious mental illness (n=164). viable, having suffered a gunshot wound to the left Structural equation analyses show a significant shoulder. Evaluation of the placenta revealed no association between MMH problems and permissive sequelae from the acute event. Unexpectedly, two (lack of parenting confidence, lack of follow through) older, green, 7.0 cm retromembranous hematomas were parenting and verbal hostility as well as worse present, both ringed by hemosiderin-laden academic outcomes (school recorded grades, teacher macrophages. These hemorrhages clearly preceded the reported behaviour). Permissive parenting completely acute event. Although these findings seemed suspicious mediated the direct effect of MMH on academic for a history of prior abuse or trauma, corroborative outcomes. Further analyses showed that the mediation clinical data were unavailable at the time of initial effect was attributed to a single component of placental evaluation. However, days later, the victim permissive parenting-lack of parenting confidence. admitted to a history of interpersonal violence, with previous abuse from her boyfriend, a fatal victim of the Paavilainen E, Astedt-Kurki P, Paunonen-Ilmonen M, same attack. The old retroplacental hemorrhages Laippala P. Caring for maltreated children: a challenge proved to be the only physical documentation of her for health care education. J Adv Nurs 2002; 37(6):551- previous abuse. 7. Abstract: AIM OF THE STUDY: The aim of this study Owens PL, Hoagwood K, Horwitz SM et al. Barriers to was to establish whether paediatric nurses and doctors children's mental health services. J Am Acad Child in a university hospital need supplementary training in Adolesc Psychiatry 2002; 41(6):731-8. the identification of child physical abuse and whether Abstract: OBJECTIVE: To examine the characteristics there is a need to develop health care education on associated with barriers to children's mental health child abuse issues. BACKGROUND: Child physical services, focusing on the effect of children's abuse was defined as actions of a parent or a primary psychosocial problems on parents. METHOD: Data caregiver of a child under 18 years of age, which have come from a first-grade, prevention-intervention caused physical injuries to the child. METHODS: The project conducted in Baltimore, Maryland. Analyses sample consisted of paediatric staff (n=513) in a were restricted to 116 families who participated in university hospital. Data were collected with a seventh-grade interviews and indicated the index child questionnaire, and the response rate was 62%. The data needed services. The Services Assessment for Children were analysed using statistical methods and and Adolescents was used to measure barriers to quantitative content analysis. FINDINGS: Sixty per children's mental health services. RESULTS: More cent of respondents needed supplementary training in than 35% of parents reported a barrier to mental health the identification of child abuse. Those having services. Types of barriers included those related to experience in caring for abused children considered the structural constraints, perceptions of mental health, and identification most difficult (P < 0.001) and needed perceptions of services (20.7%, 23.3%, and 25.9%, training more often (P < 0.005) than the others. The respectively). Although parenting difficulties were need for training was explained by stating that their associated with all barriers (structural: OR = 10.63, basic education had not addressed child abuse issues, 95% CI: 2.37, 47.64; mental health: OR = 8.31, 95% and by the complexity of the issue. CONCLUSIONS: CI: 1.99, 34.79; services: OR = 5.22, 95% CI: 1.56, The findings indicate that research-based knowledge of 17.51), additional responsibilities related to attendance the identification and treatment of child abuse should at meetings was associated only with structural barriers be incorporated into health care education. (OR = 5.49, 95% CI: 1.22, 24.59). CONCLUSIONS: Supplementary education should address the Researchers and policymakers interested in increasing management of complex and sensitive issues with children's access to mental health services should customers, legislation, division of labour and consider strategies to reduce barriers related to multiprofessional collaboration in which nurses and perceptions about mental health problems and services, doctors have an important, family wellbeing promoting in addition to structural barriers. Particular attention role. should be given to programs that focus on the needs of families who are most affected by their child's Paavola L, Kunnari S, Moilanen I. Maternal responsiveness psychosocial problems. and infant intentional communication: implications for the early communicative and linguistic development. Oyserman D, Bybee D, Mowbray C, Hart-Johnson T. When Child Care Health Dev 2005; 31(6):727-35. 757
- 766. Abstract: BACKGROUND: Maternalresponsiveness connectionist model is proposed as an instantiation of has been found to have an important role in early such mechanisms. language acquisition. From early on, children can also be regarded as active participants in interaction who Paeglis C, Loftus-Hills A. Child protection: reflection on demonstrate increasing competence in conveying practice. RCM Midwives 2004; 7(6):246-7. messages to their interactive partners. Hence, in order to demonstrate consistent effects of maternal responses, Pagani L, Jyrkinen L, Niinimaki J et al. A portable it is important to take into account individual diagnostic workstation based on a Webpad: differences among children. In the present study, the implementation and evaluation. J Telemed Telecare relation between the frequencies of maternal responses 2003; 9(4):225-9. and infant intentional communicative acts as well as Abstract: A wireless hand-held Webpad device was their predictive validity to subsequent early used to review a sample set of cranial computerized communicative and linguistic skills was examined. tomography (CT) studies to assess its diagnostic METHODS: The participants were 27 Finnish- capabilities and its feasibility as a portable diagnostic speaking mothers and their healthy firstborn infants. workstation for radiology. The data-set consisted of 30 Maternal and infant interactive behaviour was analysed head CT studies of emergency cases. Two from 20-min samples of free play collected during neuroradiologists and a senior radiologist participated home visits at the infants' age of 10 months. At 12 in the evaluation of the portable workstation. They months the children were assessed for their used a Web-based viewer that we developed, which communicative and linguistic skills by using the provided all the major functionalities required for Finnish version of the MacArthur Communicative radiological image review. The reported radiological Development Inventories and the Communication and findings and diagnoses were compared with a gold Symbolic Behaviour Scales. RESULTS: The standard, comprising a set of diagnoses previously frequencies of maternal responses and infant formulated by a consensus panel of radiologists who intentional communicative acts were not had reviewed the original studies. The diagnoses made intercorrelated. As for subsequent communicative and using the Webpad were correct (no major linguistic skills, the results of regression analyses discrepancies) in 82 out of 90 interpretations (91%), indicated that both maternal responsiveness and infant which is comparable to the accuracy reported in image intentional communication predict early review with a conventional radiological workstation. comprehensive skills, whereas expressive skills--the The average total working time per diagnosis was 5 use of both verbal and gestural communicative means-- min 25 s (range 2-12 min). The simplicity of use of the are predicted only by infant intentional communication. system and its low cost make it suitable for distributing CONCLUSION: The results of the present study radiological studies within hospital facilities. suggest that maternal responsiveness during the prelinguistic stage is not necessarily dependent on Paget WJ, Meerhoff TJ, Meijer A. Epidemiological and children's communicative competence. As predictors of virological assessment of influenza activity in Europe early communicative and linguistic skills, both during the 2003-2004 season. Euro Surveill 2005; maternal responsiveness and infant intentional 10(4):107-11. communication make a distinctive contribution. Notes: CORPORATE NAME: EISS Abstract: The 2003-2004 influenza season in Europe Pacton S, Perruchet P, Fayol M, Cleeremans A. Implicit was dominated by the spread of the new drift variant learning out of the lab: the case of orthographic A/Fujian/411/2002 (H3N2)-like virus which was not regularities. J Exp Psychol Gen 2001; 130(3):401-26. perfectly matched with the A(H3N2) component of the Abstract: Children's (Grades 1 to 5) implicit learning of influenza vaccine. Sporadic cases of this virus were French orthographic regularities was investigated detected in Europe at the end of the 2002-2003 season through nonword judgment (Experiments 1 and 2) and and influenza activity associated with this virus began completion (Experiments 3a and 3b) tasks. Children relatively early during the 2003-2004 season. were increasingly sensitive to (a) the frequency of Generally, influenza activity first occurred in the west double consonants (Experiments 1, 2, and 3a), (b) the of Europe (Ireland, the United Kingdom and the fact that vowels can never be doubled (Experiment 2), Iberian Peninsula) in October/November and gradually and (c) the legal position of double consonants moved east across Europe, affecting Latvia, Lithuania (Experiments 2 and 3b). The latter effect transferred to and Poland during the months of January and February never doubled consonants but with a decrement in 2004. In general, the intensity of clinical activity was performance. Moreover, this decrement persisted higher than during the 2002-2003 season (in 13 out of without any trend toward fading, even after the massive 20 networks) and, in countries reporting age specific amounts of experience provided by years of practice. data, the highest consultation incidences were observed This result runs against the idea that transfer to novel among children aged 0-14. However, despite the material is indicative of abstract rule-based knowledge emergence of the A(H3N2) drift variant, clinical and suggests instead the action of mechanisms incidences were not especially high compared with sensitive to the statistical properties of the material. A 758
- 767. historical data. Thecomposition of the 2004-2005 videoconferencing were installed, connected by ISDN influenza vaccine has been modified compared with the lines at 128 kbit/s. Fifty-three general practitioners 2003-2004 season and includes an A/Fujian/411/2002 (GPs) were surveyed. The survey showed that the GPs (H3N2)-like virus strain and a new B virus strain (a had difficulties in using computers, but they had B/Shanghai/361/2002-like virus). definite intentions to use teleconsultation for neurology cases and 83% of the respondents stated that they Paine RW, Grossberg S, Van Gemmert AW. A quantitative would probably use the technique. During the study, 90 evaluation of the AVITEWRITE model of handwriting neurology teleconsultations took place over 55 weeks. learning. Hum Mov Sci 2004; 23(6):837-60. The average consultation rate was 1.6 teleconsultations Abstract: Much sensory-motor behavior develops per week (SD 1.3, range 0-6). The conferences lasted through imitation, as during the learning of 10-45 min. Longer teleconsultations were mainly due handwriting by children. Such complex sequential acts to technical difficulties in using computers on the part are broken down into distinct motor control synergies, of users with a low level of computer literacy. The or muscle groups, whose activities overlap in time to patients were 42 males and 46 females, with a mean generate continuous, curved movements that obey an age of 38 years (SD 20, range 1-84); two patients were inverse relation between curvature and speed. The discussed twice. The benefits consisted mainly of adaptive vector integration to endpoint handwriting advice on patient medication, diagnosis and the (AVITEWRITE) model of Grossberg and Paine (2000) prevention of unnecessary specialist consultations or [A neural model of corticocerebellar interactions laboratory examinations. Doctor-doctor during attentive imitation and predictive learning of teleconsultation allows the rapid resolution of queries sequential handwriting movements. Neural Networks, which otherwise cause stress to patients and increase 13, 999-1046] addressed how such complex the cost and complexity of care. movements may be learned through attentive imitation. The model suggested how parietal and motor cortical Paivio SC. Stability of retrospective self-reports of child mechanisms, such as difference vector encoding, abuse and neglect before and after therapy for child interact with adaptively-timed, predictive cerebellar abuse issues. Child Abuse Negl 2001; 25(8):1053-68. learning during movement imitation and predictive Abstract: OBJECTIVE: This study is a follow-up to a performance. Key psychophysical and neural data previously reported outcome study evaluating the about learning to make curved movements were efficacy of an emotionally focused therapy for adult simulated, including a decrease in writing time as survivors of childhood abuse. The present purpose was learning progresses; generation of unimodal, bell- to evaluate the stability of self-reports of child shaped velocity profiles for each movement synergy; maltreatment in the context of reduced size scaling with isochrony, and speed scaling with psychopathology after therapy. The Childhood Trauma preservation of the letter shape and the shapes of the Questionnaire (CTQ; Bernstein et al., 1994) was used velocity profiles; an inverse relation between curvature to measure the extent of child abuse and neglect. and tangential velocity; and a two-thirds power law METHOD: The CTQ and measures of relation between angular velocity and curvature. symptomatology, abuse resolution, and self-esteem However, the model learned from letter trajectories of were administered at pretreatment to 44 clients and only one subject, and only qualitative kinematic after 6 months of therapy to 33 therapy completers. comparisons were made with previously published Post-treatment interviews also assessed changes in human data. The present work describes a quantitative clients' perceptions of self and abusive and neglectful test of AVITEWRITE through direct comparison of a others. Analyses examined change on dependent corpus of human handwriting data with the model's measures, in interviews, and on the CTQ, as well as the performance when it learns by tracing the human test-retest and alpha reliabilities of CTQ factor scales, trajectories. The results show that model performance and the relationship of CTQ factor scales with was variable across the subjects, with an average pretreatment measures of distress. RESULTS: correlation between the model and human data of Analyses revealed significant reductions in 0.89+/-0.10. The present data from simulations using psychopathology on all dependent measures and the AVITEWRITE model highlight some of its reduced self-blame, negatively biased memories, strengths while focusing attention on areas, such as avoidance, and minimization of the abuse after therapy. novel shape learning in children, where all models of Reports of abuse and physical neglect on the CTQ handwriting and the learning of other complex sensory- remained stable from pre- to post-therapy. All CTQ motor skills would benefit from further research. dimensions demonstrated good internal consistency and convergent validity with trauma-specific measures Paiva T, Coelho H, Araujo MT et al. Neurological of distress. CONCLUSIONS: The stability of the CTQ teleconsultation for general practitioners. J Telemed in the context of significantly reduced psychopathology Telecare 2001; 7(3):149-54. contributes to evidence supporting the accuracy of Abstract: A neurology teleconsulting network was retrospective self-reports of childhood abuse. implemented between a university hospital in Lisbon and five nearby health centres. PCs equipped for Paivio SC, Laurent C. Empathy and emotion regulation: 759
- 768. reprocessing memories ofchildhood abuse. J Clin About 36.2% had history of abortion and 65.51 % had Psychol 2001; 57(2):213-26. living children. Abstract: This article argues that therapist empathy is both an essential context and an active intervention for Pal DK, Chaudhury G, Das T, Sengupta S. Predictors of addressing the emotion regulation problems common parental adjustment to children's epilepsy in rural India. among adult survivors of child abuse. We define Child Care Health Dev 2002; 28(4):295-300. healthy emotion regulation, the role of parental Abstract: BACKGROUND: Negative societal attitudes empathy in the development of these capacities, and towards disability affect the adjustment of parents the results of abuse and neglect as empathic failures. when their child is diagnosed with epilepsy. Recent We define therapeutic empathy and outline how it studies have suggested that parental and child functions both to modulate arousal and to increase outcomes, including adjustment, can be influenced by client awareness of emotional experience, thus non-directed social support to mothers of children with facilitating emotional processing of trauma memories. disability. The objective of our study was to test the hypothesis that maternal satisfaction with social Pakalnis A, Paolicchi J. Frequency of secondary conversion support, measured at the beginning of treatment, would symptoms in children with psychogenic nonepileptic predict parental adjustment to the child's epilepsy after seizures. Epilepsy Behav 2003; 4(6):753-6. 1 year of treatment. METHODS: We enrolled 46 Abstract: We retrospectively identified 22 patients (19 mothers of children aged 6-18 years with epilepsy in were girls) with psychogenic nonepileptic seizures the study. We measured social support using the (NES) studied with video EEG telemetry over a 24- modified Dunst family support scale, and parental month period. A history of other conversion symptoms adjustment using a locally validated instrument (S- was identified in 11 of 22 patients. Symptoms were PAM). Correlation was tested using a multiple linear frequently neurological in nature. A strong association regression model, allowing for confounding variables. with depression and history of abuse was noted in RESULTS: Parental adjustment at outcome was children with multiple conversion manifestations. positively independently correlated with satisfaction These NES patients with secondary conversion with social support at baseline,and negatively with symptoms may require more intensive psychological severity of the child's epilepsy. The regression model therapy and be at risk for long-term pathology. explained 34% of the total variance. CONCLUSIONS: Taken together with evidence from previous studies, Pal D, Raut DK, Das A. A study of HIV/STD infections this finding supports the idea that helping parents to amongst commercial sex workers in Kolkata (India). find more satisfaction within their (new or existing) Part-I: some socio-demographic features of commercial social networks will promote adjustment to their child's sex workers. J Commun Dis 2003; 35(2):90-5. disability. Abstract: A community-based survey of Human Immunodeficiency Virus (HIV) and sexually Palermo GB. Adult antisocial behavior following childhood transmitted diseases (STD) was carried out among abuse: a new protective factor? Int J Offender Ther commercial sex worker's (CSW) in different red light Comp Criminol 2004; 48(6):635-7. areas of Kolkata. By multistage random sampling technique 867 female sex workers (FSW) studied who Palermo TM, Childs G, Burgess ES, Kaugars AS, Comer D, were belonging to Sonagachi 77.28%, Metiabruz Kelleher K. Functional limitations of school-aged 14.07%, Rampurgali and Khidderpore 8.65% red light children seen in primary care. Child Care Health Dev areas. Among sex workers surveyed 58.94% were 2002; 28(5):379-89. Hindu and 33.33% Muslims. There were 22.07% CSW Abstract: OBJECTIVE: The purpose of the present of foreign origin, out of which 17.99% from study was to assess the prevalence of functional Bangladesh and 4.04% from Nepal. Majority of CSW limitations in children seen in a large paediatric 74.28% were under thirty years of age. The lowest age practice network and to identify sociodemographic, was 13 years and mean age was 26.55 years. There family and psychosocial factors related to functional were 22.26% sex workers under twenty years and limitations. STUDY DESIGN: Cross-sectional 6.92% above forty years of age. About 79.0% of sex analysis. POPULATION: Children were recruited from workers were illiterate. The average number of clients two large, practice-based primary care research visiting each sex workers was 2.67, with a range networks during their paediatric office visits. For the between 1 to 8 clients per day. The average duration present study, participants included 14 630 school-aged for which sex workers remain in the trade was 6 to 7 children (ages 6-15 years) and their caregivers. years. Around 60.09% sex workers were in the trade OUTCOMES MEASURED: Parents completed written for five years, while 2.64% were for more than twenty questionnaires including the Pediatric Symptom years. Average monthly income of sex workers was Checklist, the Family Apgar and the Functional around Rs. 500-1000. History of pregnancy was Limitations Index. RESULTS: Findings indicated that present in 84.66% with one child in 24.91 % to 15% of children surveyed had some limitation in their maximum eight in 0.23% sex workers. The mean daily functioning. More children had schoolwork and number of pregnancies was 1.9 per female sex workers. 760
- 769. physical function limitationsthan limitations in characteristics, Internet use, and attitudes towards personal and self-care. Logistic regression equations engaging in illicit behaviors over the Internet. About predicted functional limitations and health status in half of the students reported that they used the Internet children from a model of sociodemographic factors, at least several times a year, with 8% reporting daily psychosocial symptoms and family functioning. use of the Internet. Among Internet users, most CONCLUSIONS: A low but significant number of reported having Internet access either at home or at a school-age children seen in the primary care setting friends' home, and 16 % reported having Internet experience functional limitations. Children with any access from work, school, or a computer center. psychosocial symptoms were at increased risk for Among Internet users, the main purpose was for functional limitations, indicating the critical need to school-related activities (60%), followed by e-mail screen for functional impairment in children with (55%), entertainment (50%), chatting (24%), and suspected behavioural or emotional problems. A searching for pornography (6%). Although most screening tool of functional limitations may be useful students thought it was inappropriate to read someone for assessing the presence or absence of such else's e-mail, use someone else's password or credit limitations in children's daily function and warrants card information without their permission, or break further investigation. into someone's computer, many students did endorse those illicit behaviors. Over a fifth of the students Palermo TM, Valenzuela D, Stork PP. A randomized trial of reported that they knew hackers. Forty three percent of electronic versus paper pain diaries in children: impact students agreed that people make too much fuss about on compliance, accuracy, and acceptability. Pain 2004; watching videos, movies or downloading music on the 107(3):213-9. Internet without paying. Males were more likely than Abstract: Electronic diary assessment of pain and females to report using the Internet for entertainment disability has become increasingly popular in adult purposes (p = 0.006) and were more likely to agree that chronic pain research but use of this methodology with it was okay to break into someone's computer (p = children has received limited attention. The aim of this 0.04). The results of this study suggest that these study was to compare two formats of a prospective Russian college students predominately use the Internet daily diary (handheld computer=e-diary; paper to help with their schoolwork, to communicate with diary=p-diary) on children's compliance, accuracy, and others, and for entertainment. These results also acceptability ratings. Sixty children, ages 8-16 suggest that interventions may be useful to change (M=12.3) with headaches or juvenile idiopathic attitudes endorsing illicit uses of the Internet. arthritis, were randomized to receive either e-diaries administered via home visits (n=30) or p-diaries (n=30) Palmieri TL, Aoki T, Combs E et al. Saturday-morning handed out during clinic visits for return by mail. television: do sponsors promote high-risk behavior for Results demonstrated significant mean differences in burn injury? J Burn Care Rehabil 2004; 25(4):381-5; diary entries completed between groups, with children discussion 372-3. with e-diaries completing more days (M=6.6) Abstract: Television has become an important tool for compared to children with p-diaries (M=3.8), P<0.001. learning and socialization in children. Although Diaries returned by children in the p-diary group television violence has been associated with adverse contained significantly more errors and omissions effects, data on depiction of fire and burn injury are compared to diaries returned by children in the e-diary lacking. We sought to determine whether Saturday- group (which contained none), P<0.001. Children rated morning television programming, viewed primarily by both diary formats as highly acceptable and easy to children, depicts fire and burn injury as safe or without use. A significant gender x diary format interaction consequence, thus potentially increasing the incidence (P<0.01) was found for compliance where boys of burn injury in children. This was a prospective demonstrated greater compliance with the e-diary observational study. Saturday-morning children's format. Findings demonstrated that the e-diary was television programs were videotaped from 7 AM to 11 feasible to use with children and showed significantly AM for eight different television networks during a 6- greater compliance and accuracy in diary recording month period. Tapes were scored for scenes depicting compared to traditional paper diaries in a population of fire or smoke by independent observers. Recorded children with recurrent pain. items included show category, scene type, gender target, context of fire, and outcome after exposure to Palesh O, Saltzman K, Koopman C. Internet use and flame. Fire events were documented during programs attitudes towards illicit internet use behavior in a and their associated commercials. A total of 108 hours sample of Russian college students. Cyberpsychol of children's programs, 16 hours per network, were Behav 2004; 7(5):553-8. recorded. Scenes depicting fire or smoke were Abstract: This study assessed Internet use and attitudes identified 1960 times, with 39% of events occurring toward illicit use of the Internet in a sample of Russian during the program itself and 61% in commercials. Fire college students. A sample comprised of 198 students was depicted as either safe or without consequence in was recruited from a university in Moscow. Each 64% of incidents. Action adventure stories accounted participant completed a survey assessing demographic for 56% of flame depictions. Overall, one incident 761
- 770. involving flame andfire was portrayed for each 3 Abstract: A meta-analysis of the published research on minutes of television programming. Saturday-morning the effects of child sexual abuse (CSA) was undertaken television programming frequently depicts fire as safe, for 6 outcomes: posttraumatic stress disorder (PTSD), empowering, or exciting. The incidence of flame use in depression, suicide, sexual promiscuity, victim- programming varies between stations but is most perpetrator cycle, and poor academic performance. prevalent in action/adventure stories. Television Thirty-seven studies published between 1981 and 1995 commercials, although brief, provide the majority of involving 25,367 people were included. Many of the the misinformation regarding fire. Medical professional studies were published in 1994 (24; 65%), and most societies should alert the public to this potential hazard were done in the United States (22; 59%). All six and recommend responsible portrayal of fire in dependent variables were coded, and effect sizes (d) children's television programming. were computed for each outcome. Average unweighted and weighted ds for each of the respective outcome Pan RJ, Littlefield D, Valladolid SG, Tapping PJ, West DC. variables were .50 and .40 for PTSD, .63 and .44 for Building healthier communities for children and depression, .64 and .44 for suicide, .59 and .29 for families: applying asset-based community development sexual promiscuity, .41 and .16 for victim-perpetrator to community pediatrics. Pediatrics 2005; 115(4 cycle, and .24 and .19 for academic performance. A file Suppl):1185-7. drawer analysis indicated that 277 studies with null ds Abstract: Social capital is the power of social networks would be required to negate the present findings. The and relationships, which constitute the social analyses provide clear evidence confirming the link environment. Social capital has been associated with between CSA and subsequent negative short- and long- many measures of health and development. Asset- term effects on development. There were no based community development (ABCD) provides a statistically significant differences on ds when various framework to increase social capital and build stronger, potentially mediating variables such as gender, healthier communities for children. ABCD is a socioeconomic status, type of abuse, age when abused, strength-based approach to community building that relationship to perpetrator, and number of abuse emphasizes bringing together community assets incidents were assessed. The results of the present including individual community members, voluntary meta-analysis support the multifaceted model of associations, and institutions. How pediatricians can traumatization rather than a specific sexual abuse apply ABCD to child health is described. syndrome of CSA. Panchaud C, Woog V, Singh S, Darroch JE, Bankole A. Papanikolaou EG, Plachouras N, Drougia A et al. Issues in measuring HIV prevalence: the case of Comparison of misoprostol and dinoprostone for Nigeria. Afr J Reprod Health 2002; 6(3):11-29. elective induction of labour in nulliparous women at Abstract: This article reviews methodologies and data full term: a randomized prospective study. Reprod Biol sources that have been used to measure HIV Endocrinol 2004; 2:70. prevalence and sexual behaviours associated with the Abstract: BACKGROUND: The objective of this transmission of HIV in Nigeria. The review includes 35 randomized prospective study was to compare the studies on HIV prevalence and methodology and 34 efficacy of 50 mcg vaginal misoprostol and 3 mg studies on sexual behaviour published between 1990 dinoprostone, administered every nine hours for a and 2000. As at 1999, 5.1-5.4% of the general maximum of three doses, for elective induction of labor population was estimated to be infected with HIV. in a specific cohort of nulliparous women with an Trend data, although limited, indicate that HIV unfavorable cervix and more than 40 weeks of prevalence is increasing among both the general gestation. MATERIAL AND METHODS: One population and specific subgroups. Data on sexual hundred and sixty-three pregnant women with more behaviours indicate that risk behaviours are very than 285 days of gestation were recruited and analyzed. common in Nigeria while condom use remains low. The main outcome measures were time from induction Studies in local areas and on population subgroups to delivery and incidence of vaginal delivery within 12 indicate great variability in both HIV prevalence and and 24 hours. Admission rate to the neonatal intensive sexual risk behaviour. Comparability of data is limited care unit within 24 hours post delivery was a secondary as a result of differences in design and measurement outcome. RESULTS: The induction-delivery interval across studies. Also, there is a dearth of information on was significantly lower in the misoprostol group than certain groups at high risk for HIV. Despite efforts to in the dinoprostone group (11.9 h vs. 15.5 h, p < establish and improve HIV surveillance in Nigeria, this 0.001). With misoprostol, more women delivered review illustrates limitations and challenges within 12 hours (57.5% vs. 32.5%, p < 0.01) and 24 undoubtedly shared by other countries. hours (98.7% vs. 91.4%, p < 0.05), spontaneous rupture of the membranes occurred more frequently Paolucci EO, Genuis ML, Violato C. A meta-analysis of the (38.8% vs. 20.5%, p < 0.05), there was less need for published research on the effects of child sexual abuse. oxytocin augmentation (65.8% vs. 81.5%, p < 0.05) J Psychol 2001; 135(1):17-36. and fewer additional doses were required (7.5% vs. 22%, p < 0.05). Although not statistically significant, a 762
- 771. lower Caesarean section(CS) rate was observed with greater co-occurrence of different forms of misoprostol (7.5% vs. 13.3%, p > 0.05) but with the maltreatment, especially involving sexual abuse, than disadvantage of higher abnormal fetal heart rate (FHR) men. tracings (22.5% vs. 12%, p > 0.05). From the misoprostol group more neonates were admitted to the Paradise JL, Dollaghan CA, Campbell TF et al. Otitis media intensive neonatal unit, than from the dinoprostone and tympanostomy tube insertion during the first three group (13.5% vs. 4.8%, p > 0.05). One woman had an years of life: developmental outcomes at the age of unexplained stillbirth following the administration of four years. Pediatrics 2003; 112(2):265-77. one dose of dinoprostone. CONCLUSIONS: Vaginal Abstract: OBJECTIVE: In a long-term, prospective misoprostol, compared with dinoprostone in the study, we set out to determine whether otitis media in regimens used, is more effective in elective inductions the first 3 years of life persisting for periods currently of labor beyond 40 weeks of gestation. Nevertheless, considered developmentally threatening actually results this is at the expense of more abnormal FHR tracings in later impairments of children's cognitive, language, and more admissions to the neonatal unit, indicating speech, or psychosocial development; whether prompt that the faster approach is not necessarily the better insertion of tympanostomy tubes prevents or lessens approach to childbirth. any such impairments; and whether, irrespective of causality, associations exist between persistent early- Papin T, Houck T. All it takes is leadership. Child Welfare life otitis media and later developmental impairments. 2005; 84(2):299-310. This report describes findings in study participants at Abstract: The authors, as leaders in a public child the age of 4 years. METHODS: We enrolled 6350 welfare system, have teamed together and reached out healthy infants from 2 to 61 days of age at urban to their private sector partners in a large, rural county hospitals and 2 small-town/rural and 4 suburban private in western Colorado. This effort was part of a pediatric practices. We regularly evaluated the children comprehensive, communitywide effort to redesign and for the presence of middle-ear effusion (MEE) fundamentally improve the entire child welfare service throughout their first 3 years of life by pneumatic delivery system. Across the country in many areas otoscopy, supplemented by tympanometry; we where collaboration and integration have been the monitored the validity of the otoscopic observations on focus, we often hear voices in the private and public an ongoing basis; and we treated children for otitis sector declaring the importance of integration. Why, media according to specified guidelines. In the clinical then, does it not happen as a general course of action? trial component of the study, we randomly assigned The authors believe the answer lies in leadership, both 429 children who met specified minimum criteria public and private. They hold the Mesa County model regarding the persistence of MEE to undergo up as witness to that fact. tympanostomy tube insertion either promptly or after a defined extended period if MEE remained present. In Papworth S, Cartlidge P. Learning from adverse events - the the associational component of the study, we selected a role of confidential enquiries. Semin Fetal Neonatal representative sample of 241 children who ranged from Med 2005; 10(1):39-43. having no MEE to having MEE the cumulative Abstract: National confidential enquiries collect data duration of which fell just short of meeting on adverse events to identify shortfalls and improve randomization criteria for the clinical trial. In 397 future clinical care; they also highlight inadequacies in (92.5%) of the children in the clinical trial and in 234 service organisation. This article focuses on the work (97.1%) of the children in the representative sample, of the Confidential Enquiry into Maternal Deaths we assessed cognitive, language, speech, and (CEMD) and the Confidential Enquiry into Stillbirths psychosocial development at the age of 4 years, using and Deaths in Infancy (CESDI). formal tests, conversational samples, and parent questionnaires. RESULTS: In children in the Paquette D, Laporte L, Bigras M, Zoccolillo M. [Validation randomized clinical trial, there were no statistically of the French version of the CTQ and prevalence of the significant differences in mean (+/-standard deviation) history of maltreatment]. Sante Ment Que 2004; scores (higher denotes more favorable) favoring the 29(1):201-20. early-treatment group over the late-treatment group on Abstract: This study demonstrates that the five the General Cognitive Index of the McCarthy Scales of maltreatment scales in the long and short versions of Children's Abilities (97 +/- 14 and 98 +/- 14, the CTQ are valid and usable with French-speaking respectively); the Peabody Picture Vocabulary Test- populations. It also shows emotional neglect to be the Revised, a measure of receptive language (90 +/- 15 vs most common form of maltreatment in its general 92 +/- 16); the Nonword Repetition Test, a measure of population sample, and physical neglect to be the least phonological memory (66 +/- 12 vs 70 +/- 12); the common. Physical, emotional and sexual abuse Number of Different Words, a measure of word prevalences in the convenience sample roughly diversity (150 +/- 34 vs 150 +/- 31); the Mean Length correspond to the rates generally obtained in non- of Utterance in Morphemes, a measure of sentence clinical samples. Finally, women in the sample display length and grammatical complexity (3.4 +/- 0.8 vs 3.4 +/- 0.7); or the Percentage of Consonants Correct- 763
- 772. Revised, a measureof speech-sound production (92 +/- timing of puberty may provide unique information 5 vs 93 +/- 5). There were also no significant about the interactions of either environmental differences in ratings (higher denotes less favorable) on conditions or genetic susceptibility with the the Parenting Stress Index-Short Form (Total Stress hypothalamic mechanism controlling the onset of scores: 68 +/- 18 vs 65 +/- 17) or the Child Behavior sexual maturation, as shown by examples of precocious Checklist (Total Problem T scores: 50 +/- 10 vs 49 +/- puberty following exposure to endocrine disrupters or 10). In the associational component of the study, due to hypothalamic hamartoma. correlations between the children's durations of MEE and their developmental outcomes were generally weak Parfitt T. Care of learning-disabled Russian children and, in most instances, nonsignificant. Exceptions, condemned. Lancet 2003; 362(9392):1291. after adjustment for sociodemographic variables and for hearing thresholds at the time of developmental Paris JJ. Resuscitation decisions for "fetal infants". testing, consisted of a significant negative correlation Pediatrics 2005; 115(5):1415. between children's cumulative durations of MEE in their first 3 years of life and scores on the McCarthy Paris JJ, Ferranti J, Reardon F. From the Johns Hopkins Verbal subscale, and significant positive correlations Baby to Baby Miller: what have we learned from four between durations of MEE and scores on 2 measures of decades of reflection on neonatal cases? J Clin Ethics parent-child stress. The percentage of variance in these 2001; 12(3):207-14. scores explained by time with MEE beyond that Notes: GENERAL NOTE: KIE: Paris, John J; Ferranti, explained by sociodemographic variables ranged from Jeffrey; Reardon, Frank 1.6% to 3.3%. In both the randomized clinical trial and GENERAL NOTE: KIE: 42 fn. the associational component, sociodemographic GENERAL NOTE: KIE: KIE Bib: allowing to variables seemed to be the most important factors die/infants; allowing to die/legal aspects; patient influencing developmental outcomes, and in both care/minors components, the results at 4 years of age were consistent with the results that had been obtained at 3 Paris JJ, Schreiber MD, Reardon F. The "emergent years of age. CONCLUSIONS: In otherwise healthy circumstances" exception to the need for consent: the children who are younger than 3 years and have Texas Supreme Court ruling in Miller v. HCA. J persistent MEE within the duration limits that we Perinatol 2004; 24(6):337-42. studied, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at 4 Parizel PM, Ceulemans B, Laridon A, Ozsarlak O, Van years of age. In such children, persistent MEE within Goethem JW, Jorens PG. Cortical hypoxic-ischemic the duration limits that we studied is negligibly brain damage in shaken-baby (shaken impact) associated with and probably does not affect syndrome: value of diffusion-weighted MRI. Pediatr developmental outcomes at 4 years of age. Radiol 2003; 33(12):868-71. Abstract: Shaken-baby syndrome (SBS) is a type of Parent AS, Rasier G, Gerard A et al. Early onset of puberty: child abuse caused by violent shaking of an infant, with tracking genetic and environmental factors. Horm Res or without impact, and characterized by subdural 2005; 64 Suppl 2:41-7. hematomas, retinal hemorrhages, and occult bone Abstract: Under physiological conditions, factors fractures. Parenchymal brain lesions in SBS may be affecting the genetic control of hypothalamic functions missed or underestimated on CT scans, but can be are predominant in determining the individual detected at an earlier stage with diffusion-weighted variations in timing of pubertal onset. In pathological MRI (DW-MRI) as areas of restricted diffusion. We conditions, however, these variations can involve demonstrate the value of DW-MRI in a 2-month-old different genetic susceptibility and the interaction of baby boy with suspected SBS. The pattern of diffusion environmental factors. The high incidence of abnormalities indicates that the neuropathology of precocious puberty in foreign children migrating to parenchymal lesions in SBS is due to hypoxic-ischemic Belgium and the detection in their plasma of a long- brain injuries, and not to diffuse axonal injury. lasting 1,1,1-trichloro-2,2-bis(4-chlorophenyl) ethane (DDT) residue suggest the potential role of Parker MH, Forbes KL, Findlay I. Eugenics or empowered environmental endocrine disrupting chemicals in the choice? Community issues arising from prenatal early onset of puberty. This hypothesis was confirmed testing. Aust N Z J Obstet Gynaecol 2002; 42(1):10-4. by experimental data showing that temporary exposure Notes: GENERAL NOTE: KIE: KIE Bib: genetic of immature female rats to DDT in vivo results in early screening; prenatal diagnosis onset of puberty. We compared the gene expression Abstract: The prevention of inherited disabilities is profile of hypothalamic hamartoma associated or not viewed in two contrasting ways--either as enhancing with precocious puberty in order to identify gene reproductive choice and improving population health, networks responsible for both hamartoma-dependent or as discriminating against disabled community sexual precocity and the onset of normal human members. We argue that modern clinical genetics, puberty. In conclusion, pathological variations in the 764
- 773. including preimplantation geneticdiagnosis (PGD), Drinking Situations (IDS) were examined using a reflects a persistent and defensible desire by the sample of adolescents with Alcohol Use Disorders community to prevent disability, rather than as (AUDs; N = 352; mean age=16.6; 65.6% boys). increasing discrimination or threatening to produce a Relations of drinking situations to alcohol-related 'new eugenic' society Screening should be presented as outcomes 1 and 3 years following treatment also were a distinct issue for decision-making about the investigated. Consistent with the higher-order structure prevention or acceptance of disability, rather than as a of the IDS reported in adult samples, findings indicated routinely accepted component of antenatal care. The that a 3 factor solution provided the best fit to the data: community must improve its understanding of the Negative (alpha = .98), Social (alpha = .95), and experiences of those who manage disability, and Temptation (alpha = .84) Situations. With regard to continue to debate the issues of discrimination, convergent and discriminate validity, evidence selective genetic prevention and enhancement, suggested that the Negative Situations subscale was reproductive freedom, and eugenics. related more strongly to an indicator of negative emotionality than to an indicator behavioral Parkes J, Donnelly M, Dolk H, Hill N. Use of physiotherapy undercontrol. Conversely, the Social Situations and alternatives by children with cerebral palsy: a subscale was associated more strongly with an population study. Child Care Health Dev 2002; indicator of behavioral undercontrol than an indicator 28(6):469-77. of negative emotionality. Social and temptation Abstract: OBJECTIVES: To describe the use of drinking situations were associated with alcohol-related physiotherapy services and alternative therapies by a outcomes 1 year following treatment, but this was population of children with moderate to severe cerebral generally not the case 3 years following treatment. palsy (CP). DESIGN: Descriptive cross-sectional These results indicate that the IDS is a reliable and survey. SUBJECTS: A total of 212 parents of children valid measure for use with adolescents receiving aged 4-14 years with moderate to severe CP were treatment for alcohol-related problems. identified from the Northern Ireland Cerebral Palsy Register (NICPR) and a random subsample of their Parra GR, O'Neill SE, Sher KJ. Reliability of self-reported paediatric physiotherapists. MAIN MEASURES: A age of substance involvement onset. Psychol Addict standardized description of motor impairment or Behav 2003; 17(3):211-8. assessment form; a postal questionnaire to parents and Abstract: The authors investigated the reliability of paediatric physiotherapists (to validate parents' reports self-reported age of onset (AO) for alcohol, tobacco of service use). RESPONSE RATES: In total, 85% of (cigarette), and illicit drug involvement. Participants parent questionnaires were returned and 100% of were 410 young adults taking part in an 11-year paediatric physiotherapists responded. RESULTS: longitudinal study. A moderate degree of reliability Service use among families was high; on average the was found for the 3 substances. Despite this level of families had contact with approximately seven services stability, results illustrate a tendency for reported AOs in a 6-month time interval. The overwhelming majority to increase over time. The trend is more salient for of children (96%) received physiotherapy during the participants who reported younger AOs at the initial school term and most (59%) received treatment at least assessment. Findings also indicate that, for alcohol and twice a week for 30 min; 43% of children had their tobacco, more individuals were classified as early onset physiotherapy discontinued over the summer holidays. based on Year 1 compared with Year 11 reports. Over one-quarter (28%) of families had opted out of Despite these systematic changes, at least for alcohol the NHS and bought alternatives like conductive and illicit drugs, age at which onset was assessed did education (21%) or private forms of conventional not moderate the association between AO and physiotherapy (16%). Children with more severe forms substance-related outcomes. of CP, in special education, particularly at schools for physical disability, were high-intensity users of the Pascalis O, de Haan M, Nelson CA. Is face processing physiotherapy service. Despite this, 74% of parents species-specific during the first year of life? Science wanted more physiotherapy for their child. 2002; 296(5571):1321-3. CONCLUSIONS AND IMPLICATIONS: The demand Abstract: Between 6 and 10 months of age, the infant's for physiotherapy services is likely to continue given ability to discriminate among native speech sounds the relatively stable prevalence rate of CP, the improves, whereas the same ability to discriminate proportion of children with disabling CP and the level among foreign speech sounds decreases. Our study of parent interest in the service. A number of quality aimed to determine whether this perceptual narrowing aspects and gaps in the service have been identified. is unique to language or might also apply to face processing. We tested discrimination of human and Parra GR, Martin CS, Clark DB. The drinking situations of monkey faces by 6-month-olds, 9-month-olds, and adolescents treated for alcohol use disorders: a adults, using the visual paired-comparison procedure. psychometric and alcohol-related outcomes Only the youngest group showed discrimination investigation. Addict Behav 2005; 30(9):1725-36. between individuals of both species; older infants and Abstract: Psychometric properties of the Inventory of adults only showed evidence of discrimination of their 765
- 774. own species. Theseresults suggest that the "perceptual they were. From the letters of referral, 37% contained a narrowing" phenomenon may represent a more general reason for GA and 63% did not give any reason or change in neural networks involved in early cognition. justification for GA. CONCLUSION: There is evidence that referring practitioners do not adequately Pascual-Castroviejo I, Pascual Pascual SI, Ruza-Tarrio F, explain the risks of the anaesthetic to parents or Viano J, Garcia-Segura JM. [Battered baby syndrome. guardians of children undergoing GA. There is also a Report of a case with severe sequelae]. Rev Neurol lack of clear justification in the letters of referral for 2001; 32(6):532-5. providing GA. PRACTICE IMPLICATION: It is Abstract: OBJECTIVE. To present a case with shaken- essential that the alternatives and the risks of GA are baby syndrome after having seizures and respiratory discussed and if GA is still required, a clear problems. CLINICAL CASE. A previously normal justification should be contained in the letter of referral child of 7 months of age presented an acute picture of as part of informed consent. More importantly the status epilepticus with respiratory problems and referring practitioner should keep a contemporaneous periods of apnea. He was studied with record of this, preferably with a signature from the electroencephalography, computerized tomography, parent or guardian on agreement of referral. magnetic resonance (MR) imaging and spectroscopic- MR. The child showed the presence of small subdural Paterson J, Tukuitonga C, Butler S, Williams M. Infant bed- and epidural hematomas in both frontal regions 24 sharing among Pacific families in New Zealand. N Z hours after the onset of the problem. The follow-up Med J 2002; 115(1154):241-3. with MR studies revealed voluminous subdural Abstract: AIM: To describe infant bed-sharing among bilateral hygroma that increased the size along the Pacific families in New Zealand. METHODS: The data following six months, despite treatment with bilateral were gathered as part of the Pacific Island Families: subdural-peritoneal shunt, and the patient showed First Two Years of Life (PIF) Study in which 1376 infantile spasms. At 8 years of age, the patient shows mothers were interviewed when their infants were six- severe mental retardation with autistic behavior and weeks-old. Maternal reports of infant bed-sharing blindness, though he is able to walk without help and practices were assessed by questions about infant sleep he has not seizures. The subdural hygroma decreased location and the number of people who usually shared the size, but MR shows severe cortico-subcortical a mattress with the infant. RESULTS: Over half of the atrophy of both parieto-occipital regions. Spectroscopic mothers (54.9%) reported that their infants shared a MR study discloses severe neuronal lost and gliosis. mattress with other people, 44.2% sharing with one CONCLUSIONS. The shaken-baby syndrome causes other person, the remainder sharing with two or more severe encephalopathy and vision problems, blindness people. Of the bed-sharing infants, 4.7% slept on a in many cases, after showing voluminous subdural mattress on top of the bed, and 4.7% only slept part of and/or epidural hematomas which lead to a severe the night in the shared bed. CONCLUSIONS: Together neuronal lost and gliosis. Shaken-baby syndrome is not with effective information delivery, the educational and always associated with skull fracture nor is necessarily housing issues that many Pacific families in New related with battered-child syndrome. Zealand face need to be addressed so that parents can make informed decisions about infant care practices. Patel AM. Appropriate consent and referral for general anaesthesia - a survey in the Paediatric Day Care Unit, Patric D. Safeguarding children through police checks: a Barnsley DGH NHS Trust, South Yorkshire. Br Dent J discussion. Paediatr Nurs 2004; 16(9):36-8. 2004; 196(5):275-7; discussion 271. Notes: GENERAL NOTE: KIE: 7 refs. Patten P. Medicolegal diary: standards of conduct. N Z Med GENERAL NOTE: KIE: KIE Bib: informed J 2001; 114(1125):50-1. consent/minors Abstract: BACKGROUND: In November 1998 the Patterson GR, DeGarmo D, Forgatch MS. Systematic General Dental Council introduced guidelines for changes in families following prevention trials. J dental practitioners when referring a patient for general Abnorm Child Psychol 2004; 32(6):621-33. anaesthesia (GA). The practitioner is required to Abstract: A selective prevention design was applied to explain the risks associated with GA and the 238 recently separated families. Of these, 153 mothers alternatives, give a detailed medical history and a clear randomly assigned to the experimental (E) group justification for providing GA in the letter of referral. participated in 14 group sessions focused on Parent METHOD: A survey was administered on 202 parents Management Treatment (PMT). Prior analyses showed or guardians, which aimed to investigate whether they that, over time, the group of families in the untreated felt that their dental practitioners had advised them of group deteriorated in both parenting practices and in any risks of GA prior to referral. A record was also child outcomes. In keeping with the classic prevention made if any reasons were given for the provision of pattern, families in the E group showed modest GA in the letter of referral. RESULTS: The majority of improvements in parenting and in child outcomes. the parents or guardians (66%) felt that they were not Improvements in parenting were associated with informed of any of the risks of GA and 25% felt that 766
- 775. significant reductions inproblem behavior. The data developing positive emotionality. There were showed that those mothers who improved their indications of a stronger association between the parenting skills during the first 12 months also showed maternal characteristics and developing significant reductions in maternal depression during withdrawal/fear in irritable infants. that same interval. A cross-lagged panel analysis showed that a reduction in maternal depression during Payne CA. The evolution of community involvement in the first year of the study was a significant predictor of public health community-based efforts: a case study. J maintenance or improvements over the next 18 months. Health Soc Policy 2001; 14(2):55-70. The findings are consistent with the concept of the Abstract: It is the opinion of many practitioners and family as a system. analysts of public health efforts that community involvement is necessary to improve local health Paul B, Bryant JA. Adolescents and the internet. Adolesc status. The nature of community involvement, Med Clin 2005; 16(2):413-26, x. however, can vary among projects, among sites in the Abstract: The interactive, multimedia nature of the same project and through time in the same site. Clear Internet makes it a potentially invaluable resource for conceptions of community involvement assist in adolescents. These same characteristics also mean that foreseeing the potential activities, outcomes and the Internet could be a potentially hazardous medium challenges of any particular community-based effort. for certain members of this age group. Although the Himmelman's concepts of community betterment and Internet allows adolescents access to an unprecedented community empowerment offer a useful framework amount of content in an endless number of areas, it also when community-involvement entails the direct allows them access to content that many parents and participation of local organizations and constituencies. caregivers find particularly objectionable. This article These two concepts are the ends of a continuum addresses several primary benefits and potential whereby in the movement from a community hazards associated with adolescent Internet use. It betterment to a community empowerment effort, there describes general trends in adolescent Internet use and is an increase in community ownership and self- considers how the medium allows individuals to extend determination over all aspects of a project. This paper their social networks and create new ones. Several presents an empirical investigation of one community- ideas for maximizing the potential benefits and based public health effort which instances a movement minimizing any potential harms are presented. from community betterment to community empowerment. Pauli-Pott U, Mertesacker B, Beckmann D. Predicting the development of infant emotionality from maternal Paz I, Jones D, Byrne G. Child maltreatment, child characteristics. Dev Psychopathol 2004; 16(1):19-42. protection and mental health. Curr Opin Psychiatry Abstract: Few studies have examined the associations 2005; 18(4):411-21. between environmental conditions and developing Abstract: PURPOSE OF REVIEW: This review infant emotionality or the differential susceptibility to summarizes advances in our understanding of child those conditions. The present longitudinal study aims maltreatment and the implications thereof for physical, to make a contribution to close that gap. We analyzed psychological and social development, with special whether positive emotionality, negative emphasis on mental health aspects. RECENT emotionality/irritability, and withdrawal/fear at the end FINDINGS: Methodological problems persist. These of the first year of life are predictable from preceding may be related in part to an over-emphasis on type of caregiver's depression/anxiety, social support, and maltreatment, to the detriment of consideration of sensitivity in the interaction with the infant while degree and extent of maltreatment. They may also be controlling for antecedent states of emotionality. related to inadequate application of a comprehensive Furthermore, the question of whether associations model of maltreatment and its consequences. Recent between maternal characteristics and subsequent fear studies underline the inter-relatedness and cross-over are stronger in the subgroup of infants high in between different types of child maltreatment and irritability as opposed to those who are low in family violence. Research also underlines the extent to irritability was investigated. Subjects were 101 healthy which child maltreatment is a major public health crisis firstborn infants and their primary caregivers. internationally. Effects are seen on physical health and Assessments were conducted at infant ages of 4, 8, and development as well as mental health, and it is 12 months. Depression, anxiety, and the social support becoming increasingly evident that these outcomes are of the caregiver were assessed by questionnaire. inextricably linked to one another. There are Sensitivity in the caregiver-infant interaction was encouraging signs that certain interventions are assessed by behavior observations within the scope of effective. SUMMARY: There is a need for a more home visits. Temperament characteristics were sophisticated model of child maltreatment that includes observed in standardized laboratory episodes. Whereas not only degree but also the extent to which basic negative emotionality and withdrawal/fear were developmental needs are overridden when children are significantly predictable from the maternal maltreated, and that includes children's responses to characteristics, no predictability could be shown for maltreatment as a mediating influence. More studies 767
- 776. are needed ofsamples of children who have been intelligence, and executive function. There were no maltreated in order to gain a better understanding of significant associations between length of time in foster how maltreatment distorts the trajectory of normal care, number of transitions, and emotion understanding development. Crucially, we need more research on and theory of mind. Results help to expand knowledge intervention, including both case management and about the cognitive and affective deficits of children in psychological treatment approaches. foster care and suggest that interventions targeted at these deficits include an emphasis on emotion Pearn J. Bioethical issues in caring for conjoined twins and understanding and theory of mind. their parents. Lancet 2001; 357(9272):1968-71. Notes: GENERAL NOTE: KIE: Pearn, John Pedersen W, Hegna K. Children and adolescents who sell GENERAL NOTE: KIE: 30 refs. sex: a community study. Soc Sci Med 2003; 56(1):135- GENERAL NOTE: KIE: KIE Bib: patient care/minors 47. Abstract: Adolescents who reported to have given Pearn J, Gardner-Thorpe C. James Parkinson (1755-1824): a sexual favors for payment were investigated. The pioneer of child care. J Paediatr Child Health 2001; sample consisted of all adolescents in the public and 37(1):9-13. private school systems in Oslo, the capital in Norway Abstract: James Parkinson (1755-1824) of Parkinson's (age group 14-17, response rate 94.3%, disease, is well recognized as a pioneer of clinical N=10,828).Adolescents who had sold sex form 1.4%, neurology; and is even more famous as a founder of three times as many boys as girls. Half the group had modern palaeontology. We have reviewed from done it more than 10 times. Most were under the legal primary sources his extensive contributions to clinical age of sex in Norway (16 years) when this first child care and his pioneering advocacy for child happened. We found no associations with welfare, protection and safety. His writings, outreach sociodemographic variables or residential area in Oslo. and advocacy for children's health characterizes him as However, sex sale was associated with low intercourse one whose influence was an important springboard debut age, conduct problems, alcohol problems, use of from which evolved the modern specialty of drugs (including heroin) and violent victimization.The paediatrics. Parkinson was one of the first to write on conclusion is that a small group in the general child-rearing practices and in this context antedated adolescent population sells sex, and many of the clients Benjamin Spock by 150 years. Parkinson was a pioneer are assumed to be homosexual or bisexual men. of child safety and the prevention of childhood trauma. Adolescents who take part in these activities are often He wrote of the resuscitation of near-drowned children heavily involved in delinquent behaviors and use of and of first aid for injured children. This critical drugs, and many probably are in a risk zone for analysis reviews his pioneering description of child sexually transmitted diseases (including HIV), drug abuse and the development of post-abuse abuse and a delinquent and criminal development. hydrocephalus. He wrote the datum description (in English) of the pathophysiology and pathology of Pedersen W, Mastekaasa A, Wichstrom L. Conduct appendicitis in children, of fatal rabies in children and problems and early cannabis initiation: a longitudinal highlighted the risk of death even when the biting dog study of gender differences. Addiction 2001; was not clinically rabid. His advocacy for social reform 96(3):415-31. for children's welfare was courageous and pioneering. Abstract: AIM. To investigate the relationship between James Parkinson, hitherto unacknowledged, was a early conduct problems and early onset of cannabis significant founder of the evolving discipline of use, with special emphasis on possible gender paediatrics and child health. differences. DESIGN. A prospective longitudinal study of a national sample of 2436 adolescents. The sample Pears KC, Fisher PA. Emotion understanding and theory of was followed up over a year and a half, when the mind among maltreated children in foster care: adolescents were in their early teens. SETTING. evidence of deficits. Dev Psychopathol 2005; 17(1):47- Norway. MEASUREMENTS. On the basis of an 65. earlier study, conduct problems (CP) closely related to Abstract: Children in foster care are at heightened risk the criteria for conduct disorder (CD) in DSM-III-R for poor psychosocial outcomes. This study examined were decomposed into three dimensions, labelled differences in two areas that may be associated with serious, aggressive and covert. Further, information many of these outcomes, emotion understanding and was collected about alcohol intoxication, daily smoking theory of mind, using a sample of 3- to 5-year-old and use of cannabis. A number of questions were posed maltreated foster children (n = 60) and a comparison about sexual interactions and perceived puberty group of same-aged, low-income, nonmaltreated development. Parental socio-economic status was children living with their biological families (n = 31). measured according to the ISCO-88. Separate Being in foster care was significantly associated with information was collected as to whether the parents worse emotion understanding and theory of mind were on social welfare or unemployed. A parental capabilities, even when accounting for age, bonding measure (PBI) was used to measure the emotional relationship between respondents and 768
- 777. parents. Further, ameasure of parental monitoring was half of the plans had restrictions on the number of used, and information was also collected on other outpatient visits, with limits ranging from 12 to 60 aspects of the family milieu, and on the adolescents' clinic visits a year. More than half of the plans had peers. Statistical models. Logistic regression analysis limitations on the number of inpatient days, ranging was employed. As the sample consisted of pupils from 20 to 60 days a year. Diagnoses excluded from clustered within classes within schools, a three-level coverage included autism, mental retardation, problems error structure for the logistic regression model was related to child abuse, and impulse control disorders, estimated. FINDINGS. There was a strong association such as kleptomania and pyromania. Half of the between early conduct problems and subsequent services excluded could be categorized as either social cannabis initiation. Also conduct problems at a and human services or complementary medicine rather potential subclinical level seemed to have great impact. than as mental health care. CONCLUSIONS: Plans The effect was significantly stronger in girls than in commonly had service and diagnostic exclusions that boys. Serious CP was found to have a moderate effect could disrupt children's health care. The results of the upon cannabis initiation in boys, whereas aggressive study emphasize a need to address the types of and covert CP had strong effects in girls. Early onset of treatment covered by mental health insurance. puberty and early sexual involvement had no impact, whereas early use of cigarettes proved an important Peeters F, Wessel I, Merckelbach H, Boon-Vermeeren M. precursor to cannabis use. CONCLUSIONS. Conduct Autobiographical memory specificity and the course of problems are important precursors of early onset major depressive disorder. Compr Psychiatry 2002; cannabis use, but probably represent gender-specific 43(5):344-50. aetiologies. There might be an important potential for Abstract: This study examined the stability of prevention of early onset drug use in the prevention of autobiographical memory dysfunction (i.e., difficulties early conduct problems, in particular for girls. in retrieving specific memories) during the course of major depressive disorder, its relation to early adverse Pedersen W, Samuelsen SO. [New patterns of sexual experiences, and its influence on the course of behaviour among adolescents]. Tidsskr Nor Laegeforen depressive disorder. Using the Autobiographical 2003; 123(21):3006-9. Memory Test (AMT), specificity of autobiographical Abstract: BACKGROUND: We wanted to investigate memory was assessed in 25 subjects with a current erotic and sexual behaviour in adolescents, with depressive disorder at baseline, and at 3 and 7 months emphasis on the trend over the last decade. follow-up. Also, information about self-reported MATERIALS AND METHODS: Two large, survey- childhood traumatization, and demographic and based representative studies of Norwegian adolescents clinical variables was obtained. Autobiographical (each with approx. 11 000 respondents) from 1992 and memory performance was relatively stable over time 2002 (response rates 97% and 92%). FINDINGS: despite clinical improvement in the sample. It was not Median age at first intercourse has decreased by 12 related to depression severity at baseline, while higher months in females over this ten-year time span (to 16.7 levels of childhood traumatization were correlated with years), while the decrease among males was more more specific memory performance to negative cue modest. Furthermore, oral sex now has the same words at baseline, but not during follow-up. Specific prevalence as coitus from the mid-teen years on and autobiographical responses to negative cue words seems to be introduced at the same point in time. predicted a better prognosis, whereas specific Finally, females are as inclined as males to break the responses to positive cue words were not related to norm of being in love as the basis for a sexual prognosis. Autobiographical memory dysfunction in relationship. INTERPRETATION: More adolescents depression appears to be stable over time, is related to are now sexually active and more risky sexual short-term prognosis in depression, and may act as a behaviour might be a consequence. However, the vulnerability factor that influences the long-term findings also suggest increased gender equality and a course of depressive disorders. new cohort of more sexually active and self-confident females. Pelias MK, Markward NJ. Newborn screening, informed consent, and future use of archived tissue samples. Peele PB, Lave JR, Kelleher KJ. Exclusions and limitations Genet Test 2001; 5(3):179-85. in children's behavioral health care coverage. Psychiatr Notes: GENERAL NOTE: KIE: 25 refs. Serv 2002; 53(5):591-4. GENERAL NOTE: KIE: KIE Bib: genetic research; Abstract: OBJECTIVE: The objective of this study was genetic screening; human experimentation/informed to identify benefit limits, diagnostic exclusions, and consent service exclusions of private behavioral health care Abstract: Recent advances in genetic technologies have plans that can influence the delivery of care to children. combined with established protocols for genetic METHODS: A total of 128 commercial, employment- screening to provide immense benefits to individuals based behavioral health plans were examined for types and the public. In most American jurisdictions, of benefit limits, service exclusions, and diagnostic newborn screening is mandated by law and does not exclusions applicable to children. RESULTS: Almost require parental consent for the collection or testing of 769
- 778. the blood samples.Screening programs have been reuptake inhibitors are limited in number, evidence successful in identifying affected infants at an early supports their use as first-line antidepressant stage for effective treatment of some genetic diseases. medication in youth depression. Available evidence The public health benefit of screening programs is suggests that various treatment modalities are useful in recognized and affirmed. However, collections of the treatment of suicidal youths, e.g. cognitive surplus, stored samples have become immensely behavioral therapy and specialized emergency room attractive to researchers in medical genetics and the interventions. Much of the decrease in suicide ideation biomedical sciences. As geneticists have sought access and suicide attempts seems to be attributable to to the newborn screening samples, they have nonspecific elements in treatment. For high-risk youth, recognized concerns related to whether they should use providing continuity of care is a challenge, since they the samples, and, if so, under what conditions. This are often noncompliant and commonly drop out or paper addresses the ethical issues associated with terminate their treatment prematurely. Developing genetic screening and recommends an informed efficacious treatments for suicidal children and consent protocol that may be used to balance individual adolescents would offer better possibilities to prevent and parental rights with the interests of researchers suicides. who wish to use surplus samples in studies of genetic disease. Pellai A, Castelli B, Scyslowska G et al. [Child sexual abuse primary prevention: outcome evaluation of a health Pelkonen M, Marttunen M. Child and adolescent suicide: education project implemented in Milan's elementary epidemiology, risk factors, and approaches to schools]. Ann Ig 2003; 15(5):529-39. prevention. Paediatr Drugs 2003; 5(4):243-65. Abstract: The study we present is aimed at evaluating Abstract: Suicide is rare in childhood and early the efficacy of a child sexual abuse prevention program adolescence, and becomes more frequent with that involved children attending 4th and 5th grade in increasing age. The latest mean worldwide annual rates Milan's (Italy) elementary schools. The project of suicide per 100 000 were 0.5 for females and 0.9 for involved 53 classes (10 of 4th, 43 of 5th grade) during males among 5-14-year-olds, and 12.0 for females and school year 2000-2001. Children filled a questionnaire 14.2 for males among 15-24-year-olds, respectively. In before the beginning of the project and two months most countries, males outnumber females in youth after the end; the questionnaire evaluates children's suicide statistics. Although the rates vary between perception of risk and their self-efficacy skills in countries, suicide is one of the commonest causes of adopting protective strategies when involved in at risk death among young people. Due to the growing risk for situations. Final analysis has involved 674 children, suicide with increasing age, adolescents are the main 51.8% girls, 48.2% boys; 19.6% of children attended target of suicide prevention. Reportedly, less than half 4th grade, 80.4% 5th grade. Percentage of children that of young people who have committed suicide had recognize the potential danger in the suggested at-risk received psychiatric care, and thus broad prevention situation is higher in post-test then in pre-test (87.9% strategies are needed in healthcare and social services. vs 73.2%) and the number of them that does not adopt Primary care clinicians are key professionals in any self-defence strategy decreases (from 35.3% to recognizing youth at risk for suicide. This article 21.0%). The project increased the number of children reviews recent population-based psychological autopsy that know body puberal changes (from 16.0% to studies of youth suicides and selected follow-up studies 32.8%). According to these results it is evident that the of clinical populations and suicide attempters, program increased children's capacity to recognize and analyzing risk factors for youth suicides. As youth use self defence strategies in at risk situations. These suicides are rare, research on risk factors for youth results call for a potential extention and replication of suicidal ideation and attempted suicide is also briefly this health education program. reviewed. The relationship between psychiatric disorders and adolescent suicide is now well Pennington DJ, Lonergan GJ, Mendelson KL. How well do established. Mood disorders, substance abuse and prior we prepare pediatric radiologists regarding child suicide attempts are strongly related with youth abuse? Results of a survey of recently trained fellows. suicides. Factors related to family adversity, social Pediatr Radiol 2004; 34(1):59-65. alienation and precipitating problems also contribute to Abstract: BACKGROUND: Pediatric radiologists the risk of suicide. The main target of effective serve an important role in the radiologic diagnosis, prevention of youth suicide is to reduce suicide risk investigation, and in legal proceedings in cases of child factors. Recognition and effective treatment of abuse. The Society for Pediatric Radiology should psychiatric disorders, e.g. depression, are essential in evaluate and insure the adequacy of training of preventing child and adolescent suicides. Research on pediatric radiologists for this important role. the treatment of diagnosed depressive disorders and of OBJECTIVE: The Society for Pediatric Radiology those with suicidal behavior is reviewed. In the Committee on Child Abuse, 2002, conducted a 24- treatment of youth depression, psychosocial treatments question survey to evaluate the scope and perceived have proved to be useful and efficacious. Although adequacy of training received by pediatric radiology studies on the effectiveness of selective serotonin fellows regarding the radiologic diagnosis of child 770
- 779. abuse and theassociated legal process. MATERIALS identified an acute opiate intoxication. The child also AND METHODS: Eighty-four surveys were mailed to developed chest wall rigidity, a rare complication of radiologists who had completed a year in pediatric narcotic use. We discuss the emergency department radiology fellowship training during the years 1999 and management, as well as the toxicologic and child 2000. There were 33 surveys returned for an overall protection investigations. response of 39%. RESULTS: Respondents' perception of adequacy of training was best for the radiologic Perez-Albeniz A, de Paul J. Dispositional empathy in high- diagnosis of child abuse. The majority perceived they and low-risk parents for child physical abuse. Child were not well trained in the investigative and legal Abuse Negl 2003; 27(7):769-80. processes regarding child abuse. The majority would Abstract: OBJECTIVE: The present study was welcome standardized training. CONCLUSION: designed to investigate dispositional empathy in high- Current pediatric radiology training programs do not risk parents for child physical abuse, using self-report sufficiently prepare pediatric radiologists for their role instruments. More specifically, the objective was to in the legal system regarding child abuse. A know if high-risk parents for child physical abuse, in standardized program to train pediatric radiologists comparison with low-risk parents, show deficits on about the imaging diagnosis of child abuse and their main dimensions of dispositional empathy: empathic role in the legal system is recommended. concern, role-taking, and personal distress. METHOD: Based on their scores on the Abuse Scale of the CAP Penson RT, Amrein PC. Faith and freedom: leukemia in Inventory (Milner, 1986), 36 high-risk and 38 low-risk Jehovah Witness minors. Onkologie 2004; 27(2):126-8. for child physical abuse participants were selected from a total sample of 440 Basque Country (Spain) general Perera H, Rodrigo GD. Met and unmet needs of children population parents. Both groups were statistically with epilepsy in a paediatric tertiary care setting. matched on sociodemographic variables. The Ceylon Med J 2004; 49(1):11-4. Interpersonal Reactivity Index (IRI, Davis, 1980), the Abstract: OBJECTIVE: To investigate the extent to Hogan Empathy Scale (HES, Hogan, 1969) and the which the health needs were met or unmet in children Questionnaire Measure of Emotional Empathy with epilepsy attending a tertiary care outpatient (QMEE, Mehrabian & Epstein, 1972) were used to setting. PATIENTS AND METHOD: A semi- assess dispositional empathy. RESULTS: As expected, structured interview was used to collect relevant high-risk, relative to low-risk, parents showed lower information from the parents. It focused on total scores on the HES and QMEE measures and ascertaining the quality of health care received by the lower scores on the IRI "Empathic concern" dimension. children, including the extent to which attention was Moreover, high-risk, relative to low-risk, parents given to epilepsy related physical, behavioural, social showed higher scores on the IRI "Personal distress" and educational impairments that were identified by the dimension. No differences between groups were parents. RESULTS: There was satisfactory seizure observed for the IRI "Perspective-taking" dimension. control in the majority. Most children received only CONCLUSIONS: Findings of the present study one anticonvulsant and side-effects were reported to be supported the hypothesis that high-risk parents for minimal. A large majority had behavioural problems, child physical abuse show a deficit in dispositional and social and educational difficulties to a lesser empathy. High-risk parents reported less feelings of extent. Parents were concerned about the implications warmth, compassion and concern for others and more of these problems, but there was little communication feelings of anxiety and discomfort that result from about them in the doctor-patient contact. Even where observing another's negative experience. the problems were communicated, parent satisfaction about the interventions was low. Parents identified the Perez-Albeniz A, de Paul J. Gender differences in empathy availability of more consultation time and provision of in parents at high- and low-risk of child physical abuse. more information on epilepsy as their expectations Child Abuse Negl 2004; 28(3):289-300. from doctors. CONCLUSIONS: This study shows that Abstract: OBJECTIVES: The present research was awareness and communication about the multiple designed to study empathy in high-risk parents for health problems of children with epilepsy are necessary child physical abuse. The main objective was to study to improve the quality of health care given to them. if high-risk mothers and fathers, compared to low-risk mothers and fathers, presented more Personal distress, Perez A, Scribano PV, Perry H. An intentional opiate less Perspective-taking, less Empathic concern and a intoxication of an infant: when medical toxicology and deficit in dispositional empathy toward their partner child maltreatment services merge. Pediatr Emerg Care and children. METHOD: Based on their scores on the 2004; 20(11):769-72. Abuse Scale of the CAP Inventory [J.S. Milner, The Abstract: We present an instructive case of a 5-week- Child Abuse Potential Inventory: Manual, 2nd ed., old infant seen in the emergency department with acute Psytec Corporation, Webster, NC], 19 (9 fathers and 10 inspiratory stridor and depressed level of mothers) high- and 26 (12 fathers and 14 mothers) low- consciousness. His emergency department course risk parents for child physical abuse were selected from a total sample of 331 parents of the Spanish general 771
- 780. population. Both groupswere statistically matched on healthcare districts, a total of 65 being overusers of sociodemographic variables. The Interpersonal emergency care (8 or more visits). The month of Reactivity Index (IRI) [Catalog of Selected Documents August (32.3%). Sundays (44.56%) and the 12:00 in Psychology 10 (1980) 85] and the Parent/Partner p.m.-2:00 p.m. timeframe (8.38%) are the times when Empathy Scale (PPES) [N.D. Feshbach, N. Caskey, A the greatest demand for care occurs, the differences new scale for measuring parent empathy and partner being statistically significant. Televised soccer games empathy: factorial structure, correlates and clinical were associated to a 19.8% (p < 0.001) rise in demand discrimination, 1985] were used to assess dispositional as compared to the control period. CONCLUSIONS: A empathy. RESULTS: An interaction between risk high degree of use of the extrahospital emergency care status and gender for "Personal distress" and units has been found to exist, a major part of the "Perspective-taking" was found. High-risk mothers for demand being concentrated at highly specific points in child physical abuse showed more "Personal distress" time. A major degree of care is provided to those than low-risk mothers and low-risk fathers. High-risk visiting from outside their own healthcare districts. fathers for child physical abuse showed less Television soccer game broadcasts is associated with "Perspective-taking" than low-risk mothers and low- the greater utilization of the emergency care services. risk fathers. No difference between both groups was found for the IRI "Empathic concern" dimension. Perez-Duenas B, Valls-Sole J, Fernandez-Alvarez E et al. Moreover, high-risk, compared to low-risk, parents Characterization of tremor in phenylketonuric patients. showed lower scores both on the "Empathy toward the J Neurol 2005; 252(11):1328-34. partner" and on the "Empathy toward the child" Abstract: Tremor of unknown origin is detected in 10- dimensions of the PPES. No interaction between risk 30% of early-treated and in more than 30% late-treated status and gender was found for the PPES dimensions. phenylketonuric patients. With the aim of CONCLUSIONS: Findings of the present study characterizing tremor in phenylketonuria, we carried supported the hypothesis that high-risk parents for out a systematic study in 54 patients aged 6 to 37 years. child physical abuse show a deficit both in general Tremor examination was done by applying the empathy and in empathy toward their family members. WHIGET Tremor Rating Scale and by accelerometer Moreover, findings suggested the existence of a recording (BYOPAC System MP100WSW). Age at different pattern of deficits in empathy for high-risk diet onset, IQ test results, concomitant plasma fathers and high-risk mothers. phenylalanine levels and index of dietary control were also studied. Tremor was not observed at rest in any Perez Alonso EJ. [Critical considerations on the legal case, but was apparent in 22 patients (40.7%) when regulation of sex selection (II)]. Law Hum Genome carrying out a kinetic task. In 15 patients tremor was Rev 2002; (17):99-124. also evident during maintenance of a postural task at a frequency ranging between 7.5 and 12.7 Hz. Frequency Perez-Ciordia I, Catalan Fabo F, Zalacain Nicolay F, of tremor was not significantly modified by loading the Barriendo Antonanzas M, Solaegui Diaz de Guerenu R, arms or by increasing muscle contraction. Patients with Guillen Grima F. [Profile of the Emergency demand tremor had a later age at onset of phenylalanine and influence of televised soccer games on an extra- restricted diet (p < 0.001). Other treatment-related hospital center in the Tafalla health care district. variables did not differ between patients with and Navarre, Spain]. Rev Esp Salud Publica 2003; without tremor. Our results of the neurophysiological 77(6):735-47. examination suggest that tremor in phenylketonuric Abstract: BACKGROUND: The demand placed on patients is dependent on a dysfunction of central both hospital as well as extrahospital emergency care nervous system networks and may be an index of units currently continues to increase at a growing rate. cerebral damage. This study has a twofold objective: the quantification and study of the personal characteristics of the users Perez-Olmos I, Fernandez-Pineres PE, Rodado-Fuentes S. who are demanding emergency care and assessing [The prevalence of war-related post-traumatic stress whether televised soccer games have any bearing on disorder in children from Cundinamarca, Colombia]. the utilization of emergency care services. METHODS: Rev Salud Publica (Bogota) 2005; 7(3):268-80. A longitudinal descriptive study (9,723 users Abstract: OBJECTIVE: Determining the prevalence of demanding care) and study of cases and controls (1,284 post-traumatic stress disorder (PTSD) related to the users demanding care) according to whether or not a type of war exposure and associated factors in school- soccer game was being televised by means of a logistic aged children from three Colombian towns. regression model. The associations were quantified by METHODS: Cross-sectional epidemiological study. means of the odds ratio (OR). Those dealt with by Representative randomised sample of 493 children telephone or in infirmaries were not included in the aged 5-14. The children were evaluated during 2002 study. RESULTS: A total 10.6% of the demand using semi-structured psychiatric interviews and the involved home visits, 4.8% of this total having been clinician administered PTSD scale. 167 children were sent to hospital. A total 13.3% of the demand evaluated in La Palma who had been chronically corresponds to individuals visiting from other exposed to war, 164 in Arbelaez who had had recent 772
- 781. war-exposure and 162in Sopo who had not been J Ky Med Assoc 2005; 103(9):436-41. exposed to war. War-related PTSD prevalence was Abstract: Sexual violence is a monumental problem in calculated in each municipality. Odds ratio (OR) and Kentucky and elsewhere, and healthcare providers play chi-square were used for evaluating the association a critical role in its identification, treatment, and between exposure to war and PTSD and the related prevention. This article provides essential information risk. Multivariate analysis used the logistic regression for physicians treating survivors of sexual violence, model. The affected children required specialised including treatment options, protocol for medical- mental health counselling. RESULTS: The prevalence forensic examinations, tips for documentation, and of PTSD resulting from war was 16,8 % in La Palma, information about community resources that can 23,2 % in Arbelaez and 1.2% in Sopo. A 19.9 OR (CI facilitate treatment outcomes and proide follow-up 4.7, 119.2), 30,5 Chi-square and p = 0.000 revealed services. war-related PTSD association and risk for children when comparing the exposed towns to Sopo. The Persson EK, Dykes AK. Parents' experience of early logistic regression showed that geographical closeness discharge from hospital after birth in Sweden. to war zone and intense emotional reaction to war Midwifery 2002; 18(1):53-60. increased the probability of war-related PTSD. Abstract: OBJECTIVE: to investigate the factors that Vulnerability factors were predominant in war-exposed influence the experience of mothers and fathers when towns. Poverty, parents' low educational level and child they have chosen to return home, earlier than is the abuse predominated in La Palma. Attention-deficit and normal routine, following the birth of their baby. psychosomatic disorders were more prevalent in DESIGN: a qualitative study, using open interviews, Arbelaez. CONCLUSIONS: War affects children's was undertaken. The text of the transcripts was coded mental health; the children from the exposed towns had and categorised according to the grounded theory 19 times greater probability of war-related PTSD than method using constant comparative analysis. those from a non-exposed town. Early therapeutic SETTING: interviews were carried out with 12 parents, intervention is a public health priority. The results are six mothers and six fathers, individually in their own useful for countries suffering from war, internal homes. They had all left a maternity/family ward at the conflict and/or terrorism. Helsingborg Hospital in southern Sweden within 26 hours of birth whereas the normal discharge time is 72 Perfumo F, Martini A. Lupus nephritis in children. Lupus hours. MEASUREMENTS AND FINDINGS: 'a sense 2005; 14(1):83-8. of security' was the core category. Achieving a sense of Abstract: In systemic lupus erythematosus renal security linked to informed choice for early discharge involvement is more frequent in children than in adults. appeared to be dependent on the following categories: Overall, 60-80% of children with systemic lupus (l) the midwives' empowering behaviour; (2) affinity erythematosus have urinary or renal function within the family; (3) the parents' right to abnormalities early in the disease course. In 90% of autonomy/control; (4) physical well-being. There patients, renal disease occurs within two years from appears to be an inner connection between each of disease onset. Clinically significant renal involvement these categories. KEY CONCLUSIONS: the midwife's ranges from asymptomatic urinary findings to empowering behaviour supports the parents' sense of nephrotic syndrome and renal failure. Long-term security and encourages their informed choice of prognosis is similar to that observed in adults. earlier discharge after birth. When the mothers' and Treatment aspects that are peculiar to children include babies return home it strengthens the affinity within the drug side-effects, such as growth inhibition induced by family and the father's sense of participation. steroids, the need to consider morbidity-related issues with respect to the very long life expectancy of patients Peters RD, Petrunka K, Arnold R. The Better Beginnings, and the problems related to the impact of disease in Better Futures Project: a universal, comprehensive, adolescents. The recent availability of a childhood SLE community-based prevention approach for primary definition of improvement and the presence of large school children and their families. J Clin Child Adolesc international paediatric rheumatology networks should, Psychol 2003; 32(2):215-27. in the future, facilitate the implementation of controlled Abstract: Evaluated a community-based, universal clinical trials devoted to paediatric SLE. project designed to prevent emotional and behavioral problems and promote general development in young Perlman J. Concern about Fetus and Newborn Committee children, while also attempting to improve family and statement on corticosteroid use. Pediatrics 2002; neighborhood characteristics, to link effectively with 110(5):1034. existing services, and to involve local residents in Notes: CORPORATE NAME: American Academy of project development and implementation. The research Pediatrics. Fetus and Newborn Committee involved 554 4-year-old children and their families living in 3 disadvantaged neighborhoods in Ontario, Perry MU, Collins-Willard R, Smock WS. Responding to Canada. Longitudinal analyses of changes over the first sexual violence: critical issues for healthcare providers. 5 years of project operation indicated significant improvements in children's and parents' social- 773
- 782. emotional functioning andphysical health, parenting 1999, 30 patients [19 women and 11 men, mean age 35 behaviors, and neighborhood and school years (range 2.50 to 65)], followed at the Clinic for characteristics. The findings from the Better Allergic Diseases of the University hospital Beginnings, Better Futures Project are encouraging and "Aleksandrovska", Medical University of Sofia, provide unique evidence for the extent to which a Bulgaria, were interviewed blindly in order to assess universal, comprehensive, community-based their compliance with pharmacologic therapy. All prevention strategy can promote the longer term patients were suffering from different types of asthma. development of young children, their families, and RESULTS: The level of compliance among the studied their neighborhoods. group of patients is 86%. In comparison with the literary data where the level of non-compliance is 20% Peters RJ Jr, Tortolero SR, Addy RC et al. The relationship the obtained level is lower--14%. The reasons for non- between sexual abuse and drug use: findings from compliance according to the patients are: the Houston's Safer Choices 2 program. J Drug Educ 2003; appearance of ADRs, the high prize of the drugs, the 33(1):49-59. hard application of the drug form. Abstract: Self-report drug use data were collected from 282 female alternative school students surveyed Petrunik M, Weisman R. Constructing Joseph Fredericks: through the Safer Choices 2 study in Houston, Texas. competing narratives of a child sex murderer. Int J Law Data collection took place between October 2000 and Psychiatry 2005; 28(1):75-96. March 2001 via audio-enabled laptop computers Abstract: Joseph Fredericks--one of Canada's most equipped with headphones. Logistic regression notorious sex offenders--was defined through the analyses indicated that sexual abuse history was institutions that dealt with him from his infancy to his significantly associated with lifetime use (OR = 1.9, p death to the inquest held after his death. In this paper, < or = 0.05). While the relationships tested in this study we locate in historical context and compare the are exploratory, they provide evidence for an important different narratives that were constructed of his life in connection between sexual abuse and substance use each of these institutional settings from unwanted child among female alternative school students. to 'mental defective' to psychiatric offender to criminal recidivist to victim to iconic sexual predator. We show Peterson C, Ringner M. Analyzing tumor gene expression that each of these narratives claimed to capture the profiles. Artif Intell Med 2003; 28(1):59-74. essence of Fredericks in terms of what were his core Abstract: A brief introduction to high throughput characteristics and what remedies were necessary for technologies for measuring and analyzing gene the problems he posed only to be superseded by new expression is given. Various supervised and narratives based on different assumptions. Finally, we unsupervised data mining methods for analyzing the show how one of these conceptions of Frederick's produced high-dimensional data are discussed. The essence influenced a shift in Canadian public policy for main emphasis is on supervised machine learning sex offenders toward the greater emphasis on methods for classification and prediction of tumor gene community protection characteristic of public policy in expression profiles. Furthermore, methods to rank the the United States. genes according to their importance for the classification are explored. The approaches are Petry NM, Steinberg KL. Childhood maltreatment in male illustrated by exploratory studies using two examples and female treatment-seeking pathological gamblers. of retrospective clinical data from routine tests; Psychol Addict Behav 2005; 19(2):226-9. diagnostic prediction of small round blue cell tumors Notes: CORPORATE NAME: The Women's Problem (SRBCT) of childhood and determining the estrogen Gambling Research Center receptor (ER) status of sporadic breast cancer. The Abstract: Little empirical research has evaluated classification performance is gauged using blind tests. childhood abuse in pathological gamblers. This study These studies demonstrate the feasibility of machine describes results of an analysis of childhood learning-based molecular cancer classification. maltreatment histories among 149 pathological gamblers being treated at 1 of 7 gambling treatment Petkova V, Dimitrova Z. Asthma, drug medication and programs. Measurements included instruments noncompliance. Boll Chim Farm 2002; 141(5):355-6. assessing gambling behavior and the Childhood Abstract: According to the new concepts, asthma is a Trauma Questionnaire (CTQ; D. P. Bernstein et al., chronic disease of the upper respiratory tracts, caused 1994). Women scored higher than men on the overall by different cells, including the mastocits and CTQ scale and subscales measuring childhood physical eozinofils. The patients that are suffering from neglect, emotional abuse, and sexual abuse. Severity of episodic, frequent, or chronic asthma are participating childhood maltreatment was significantly and very energetic in the treatment--they have to know and independently associated with lower age of onset of control the symptoms of their disease and also to gambling and increased severity of gambling problems. possess technical skills to perform the treatment. This study suggests that childhood maltreatment is METHODOLOGY: Between March 1 and July 31, prevalent in pathological gamblers, especially female gamblers. These results warrant further investigation of 774
- 783. the role ofchildhood maltreatment in the etiology of relationship between exposure and posttraumatic stress, pathological gambling and its treatment. but one's subjective appraisal of danger and threat at the time of exposure may be a better predictor of Petticrew M. Systematic reviews from astronomy to posttraumatic stress than more objective measures of zoology: myths and misconceptions. BMJ 2001; exposure. We examined the role of peritraumatic 322(7278):98-101. response in posttraumatic stress reactions in over 2,000 middle school children 7 weeks after the 1995 Peychl I. [Shaken baby syndrome]. Cas Lek Cesk 2005; Oklahoma City, Oklahoma, bombing. While many 144(3):185-7; discussion 188-9. children reported hearing and feeling the blast and Abstract: Shaken baby syndrome represents a specific knowing direct victims, most were in school at the time form of the Abused child syndrome. Injury usually of the explosion and therefore were not in direct concerns the baby's head and the brain and it is caused physical proximity to the incident. Physical, by thoughtless treatment accompanied by harsh interpersonal, and television exposure accounted for shaking movements of the head and neck. It can cause 12% of the total variance in our measure of a contusion of the cervical spinal hord, a rupture of the posttraumatic stress when peritraumatic response was bridging veins, intracranial bleeding and a brain tissue ignored. Peritraumatic response and television impairment either due to the direct axonal damage, or exposure accounted for 25% of the total variance, and namely by hypoxic-ischaemic insult. The development physical and interpersonal exposure were not of the lesion can be fatal, or it can result in permanent significant in this context. These findings suggest the impairment of the motor system, in mental or sensory importance of peritraumatic response in children's deficits. Occurrence of the syndrome in the Czech reactions to terrorism. These early responses can be Republic is not known, foreign data give 25 cases per used to help determine which children may experience 100000 children below one year of age. Injured babies difficulty over time. represent over 1% of those hospitalised at paediatric units of intensive care and more than 10% of the death Phillips M. Joan of Arc meets Mary Poppins: maternal re- rate at those departments. Proved abuse has forensic nurturing approaches with male patients in Ego-State consequences: however, convictive evidence can be Therapy. Am J Clin Hypn 2004; 47(1):3-12. difficult to obtain. Article gives a concrete case of a Abstract: Many patients with posttraumatic boy with the diagnose Shaken baby syndrome. fragmentation demonstrate a positive response to the corrective possibilities provided through Ego-State Pezdek K, Morrow A, Blandon-Gitlin I et al. Detecting Therapy. However, full resolution of presenting deception in children: event familiarity affects symptoms may not occur for individuals with criterion-based content analysis ratings. J Appl Psychol significant childhood histories of parental abuse and 2004; 89(1):119-26. neglect without opposite sex, as well as same sex, re- Abstract: Statement Validity Assessment (SVA) is a nurturing interventions. This presentation emphasizes comprehensive credibility assessment system, with the the use of maternal re-nurturing methods with men Criterion-Based Content Analysis (CBCA) as a core who struggle with the effects of significant attachment component. Worldwide, the CBCA is reported to be deficits in early life. Case examples feature male the most widely used veracity assessment instrument. patients with long-term difficulties in their adult We tested and confirmed the hypothesis that CBCA relationships with women that had proved refractory to scores are affected by event familiarity; descriptions of other therapy methods. Following Ego-State Therapy familiar events are more likely to be judged true than interventions with maternal symbolic figures, however, are descriptions of unfamiliar events. CBCA scores these problems improved dramatically. Therapeutic were applied to transcripts of 114 children who implications for cross-gender re-nurturing with patients recalled a routine medical procedure (control) or a who report different types of maternal attachment traumatic medical procedure that they had experienced trauma are explored and discussed. one time (relatively unfamiliar) or multiple times (relatively familiar). CBCA scores were higher for Piaggio G, Carroli G, Villar J et al. Methodological children in the relatively familiar than the relatively considerations on the design and analysis of an unfamiliar condition, and CBCA scores were equivalence stratified cluster randomization trial. Stat significantly correlated with age. Results raise serious Med 2001; 20(3):401-16. questions regarding the forensic suitability of the Notes: CORPORATE NAME: WHO Antenatal Care CBCA for assessing the veracity of children's accounts. Trial Research Group Abstract: The World Health Organization and Pfefferbaum B, Doughty DE, Reddy C et al. Exposure and collaborating institutions in four developing countries peritraumatic response as predictors of posttraumatic have conducted a multi-centre randomized controlled stress in children following the 1995 Oklahoma City trial, in which clinics were allocated at random to two bombing. J Urban Health 2002; 79(3):354-63. antenatal care (ANC) models. These were the standard Abstract: Studies have demonstrated a positive 'Western' ANC model and a 'new' ANC model consisting of tests, clinical procedures and follow-up 775
- 784. actions scientifically demonstratedto be effective in screening of melanoma, particularly at centres not improving maternal and newborn outcomes. The two experienced in dermoscopy. models were compared using the equivalence approach. This paper discusses the implications of the Pierce JP, Distefan JM, Jackson C, White MM, Gilpin EA. equivalence approach in the sample size calculation, Does tobacco marketing undermine the influence of analysis and interpretation of results of this cluster recommended parenting in discouraging adolescents randomized trial. It reviews the ethical aspects from smoking? Am J Prev Med 2002; 23(2):73-81. regarding informed consent, concluding that the Zelen Abstract: OBJECTIVE: The tobacco industry contends design has a place in cluster randomization trials. It that parenting practices, not marketing practices, are describes the estimation of the intracluster correlation critical to youth smoking. Our objective was to coefficient (ICC) in a stratified cluster randomized trial examine whether tobacco-industry marketing practices using two methods and reports estimates of the ICC undermine the protective effect of recommended obtained for many maternal, newborn and perinatal authoritative parenting against adolescent smoking. outcomes. Finally, it discusses analytical problems that DESIGN AND SETTING: Receptivity to tobacco arose: issues encountered using a composite index, advertising and promotions was assessed in 1996 from heterogeneity of the intervention effect across sites, the a representative sample of California adolescent never- choice of the method of analysis and the importance of smokers aged 12 to 14 years. A follow-up survey of efficacy analyses. The choice of the clustered Woolf 1641 of these adolescents was conducted in 1999 that estimator and the generalized estimating equations included measures of the key components of (GEE) as the methods of analysis applied is discussed. authoritative parenting: parental responsiveness, monitoring, and limit setting. MAIN OUTCOME Piccolo D, Ferrari A, Peris K, Diadone R, Ruggeri B, MEASURE: Smoking initiation in adolescents. Chimenti S. Dermoscopic diagnosis by a trained RESULTS: Adolescents in families with more- clinician vs. a clinician with minimal dermoscopy authoritative parents were half as likely to smoke by training vs. computer-aided diagnosis of 341 follow-up as adolescents in families with less- pigmented skin lesions: a comparative study. Br J authoritative parents (20% vs 41%, p <0.0001). In Dermatol 2002; 147(3):481-6. families with more-authoritative parents, adolescents Abstract: BACKGROUND: In the last few years who were highly receptive to tobacco-industry digital dermoscopy has been introduced as an advertising and promotions were significantly more additional tool to improve the clinical diagnosis of likely to smoke (odds ratio=3.52, 95% confidence pigmented skin lesions. OBJECTIVE: To evaluate the interval =1.10-11.23), compared to those who were validity of digital dermoscopy by comparing the minimally receptive. This effect was not significant in diagnoses of a dermatologist experienced in adolescents in families with less-authoritative parents. dermoscopy (5 years of experience) with those of a The overall attributable risk (adjusted for exposure to clinician with minimal training in this field, and then peer smokers) of smoking from tobacco-industry comparing these results with those obtained using advertising and promotions was 25%. However, an computer-aided diagnoses. METHODS: Three hundred estimated 40% of adolescent smoking in families with and forty-one pigmented melanocytic and non- more-authoritative parents was attributable to tobacco- melanocytic skin lesions were included. All lesions industry advertising and promotions; this was five were surgically excised and histopathologically times the attributable risk seen in families with less- examined. Digital dermoscopic images of all lesions authoritative parents (8%). CONCLUSION: The were framed and analysed using software based on a promotion of smoking by the tobacco industry appears trained artificial neural network. Cohen's kappa statistic to undermine the capability of authoritative parenting was calculated to assess the validity with regard to the to prevent adolescents from starting to smoke. correct diagnoses of melanoma and non-melanoma. RESULTS: Sensitivity was high for the experienced Pierce R. Thoughts on interpersonal violence and lessons dermatologist and the computer (92%) and lower for learned: fact or fiction. J Interpers Violence 2005; the inexperienced clinician (69%). Specificity of the 20(1):43-50. diagnosis by the experienced dermatologist was higher Abstract: Although interpersonal violence is evident in (99%) than that of the inexperienced clinician (94%) all strata of society, every geographical area in the and the computer assessment (74%). Notably, country, and across each gender, it takes courage to computer analysis gave a higher number of false acknowledge our passivity about the phenomena, positives (26%) compared with the experienced particularly when people of color are involved. Thus, dermatologist (0.6%) and the inexperienced clinician the mass incarcerations of African American men and (5.5%). CONCLUSIONS: Our results indicate that women and data citing the overrepresentation of analysis either by a trained dermatologist or an African American children not being adequately served artificial neural network-trained computer can improve in the child welfare system are highlighted to address the diagnostic accuracy of melanoma compared with the three questions posed to authors: What have we that of an inexperienced clinician and that the computer learned about violence and trauma over two decades? diagnosis might represent a useful tool for the What should be learned over the next 10 years about 776
- 785. violence and trauma?What methodologies exist that Compared with the nonresilient, resilient children were show promise of affecting a better understanding of less likely to use two avoidance coping strategies violence and trauma? (internalizing [p=.002] and externalizing [p=.017]). The level of actual support received by resilient and Pilowsky DJ, Zybert PA, Hsieh PW, Vlahov D, Susser E. nonresilient children did not differ significantly Children of HIV-positive drug-using parents. J Am (p=.202). Perceived support was greater among Acad Child Adolesc Psychiatry 2003; 42(8):950-6. resilient children (as reported by their parents; p Abstract: OBJECTIVE: Associations between human <.001), and their parents reported lower parenting immunodeficiency virus (HIV) status of injection drug stress (p=.042). CONCLUSIONS: A significant users (IDUs) and their children's psychopathology and proportion of children of injection drug users are in social functioning were examined. METHOD: Parents need of clinical care. Interventions to help children of (N = 61) were drawn from an ongoing longitudinal substance-abusing parents modify their coping style study of inner city, primarily African-American IDUs. merit exploration. Children (N = 79) were 6 to 11 years of age, currently living with the IDU parent. Parental variables included Pimlott-Kubiak S, Cortina LM. Gender, victimization, and HIV status, apparent and inapparent HIV infection outcomes: reconceptualizing risk. J Consult Clin (with HIV-related medical symptoms and/or disclosure Psychol 2003; 71(3):528-39. of parental HIV status to children; with neither medical Abstract: Large-scale studies of gender differences in symptoms nor disclosure, respectively), presence of psychopathological reactions to victimization have HIV-related medical symptoms, HIV disclosure status focused on posttraumatic stress disorder, overlooking to each child, and depression as ascertained by the other trauma-related disorders. The present study Center for Epidemiologic Studies-Depression. expands this literature with a contextualized Children's outcomes (competencies, psychiatric examination of interpersonal aggression exposure and symptoms, and disorders) were assessed with the Child sequelae. Using k-means cluster analysis on a sample Behavior Checklist and the Schedule for Affective of 16,000, the authors identified 8 distinct profiles of Disorders and Schizophrenia for School-Age Children. exposure to sexual violence, physical assault, stalking, RESULTS: Children of IDU parents exhibited high and emotional abuse. Analyses of covariance then rates of psychopathology. Parental HIV infection per se suggested links among victimization profile, gender, had no discernible impact on children's outcomes. The and mental and physical health. Results revealed no apparent HIV infection of a parent was associated with meaningful interactive effects of gender and an eightfold increase (odds ratio 7.80; 95% confidence interpersonal aggression on outcomes, once lifetime interval 1.56-39.09) in the prevalence of disruptive exposure to aggressive events was adequately taken behavior disorders (compared with children of HIV- into account. These findings argue against theories of negative parents). Parental depression was associated female victims' greater vulnerability to pathological with a threefold increase in the prevalence of children's outcomes, instead linking risk to exposure history. disruptive behavior disorders (odds ratio 3.49, 95% confidence interval 1.11-11.04). CONCLUSIONS: Pinosa C, Marchand C, Tubiana-Rufi N, Gagnayre R, Parental HIV status per se does not seem to have a Albano MG, D'Ivernois JF. The use of concept differential impact on the affected children. The mapping to enlighten the knowledge networks of apparent HIV infection of a parent may be associated diabetic children: a pilot study. Diabetes Metab 2004; with children's externalizing symptoms and disorders. 30(6):527-34. Abstract: OBJECTIVE: The value of concept mapping Pilowsky DJ, Zybert PA, Vlahov D. Resilient children of in enlightening nature and organization of knowledge injection drug users. J Am Acad Child Adolesc was shown with adult diabetic or obese patients. Our Psychiatry 2004; 43(11):1372-9. objectives were to ascertain the relevance and Abstract: OBJECTIVE: To examine associations feasability of concept mapping in diabetic children between resilience in children of injection drug users during an educational program. METHOD: This and children's coping strategies, parenting stress, and qualitative research was performed in 5 children from 8 children's social support. METHOD: Injection drug- to 13 years. Concept maps were drawn at the beginning using parents (n=91) and their children aged 6 to 11 (Phase 1) and at the end (Phase 2) of an educational (n=117) were recruited in Baltimore (1997-1999). program. During the interview each child was invited Resilience was defined as scoring in the lowest quartile to express himself starting from the central concept: of the Child Behavior Checklist total psychopathology "diabetes", and to express his/her knowledge, score. Coping strategies used by resilient and representations, and life experience. RESULTS: The nonresilient children, the extent and types of social ten maps analysis shows: an increase of knowledge support that they received, and the level of parenting between phase 1 and phase 2 (+34%), towards a stress reported by their parents were compared and deepening of initial knowledge and an addition of new contrasted. RESULTS: Rates of depressive, anxiety, knowledge (43% and 41% of the added knowledge); a and disruptive behavior disorders were 15.4%, 22.2%, decrease of inaccurate knowledge in phase 2; an and 21.4%, respectively, for the entire sample. enrichment of the knowledge networks (+16 cross 777
- 786. links); an increaseof knowledge related to the ways to child's family in 3 cases, a household employee behave knowledge (+42%). CONCLUSION: This working at the child's home in three cases, a teacher in preliminary report demonstrated that concept maps 1, and a neighbor in 1. Syphilitic tests were negative in were feasible, useful and relevant in therapeutic all children. However HIV infection was detected and education of children. This method allowed us to show the contaminator was identified in one 10-year-old girl. how every child connected his knowledge and how it The results of this study document the correlation was modified by an educational intervention. Concept between anogenital warts and sexual abuse. In Black maps therefore contributed to individual educational Africa, the consequences of child sexual abuse, which diagnosis and assessment of new knowledge is not uncommon especially in major cities, are integration. aggravated by the high prevalence of HIV infection. Pirila-Parkkinen K, Pirttiniemi P, Alvesalo L, Silven O, Pittman T. Significance of a subdural hematoma in a child Heikkila J, Osborne RH. The relationship of with external hydrocephalus. Pediatr Neurosurg 2003; handedness to asymmetry in the occlusal morphology 39(2):57-9. of first permanent molars. Eur J Morphol 2001; 39(2):81-9. Pivarcsi A, Homey B. Chemokine networks in atopic Abstract: Handedness has been shown to be related to a dermatitis: traffic signals of disease. Curr Allergy number of systematic asymmetries in body dimensions, Asthma Rep 2005; 5(4):284-90. dermatoglyphic patterns and cerebral morphology. The Abstract: Atopic dermatitis is a chronic or chronically aim here was to compare linear and angular tooth relapsing inflammatory skin disease with a prevalence crown asymmetries of the permanent molars in healthy ranging from 10% to 20% in children and 1% to 3% in right-handed and left-handed subjects. The material adults of developed countries. Skin-infiltrating comprised 27 children with recorded concordant left- leukocytes play a pivotal role in the initiation and side dominance of hand, eye and foot. The controls amplification of atopic skin inflammation. Recent were an age- and sex-matched group with right side studies demonstrated that infiltration of inflammatory dominance. The material is based on the Collaborative cells into tissues is regulated by chemokines. A subset Perinatal Project where detailed medical records and of chemokines including CCL27, CCL17, CCL22, the dentitions, including accurate dental impressions, CCL18, CCL11, and CCL13 are highly expressed in of over two thousand American children were atopic dermatitis. The corresponding chemokine examined in the USA in the sixties. Machine vision receptors are found on the main leukocyte subsets technique was used to obtain accurate three- involved in allergic skin inflammation, such as T cells, dimensional information from the occlusal surfaces of eosinophils, and dendritic cells. In this article, we the first permanent upper and lower molars. The provide an overview of the role of chemokines in the directional asymmetry values of angular measurements complex immunopathogenesis of atopic dermatitis, of mandibular first molars showed evidence of highlighting potential areas for therapeutic asymmetry of opposite direction between the two intervention. examined groups. The results indicate that occlusal morphology of first permanent molars may be affected Pizzi NJ. Bleeding predisposition assessments in by handedness, and this tendency is most evident in the tonsillectomy/adenoidectomy patients using fuzzy angular measurements of the mandibular molars. interquartile encoded neural networks. Artif Intell Med Fluctuating asymmetry did not differ significantly 2001; 21(1-3):65-90. between the examined groups. Abstract: A fuzzy set theoretic methodology is described that serves as a classification preprocessing Pitche P, Kombate K, Gbadoe AD, Tchangai-Walla K. strategy for supervised feed-forward neural networks. [Anogenital warts in young children in hospital This methodology, fuzzy interquartile encoding, consultation in Lome (Togo). Role of transmission by determines the respective degrees to which a feature sexual abuse]. Med Trop (Mars) 2001; 61(2):158-62. belongs to a collection of fuzzy sets that overlap at the Abstract: The purpose of this 20-month prospective respective quartile boundaries of the feature. These study conducted in the dermatology department of membership values are subsequently used in place of Lome Teaching Hospital was to determine the the original feature. This transformation has a prevalence of sexual abuse in pre-adolescent children normalizing effect on the feature space and is more with anogenital warts. From May 1997 to December robust to feature outliers. Its effectiveness is 1998, a total of 16 cases of anogenital warts were scrutinized using several synthetic data sets with diagnosed in children under the age of 12 years. Sexual various underlying distributions. Fuzzy interquartile abuse was discovered in 8 cases. All 8 cases involved encoding is shown to consistently improve the girls (mean age, 6.1 +/- 1.9 years). The mode of discriminatory power of the underlying classifiers.The acquisition involved self-infection from non anogenital methodology is also applied to two biomedical data warts in three cases and contamination by the mother in sets relating to tonsillectomy and/or adenoidectomy three cases. In two cases the mode of acquisition could patients who may or may not have had a predisposition not be identified. The alleged abuser was a member of 778
- 787. to excessive bleedingduring their operation. The Children's Health Insurance Program. J Health Hum features of the first data set are blood sample test Serv Adm 2004; 27(2):210-39. results acquired from a coagulation laboratory and the Abstract: This article examines state efforts to build class labels are one of three hemostatic defects as administrative structures and outreach networks in the identified by the reference tests. The second data set State Children's Health Insurance Program (CHIP) consists of patient responses to queries from a bleeding through a comparative review of 18 states that have tendency questionnaire. Normal and abnormal class been the subject of ongoing research by the Nelson A. labels were derived from a hematology expert system Rockefeller Institute of Government. The article designed in consultation with a pediatric hematologist. explores the role that institutional structures play at the Fuzzy interquartile encoding effected an 11% state level in shaping the implementation and improvement in the classification accuracy of the administration of federal policy choices. States have underlying neural network classifier with the former generally opted to rely largely on existing Medicaid data set and 18% with the latter. bureaucracies in order to implement the new CHIP programs. As a result, CHIP programs have been Place I, Englert Y. A prospective longitudinal study of the tightly integrated into existing Medicaid structures. physical, psychomotor, and intellectual development of Rarely put forward as exemplars of responsiveness singleton children up to 5 years who were conceived by and, these bureaucracies have nonetheless played a intracytoplasmic sperm injection compared with crucial role in building and managing CHIP programs children conceived spontaneously and by in vitro across the United States. As this analysis will show, fertilization. Fertil Steril 2003; 80(6):1388-97. this has even been the case in those few states that have Abstract: OBJECTIVE: To assess the somatic, opted to officially house CHIP administration outside psychomotor, and intellectual development of children of the Medicaid bureaucracy. Furthermore, existing conceived through intracytoplasmic single sperm Medicaid systems have often been active as partners injection (ICSI) over the whole preschool period. and participants in efforts to publicize and promote the DESIGN: Prospective, controlled, cohort study. CHIP program through outreach and education efforts. SETTING: Fertility clinic in Brussels, Belgium. As part of these initiatives, efforts have been made to PATIENT(S): Sixty-six ICSI-conceived children portray CHIP as a form of health insurance rather than prospectively compared with 52 IVF-conceived and 59 a welfare benefit. A slight paradox results where key spontaneously conceived children. All children were actors in the health and human services bureaucracy full-term singletons. INTERVENTION(S): Home visits play an active role in program management while by a trained psychologist. Standardized interviews. making efforts to dissassociate the program from the Assessments using the revised Brunet-Lezine scale and traditional welfare system. These efforts have been the revised Wechsler preschool and primary scale of largely successful. And in doing so, not only have intelligence. MAIN OUTCOME MEASURE(S): children been brought into the CHIP program but more Physical growth and general health. Formal families have been connected to the Medicaid program. developmental and intellectual assessments. In short, a review of state experiences reveals the RESULT(S): Children conceived by ICSI were resiliency and flexibility of existing state healthy: no significant differences appeared in the administrative systems in responding to and addressing incidence of combined congenital malformations substantive policy change. (11.3%), health problems (44.1%), surgical interventions (18.6%), and hospitalizations (6.8%), nor Plews C, Bryar R, Closs J. Clients' perceptions of support for the developmental assessments (mean received from health visitors during home visits. J Clin developmental quotient at 9 months: 93.9; at 18 Nurs 2005; 14(7):789-97. months: 102.0). For the intellectual assessments, the Abstract: AIMS AND OBJECTIVES: The current between-group differences disappeared when adjusted study sought to identify how many mothers from 149 for levels of parental education (mean intelligence visits carried out by seven health visitors identified quotient at 3 years: 97.0; at 5 years: 103.3). support as a feature of the visit, whether this type of CONCLUSION(S): This pilot study shows that support was unique to the health visitor and what throughout the preschool period, ICSI-conceived support meant to them. These responses were then children have psychomotor and intellectual compared with the taxonomies of social support from development similar to that of IVF-conceived and the social support literature. BACKGROUND: Some spontaneously conceived children. These conclusions studies of client perceptions describe support as an need to be confirmed by multicenter studies. element of home visits by health visitors. However, the importance, relevance and impact on the client of this Place MD. Three harsh new realities. Health Prog 2002; support are not described in detail. Social support 83(5):6-8. theory suggests that there are tangible benefits to people's well-being and their ability to cope with Plein LC. Activism in an age of restraint: the resiliency of various challenges that may arise from individuals' administrative structure in implementing the State perceptions of receiving support. DESIGN: Qualitative study using semistructured interviews. METHODS: 779
- 788. Seven volunteer healthvisitors recruited 149 women with patients with ADHD should be prepared to deal into the study. These clients were interviewed by the with a wide range of emotional and behavioral researcher, usually within one week of the home visit problems beyond the core symptoms of inattention and by their health visitor. The discussions were audio- impulsivity/hyperactivity. taped and the resulting transcripts analysed using content analysis. FINDINGS: Thirty-seven women Pliszka SR, Lopez M, Crismon ML et al. A feasibility study identified receiving support which they said was only of the children's medication algorithm project (CMAP) available from the health visitor. The relevance of this algorithm for the treatment of ADHD. J Am Acad support to the mother and the impact on her well-being Child Adolesc Psychiatry 2003; 42(3):279-87. varied within the group suggesting differing Abstract: OBJECTIVE: To determine whether an perceptions of support by clients according to their algorithm for the treatment of attention- personal situation. There was a correspondence deficit/hyperactivity disorder (ADHD) can be between the descriptions of support given by the implemented in a community mental health center. women and the taxonomies of social support from the METHOD: Fifty child and adolescent patients at Texas social support literature. CONCLUSION: For some community mental health centers who met criteria for interactions between clients and their health visitors the ADHD were treated according to an algorithm-based existing theory of social support may provide an disease management program for ADHD. Psychiatrists explanation of how health visitors contribute to clients' were trained in the use of the algorithm, and each perceived ability to cope and well-being. subject underwent a baseline assessment consisting of a RELEVANCE TO CLINICAL PRACTICE: Social structured interview and standardized rating scales. support may be defined as a possible outcome of health Subjects were monitored for 4 months. At the end of visiting. This concept will have use within educational treatment, the psychiatrists completed the Clinical programmes to demonstrate to students how health Global Impression Scale (CGI) and the baseline rating visiting can have an impact on clients' well-being. scales were repeated. The primary variables of interest Similarly, the concept could be used to investigate and were psychiatrist and family adherence to the record health visiting practice. algorithm. To examine impact on treatment outcome, the CGI of the algorithm subjects was compared with Pliszka SR. Psychiatric comorbidities in children with CGIs based on chart reviews of 118 historical controls. attention deficit hyperactivity disorder: implications for RESULTS: Psychiatrists implemented the major management. Paediatr Drugs 2003; 5(11):741-50. aspects of the algorithm, but the detailed tactics of the Abstract: Attention deficit hyperactivity disorder algorithm (use of fixed titration of stimulants) were (ADHD) is frequently comorbid with a variety of less well adhered to. CONCLUSIONS: An algorithm psychiatric disorders. These include oppositional for the treatment of ADHD can be implemented in a defiant disorder and conduct disorder (CD), as well as community mental health center. affective, anxiety, and tic disorders. ADHD and ADHD with comorbid CD appear to be distinct subtypes; Pollack-Nelson C, Drago DA. Supervision of children aged children with ADHD/CD are at higher risk of antisocial two through six years. Inj Control Saf Promot 2002; personality and substance abuse as adults. Stimulants 9(2):121-6. are often effective treatments for aggressive or Abstract: Manufacturers of household products-- antisocial behavior in patients with ADHD, but mood including appliances, exercise equipment, and even stabilizers or atypical antipsychotics may be used to some children's toys--expect consumers to supervise treat explosive aggressive outbursts. Response to their children to prevent product-related injuries. This stimulants is not affected by comorbid anxiety, but approach to hazard prevention places the burden of children with ADHD/anxiety disorder may show safety on parents and caretakers. This study examined greater benefit from psychosocial interventions than actual supervision practices of parents of children those with ADHD alone. The degree of prevalence of between the ages of two and six years. 59 parents, aged major depressive disorder (MDD) and bipolar disorder 31 to 40 years, residing in Montgomery County, among children with ADHD is controversial, but a Maryland, completed a 24-item self-administered subgroup of severely emotionally labile ADHD questionnaire, consisting of multiple choice and open- children who present serious management issues for ended questions. Nearly all respondents reported that the clinician clearly exists. Antidepressants may be there are times when their children are in a different used in conjunction with stimulants to treat MDD, room from them. When the children are out of sight, while mood stabilizers and atypical antipsychotics are parents reported checking on their children often required to treat manic symptoms or aggression. periodically, with increasingly longer periods between After resolution of the manic episode, stimulant observations, as the child gets older. Nearly half of the treatment of the comorbid ADHD may be safely children got out of bed in the morning always or often undertaken. Recent research suggests that stimulants before a parent. Ninety-five percent of parents can be safely used in children with comorbid ADHD perceived that their child was at no risk or slight risk of and tic disorders, but the addition of anti-tic agents to injury when getting up in the morning before them. In stimulants is often necessary. Clinicians who work conclusion, it can be said that many parents supervise 780
- 789. their children bybeing close-by and on-hand as adaptive self-regulation. Existing data suggest that needed, rather than being directly involved in the physically abused children overattend to angry child's activities. Manufacturers are encouraged to expressions, but the attentional mechanisms underlying employ passive measures and sound designs, rather such behavior are unknown. The authors tested 8-11- than rely on close parental supervision for injury year-old physically abused children to determine prevention. whether they displayed specific information-processing problems in a selective attention paradigm using Pollak SD. Experience-dependent affective learning and risk emotional faces as cues. Physically abused children for psychopathology in children. Ann N Y Acad Sci demonstrated delayed disengagement when angry faces 2003; 1008:102-11. served as invalid cues. Abused children also Abstract: The influence of childhood affective demonstrated increased attentional benefits on valid experiences across development may be understood in angry trials. Results are discussed in terms of the terms of preparedness to learn about emotion, influence of early adverse experience on children's combined with general immaturity and neuro-plasticity selective attention to threat-related signals as a of perceptual systems. Early in development, mechanism in the development of psychopathology. processing resources are relatively immature and limited in capacity, thereby constraining how much Pollitt RJ. Compliance with science: consent or coercion in information the young child can absorb. But it is clear newborn screening. Eur J Pediatr 2004; 163(12):757-8. that learning about emotions proceeds swiftly in nearly Notes: GENERAL NOTE: KIE: 4 refs. all children, suggesting biological preparedness to track GENERAL NOTE: KIE: KIE Bib: genetic screening; associations between certain stimuli and outcomes. It is mass screening; treatment refusal/minors proposed here that limited processing capacity, in tandem with dispositions to filter or select key Pollock L. Discrimination and prejudice: Muslim women's privileged stimuli in the environment, facilitates experiences of maternity care. RCM Midwives 2005; adaptive, rapid, affective learning. The developmental 8(2):55. organization of affective systems is contingent upon those features of input that are most learnable, such as Pollock L. Maternity leave challenge to students' rights. signals that are particularly salient, frequent, or RCM Midwives 2003; 6(7):284-5. predictable. Therefore, plasticity confers risk for maladaptation in that children's learning will be based Pollock TR, Franklin C. Use of evidence-based practice in upon these prominent features of the environment, the neonatal intensive care unit. Crit Care Nurs Clin however aberrant. North Am 2004; 16(2):243-8. Abstract: The process change described is an ongoing Pollak SD, Kistler DJ. Early experience is associated with project in the HICN. Through this process we found the development of categorical representations for that developmentally sensitive care can be facial expressions of emotion. Proc Natl Acad Sci U S accomplished as early as the time of birth by A 2002; 99(13):9072-6. minimizing trauma to ELBW infants, keeping them Abstract: A fundamental issue in human development nested with minimal handling. This also supports the concerns how the young infant's ability to recognize goal for this population of minimizing cold stress and emotional signals is acquired through both biological its effects. Gentle ventilation can be achieved in the programming and learning factors. This issue is delivery room by understanding physiology and the extremely difficult to investigate because of the variety effects of ventilation on the ELBW lung tissue. of sensory experiences to which humans are exposed immediately after birth. We examined the effects of Pomery EA, Gibbons FX, Gerrard M, Cleveland MJ, Brody emotional experience on emotion recognition by GH, Wills TA. Families and risk: prospective analyses studying abused children, whose experiences violated of familial and social influences on adolescent cultural standards of care. We found that the aberrant substance use. J Fam Psychol 2005; 19(4):560-70. social experience of abuse was associated with a Abstract: Parental, peer, and older siblings' change in children's perceptual preferences and also contributions to adolescents' substance use were altered the discriminative abilities that influence how investigated with 2 waves of panel data from 225 children categorize angry facial expressions. This study African American families. Structural equation suggests that affective experiences can influence modeling showed that older siblings' behavioral perceptual representations of basic emotions. willingness (BW) to use substances at Time 1 (T1) predicted target adolescents' Time 2 (T2) use, Pollak SD, Tolley-Schell SA. Selective attention to facial controlling for other T1 variables. Regression analyses emotion in physically abused children. J Abnorm revealed an interaction between targets' and siblings' Psychol 2003; 112(3):323-38. BW, such that targets were more likely to use at T2 if Abstract: The ability to allocate attention to emotional both they and their siblings reported BW at T1. This cues in the environment is an important feature of interaction was stronger for families living in high-risk 781
- 790. neighborhoods. Finally, siblings'willingness buffered Porjesz B, Almasy L, Edenberg HJ et al. Linkage the impact of peer use on targets' later use: Low sibling disequilibrium between the beta frequency of the BW was associated with less evidence of peer human EEG and a GABAA receptor gene locus. Proc influence. Natl Acad Sci U S A 2002; 99(6):3729-33. Abstract: Human brain oscillations represent important Poole CA, Brookes NH, Clover GM. Confocal imaging of features of information processing and are highly the human keratocyte network using the vital dye 5- heritable. A common feature of beta oscillations (13-28 chloromethylfluorescein diacetate. Clin Experiment Hz) is the critical involvement of networks of Ophthalmol 2003; 31(2):147-54. inhibitory interneurons as pacemakers, gated by Abstract: BACKGROUND: The human corneal stroma gamma-aminobutyric acid type A (GABA(A)) action. consists of intercalated layers of collagen and Advances in molecular and statistical genetics permit keratocytes. These cells are known to maintain the examination of quantitative traits such as the beta stroma and aid in repair but it is likely they have other frequency of the human electroencephalogram in crucial roles throughout the cornea. The complexity of conjunction with DNA markers. We report a their anatomy is revealed in this study by ex vivo in significant linkage and linkage disequilibrium between situ images of the human keratocyte covering a range beta frequency and a set of GABA(A) receptor genes. of ages. METHODS: Human donor corneas of Uncovering the genes influencing brain oscillations different ages were stained with 5- provides a better understanding of the neural function chloromethylfluorescein diacetate (CMFDA), a dye involved in information processing. that is anchored and retained within the cell cytoplasm. The tissue was fixed, sectioned, mounted, and then Porter LS, Porter BO. A blended infant massage--parenting imaged using a confocal laser scanning microscope at enhancement program for recovering substance- various magnifications and tissue planes. The digital abusing mothers. Pediatr Nurs 2004; 30(5):363-72, image sets were transferred to multifunction image 401. processing software for analysis and production of 3-D Abstract: Interventions that build upon the natural stereo images of keratocyte networks throughout the components of early mother-infant interactions are stroma. RESULTS: High quality images of CMFDA- critical to reversing the sequelae of maternal substance stained cells revealed differences in the structure and abuse and breaking the cycle of addiction. This paper orientation of keratocytes in the anterior, central and proposes a theoretical model that blends infant massage posterior stroma, which did not differ throughout the (IM) into a planned parenting enhancement program age-range studied. This method reveals very fine cell (PEP) to promote improved health outcomes in process ramifications not previously visualized, recovering substance- abusing mothers (SAMs) and orientated in lateral and antero-posterior directions, and their babies. With 4.6 million women of child-bearing it confirms the potential for multidirectional age regularly using cocaine in the United States and communication between keratocyte networks. 750,000 drug-exposed births annually, maternal CONCLUSIONS: This qualitative study found substance abuse highlights the multigenerational consistency of keratocyte morphology in the normal impact of drug use in high-risk populations and its risks human cornea throughout life. It confirmed differences to our children. The proposed IMPEP model provides a in keratocyte anatomy, and the potential for rapid means to assist recovering SAMs in making cognitive- cellular communication by multiple interconnecting behavioral changes through new knowledge about processes supporting cohesive keratocyte activity. This parenting and parenting skills, with a special focus on high-resolution 3-D microscopic study should assist in infant stimulation via massage. The goal is to enable identifying gross deviant cellular behaviour in post- recovering SAMs to become confident and responsive surgical and disease states. mothers, empowering them to become effective parents. Pilot data suggest the Infant Massage Popp J, Douglas-England K, Casebeer A, Tough SC. Parenting Enhancement Program (IMPEP) is effective Creating frameworks for providing services closer to for both mother and infant, and merits a controlled home in the context of a network. Healthc Manage systematic study. Forum 2005; 18(2):27-33. Abstract: Networks can be used to develop shared Portwood SG, Dodgen DW. Influencing policymaking for frameworks that extend limited specialized healthcare maltreated children and their families. J Clin Child services beyond tertiary level settings to provide Adolesc Psychol 2005; 34(4):628-37. services closer to home. This article provides an Abstract: Public policy can be a powerful tool for overview of networks, describes the context and children and their families. Accordingly, this article purpose of the Southern Alberta Child & Youth Health addresses how psychologists and other child-oriented Network, reports on early experiences with researchers can leverage this tool to ensure that child implementation of an Outreach Services Framework, and family issues, specifically issues related to child and discusses implications from a network perspective. abuse and neglect, receive adequate attention. We encourage a bidirectional relationship between policymakers and experts in child maltreatment 782
- 791. through which policymakerssolicit and employ bringing up children the Honduran way. J Fam Health relevant expertise, and psychologists, in turn, provide Care 2005; 15(1):26-8. useful information to policymakers. To facilitate such Abstract: The author, a health visitor now living in relationships, this article offers practical guidance to Honduras, Central America, describes child-rearing psychologists on understanding the policymaking practices in Honduras and contrasts them with those in process, gaining familiarity with relevant policy, the UK. communicating effectively with policymakers, and understanding the unique contributions that Pottinger AM. Children's experience of loss by parental psychologists can make to the policy process. migration in inner-city Jamaica. Am J Orthopsychiatry 2005; 75(4):485-96. Posner MI, Rothbart MK. Influencing brain networks: Abstract: Migratory separation, when parents migrate implications for education. Trends Cogn Sci 2005; and leave their children behind, was investigated in a 9(3):99-103. case-control sample of 9- to 10-year-olds living in Abstract: In our view, a central issue in relating brain inner-city communities in Kingston and St Andrew, development to education is whether classroom Jamaica (N = 54). Data analyses using descriptive interventions can alter neural networks related to statistics and bivariate correlations showed that cognition in ways that generalize beyond the specific children's reactions to their parents' migration were domain of instruction. This issue depends upon directly related to poor school performance and understanding how neural networks develop under the psychological difficulties. Additionally, being currently influence of genes and experience. Imaging studies exposed to violence in the home and/or community have revealed common networks underlying many was significantly associated with high scores on a important tasks undertaken at school, such as reading measure of grief intensity. "Protective" factors included and number skills, and we are beginning to learn how having someone to talk to about the migration and genes and experience work together to shape the living in a supportive family. Migratory separation development of these networks. The results obtained needs detailed investigation like that devoted to other appear sufficient to propose research-based childhood family disruptions, such as parental divorce interventions that could prove useful in improving the or death. ability of children to adjust to the school setting and to acquire skills like literacy and numeracy. Powderly K. Ethical and legal issues in perinatal HIV. Clin Obstet Gynecol 2001; 44(2):300-11. Potegal M, Archer J. Sex differences in childhood anger and Notes: GENERAL NOTE: KIE: KIE Bib: AIDS aggression. Child Adolesc Psychiatr Clin N Am 2004; 13(3):513-28, vi-vii. Powell C. 'Children are unbeatable' a nurse's perspective. Abstract: There are few differences in the frequency or Paediatr Nurs 2004; 16(8):29. intensity of men's and women's self-reported or observed anger. Women are more likely to be angered Powell DL, Stewart V. Children. The unwitting target of by relationship conflicts than men. Men are more environmental injustices. Pediatr Clin North Am 2001; frequently the targets of anger than women. Typically, 48(5):1291-305. men see the expression of anger as exerting dominance, Abstract: Children have little control over where they where as women view it as a loss of control. There are live, what they eat, the financial circumstances of their also sex differences in the mode of anger expression. families, or the developmental activities and behaviors At ages 8 and older, girls are more likely to engage in that make them vulnerable to environmental "relational" aggression (eg, deliberate social contaminants. Minority and poor families ostracism). The most consistent and salient difference disproportionately live in communities with landfills, in anger expression is women's tendency to cry when hazardous waste facilities, incinerators, industrial angry, whereas men are more likely to throw things or plants, and old housing with poor indoor air quality and hit. The difference in physical aggression appears in lead-based paint. Residents of these communities are children who are as young as 1 to 2 years of age. also more likely than are more affluent communities to Despite an overall reduction in physical aggression consume fish on a regular basis from local waters, after 2 to 3 years of age, the sex difference remains many of which have banned fishing. Consequently, consistent into adulthood. In contrast to differences in these children and their families are exposed more physical aggression, differences in anger are few and frequently than are children in other communities to inconsistent up to 4 or 5 years of age. By this age, girls potentially dangerous chemicals that can affect health. tend to suppress the expression of anger consciously. Data indicate that poor and minority children have By about 7 to 8 years of age, adult like differences higher rates of asthma, elevated blood lead levels, become more consistent, with boys expressing more learning disabilities, and hyperactivity than do non- anger. minority and more affluent children. When a group of people is exposed unfairly and inequitably to toxins in Potter N. Differences in child rearing. Cultural contrasts: their communities, workplaces, and schools, a 783
- 792. phenomenon called environmentaldiscrimination or measured under all other conditions. CONCLUSIONS: environmental racism exists. Environmental justice is a Vigorous shakes of this infant model produced US governmental remedy that requires the application rotational responses similar to those resulting from of fair strategies and processes in the resolution of minor falls, but inflicted impacts produced responses inequality related to environmental contamination. The that were significantly higher than even a 1.5-m fall US response resulted in the establishment of offices of onto concrete. Because larger accelerations are Environmental Justice within the EPA and ATSDR and associated with an increasing likelihood of injury, the passage of important legislation and policies, such as findings indicate that inflicted impacts against hard the Community Planning and Right-to-Know Act of surfaces are more likely to be associated with inertial 1986, Executive Order 12898 (Federal Actions to brain injuries than falls from a height less than 1.5 m or Address Environmental Justice in Minority from shaking. Populations), and Executive Order 13045, a parallel order to protect low-income and minority children from Prater CD, Zylstra RG. Autism: a medical primer. Am Fam actual and potential environmental hazards. Physician 2002; 66(9):1667-74. Communities and advocacy groups play an important Abstract: Autistic disorder, a pervasive developmental role in promoting healthier environments for children. disorder resulting in social, language, or sensorimotor Frequently, low-income and minority communities are deficits, occurs in approximately seven of 10,000 perceived as less powerful, less organized, and ill persons. Early detection and intervention significantly equipped to defend against actual and potential sources improve outcome, with about one third of autistic of environmental contamination. Health care persons achieving some degree of independent living. professionals are in a strategic position to assist with Indications for developmental evaluation include no community development, organizing, and babbling, pointing, or use of other gestures by 12 empowerment through educational programming, months of age, no single words by 16 months of age, networking, and supporting other activities that bring no two-word spontaneous phrases by 24 months of age, attention to the plight of environmentally vulnerable and loss of previously learned language or social skills communities. at any age. The differential diagnosis includes other psychiatric and pervasive developmental disorders, Prange MT, Coats B, Duhaime AC, Margulies SS. deafness, and profound hearing loss. Autism is Anthropomorphic simulations of falls, shakes, and frequently associated with fragile X syndrome and inflicted impacts in infants. J Neurosurg 2003; tuberous sclerosis, and may be caused by lead 99(1):143-50. poisoning and metabolic disorders. Common Abstract: OBJECT: Rotational loading conditions have comorbidities include mental retardation, seizure been shown to produce subdural hemorrhage and disorder, and psychiatric disorders such as depression diffuse axonal injury. No experimental data are and anxiety. Behavior modification programs are available with which to compare the rotational helpful and are usually administered by response of the head of an infant during accidental and multidisciplinary teams, targeted medication is used to inflicted head injuries. The authors sought to compare address behavior concerns. Many different treatment rotational deceleration sustained by the head among approaches can be used, some of which are unproven free falls, from different heights onto different surfaces, and have little scientific support. Parents may be with those sustained during shaking and inflicted encouraged to investigate national resources and local impact. METHODS: An anthropomorphic surrogate of support networks. a 1.5-month-old human infant was constructed and used to simulate falls from 0.3 m (1 ft), 0.9 m (3 ft), Pratt HD, Greydanus DE. Violence: concepts of its impact and 1.5 m (5 ft), as well as vigorous shaking and on children and youth. Pediatr Clin North Am 2003; inflicted head impact. During falls, the surrogate 50(5):963-1003. experienced occipital contact against a concrete Abstract: Although nations continue to remain surface, carpet pad, or foam mattress. For shakes, involved in ongoing armed conflicts, the threat of investigators repeatedly shook the surrogate in an direct exposure to violence for American children and anteroposterior plane; inflicted impact was defined as youth is more likely to be from the interpersonal the terminal portion of a vigorous shake, in which the violence that occurs in homes, neighborhoods, and surrogate's occiput made contact with a rigid or padded schools. Exposure to interpersonal violence has a very surface. Rotational velocity was recorded directly and serious impact on most youth. Focusing on violence the maximum (peak-peak) change in angular velocity prevention remains a vital component of providing (delta theta(max)) and the peak angular acceleration comprehensive health care for all youth. (theta(max)) were calculated. Analysis of variance revealed significant increases in the delta theta(max) Premji SS, McNeil DA, Scotland J. Regional neonatal oral and theta(max) associated with falls onto harder feeding protocol: changing the ethos of feeding preterm surfaces and from higher heights. During inflicted infants. J Perinat Neonatal Nurs 2004; 18(4):371-84. impacts against rigid surfaces, the delta theta(max) and Abstract: The Calgary Health Region Neonatal Oral theta(max) were significantly greater than those 784
- 793. Feeding Protocol isthe culminating work of a broad adults did not believe that any of the characteristics of range of healthcare professionals, including staff children posed to them predisposed a child to abuse. In nurses, nurse practitioners, nurse educators, nurse contrast, 40% of respondents claimed child abuse could managers, dietitians, lactation consultants, clinical not occur in a family like the one in which they grew nurse specialists, and occupational therapists. The up. The majority perceived only one characteristic, protocol represents a synthesis of research evidence alcohol abuse, as a characteristic of child abusers. Few and expert opinion pertaining to the introduction and respondents (10%) believed that child abusers could management of oral milk feedings for high-risk infants not be helped, and 25% were not sure. Adults' in the neonatal intensive care unit. This evidence-based perceptions of child abuse and abusers varied by sex, neonatal oral feeding protocol is presented to share age, socioeconomic status, and whether the knowledge and skill required to create positive feeding respondents had children. The data indicate that there experiences while assisting high-risk infants to achieve are significant deficits in the respondents' knowledge of full oral feedings. Goals of this project include child abuse and neglect. promoting consistent neonatal nursing feeding practices and changing the ethos in relation to feeding Price JM, Glad K. Hostile attributional tendencies in interactions between caregiver and infant in the maltreated children. J Abnorm Child Psychol 2003; neonatal intensive care unit. This culture change will 31(3):329-43. assist nurses to identify what is unique about their Abstract: The hostile attributional tendencies of professional practice, which is of particular importance maltreated children in elementary school across key given the skill mix resulting from hospital relationship figures (i.e., parents, teachers, and peers), understaffing and a growing nursing workforce the relation between children's hostile attributional shortage. tendencies and the frequency and severity of maltreatment, and the role of children's hostile Premji SS, Paes B, Jacobson K, Chessell L. Evidence-based attributions of their parents in mediating the relation feeding guidelines for very low-birth-weight infants. between maltreatment and children's hostile Adv Neonatal Care 2002; 2(1):5-18. attributions of unfamiliar peers were examined. The Abstract: Clinical practice guidelines (CPG) for the sample consisted of 44 maltreated and 56 nutritional management of premature infants are nonmaltreated children (females = 51) of mixed limited. This project focused on the development of a ethnicity. Subjects were administered a 20-item research-based enteral feeding CPG for infants of < measure of attributional processes. The results 1,500 g. The CPG was based on an extensive literature indicated that relative to nonmaltreated children, review and developed through a process of consensus physically abused boys were more likely to attribute decision making by a team of clinical researchers. hostile intentions to a variety of relationship figures, Infants that weigh < 1,000 g initiate minimal enteral including their parents, an unfamiliar teacher, their best nutrition (MEN) at 48 hours; nutritional feedings begin friend, and unfamiliar peers. A positive relation was on day 5 to 6 of life. For infants between 1,000 and also found between the frequency of physical abuse 1,500 g, nutritional feedings begin at 48 hours and are and hostile attributional tendencies among males. advanced at a rate of less than 30 mL/kg per day. The Finally, support was found for the role of children's benefits and risks of continuous versus intermittent hostile attributions of their mothers in mediating the nasogastric tube feeding were inconclusive; therefore, relation between physical abuse and children's hostile the CPG does not stipulate a feeding method. Breast attributions of unfamiliar peers. The results support a milk is used preferentially, and specific guidelines for link between physical abuse and hostile attributional the definition and management of feeding intolerance tendencies in children in early elementary school. are provided. A follow-up study testing this CPG has been completed and is published in the original Price M, Kafka M, Commons ML, Gutheil TG, Simpson W. research section of this issue. Telephone scatologia. Comorbidity with other paraphilias and paraphilia-related disorders. Int J Law Prentky R. A sex offender as a patient. Am Fam Physician Psychiatry 2002; 25(1):37-49. 2005; 72(7):1386, 1389. Prudent N, Johnson P, Carroll J, Culpepper L. Attention- Prentky RA, Janus ES, Seto MC. Introduction. Human deficit/hyperactivity disorder: presentation and sexual aggression. Ann N Y Acad Sci 2003; 989:ix- management in the Haitian American child. Prim Care xiii. Companion J Clin Psychiatry 2005; 7(4):190-7. Abstract: A case study of a young Haitian American is Price JH, Islam R, Gruhler J, Dove L, Knowles J, Stults G. presented that is illustrative of cultural issues that Public perceptions of child abuse and neglect in a influence care of those with attention- midwestern urban community. J Community Health deficit/hyperactivity disorder (ADHD). Medications 2001; 26(4):271-84. are the preferred treatment for ADHD and can be Abstract: This study found that the majority of urban combined with psychological intervention. However, 785
- 794. many Haitians andHaitian Americans see psychoactive partially offset by cost savings on formula and health medications as leading to substance abuse or mental care. CONCLUSIONS: Community health nurse and illness. Efficacious psychosocial treatments include peer counselor support can increase breastfeeding contingency management, parent training, and behavior duration in low-income women, and has the potential therapy; cognitive-behavioral treatment has not been to reduce total costs including the cost of support. helpful. Complementary and alternative medicine might have appeal; primary care physicians can help Puklova V, Cerna M, Smid J et al. Copper saturation families to assess such treatments and not to be enticed pathways of the urban population in the Czech by expensive ones of little benefit. A determinant of Republic. Cent Eur J Public Health 2001; 9(3):119-25. the treatment a family pursues is their perception of the Abstract: The estimation of the copper saturation cause of the ADHD behaviors. While there is no term pathways of the Czech urban population is presented. for ADHD in the Haitian-Creole language, in the The data on copper concentrations proceed from the Haitian culture the behaviors consistent with the System of monitoring the environmental impact on diagnosis might be interpreted as indicating a poorly population health in the Czech Republic in the period raised child whose behavior could be modified by 1994-1998. The copper concentrations were monitored parental discipline, an intentionally bad child, or a in foodstuffs from the commercial network, in drinking psychically victimized child suffering from an water at the outlets of the waterworks and in the public "unnatural" condition. "Natural" ailments are attributed water main networks, and in the ambient air. The to natural forces (e.g., wind, temperature), while copper levels were measured also in biological material "unnatural" ones are attributed to bad spirits or to obtain the data on the copper saturation of the punishment by God. Families may "lift their feet" population under monitoring. The copper intake from (Leve pye nou: to see a Hougan or voodoo priest) to foodstuffs and drinking water did not vary significantly determine the unnatural cause. Haitian Americans often either in the particular years of monitoring or combine therapeutic foods that are considered cold in individual cities. The same concerns also the copper nature, natural sedatives and purgatives from herbal levels in biological material. The total copper intake for medicine, religious treatments, and Western medicine. an average adult was estimated to be 20.2 Immigrants often lack support of extended families in micrograms/kg b.w./d., i.e. 1300 micrograms/d. Over an environment not supportive of their interpretation of 99% of the total intake was that from the diet. The child behaviors and traditionally accepted parental exposure from the intake of drinking water as well as disciplinary style. Stigma, language, cultural from ambient air was low. The total daily intake lies in conceptions, concerns about governmental agencies, the interval 1000-2000 micrograms/d which is usually and physician bias can all be barriers to care for found in the similar studies of the copper intake. It immigrant families. Primary care and behavioral represents only 40% of the daily dietary copper intake integration are useful in managing families from other recommended by the JECFA FAO/WHO Commission, cultures. 1982. The copper levels in biological material did not differ from the reference values, and did not indicate Pugh LC, Milligan RA, Frick KD, Spatz D, Bronner Y. any evincible hyposaturation of the population with Breastfeeding duration, costs, and benefits of a support copper. program for low-income breastfeeding women. Birth 2002; 29(2):95-100. Pulido ML. Pregnancy: a time to break the cycle of family Abstract: BACKGROUND: Breastfeeding can violence. Health Soc Work 2001; 26(2):120-4. ameliorate some of the complex health issues faced by low-income families. Women who breastfeed and their Puligheddu M, de Munck JC, Stam CJ et al. Age distribution infants have lower health care costs compared with of MEG spontaneous theta activity in healthy subjects. those who formula feed. Increasing the duration of Brain Topogr 2005; 17(3):165-75. breastfeeding is recognized as a national priority, Abstract: This study investigates the possible relevance particularly for low-income women. This community- of distribution and age variation of spontaneous theta based randomized clinical trial involving low-income activity (4-8 Hz) in normal subjects using mothers compared usual care with an intervention magnetoencephalography (MEG) recordings. comprising hospital and home visits, and telephone Spontaneous theta was recorded with a 151-channel support by a community health nurse/peer counselor MEG in healthy subjects; moreover, in a group of 10 team for 6 months after delivery. METHODS: Forty- subjects, simultaneous MEG-EEG was recorded in one women were recruited after delivery of a full-term order to compare the two methods. Theta was divided singleton infant and randomly assigned to intervention in two sub-bands: T(A) (4-6 Hz) and T(B) (6-8 Hz). or usual care groups. RESULTS: Women receiving the The pre-processed data were transformed into the community health intervention breastfed longer than frequency domain by Fast Fourier Transform (FFT)- the women receiving usual care. The infants in the based software by subdividing the data in epochs of 5 intervention group had fewer sick visits and reported sec, on which FFT amplitudes are computed. use of fewer medications than infants in the usual care Moreover, on all trials a simple model of a single group. The intervention cost ($301/mother) was 786
- 795. electric current embeddedin a spherically symmetric have led to the proposal that there is a 'unified conductor was fitted automatically to the magnetic hypothesis', the essential feature of which is hypoxic fields and projected onto an averaged MRI. The results brain swelling secondary to cervicomedullary injury. It obtained show that FFT-based theta power spectrum has been suggested that less than violent forces may be was distributed in adults with the highest power over involved and even that some cases may not be due to the posterior parietal and occipital areas with T(B) trauma at all. The purpose of this paper is to provide a dominance. The dipole analysis resulted in a mid- critical review of the data upon which these sagittal distribution, though the youngest group suppositions are based on a background of what is displayed theta dipoles fitting more posteriorly respect already known. It is submitted that there are serious to the adults and the elderly. These results suggest that flaws in the methodology; the conclusions reached spontaneous theta activity is a diffuse and pervasive cannot logically be drawn from the data; and the rhythm which shows some different topographical 'unified hypothesis' is not supported by the evidence. distribution among the age groups. Whether the On the basis of the data presented, it is also difficult to prevalent posterior distribution of theta is the sustain the secondary hypothesis purporting to describe expression of distinct networks or the outcome of a minority cohort with 'infantile encephalopathy with complex dynamics are questions of possible relevance subdural and retinal bleeding' of non-traumatic in the organization of higher order processes. causation. Pulkki L, Keltikangas-Jarvinen L, Ravaja N, Viikari J. Puntis JW, Kirpalani H. Letter from Puntis. J Clin Forensic Child-rearing attitudes and cardiovascular risk among Med 2005; 12(3):167. children: moderating influence of parental socioeconomic status. Prev Med 2003; 36(1):55-63. Purcell R, Pathe M, Mullen PE. The prevalence and nature Abstract: BACKGROUND: We examined associations of stalking in the Australian community. Aust N Z J of parental socioeconomic status (SES) and hostile Psychiatry 2002; 36(1):114-20. maternal child-rearing attitudes with the insulin Abstract: OBJECTIVE: This study examines the extent resistance syndrome (IRS) precursors in children. and nature of stalking victimisation in a random METHODS: The participants were 210 randomly community sample. METHOD: A postal survey was selected healthy boys and girls who participated in the distributed to 3700 adult men and women selected epidemiological Cardiovascular Risk in Young Finns from the electoral roll in the State of Victoria. Outcome study and who were 3, 6, and 9 years of age at the three measures included the lifetime and annual cumulative study phases. Hostile maternal child-rearing attitudes incidence of stalking, the duration and methods of were self-rated by the mothers. SES consisted of the harassment, rates of associated violence and responses years of education of the parents and family income. to victimisation. RESULTS: Almost one in four The IRS comprised serum insulin, high-density respondents (23.4%;432) had been stalked, the lipoprotein cholesterol, triglycerides, systolic blood unwanted behaviour they were subjected to being both pressure, and body mass index. RESULTS: Among repeated and fear-provoking. One in 10 (197) had boys, low parental SES and strict maternal discipline experienced a protracted course of stalking involving were associated with heightened somatic risk. Among multiple intrusions spanning a period of at least one girls, parental SES moderated the association between month. Women were twice as likely as men to report maternal child-rearing attitudes and somatic risk so that having been stalked at some time in their lives, though belonging to a high-SES family seemed to protect the the rates of victimisation in the 12 months prior to the girls against the adverse health effects of hostile study did not differ significantly according to gender. mothering. CONCLUSIONS: The findings indicate Younger people were significantly more likely than that the psychosocial environment is differentially older respondents to report having been stalked. related to girls' and boys' somatic risk. It is concluded Victims were pursued by strangers in 42% of cases. that belonging to high social class may buffer against The most common methods of harassment involved childhood stress, while belonging to low social class unwanted telephone calls, intrusive approaches and may enhance vulnerability to stressors in childhood. following. Associated threats (29%) and physical assaults (18%) frequently arose out of the stalking. Punt J, Bonshek RE, Jaspan T, McConachie NS, Punt N, Significant social and economic disruption was created Ratcliffe JM. The 'unified hypothesis' of Geddes et al. by the stalking for 63% of victims. Most sought is not supported by the data. Pediatr Rehabil 2004; assistance to manage their predicament (69%). 7(3):173-84. CONCLUSIONS: The experience of being stalked is Abstract: Inflicted head injury to the developing brain common and appears to be increasing. Ten percent of frequently results in serious disability. The people have been subjected at some time to an episode pathogenesis of the neuraxial and ocular findings in of protracted harassment. Assaults by stalkers are infants believed to have suffered inflicted head injury disturbingly frequent. Most victims report significant remains the subject of considerable debate. Recent disruption to their daily functioning irrespective of neuropathology studies of fatal cases of inflicted head exposure to associated violence. injury and of a foetal/perinatal non-traumatic model 787
- 796. Purssell E. HIVand breastfeeding feedback. Prof Nurse medical care in King Abdulaziz University Hospital. 2002; 18(2):64; author reply 64-5. CONCLUSION: Diabetic ketoacidosis is a fatal complication among our diabetic patients. Purugganan OH, Stein RE, Silver EJ, Benenson BS. Implementing a patient education program to increase Exposure to violence and psychosocial adjustment awareness of the disease is the most important step in among urban school-aged children. J Dev Behav the prevention of this complication. The authorities Pediatr 2003; 24(6):424-30. should ensure availability of insulin to all patients, Abstract: This study determines the relationship either free or at lower prices. The role of cultured and between psychosocial adjustment in school-aged socioeconomic factors in aggravating or precipitating children and one aspect of exposure to violence, the diabetic ketoacidosis should always be considered and proximity of exposure, in terms of (1) "physical" where possible, eliminated proximity and (2) "emotional" proximity to the victims of violence. A convenience sample of 175 children Qouta S, Punamaki RL, El Sarraj E. Prevalence and aged 9 to 12 years from a primary care clinic of a large determinants of PTSD among Palestinian children urban hospital were interviewed about their exposure to exposed to military violence. Eur Child Adolesc violence using the Children's Report of Exposure to Psychiatry 2003; 12(6):265-72. Violence. Psychosocial adjustment was measured Abstract: The prevalence and determinants of PTSD through maternal reports using the Child Behavior were assessed among 121 Palestinian children (6-16 Checklist (CBCL) and the Personal Adjustment and years; 45% girls and 55% boys) living in the area of Role Skills Scale (PARS III). Children were bombardment. The mothers (21-55 years) and the categorized into three groups according to their closest children themselves reported their exposure to military proximity to exposure to violence ("victim" > violence (being personally the target of violence or "witness" > exposure through other people's "report") witnessing it towards others) and symptoms of and two groups according to emotional proximity posttraumatic stress disorders (PTSD: intrusion, (victim was a "familiar person" or "stranger"). All avoidance and hypervigilance). The results showed that children (23/175) who scored above the CBCL clinical 54% of the children suffered from severe, 33.5 % from cutoff (T score > 63) were witnesses or victims of moderate and 11 % from mild and doubtful levels of violence. The CBCL total T scores (higher score = PTSD. Girls were more vulnerable; 58% of them more maladjustment) showed that the "victims" group suffered from severe PTSD, and none scored on the (mean 52.4) scored significantly higher than the mild or doubtful levels of PTSD. The child's gender "witness" group (mean 50.0) and "report" group (mean and age, mother's education and PTSD symptoms were 47.4). The PARS III total scores (lower scores = more significant, and the exposure to traumatic experiences maladjustment) showed that the "victims" group (mean marginally significant determinants of children's PTSD 87.5) scored significantly lower than the "witness" symptoms. The most vulnerable to intrusion symptoms group (mean 93.1) and "report" group (mean 98.2). The were younger girls whose mothers showed a high level relationship of the child to the victim was not of PTSD symptoms, whereas those most vulnerable to associated with significantly different CBCL and avoidance symptoms were children who had personally PARS III scores. Children exposed to more proximal been targets of military violence and whose mothers forms of violence as victims or witnesses exhibited were better educated and showed a high level of PTSD more psychosocial maladjustment. symptoms. The results are discussed in the context of military violence interfering with the protective Qari FA. Precipitating factors for diabetic ketoacidosis. function of family and home. Saudi Med J 2002; 23(2):173-6. Abstract: OBJECTIVE: The aim of this study is to Quance K. Erinn Walton's letter in the September issue. identify the precipitating factors from a medical and RCM Midwives 2005; 8(12):500. social point of view, in addition to discussing some clinical and laboratory aspects of diabetic ketoacidosis. Quayle E, Taylor M. Child seduction and self-representation METHODS: Sixty-eight patients were admitted to on the Internet. Cyberpsychol Behav 2001; 4(5):597- King Abdulaziz University Hospital, Jeddah, Kingdom 608. of Saudi Arabia, over a 2 year period, (April 1999 Abstract: This paper presents a case study of a man through to April 2001). Diagnosis of diabetic charged with the offense of downloading child ketoacidosis was based on: clinical features, serum pornography from the Internet. He had used the sugar >12 mmol/L with ketonuria, bicarbonate and Internet to traffic child pornography, and, in addition, base deficit. RESULTS: The mean age was 22.5 years to locate children to abuse, to engage in inappropriate (0.5-87) years with a male to female ratio of 1.4:1. sexual communication with children, and to Poor compliance to continue the treatment and communicate with other pedophiles. Such offenses infection were the most common precipitating factors were facilitated by self-representing in Chat rooms as being responsible for 54.4% and 28% cases. A low both a child and an adult. The case study illustrates mortality rate of 2.9% in our study compared favorably how such offenders move through a repertoire of with other studies, which contributed to a high level of 788
- 797. offending behavior anddiscusses the role that the Abstract: OBJECTIVES: To ascertain how UK Internet can play in supporting inappropriate and accident and emergency (A&E) departments access the disinhibited sexual behavior that victimizes children child protection register, their levels of satisfaction through the trading of child pornography and possible with that access and their criteria for checking the child seduction. The Internet is seen to play a unique register. METHODS: A postal questionnaire was sent role in allowing individuals to self-represent aspects to 254 "major" A&E departments listed in the 1996 that might otherwise remain hidden or dormant. British Association for Accident and Emergency Medicine directory. RESULTS: 190 questionnaires Quayle E, Taylor M. Model of problematic internet use in were returned (response rate 75%). Ninety (48%) people with a sexual interest in children. Cyberpsychol responding departments access the register through the Behav 2003; 6(1):93-106. duty social worker, 33 (17%) use a computerised copy, Abstract: Agencies working with sex offenders are 32 (17%) a hard copy and 27 (14%) a combination. starting to see the emergence of people with a sexual Twenty seven of 33 respondents (82%) using a interest in children who meet some of their needs computerised copy were satisfied with their mode of through the use of child pornography, or the seduction access. This compares with figures of 21 (66%) for of children, through the Internet. While CBT models hard copy, 45 (50%) for duty social worker and 14 dominate our understanding of sex offenders, there has (50%) for a combination. No departments using the been little research into the role that such new duty social worker checked all patients routinely technologies may play in offending behavior. Data compared with 23 (72%) for hard copy, 22 (67%) for from the COPINE project has been used to generate a computer copy and 12 (44%) for departments using a model of such offending behavior that emphasizes the combination of modes of access. CONCLUSION: role of cognitions in both the etiology, engagement There is no uniformity of the way in which UK A&E with and problematic use of the Internet for those with departments access the child protection register and a sexual interest in children. Such a model seeks to there is also substantial variation in the criteria used to incorporate contemporary thinking about the role of check the register. This survey suggests that the most cognitions in Pathological Internet Use, but applies this common form of access (via the duty social worker) from a nonpathological perspective. This model is a often fails to meet the needs of A&E departments, first step towards providing a conceptual framework principally because it takes so long. for such offending that will help inform both assessment and therapy. Quinlivan JA, Evans SF. A prospective cohort study of the impact of domestic violence on young teenage Quillin JM, Jackson-Cook C, Bodurtha J. The link between pregnancy outcomes. J Pediatr Adolesc Gynecol 2001; providers and patients: how laboratories can ensure 14(1):17-23. quality results with genetic testing. Clin Leadersh Abstract: INTRODUCTION: The incidence of Manag Rev 2003; 17(6):351-7. domestic violence among pregnant Australian Notes: GENERAL NOTE: KIE: 41 refs.. teenagers is higher than rates reported for the general GENERAL NOTE: KIE: KIE Bib: genetic screening community. However, there are limited data that Abstract: Advances in genetic testing technology can address the impact of this abuse upon pregnancy provide important opportunities for health outcome. We have examined the significant antenatal improvement. Simultaneously, they entail complexity associations of domestic violence in young teenage in laboratory analysis and interpretation. The nature of pregnancy, and the impact of this abuse upon genetic testing may engender implications distinct from pregnancy outcome. DESIGN, SETTING, other diagnostic tests. In this article, we summarize PARTICIPANTS: A multicenter prospective cohort these implications, including the role of informed study was performed between January 1, 1997 and consent; quality assurance in diagnostic testing June 30, 1999. Patients were interviewed and services; interpretation of the test results; patient completed questionnaires in the antenatal period to support; appropriate disclosure; and regulations establish whether they were victims of domestic relevant for laboratories involved with genetic tests. violence. Labor and delivery details were Research and clinical laboratories need to stay abreast independently collated after discharge for mother and of these advancing technologies and their implications infant. Data were analyzed using an analysis of for health-care patients and providers. Collaboration variance, with a P-value of 0.05 considered significant. between testing personnel, geneticists, and other RESULTS: Of 537 patients enrolled in the study, 157 health-care providers is necessary to ensure that (29.2%) were victims of domestic violence; 380 patients receive the full benefits from testing, including (70.8%) were not and acted as pregnant teenage a clear understanding of their genetic test information. controls. Key findings were that teenage victims of domestic violence (VDV) were more likely to smoke, Quin G, Evans R. Accident and emergency department drink alcohol, or use illegal drugs than controls (P < access to the child protection register: a questionnaire 0.0001). VDV had a higher incidence of infectious survey. Emerg Med J 2002; 19(2):136-7. morbidity and Pap smear abnormalities (P < 0.007) and psychosocial pathology (P < 0.0001) than controls. A 789
- 798. higher incidence ofpuerperal and neonatal morbidity Rabahi MF, Rodrigues AB, Queiroz de Mello F, de Almeida was observed in VDV and their newborns compared to Netto JC, Kritski AL. Noncompliance with controls (P < 0.007). The estimated cost of hospital tuberculosis treatment by patients at a tuberculosis and care for teenage VDV was double that of the Australian AIDS reference hospital in midwestern Brazil. Braz J average. CONCLUSION: We need to identify all Infect Dis 2002; 6(2):63-73. teenage mothers exposed to domestic violence and Abstract: INTRODUCTION: In developing countries, provide them with expert intervention services. Early there is little information about the risk factors that intervention programs are likely to be cost effective. predict noncompliance with tuberculosis (TB) treatment in hospitals. OBJECTIVE: This study Quinn J. The Children's Aid Society community schools: a analyzes possible factors associated with full-service partnership model. New Dir Youth Dev noncompliance with TB treatment among patients 2005; (107):15-26, table of contents. treated at HAA. DESIGN: A retrospective cohort study Abstract: In 1989, the Children's Aid Society (CAS) was made including all patients who initiated TB created an unprecedented partnership with the New treatment at HAA, from January to December 1998. A York City Board of Education by developing a standard form was used to review medical records and comprehensive response to the pressing needs of to collect data on each patient. This data was evaluated children and families in the northern Manhattan in comparison with data from the state TB control neighborhood of Washington Heights. After three years program. RESULTS: Of the 341 patients included in of careful planning, CAS and the New York City the study, 186 (61.2%) were considered cured and 67 public schools opened the first community school at (22%) were non-compliant. The factors associated with Intermediate School 218, offering a full array of noncompliance were: previous anti-TB treatment (RR supports, services, and learning opportunities. Adding, = 1.95, 95% CI 1.29 to 2.93), prescription of drugs on average, one partnership school per year and other than the standard first-line regimen proposed by remaining very flexible in adapting its model to the the Brazilian Health Ministry (Rifampin + Isoniazide + individual needs of each community, CAS now has Pyrazinamide) (RR = 0.54, 95% CI 0.35 to 0.83), the thirteen community schools around New York City. need for hospitalization (RR = 2.19, 95% CI 1.46 to The model's flexibility is seen also in the success of its 3.29) and non-inclusion in the hospital s TB Control national and international adaptation-an intentional part Program for treatment follow up (RR = 0.54, 95% CI of CAS's work. 0.35 to 0.82). SETTING: Anuar Auad Hospital (HAA) Goiania, Goias, Brazil. CONCLUSION: Our results Quinn TL. Sexual orientation and gender identity: an indicate the importance of establishing Tuberculosis administrative approach to diversity. Child Welfare Control Programs in hospitals, while paying special 2002; 81(6):913-28. attention to patients with risk factors for Abstract: Research indicates that gay, lesbian, bisexual, noncompliance with TB treatment. transgender, and questioning (GLBTQ) teens in the care of a northeastern child welfare department do not Raboteg-Saric Z, Rijavec M, Brajsa-Zganec A. The relation receive adequate services due to the workers' of parental practices and self-conceptions to young homophobic attitudes. These teens are at high risk for adolescent problem behaviors and substance use. Nord alcohol and drug abuse, homelessness, prostitution, and J Psychiatry 2001; 55(3):203-9. suicide. A training module was developed for Abstract: The object of the present research was to administrators. Pretest and posttest instruments examine the role of parenting practices for young measured their education and support of GLBTQ issues adolescent psychosocial adjustment and self-regulation before and after the training. problems. The sample included 287 sixth- and seventh- grade subjects from intact families. The participants Quintana Y, Nambayan A, Ribeiro R, Bowers L, Shuler A, completed a questionnaire that measured variables O'Brien R. Cure4Kids - building online learning and including family interaction, parental involvement in collaboration networks. AMIA Annu Symp Proc 2003; children's activities, parental support, joint decision- 978. making, and monitoring of children's behavior. Abstract: The International Outreach Program of St. Children's involvement with friends, after-school Jude Childrens' Research Hospital has been developing activities, school achievement, and self-reported programs to help countries with limited resources externalizing behaviors (problem behaviors, cigarette develop treatment centers to treat children with and alcohol use) were also measured. Self-concept catastrophic diseases such as pediatric cancer and domains (scholastic competence, social acceptance, AIDS. Cure4Kids (www.cure4kids.org) is the Internet and behavioral conduct) were assessed with Harter's learning network that delivers medical education to Self-Perception Profile. The findings indicated that doctors and nurses on pediatric cancer and AIDS. The self-conceptions of positive behavioral conduct and objective of Cure4Kids is not only education, but also higher parental monitoring of children's activities were to provide tools for communications and collaborations consistently negatively related to young girls' and boys' among individuals. behavior problems and substance use. Parental monitoring was higher for girls and for younger 790
- 799. children. Lower monitoringwas also related to utilization of temporal information. Given the observed children's pattern of after-school activities that were involvement of the frontal-subcortical networks in connected to at-risk behavior. Parental involvement ADHD, we examined judgment of durations in and supervision of children's day-to-day activities seem children with ADHD (N = 27) and age- and gender- particularly important in socializing children's behavior matched control subjects (N = 15). Two judgment tasks at the time of early adolescence. were administered: short duration (550 ms) and long duration (4 s). The two groups did not differ Radimer KL, Radimer KL. Measurement of household food significantly in their judgments of short interval security in the USA and other industrialised countries. durations; however, subjects with ADHD performed Public Health Nutr 2002; 5(6A):859-64. more poorly when making judgments involving long Abstract: OBJECTIVE: To describe the history and intervals. The groups also did not differ on a judgment- current status of household food security measurement. of-pitch task, ruling out a generalized deficit in CONCLUSIONS: In the 1980s evidence of rising auditory discrimination. Selective impairment in levels of hunger was a concern for many, but disputed making judgments involving long intervals is by some, Americans. Acknowledgement and consistent with performance by patients with frontal quantification of hunger was hindered by the lack of an lobe lesions and suggests that there is a deficiency in accepted definition and measure of hunger. Qualitative the utilization of temporal information in ADHD research at Cornell provided a conceptual framework, (possibly secondary to deficits in working memory description, definition and survey items for hunger. and/or strategy utilization), rather than a problem The Community Childhood Hunger Identification involving a central timing mechanism. Project developed an instrument used in numerous communities. Based upon these initiatives, widely Raghavan C, Swan SC, Snow DL, Mazure CM. The accepted definitions of hunger and food insecurity, and mediational role of relationship efficacy and resource the US Household Food Security Module for its utilization in the link between physical and measurement, now exist. The module classifies psychological abuse and relationship termination. households as food-secure, or food-insecure without Violence Against Women 2005; 11(1):65-88. hunger or with moderate or severe hunger, and contains Abstract: This study examines the roles of physical and household-, adult- and child-referent items. Its emotional abuse and resource utilization, relationship inclusion in the Current Population Survey (CPS) since efficacy, and childhood abuse on relationship status 1995 has yielded annual estimates of food insecurity. A (together or separated) in a sample of 69 low-income, six-item short form of the module, for surveys with nonsheltered battered women. Separate path models severe time constraints, classifies households only as were conducted for physical and psychological abuse. food-secure or food-insecure without or with hunger Increased physical abuse was related to separated and contains no child-specific items. Surveys using the status, increased resource utilization, and decreased 18-item or short-form module can compare results with efficacy. The effect of physical abuse on status was published national data from the CPS. Information mediated by resource utilization and efficacy, whereas about the module is available at the effect of psychological abuse on status was http://www.ers.usda.gov/briefing/foodsecurity and partially mediated only by utilization. Increased http://www.fns.usda/fsec. Current research on food childhood abuse was associated with together status. security measurement includes measurement of Baseline psychological but not physical abuse individual food insecurity and hunger, module predicted a longer term separated status thereby performance regarding hunger duration and frequency, suggesting that the effects of psychological abuse may performance of the module in population sub-groups, be enduring. and the effect of translations on module meaning and performance. National surveys in Canada, New Rahi JS, Manaras I, Tuomainen H, Hundt GL. Meeting the Zealand and Australia also have measured food needs of parents around the time of diagnosis of security. disability among their children: evaluation of a novel program for information, support, and liaison by key Radonovich KJ, Mostofsky SH. Duration judgments in workers. Pediatrics 2004; 114(4):e477-82. children with ADHD suggest deficient utilization of Abstract: OBJECTIVE: Key worker programs for temporal information rather than general impairment in families of children with disabilities, to promote timing. Child Neuropsychol 2004; 10(3):162-72. information provision, emotional support, and liaisons Abstract: Clinicians, parents, and teachers alike have among different agencies, have long been advocated noted that individuals with ADHD often have but not extensively implemented. We report the impact difficulties with "time management," which has led on the experiences of parents and the practices of some to suggest a primary deficit in time perception in health care professionals of a novel, hospital-based, ADHD. Previous studies have implicated the basal key worker service (Community Link Team [CLT]), ganglia, cerebellum, and frontal lobes in time implemented in the pediatric ophthalmology estimation and production, with each region purported department of Great Ormond Street Hospital (London, to make different contributions to the processing and United Kingdom). DESIGN, SETTING, AND 791
- 800. PARTICIPANTS: The CLTincluded 2 members, 1 of service were identified. First, provision, within the whom was present during the first outpatient outpatient setting, of a dedicated "quiet room" and assessment by the consultant ophthalmologist of any office space for key workers was an essential physical child newly diagnosed as visually impaired (corrected requirement. Second, early identification of the key acuity of 6/18 or worse in the better eye) and workers as the parents' point of contact was essential; accompanied the family during other assessments this was achieved in this case by the CLT members performed during that visit. A dedicated room was used attending the first consultation, combined with their by the CLT members to spend time with each family detailed debriefing of families at the end of the after completion of the clinical assessments. The CLT outpatient visit. Third, the adoption of certain tasks by members reiterated and/or clarified clinical information the key workers, including some previously undertaken already provided, specifically advised the families by ophthalmologists, helped to define the liaison role about visual stimulation programs and the benefits and of the program. These tasks included discussing the purpose of visual impairment certification, and process and benefits of visual impairment certification, provided information about educational and social contacting the advisory teacher for the visually services. The same CLT member met the family at impaired, and providing written reports to educational subsequent visits to the department and acted as the and social services; analogous tasks would exist for first point of contact for parents. Parents of children other disabilities. CONCLUSIONS: Research on the newly diagnosed with visual impairment and/or needs of families of visually impaired children has ophthalmic disorders at Great Ormond Street Hospital been limited but indicates that, as with other childhood participated in a 2-stage study to assess their needs, disabilities, the greatest needs during the critical period their views about the processes of care, and their around diagnosis are for information, especially about overall satisfaction. The study included a questionnaire educational and social services, and emotional support survey with 2 standard instruments, ie, the Measure of from professionals, informal and formal social Processes of Care, specifically developed and used to networks, and support groups. Although not widely assess parents' views of the degree to which health implemented or studied, key worker programs for services for a range of childhood disorders are family- families of visually impaired children, particularly in centered, and the short form of the Client Satisfaction the context of multidisciplinary visual impairment Questionnaire, used to assess overall parental teams, have been advocated, on the basis of their satisfaction or dissatisfaction with services in the potential to facilitate coordination of health, preceding year, as in other studies of parental educational, and social services. The model of such satisfaction with pediatric services. This was followed provision evaluated in this study reflects the fact that it by in-depth individual interviews with a subsample of was established as an outpatient service in a tertiary parents who returned completed questionnaires. The referral center for pediatric ophthalmology in the views of families with experience with the new service United Kingdom, with the specific structure and (CLT) were compared with those without. The specialized roles for health care professionals that this experiences of health care professionals before and requires. Different models might be more suitable in after implementation of the service were elicited other settings in the United Kingdom or elsewhere. through group interviews and were compared. We However, the important general lessons learned should recognized that any differences would be attributable to guide implementation of such services for families of both the direct effects of the CLT, ie, actual services children with other disabilities. The recently launched provided by the team, and indirect effects, ie, broader National Service Framework for Children provides a changes in approaches or practices within the new context and standards for meeting the needs of department resulting from shifting roles and disabled children and their families in the United responsibilities regarding specific elements of Kingdom and may also guide initiatives elsewhere. The management. Therefore, both the specific findings of this study support implementation of tasks/activities undertaken by the CLT and broader programs for information provision, support, and changes in practices within the department were liaison by key workers in all specialized centers for the identified. RESULTS: Seventy-nine families from the assessment and diagnosis of children with serious pre-CLT group and 68 from the post-CLT group (68% visual problems. Implementation of similar services for and 65% of those invited, respectively) participated in families with children with other disabilities is likely to the questionnaire survey, of which 29 and 19 (71% and be equally valuable. 79% of those invited), respectively, took part in interviews. The 2 groups were comparable with respect Raine A. Biosocial studies of antisocial and violent behavior to sociodemographic and clinical characteristics. in children and adults: a review. J Abnorm Child Parents and health care professionals agreed that the Psychol 2002; 30(4):311-26. CLT provided important information and facilitated Abstract: Despite increasing knowledge of social and access to specific services, while providing both biological risk factors for antisocial and violent emotional and social support and facilitating meetings behavior, we know surprisingly little about how these with other families with children with similar two sets of risk factors interact. This paper documents conditions. A number of key generic components of the 39 empirical examples of biosocial interaction effects 792
- 801. for antisocial behaviorfrom the areas of genetics, complex decision when there are multiple treatment psychophysiology, obstetrics, brain imaging, options that differ in their profiles of risk and benefit neuropsychology, neurology, hormones, over time. Doctors from a single specialist paediatric neurotransmitters, and environmental toxins. Two main cardiac unit participated in a correlational study that themes emerge. First, when biological and social used a novel tool (subjective multi-state survival factors are grouping variables and when antisocial graphs) to elicit their beliefs about the likely outcome behavior is the outcome, then the presence of both risk of different treatments. Doctors' preferences were more factors exponentially increases the rates of antisocial closely related to their beliefs about long term, rather and violent behavior. Second, when social and than short term, outcomes. This is consistent with antisocial variables are grouping variables and placing greater value on far future than on immediate biological functioning is the outcome, then the social life years, highlighting the importance of incorporating variable invariably moderates the antisocial-biology patients' values for these outcomes into decisions of relationship such that these relationships are strongest this kind. Beliefs about likely outcomes differed with in those from benign home backgrounds. It is argued whether or not doctors encountered former paediatric that further biosocial research is critical for establishing patients who were now adults, illustrating the difficulty a new generation of more successful intervention and of deciding what risk information should be available prevention research. when the evidence base on outcomes is limited. Some problems of risk communication are identified, and the Raitt FE, Zeedyk MS. False memory syndrome: value of multi-state survival graphs as an aid to undermining the credibility of complainants in sexual communication is discussed. offences. Int J Law Psychiatry 2003; 26(5):453-71. Rakowski E. Who should pay for bad genes? Calif Law Rev Rajab LD. Traumatic dental injuries in children presenting 2002; 90(5):1345-414. for treatment at the Department of Pediatric Dentistry, Notes: GENERAL NOTE: KIE: 110 refs. Faculty of Dentistry, University of Jordan, 1997-2000. GENERAL NOTE: KIE: KIE Bib: health Dent Traumatol 2003; 19(1):6-11. care/economics; genetic intervention; wrongful life Abstract: Data pertaining to traumatic dental injuries of Abstract: Parents have long been able to influence the children seeking care at the teaching clinics of the genetic composition of their children through their Department of Pediatric Dentistry, Faculty of choice of a reproductive partner, if only very Dentistry, University of Jordan over a period of 4 years approximately. They are, however, increasingly able to were analyzed. The prevalence of traumatic dental determine the genetic make-up of their children in injuries was 14.2% from 2751 subjects. The peak other, more precise ways, such as by selecting a incidence of injury was 10-12-year age group. Boys particular gamete or embryo or by genetically were more affected (18.3%) than girls (10.1%). Most modifying an embryo prior to artificial implantation. injuries occurred at home (63.2%), and falls were the This Article discusses parents' obligations to their leading cause of injuries (49.9%). Most injuries children and other members of the community involved one tooth (69.3%) and maxillary central stemming from their children's genes. In a just state, it incisors were the most affected teeth (90.4%). The argues, parents would be responsible for redressing any commonest injury was uncomplicated crown fracture genetic disadvantage their children suffer as a result of (62.5%), then complicated crown fracture (28.7%). parents' voluntary actions. Within the context of a Only 17.1% of children sought treatment the same day liberal egalitarian account of distributive justice, this or the day after the injury. At the initial examination, responsibility might most fairly be discharged through cases seen after a long post-traumatic period required a compulsory insurance plan that provides more complicated treatment than those presented compensation to genetically disadvantaged children within a short time period. Preventive educational when they might have had non-disadvantaged children program should be instituted in Jordan, directed at instead would in some circumstances incur greater parents and school teachers to inform them about the liability, because they could not fairly push the cost of importance of traumatic dental injuries and the benefit their choices off on other members of the insurance of immediate attendance for dental treatment. pool. The Article also asks whether parents wrong a Furthermore, improving the knowledge of dental child by allowing it to be born with a genetic practitioners through continuing education would also impairment when, had they taken steps to remove the help in minimizing sequelae of traumatic dental impairment, the unimpaired child they had would have injuries. been a different person from the genetically disadvantaged child because the better-off child's Rakow T. Differences in belief about likely outcomes capacities and experiences differed considerably from account for differences in doctors' treatment those that the disadvantaged child would have had. preferences: but what accounts for the differences in Contrary to many people's moral intuitions, the Article belief? Qual Health Care 2001; 10 Suppl 1:i44-9. argues that parents do not wrong such a child. Abstract: Doctors, patients, and their relatives face a Nevertheless, parents remain morally obligated to bear any added costs occasioned by the child's impairment. 793
- 802. Any other approachwould allow them unjustly to shift education programs directed towards providing a safer the burden of their choices to other parents. Finally, the environment for our children. Article takes up the much debated question of whether parents harm a child by allowing it to be born with a Randall B, Wilson A. The 2001 annual report of the life not worth living when they could have prevented Regional Infant and Child Mortality Review its birth. It suggests that the answer to this question Committee. S D J Med 2002; 55(11):471-5. should be irrelevant to parents' legal liability. Acting on Notes: CORPORATE NAME: Regional Infant and behalf of the parental insurance pool, the state may child Mortality Review Committee nonetheless adopt a variety of measures to help Abstract: The annual report of the Regional Infant and potential parents avoid giving birth to such children, Child Mortality Review Committee (RICMRC) is which one can assume virtually all would prefer. attached. This Committee has as its mission the review of infant and child death so that information can be Raman S, Doran RM. A new cause for retinal haemorrhage transformed into action to protect young lives. The and disc oedema in child abuse. Eye 2004; 18(1):75-7. Committee review area in 2001 included South Dakota's Minnehaha, Turner, Lincoln, Moody, Lake, Ramaswamy S, Madaan V, Qadri F et al. A primary care and McCook counties. In 2001 there were no deaths in perspective of posttraumatic stress disorder for the this region due to Sudden Infant Death Syndrome Department of Veterans Affairs. Prim Care Companion (SIDS), however, there was one death due to positional J Clin Psychiatry 2005; 7(4):180-7; quiz 188-9. asphyxia that represents the hazards of soft bedding Abstract: Posttraumatic stress disorder (PTSD) is a and prone sleeping. In addition to this case, there were major mental disorder associated with significant seven other deaths due to injury mostly representing morbidity, psychosocial impairment, and disability. immaturity in driving various vehicles. These data The diagnosis of PTSD can be missed in a primary care reflect the need to remain vigilant in the public setting, as patients frequently present with somatic campaign to promote "back to sleep" and safe sleeping complaints or depression and are often reluctant to environments for infant. The RICMRC invites other discuss their traumatic experiences. As recent studies communities to join in its efforts to review deaths to of veterans returning from the Gulf War and the Iraqi prevent potential life-threatening hazards to children in War suggest high rates of PTSD, the U.S. Department their local environs. of Veterans Affairs (VA) Hospitals are gearing up to face this challenge. It is important to screen these Randall B, Wilson A. The 2002 annual report of the veterans for symptoms of PTSD and make an Regional Infant and Child Mortality Review appropriate referral if required. In this article, we Committee. S D J Med 2003; 56(12):505-9. attempt to review PTSD with a special focus on the VA Abstract: The annual report of the Regional Infant and population. In addition to discussing the epidemiology, Child Mortality Review Committee (RICMRC) is diagnosis, and treatment options for PTSD, we also attached. This Committee has as its mission the review suggest screening questions for both combat-related of infant and child death so that information can be and military sexual trauma-related PTSD. transformed into action to protect young lives. The 2002 review area includes South Dakota's Minnehaha, Randall B, Wilson A. The 2000 Annual Report of the Turner, Lincoln, Moody, Lake, McCook, and Union Regional Infant and Child Mortality Review counties. In 2002 there was one death in this region due Committee. S D J Med 2001; 54(11):447-8. to SIDS, plus one infant death due to positional Abstract: The 2000 Annual Report of the Regional asphyxia that illustrates the hazards of soft bedding and Infant and Child Mortality Review Committee prone sleeping. These data reflect the need to remain (RICMRC) is presented. Our Regional (Minneahaha, vigilant in the public campaign to promote "back to Lincoln, Turner, and McCook Counties) incidence for sleep" and safe sleeping environments for infants. Sudden Infant Death (SIDS) was much lower in 2000 There were four other deaths due to accidental injury, than seen previously in 1999 and 1998. It remains to be mostly representing immaturity in driving various seen if this is a true reduction in the incidence of SIDS vehicles. In 2002 there were two child abuse in our Region or simply a random fluctuation in the homicides, and three teenage suicides. The RICMRC SIDS rate amplified by the relatively small number of invites other communities to join in its efforts to review Regional infant deaths. We are hopeful that the deaths to prevent potential life-threatening hazards to emphasis on the Back-to-Sleep program has been in children in their local environs. part contributory towards the reduction in the number of SIDS. Accidental infant deaths in our report Rao MR, Levine RJ, Wasif NK, Clemens JD. Reliability of however emphasizes that Back-to-Sleep implies not maternal recall and reporting of child births and deaths only supine sleeping but also sleeping in a safe in rural Egypt. Paediatr Perinat Epidemiol 2003; sleeping environment, including the avoidance of soft 17(2):125-31. bedding. RICMRC serves not only as a data collection Abstract: Demographic indicators such as fertility rates committee, but also actively engages in community and infant mortality rates are often measured in census 794
- 803. surveys by interviewingmothers to obtain their within or above the 76-186 range should be further pregnancy histories and child deaths. The validity of evaluated as a predictor for assessment of the ability of such surveys depends upon accurate recall of histories, candidate vaccines to protect against CFA/I-ETEC truthful reporting of events and understanding of the diarrhea. questions posed. To measure the reliability of maternal reporting, two census surveys conducted in a rural Raposo JV, Greer MH. Child abuse and neglect reporting in Egyptian population were compared. Women between Hawaii: the role of dentists. Hawaii Dent J 2003; 15 and 55 years of age residing in 20 villages were 34(3):5-6. asked their histories of live births, stillbirths and child deaths. An identical set of questions was posed 2 years Rasmussen RC, Schermann MA, Shutske JM, Olson DK. later. Twice-monthly home visits were conducted in Use of the North American guidelines for children's the intervening 2-year interval to identify accurately agricultural tasks with Hmong farm families. J Agric any new births, stillbirths and deaths occurring in the Saf Health 2003; 9(4):265-74. population. The maternal reports from the first census Abstract: This literature review synthesizes available were combined with the prospectively identified births, studies on Hmong agricultural practices, patterns of stillbirths and deaths and compared with the maternal childhood growth and development of Hmong children reports from the second census. For 1502 women, the in the context of injury prevention, and potential discrepancies in the total number of births, stillbirths application or adaptation of the North American and child deaths reported between the two surveys Guidelines for Children's Agricultural Tasks (Lee and were 0.6%, 4% and 0.6% respectively. However, when Marlenga, 1999) for Hmong children working in the the consistency of responses was analysed, the U.S. Data from qualitative interviews, focus groups, proportion of women with discordant responses was case studies, and surveys were collected, categories 10%, 6% and 7% for the same measures. These results were determined, and themes were identified. Field suggest that, despite the large number of births and tools and practices, gender roles, and reasons for deaths that women may experience in developing farming were examined, as well as physical and countries, maternal interviews provide reliable cognitive development of Hmong children and Hmong responses that can be used to estimate mortality and parenting techniques to describe factors related to farm fertility rates in settings where vital records are task assignment of children. Current agricultural incomplete or unreliable. practices of Hmong in the U.S. can be described as generally small-scale operations that use mainly hand Rao MR, Wierzba TF, Savarino SJ et al. Serologic correlates tools, manual labor, and local direct-marketing of protection against enterotoxigenic Escherichia coli techniques. Specific practices include thinning, diarrhea. J Infect Dis 2005; 191(4):562-70. weeding, and hoeing; carrying tools, buckets, or Abstract: BACKGROUND: We conducted a nested baskets; setting plant supports; and watering. Hmong case-control study in 397 rural Egyptian children <36 children appear to be given greater amounts of months of age to assess the correlation between serum responsibility at earlier ages than North American levels of antibodies against toxin and colonization children. Hmong parenting practices, as would be used factors (CFs) and the risk of homologous in task assignment, are somewhat more authoritarian- enterotoxigenic Escherichia coli (ETEC) diarrhea. based and lead to psychosocial skills that are more METHODS: Active case detection was performed via group-oriented than individual-oriented. Hmong semiweekly home visits, and blood was obtained at 3- children were found to be shorter than children in the month intervals. After each serosurvey, case subjects U.S. of the same ages. This review suggests that the were selected from children experiencing a CF antigen NAGCAT cannot be literally translated and (CFA)/I-, CFA/II-, CFA/IV-, or heat-labile enterotoxin disseminated to Hmong farming families as an injury (LT)-ETEC diarrheal episode during the subsequent 3 prevention intervention. Further information is needed months. Up to 5 control subjects per case subject were about what farm tasks Hmong children do and how selected from children who did not experience an Hmong parents assign those tasks to children. ETEC diarrheal episode during the corresponding interval. Serum titers of immunoglobulin G antibodies Rau-Foster M. The dialysis facility's rights, responsibilities, against CFA/I, coli surface antigen (CS) 3, CS6, and and duties when there is conflict with family members. LT were measured by enzyme-linked immunosorbant Nephrol News Issues 2001; 15(5):12-4. assay. RESULTS: The distribution of serum titers of Abstract: The stressful effect that a chronic illness may LT, CS3, and CS6 antibodies did not differ between the have on a patient and his or her family can make the case and control subjects. For children <18 months of requirements of a chronic dialysis treatment program age, serum titers of CFA/I antibody were inversely most difficult. There will be times when tensions arise related to the risk of CFA/I-ETEC diarrhea; reciprocal between staff, patients, and family members, especially serum titers of CFA/I antibody > or =76 were when the needs of the families and the patients are associated with a 77% reduction in the odds of CFA/I- perceived as being unmet, unacknowledged, or ETEC diarrhea. CONCLUSION: Induction of otherwise lacking in importance to the staff. reciprocal serum titers of antibodies against CFA/I 795
- 804. Frustrations, if notaddressed and successfully Abstract: This monograph discusses research, theory, resolved, can lead to conflict and the threat of or and practice relevant to how children learn to read incidences of violence. Questions that dialysis unit English. After an initial overview of writing systems, administrators/managers should ask when considering the discussion summarizes research from or revoking visitation privileges are: What are the developmental psychology on children's language causes and contributory factors that resulted in the competency when they enter school and on the nature unresolved issues and conflict? Did we clearly of early reading development. Subsequent sections communicate our policies and procedures and the review theories of learning to read, the characteristics consequences for failing to follow them to those of children who do not learn to read (i.e., who have accompanying the patient? Did we fail to maintain developmental dyslexia), research from cognitive proper boundaries with the invitee (Allowing the psychology and cognitive neuroscience on skilled family members to engage in inappropriate behaviors reading, and connectionist models of learning to read. such as threats, cursing, name-calling)? Have we The implications of the research findings for learning attempted to resolve the issues with the family to read and teaching reading are discussed. Next, the members? If so, how and what was the outcome? Did primary methods used to teach reading (phonics and we document our actions and the family members' whole language) are summarized. The final section responses? Is the revocation of the visitation privilege reviews laboratory and classroom studies on teaching the only viable option? If so, why? If not, what else reading. From these different sources of evidence, two could be done? What steps should be taken to minimize inescapable conclusions emerge: (a) Mastering the the disruptive effect on the patient, whose family alphabetic principle (that written symbols are member is being disruptive? What are the reasonable associated with phonemes) is essential to becoming and the required steps that a facility should take to proficient in the skill of reading, and (b) methods that ensure that the patients are properly cared for and free teach this principle directly are more effective than from abuse and neglect? What did we learn from this those that do not (especially for children who are at situation that we could use in future situations? The risk in some way for having difficulty learning to read). uncomfortable position that Sacred Heart Hospital Using whole-language activities to supplement phonics found itself in is a difficult one and one that many other instruction does help make reading fun and meaningful clinics have or may experience. The focus on for children, but ultimately, phonics instruction is continuing to meet the needs of a patient while dealing critically important because it helps beginning readers with issues, such as those presented here, depicts and understand the alphabetic principle and learn new represents professionalism at work. Answering these words. Thus, elementary-school teachers who make the questions before problems arise will help unit alphabetic principle explicit are most effective in administrators be prepared to deal effectively with helping their students become skilled, independent conflict at the dialysis facility. Having a plan of action readers. in place ensures a suitable, uniform response to unacceptable situations and reduces the risk of reacting Read J. The problem of child sexual abuse. Science 2005; inappropriately when those situations arise. 309(5738):1182-5; author reply 1182-5. Ray SL. Male survivors' perspectives of incest/sexual abuse. Read J, Hammersley P. Child sexual abuse and Perspect Psychiatr Care 2001; 37(2):49-59. schizophrenia. Br J Psychiatry 2005; 186:76; author Abstract: PURPOSE: To show how understanding the reply 76. aftereffects of incest and other forms of sexual abuse from male survivors' perspectives may help clinicians Realmuto GM, August GJ, Egan EA. Testing the goodness- identify males with a possible history of sexual abuse. of-fit of a multifaceted preventive intervention for METHODS: Audiotaped interviews with 25 male children at risk for conduct disorder. Can J Psychiatry survivors described the aftereffects in eight life areas. 2004; 49(11):743-52. Data were analyzed by the double-coding qualitative Abstract: OBJECTIVE: To determine the importance method. FINDINGS: Themes identified included of parents' global adaptive functioning as a predictor of isolation, anger, depression/suicidal feelings, participation rate and subsequent child social addictions, or low sense of self, and distant competence outcome in 3 program components of an relationships with men and women. CONCLUSIONS: evidence-based, multifaceted, preventive intervention Clinicians need to explore the possibility of a history of for at-risk children. METHOD: Families of program sexual abuse with males who seek treatment for children (n = 124, mean age 6.6 years at recruitment) addictions, suicidal ideation, depression, and chronic were offered 3 program components that continued for low self-esteem. 3 years: a 6-week summer program, a biweekly family program that included concurrent parent and child Rayner K, Foorman BR, Perfetti CA, Pesetsky D, education and skills training groups, and a flexibly Seidenberg MS. How psychological science informs tailored home visitation family support program. We the teaching of reading. Psychol Sci 2001; 2(2 used structural equation modelling to test hypotheses Suppl):31-74. 796
- 805. about the effectsof parental characteristics on program hypothalamus-pituitary-adrenal axis function appears attendance in each of the program components over 3 to contribute to these costly difficulties. More broadly, years, as well as their relation to children's social the concept of attachment can contribute to defining competence. RESULTS: Predictors of attendance and managing the psychosocial dimension of routine included child IQ, socioeconomic status (SES), and paediatric care. The current under-representation of single-parent status for some components but not attachment in paediatric education, practice, and others, depending on parents' global adaptive research needs to be rectified. functioning. Predictors of child social competence outcome were mediated by attendance in specific Rees T. Kempe Children's Center report earns special program components and were dependent on parent recognition. Profiles Healthc Mark 2001; 17(6):2. global adaptive functioning. Some components contributed decisively to social competence outcomes, Reese T. Physiological responses to circumcision. MCN Am and others did not, despite subjects' participation. J Matern Child Nurs 2004; 29(4):263; author reply 263. CONCLUSIONS: Common family characteristics (that is, child IQ, SES, and single-parent status) predict Regalado M, Sareen H, Inkelas M, Wissow LS, Halfon N. program attendance differently, depending on parents' Parents' discipline of young children: results from the global adaptive functioning. Parents' global adaptive National Survey of Early Childhood Health. Pediatrics functioning determined whether attendance in specific 2004; 113(6 Suppl):1952-8. program components mediated children's social Abstract: OBJECTIVE: To examine the use and competence. In this preventive intervention, as in predictors of different discipline practices by parents of clinical practice, only knowledge of the goodness-of-fit very young children using data from the 2000 National between participant characteristics and program Survey of Early Childhood Health (NSECH). attributes can ensure optimum benefit. METHODS: NSECH is a nationally representative telephone survey of 2068 parents of young children Reboussin BA, Anthony JC. Latent class marginal between the ages of 4 and 35 months conducted by the regression models for modelling youthful drug National Center for Health Statistics. The survey involvement and its suspected influences. Stat Med includes questions about parents' use of 5 discipline 2001; 20(4):623-39. practices: yelling, spanking, time out, toy removal, and Abstract: In longitudinal behavioural studies, it is explanations. chi2 analyses and logistic multivariate common to have multiple categorical indicators for regression were used to examine associations between measuring a theoretical construct of interest. A latent discipline practices and child, parent, and demographic class model is presented that accounts for the structure factors. RESULTS: Among young children aged 19 to in a set of correlated, categorical variables measured at 35 months, frequent parental use of discipline discrete time periods, drawing information from these strategies ranged from 26% (spanking) to 65% (taking variables to form a smaller number of latent classes. away toy or treat), 67% (yelling), 70% (using time The dependence of the resulting latent class model out), and 90% (providing explanations). In multivariate parameters on suspected factors over time is analyses, child age predicts reports of more frequent simultaneously modelled using a baseline-category spanking and yelling, and child developmental risk is logistic regression model. Estimation of the model associated with increased reports of yelling. Parent parameters is achieved using an estimating equations frustration predicts frequent use of every discipline procedure. A motivating example is provided from a practice, including a greater inclination to use aversive longitudinal study of suspected linkages between practices. Lower parental emotional well-being is monitoring or supervision by parents and the associated with reports of frequent yelling and occurrence of drug use behaviours in an epidemiologic spanking. Black ethnicity and maternal age predict sample of school-attending youths. more frequent spanking, and Spanish-speaking parents reported less frequent use of time out and taking away Reece RM. The evidence base for shaken baby syndrome: a toy. CONCLUSION: Child age and developmental response to editorial from 106 doctors. BMJ 2004; risk and parents' ethnicity, emotions, and mental health 328(7451):1316-7; author reply 1317. are closely associated with discipline practices in the first 3 years of life. These factors are important for Rees CA. Thinking about children's attachments. Arch Dis pediatricians to recognize in providing anticipatory Child 2005; 90(10):1058-65. guidance about discipline. Abstract: Disordered parental attachment can commit children to lives characterised by relationship Regan J, Johnson C, Alderson A. Expert testimony linking difficulties, behaviour problems, educational failure, child sexual abuse with posttraumatic stress disorder. and poor self-esteem. It is a major root of trans- Tenn Med 2002; 95(4):157-8. generational neglect and abuse and frequently underlies mental health problems, drug and alcohol addiction, Reid MJ, Webster-Stratton C, Beauchaine TP. Parent homelessness, and crime. Early childhood setting of training in head start: a comparison of program 797
- 806. response among AfricanAmerican, Asian American, known to cry a lot, in order to help parents to cope with Caucasian, and Hispanic mothers. Prev Sci 2001; this crying. 2(4):209-27. Abstract: The effectiveness of the Incredible Years Reimherr JP, McClellan JM. Diagnostic challenges in Parenting Program was evaluated in a low-income children and adolescents with psychotic disorders. J sample of Caucasian, African American, Hispanic, and Clin Psychiatry 2004; 65 Suppl 6:5-11. Asian mothers whose children were enrolled in Head Abstract: The diagnosis of psychotic disorders in Start. Data from two prior intervention studies children and adolescents is often complex and [Webster-Stratton (1998) Journal of Consulting and challenging. The symptomatic overlap between Clinical Psychology, 66(5), 715-730; Webster-Stratton different psychotic conditions and other emotional, et al. (in press) Journal of Clinical Child Psychology] behavioral, and developmental disorders has led to were combined, yielding a sample of 634 families (370 high rates of misdiagnosis, especially at time of onset. Caucasian, 120 African American, 73 Asian, 71 The clinical expression and progression of diagnosable Hispanic) across 23 Head Start centers. Centers were disorders are affected by maturational processes. Thus, matched and assigned randomly to either an psychotic illnesses in pediatric patients may vary from experimental condition (8-12 weeks of weekly 2-hr adult presentations because of developmental factors. parenting classes), or a control condition (the regular Establishing a specific diagnosis is difficult when the Head Start Program without parenting groups). differential diagnosis comprises disorders that share Families in both conditions were assessed using home common symptoms and are frequently comorbid. The observations of parent-child interactions and parent clinical assessment depends as much on input from reports of parenting style and discipline strategies and parents and teachers as from the patients themselves, child behavior problems in the fall (baseline) and and there may be conflict between these different spring (postintervention) of the children's Head Start perceptions. This article reviews recent research and year. Families were reassessed 1 year later. Following current concepts relating to diagnostic challenges in treatment, intervention mothers were observed to be pediatric psychiatry. more positive, less critical, more consistent, and more competent in their parenting than were control mothers. Reinherz HZ, Paradis AD, Giaconia RM, Stashwick CK, Additionally, children of intervention parents were Fitzmaurice G. Childhood and adolescent predictors of observed to exhibit fewer behavior problems than were major depression in the transition to adulthood. Am J control children. Differences in treatment response Psychiatry 2003; 160(12):2141-7. across ethnic groups were few, and did not exceed the Abstract: OBJECTIVE: The identification of predictors number expected by chance. Parents from all groups of major depression in the transition to adulthood has reported high satisfaction levels following the direct application to prevention and intervention efforts parenting program. Results indicate that the Incredible designed to forestall depression in this high-risk period. Years Program is accepted by and effective with The current study identified childhood and adolescent diverse populations. familial and behavioral-emotional factors predicting depression during this critical developmental stage. Reijneveld SA, van der Wal MF, Brugman E, Hira Sing RA, METHOD: The 354 participants were part of a single- Verloove-Vanhorick SP. [Prevalence of parental age cohort from a predominately Caucasian working- behaviour to diminish the crying of infants that may class community whose psychosocial development has lead to abuse]. Ned Tijdschr Geneeskd 2004; been traced prospectively since age 5. In these 148(45):2227-30. analyses, data collected during childhood and Abstract: OBJECTIVE: To estimate the prevalence of adolescence were related to diagnoses of major parental actions to stop infant crying that may threaten depression at ages 18-26. RESULTS: During the infant health, and to determine specific risk groups transition to adulthood, 82 participants (23.2%) regarding these actions. DESIGN: Descriptive. experienced major depression. Bivariate indicators of METHOD: Before their visit to a well-baby clinic in later depression included a family history of depression the Netherlands, parents of 3345 infants aged 1-6 or substance use disorders, family composition, and months (96.5% response) filled out an anonymous childhood family environments perceived as violent questionnaire on actions that they undertook to stop and lacking cohesiveness. Also significant were self- their child crying. RESULTS: At 6 months, 5.6% (95% and mother-reported internalizing behaviors, as well as confidence interval: 4.2-7.0%) of all the parents self-rated anxiety and depressive symptoms. reported having smothered, slapped, or shaken their Multivariable analyses showed family violence, family infant at least once because of its crying. The highest composition, internalizing problems during risks for detrimental parental actions were run by adolescence, and low family cohesion to be the most infants of parents from non-industrialised countries, of salient factors. CONCLUSIONS: These results parents with no or only a part-time job, and of parents highlight familial and behavioral-emotional predictors who had judged their infant's crying as excessive. of depression that can serve as foci for identifying CONCLUSION: Clinicians should be aware of the youth in need of intervention. observed risk factors for abuse of young children 798
- 807. Reitman D, CurrierRO, Hupp SD, Rhode PC, Murphy MA, for depiction of sexual activity from cave paintings to O'Callaghan PM. Psychometric characteristics of the contemporary internet depictions, movies, and videos. Parenting Scale in a head start population. J Clin Child Playboy-type magazines are considered "tame" today. Psychol 2001; 30(4):514-24. This brief discussion will update busy physicians of all Abstract: Examined the reliability, construct, and specialties as to how their patients may be using or concurrent validity of the Parenting Scale (PS), a brief overusing available explicit materials and will also instrument designed to measure dysfunctional assess the impact on the patients' current work and parenting practices for parents of young children. In home adjustment. Study 1, 183 primarily African American mothers and their Head Start children completed the PS. The PS, Renton M. Networking neonatal units. Pract Midwife 2003; which consists of 3 subscales--Laxness, Overreactivity, 6(6):4-5. and Verbosity--was subjected to confirmatory factor analysis (CFA). Neither the original 3-factor structure, República Dominicana. Congreso Nacional. Ley No. 137-03 nor a 2-factor structure consisting of the original sobre tráfico ilícito de migrantes y personas. Santo Laxness and Overreactivity factors, fit the data. A Domingo: República Dominicana. Congreso Nacional, subsequent exploratory factor analysis yielded a 2- 2003:8. factor solution that was generally consistent with the Abstract: CONSIDERANDO: Que el tráfico de Overreactivity and Laxness subscales identified by seres humanos y la introducción, paso y salida Arnold, O'Leary, Wolff, and Acker (1993). The 2- ilegal de éstos en diferentes países del mundo se factor CFA solution was replicated with a sample of ha convertido en un negocio que genera enormes 216 similar mothers, and the 5-item Overreactivity and Laxness subscales retained internal consistencies above beneficios para los traficantes y para los .70. Analysis of the convergent validity of the modified sindicatos del crimen organizado, que unido a los PS and its 2 subscales revealed moderate associations altos niveles de pobreza, desempleo y factores with measures of permissiveness, authoritarianism, sociales y culturales, como la violencia contra la involvement, and limit setting. Scores on the PS were mujer, niños, niñas y adolescentes, la not correlated significantly with measures of social discriminación por sexo en la familia y en la desirability, maternal education level, or parent report comunidad, pasando por la feminización de la of internalizing behavior problems. Concurrent validity migración laboral en los países de origen, pueden evidence was obtained by correlating the PS with obligar a los migrantes potenciales a recurrir a las measures of parenting satisfaction and support, redes del crimen;.... parenting stress, maternal depression, and measures of externalizing child behavior problems. Resnik DB, Zeldin DC, Sharp RR. Research on environmental health interventions: ethical problems Rennison C, Planty M. Nonlethal intimate partner violence: and solutions. Account Res 2005; 12(2):69-101. examining race, gender, and income patterns. Violence Notes: GENERAL NOTE: KIE: 60 refs. 13 fn. Vict 2003; 18(4):433-43. GENERAL NOTE: KIE: KIE Bib: human Abstract: The correlation between race of victim and experimentation; public health intimate partner violence (IPV) is examined. Previous Abstract: This article reviews a variety of ethical issues research showing a relationship between Black victims one must consider when conducting research on and higher levels of violence were based on uni-variate environmental health interventions on human subjects. examinations and often do not consider other important The paper uses the Kennedy Krieger Institute lead factors. This paper presents national estimates of IPV abatement study as well as a hypothetical asthma study by victim's race using the National Crime to discuss questions concerning benefits and risks, risk Victimization Survey (NCVS), 1993-1999. The minimization, safety monitoring, the duty to warn, the estimates based only on race are then disaggregated to duty to report, the use of control groups, informed account for the victim's gender and household income. consent, equitable subject selection, privacy, conflicts Uni-variate findings demonstrate that victim's race is of interest, and community consultation. Research on significantly related to rates of intimate partner environmental health interventions can make an violence. However, after controlling for both victim's important contribution to our understanding of human gender and annual household income, the victim's race health and disease prevention, provided it is conducted is no longer significant. The importance of in a manner that meets prevailing scientific, ethical, understanding intimate partner violence through a and legal standards for research on human subjects. person's socioeconomic status rather than race is discussed. Ressler-Maerlender J, Sorensen RE. Circumcision: an informed choice. AWHONN Lifelines 2005; 9(2):146- Renshaw DC. Pornography: reactions and reality. Compr 50. Ther 2005; 31(4):251-4. Abstract: The Greek word porne (harlot) paired with Reungoat P, Chiron M, Gauvin S, Zmirou-Navier D, Momas graphe (picture or writing) has for centuries been used 799
- 808. I. Retrospective assessmentof exposure to traffic air schools and that school nurses make use of various pollution using the ExTra index in the VESTA French strategies or "tricks of the trade" to handle these epidemiological study. J Expo Anal Environ Epidemiol problems. This research highlights the need for a 2005; 15(6):524-33. contribution from the pharmacy profession in this Abstract: This study applies a traffic exhaust air important and neglected area of drug therapy. dispersion model (the ExTra index) to 403 children enrolled in a French multicentric case-control study, Rey JM, Sawyer MG, Prior MR. Similarities and differences the VESTA study (Five [V] Epidemiological Studies between aggressive and delinquent children and on Transport and Asthma). The ExTra index adolescents in a national sample. Aust N Z J Psychiatry (previously validated by our team) was used to assess 2005; 39(5):366-72. lifelong average traffic-related air pollutant (TAP) Abstract: OBJECTIVE: To examine differences in the concentrations (nitrogen oxides) children in the study correlates, comorbidity and use of services between were exposed to in front of their living places. ExTra aggressive and delinquent children and adolescents. index took into account traffic density, topographical METHOD: An Australian representative sample (n = parameters (building height, road and pavement width), 4083) of parents of children and adolescents were weather conditions (wind direction and strength) and administered a psychiatric diagnostic interview, the background pollution levels. Topographical and traffic Child Behaviour Checklist, and other instruments to data were collected, using a specific questionnaire for measure service use. The characteristics of children each home, school or nursery address, attended by with high scores (top 5%) in the aggressive and children. The assessment of time-weighted NOx levels delinquent syndromes or both were then examined. in front of the children's living places highlighted RESULTS: The proportion of aggressive children significant disparities: mean ExTra index values and decreased with increasing age while that of delinquents share attributable to proximity traffic were, increased. The aggressive group was specifically respectively, 70+/-42 and 14+/-22 microg/m3 NOx associated with the impulsive-hyperactive subtype of equivalent NO2 for the 403 children in our study. Not attention deficit hyperactivity disorder (ADHD) (OR = only would this diversity not have been revealed using 12.63; 95% CI = 5.97-26.74). Comorbidity between urban background pollution data provided by air ADHD, aggression and delinquency was less frequent quality networks, it would have resulted in 40% of the among adolescents than in children, with the exception children being misclassified with regard to their TAP of the inattentive subtype in which comorbidity was exposure by underestimating it in half of the cases and higher. Both aggressive and delinquent groups had a overestimating it in the other half. Such errors of considerable overlap with conduct disorder. Aggressive classification, which are highly prejudicial in and delinquent youths used services more often, but epidemiology, argue strongly for the use of an index parents perceived aggressive children as more in need such as the ExTra, which enables TAP exposure to be of help than delinquent ones. Living in a sole parent reconstructed within the framework of retrospective or family was specifically associated with the delinquent prospective epidemiological studies. group (OR = 3.34; 95% CI = 2.25-4.96). CONCLUSIONS: The results suggest that these Reutzel TJ, Patel R. Medication management problems empirically derived syndromes while sharing many reported by subscribers to a school nurse listserv. J Sch features also differ in important ways, highlighting the Nurs 2001; 17(3):131-9. need for further convergence between categorical and Abstract: Given the potentially serious consequences of dimensional classifications. Their differential suboptimum medication management practices in association with the subtypes of ADHD requires elementary and secondary schools and the fact that this further examination and may help to understand the topic has been subject to little empirical inquiry, the relationship between ADHD and conduct problems. purpose of this study was to obtain a preliminary The importance of aggressive behaviour in children understanding of the types of medication management should not be underestimated since it is associated with problems that school nurses face, as well as the significant psychopathology, parental distress and use strategies they use to solve those problems. An analysis of services. of messages related to medication management that appeared on the SCHLRN-L listserv (a 1,400-member Reyes H, Perez-Cuevas R, Sandoval A et al. The family as a discussion group for schools nurses) was performed. determinant of stunting in children living in conditions All messages sent to the listserv during a 5-month of extreme poverty: a case-control study. BMC Public period were monitored. Any discussion thread that Health 2004; 4:57. began during this time period and addressed the Abstract: BACKGROUND: Malnutrition in children management of medications was selected for possible can be a consequence of unfavourable socioeconomic inclusion in the study. The result was a group of 71 conditions. However, some families maintain adequate threads. The listserv participants described a wide array nutritional status in their children despite living in of medication management problems and suggested poverty. The aim of this study was to ascertain whether numerous strategies for solving them. This study shows family-related factors are determinants of stunting in that serious medication management problems exist in young Mexican children living in extreme poverty, and 800
- 809. whether these factorsdiffer between rural or urban stepfathers (30.3%) were the most frequent aggressors, contexts. METHODS: A case-control study was with the former victimizing more children (19.7%) and conducted in one rural and one urban extreme poverty the latter adolescents (17.1%). level areas in Mexico. Cases comprised stunted children aged between 6 and 23 months. Controls were Ribisl KM, Lee RE, Henriksen L, Haladjian HH. A content well-nourished children. Independent variables were analysis of Web sites promoting smoking culture and defined in five dimensions: family characteristics; lifestyle. Health Educ Behav 2003; 30(1):64-78. family income; household allocation of resources and Abstract: The present study examined smoking culture family organisation; social networks; and child health and lifestyle Web sites listed on Yahoo!, a popular care. Information was collected from 108 cases and Internet search catalog, to determine whether the sites 139 controls in the rural area and from 198 cases and were easily accessible to youth, featured age or health 211 controls in the urban area. Statistical analysis was warnings, and mentioned specific tobacco brands. A carried out separately for each area; unconditional content analysis of photographs on these sites assessed multiple logistic regression analyses were performed to the demographics of individuals depicted and the obtain the best explanatory model for stunting. amount of smoking and nudity in the photographs. The RESULTS: In the rural area, a greater risk of stunting sample included 30 Web sites, all of which were was associated with father's occupation as farmer and accessible to youth and did not require age verification the presence of family networks for child care. The services to enter them. Cigarette brand names were greatest protective effect was found in children cared mentioned in writing on 35% of the sites, and brand for exclusively by their mothers. In the urban area, risk images were present on 24% of the sites. Nearly all of factors for stunting were father with unstable job, the photographs (95%) depicted smoking, 92% presence of small social networks, low rate of featured women, and 7% contained partial or full attendance to the Well Child Program activities, breast- nudity. These results underscore the need for greater feeding longer than six months, and two variables research and monitoring of smoking-related Internet within the family characteristics dimension (longer content by health educators and tobacco control duration of parents' union and migration from rural to advocates. urban area). CONCLUSIONS: This study suggests the influence of the family on the nutritional status of Ricci FL. The Italian national telemedicine programme. J children under two years of age living in extreme Telemed Telecare 2002; 8(2):72-80. poverty areas. Factors associated with stunting were Abstract: The Italian national telemedicine programme different in rural and urban communities.Therefore, included a broad range of research projects, but they all developing and implementing health programs to served the common purpose of bringing about tackle malnutrition should take into account such improvements in health-care management and differences that are consequence of the social, performance. The programme consisted of seven economic, and cultural contexts in which the family projects, each of which had specific research and lives. training objectives, and a three-year duration. The systems developed in the course of the programme Ribeiro MA, Ferriani MG, Reis JN. [Sexual abuse of were not experimental prototypes:they were intended children and adolescents: characteristics of sexual to be pre-commercial systems. The functional and victimization in family relations]. Cad Saude Publica clinical merits of the products and systems developed 2004; 20(2):456-64. were evaluated, and their costs and benefits measured Abstract: This study analyzes the characteristics of with reference to those already in use. The seven sexual abuse committed within the family against age projects were completed in 1999. The Italian Ministry groups classified according to the Brazilian Statute for of Universities, Research and Technology granted Children and Adolescents (the prevailing legislation on research funds totalling 50,000,000 Euros for the whole matters pertaining to minors) and treated at the programme. While the results of the research were Reference Center for Children and Adolescents and the promising, successful projects alone are not sufficient Guardianship Councils in Ribeirao Preto, Sao Paulo to reduce costs in health-care. Indeed, far more money State, Brazil, from 1995 to 2000. Some 234 abuses can be saved simply by encouraging the uptake on a were identified, committed by 217 aggressors, against larger scale of many technologies and practices that 210 families and a total of 226 victims. A total of 131 already exist. children (48.7%) and 95 adolescents (41.2%), predominantly females, were victimized. Children Ricciardi C, Guastadisegni C. Environmental inequities and ranging from 10 to 12 years were the most frequently low birth weight. Ann Ist Super Sanita 2003; abused (19.5%), as well as adolescents from 12 to 14 39(2):229-34. years old (17.3%). The majority of the victims live in Abstract: The effects of environmental exposures to families with 3 (19.9%) or 4 children (177%), and the toxic agents, are related to different levels of exposure, firstborn are the most frequently abused (33.6%). The genetic and biological susceptibility, risk perception majority of aggressors who acted alone victimized only and socioeconomic status (SES). In the present study one individual (86.7%). Fathers (34.2%) and 801
- 810. we suggest thatenvironmental influences on human and provide insight into the consequences of seeking reproduction should include investigations on SES, that court intervention for the physician who encounters can play an important role in embryo-foetal parental refusal of care. development. Low birth weight (LBW) is a risk factor for developing in adulthood coronary hearth disease, Ridgway DM, White SA, Kimber RM, Nicholson ML. hypertension and type 2 diabetes. Maternal nutritional Current practices of donor pancreas allocation in the status and other hypothesis could explain LBW, UK: future implications for pancreas and islet however, environmental exposures are recognised as transplantation. Transpl Int 2005; 18(7):828-34. essential risk factors. Different studies evidenced an Abstract: Recent refinements in technique mean islet increased risk of LBW in relation to increased cell transplantation offers the chance of a cure to an environmental air levels of particulate matter, carbon increasing patient cohort with diabetes. Such monoxide, and sulphur dioxide. Considering different developments put pressure upon the scarce resource of risk possibilities and different risk perceptions, there is donor organs, with potential competition between the a need of a different scientific approach in which the modalities of cellular and solid organ transplantation. scientific knowledge is connected with ethical and This questionnaire based study examines current socioeconomic factors, for risk management, in order patterns of donor pancreas procurement and use. to overcome the environmental health inequities based Reasons for non procurement are studied together with on social contest. the attitudes of transplant professionals to pancreas allocation. The minority of potentially useful pancreata Richards TJ. Sarah's last visit. Med Econ 2002; 79(4):47-8. are currently made available to either whole pancreas or islet transplant programs. Whilst professionals Richardson C. Physician/hospital liability for negligently appreciate the role of each modality, there is a need to reporting child abuse. J Leg Med 2002; 23(1):131-50. define criteria for pancreas allocation to avoid under use of donor organs. Richens Y. Building bridges: involving Pakistani women. Pract Midwife 2003; 6(8):14-7. Riedy CA, Weinstein P, Milgrom P, Bruss M. An ethnographic study for understanding children's oral Riddell-Heaney J, Allott M. Different cultures but equal health in a multicultural community. Int Dent J 2001; needs. Prof Nurse 2003; 18(5):248-9. 51(4):305-12. Abstract: Many health professionals deal with issues of Abstract: OBJECTIVE: To provide guidance for a child protection on a regular or occasional basis, so public health intervention in a high caries rate they not only need a good understanding of their duties multicultural population by understanding cultural but also an awareness of cultural issues. issues surrounding children's oral health. METHOD: Seven community focus groups were conducted with Ridgway D. Court-mediated disputes between physicians five ethnic populations (Chamorro, Filipino, and families over the medical care of children. Arch Carolinian, Pohnpean, and Chuukese) living on the Pediatr Adolesc Med 2004; 158(9):891-6. island of Saipan, Commonwealth of the Northern Abstract: OBJECTIVE: To describe the judiciary's Mariana Islands, USA. Participants were asked approach to parent-physician disputes over the care of questions about their beliefs, attitudes, knowledge, and sick children. DATA SOURCES: Court publications. care practices regarding issues around children's oral STUDY SELECTION: Fifty parent-physician health. RESULTS: Analysis consisted of a content disagreements over the care of children led to review of participants' responses within two targeted physician requests for court intervention and resulted in areas: past and current attitudes and health beliefs, and judicial opinions published by the court. The opinions behaviours impacting risk of developing disease. Both describe 66 children from 20 states. DATA the lack of value of baby teeth and negative parental SYNTHESIS: Physicians prevailed at the initial experiences are factors underlying health beliefs and decision in 44 (88%) of the 50 disputes and at the final behaviours. Although some differences in beliefs and decision in 40 disputes (80%). Physicians were more practices existed across cultural groups, most women likely to prevail in religion-based disputes than in other were interested in learning about new preventive cases (27 of 30 vs 13 of 20; P<.03), but they were less strategies to reduce dental disease. Several new likely to prevail in disputes concerning life-threatening mothers reported that they actively sought out or potentially disabling conditions (23 of 31 vs 17 of parenting information during their initial pregnancy. 19; P<.19). Courts acknowledged the pediatric patients' CONCLUSIONS: Aversive parental experience and views in only 10 of the disputes (9 of the 19 cases disregard for primary dentition were identified as involving adolescents and 1 of the 31 cases involving serious obstacles to be addressed in order for any new children younger than 12 years). For most courts, the programme to be effective. Despite these obstacles, petitioning physicians provided the only source of new mothers were open to information and strategies to scientific information. CONCLUSIONS: Published reduce the prevalence of early childhood caries. court opinions create precedents for future decisions 802
- 811. Riem S. [Sexualabuse--neglect--violence. Accordingly you Riley EP, Mattson SN, Li TK et al. Neurobehavioral diagnose child abuse]. MMW Fortschr Med 2002; consequences of prenatal alcohol exposure: an 144(8):16. international perspective. Alcohol Clin Exp Res 2003; 27(2):362-73. Rigby MJ, Kohler LI, Blair ME, Metchler R. Child health Abstract: This article represents the proceedings of a indicators for Europe: a priority for a caring society. symposium at the 2002 Research Society on Eur J Public Health 2003; 13(3 Suppl):38-46. Alcoholism/International Society for Biomedical Abstract: BACKGROUND: Measurement of children's Research on Alcoholism meeting in San Francisco, health is important for two reasons: first, because CA. The organizers were Edward P. Riley and Sarah young people are citizens in their own right, yet largely N. Mattson, and the chairperson was Edward P. Riley. unable to act as self-advocates, particularly at the The presentations were (1) Neurobehavioral deficits in population level; and second, because their health alcohol-exposed South African infants: preliminary determines the health of the future population. findings, by Sandra W. Jacobson, Christopher D. Indicators based on measurements of child health are Molteno, Denis Viljoen, and Joseph L. Jacobson; (2) A important for identifying progress, problems and pilot study of classroom intervention for learners with priorities, changes over time, and newly emergent fetal alcohol syndrome in South Africa, by Colleen issues. The European Community Health Monitoring Adnams, M. W. Rossouw, M. D. Perold, P. W. Programme (HMP) is a comprehensive programme to Kodituwakku, and W. Kalberg; (3) Differential effects develop and implement a set of national-level of prenatal alcohol exposure on fluid versus indicators. The Child Health Indicators of Life and crystallized intelligence, by P. W. Kodituwakku, W. Development (CHILD) project is the only population Kalberg, L. Robinson, and P. A. May; (4) group-specific project, seeking to determine a holistic Neurobehavioral outcomes of prenatal alcohol set of measures. METHODS: The project endeavoured exposure: early identification of alcohol effects, by to address all aspects of child health and its Claire D. Coles; (5) Fetal alcohol syndrome in determinants, balancing positive and negative aspects. Moscow, Russia: neuropsychology test performance, It undertook a structured search of published evidence by Sarah N. Mattson, E. P. Riley, A. Matveeva, and G. to seek to identify, and validate, indicators of health Marintcheva; and (6) Long-term follow-up of Finnish and illness, health determinants and challenges to children exposed to alcohol in utero in various health, quality of healthcare support and health- durations, by Marit I. Korkman and I. Autti-Ramo. The promoting national policies. A systematic approach discussant was Ting-Kai Li. was used in identifying valid indicators, and in assembling a balanced composite list. All ages from Ripamonti C, Bianchi M. The use of methadone for cancer infancy to adolescence were covered. RESULTS: The pain. Hematol Oncol Clin North Am 2002; 16(3):543- project's final report identifies 38 core desirable 55. national indicators, citing purpose and evidence for Abstract: Methadone is not a new analgesic drug [69]. each. Of equal importance, it also identifies 17 key Several studies have demonstrated that methadone is a child health topics on which further research work is valid alternative to morphine, hydromorphone, and needed in order to identify and validate indicators fentanyl for the treatment of cancer-related pain, and appropriate across different national settings. extensive reviews on the subject have been published in recent years [10,23,25,64,70,71]. Most people Riggs SA, Jacobvitz D. Expectant parents' representations of involved in pain therapy, however, are not well early attachment relationships: associations with informed about the properties of methadone. The mental health and family history. J Consult Clin authors believe that the low cost of methadone Psychol 2002; 70(1):195-204. paradoxically contributes to the limited knowledge of Abstract: The association between adult representations its characteristics and to the restricted therapeutic use of early attachment relationships and history of of this drug. The low cost of methadone means there is individual and family mental health was examined in a little financial incentive for pharmaceutical companies sample of 233 expectant mothers and fathers. As to invest in research or to disseminate scientific predicted, security of attachment was linked to mental information. Unfortunately, the lack of scientific health. Parents classified as Preoccupied were more information from pharmaceutical companies frequently likely than other parents to report suicidal ideation. results in a lack of knowledge on the part of physicians. Whereas parents classified as Unresolved more often Unless the existing approach changes, both culturally reported suicidal ideation, emotional distress, and and politically, ignorance about methadone will persist substance abuse. With respect to family history. among medical experts. The low cost of methadone, Unresolved and Preoccupied attachment classifications rather than being an advantage, will result in the were significantly related to child abuse involving a limited exploitation of an effective drug. relative and parental separation or divorce. These findings support theoretical conceptualizations Ripley A. Inside the church's closet. Time 2002; 159(20):60- regarding the link between adult attachment and mental 4. health in middle-class American adults. 803
- 812. Ritchie A. Nutritioneducation and promotion in primary experiencing intra-familial violence among Mexican schools. Aust J Holist Nurs 2001; 8(2):39-44. and Egyptian youth and to describe its associated risk Abstract: Health promotion with school-age children factors. METHODS: Data from questionnaires applied can enhance knowledge about nutrition and change to 12,862 Mexican and 5,662 Egyptian youth, aged 10 eating habits when health workers, schools, and to 19, who attended public schools were analyzed. communities work together for a common goal. A Biviarate and logistic regression analysis were used to range of options need to be considered when designing determine the relationship between socio- an effective and appropriate school-based program. demographics, the experience of intra-familial violence and violence perpetration. RESULTS: The prevalence Ritchie LD, Welk G, Styne D, Gerstein DE, Crawford PB. of having experienced intra-familial violence was Family environment and pediatric overweight: what is comparable across the Mexican and Egyptian a parent to do? J Am Diet Assoc 2005; 105(5 Suppl populations (14% and 17%, respectively). In Mexico, 1):S70-9. young men were more likely to have experienced such Abstract: Although the causes of pediatric overweight violence (OR=2.36) than women, whereas in Egypt, are many and the levels of intervention required to young women were at slightly greater risk than young prevent overweight in children extend from the child's men (OR=1.25). Older age, male gender and urban immediate environment to the larger societal level, one residence were independent correlates of experiencing critical intervention target is the parent. Scientific intra-familial violence among Mexican youth. For evidence points to specific dietary and physical Egyptian adolescents, in contrast, younger age, female activity/inactivity behaviors that families can adopt to gender and having non-married parents were encourage healthful weight status. Dietary independent correlates of victimization. Intra-familial recommendations include providing children with violence victims were also more likely than non- ample access to nutrient-dense foods and beverages victims to perpetrate violence (Mexico: OR=13.13; and high-fiber foods, both at meals and snack times, Egypt: OR=6.58). CONCLUSIONS: Mexican and reducing children's access to high-calorie, nutrient-poor Egyptian youth experienced intra-familial violence at a beverages and foods both when eating at home and at relatively low prevalence when compared with youth restaurants, avoiding excessive food restriction or use of other countries. A strong association was found of food as a reward, and encouraging children to eat between experiencing intra-familial violence and breakfast on a daily basis. Physical activity perpetrating violence. recommendations include providing opportunities and encouragement for children to be physically active Roane KR. The long arm of abuse. US News World Rep while reducing children's television and video game 2002; 132(15):26-9. time. Parental modeling of healthful eating and physical activity practices is recommended to reinforce Robben SG. [Diagnostic image (177). A lifeless infant. these patterns in youth. Dietetics professionals, Shaken baby syndrome]. Ned Tijdschr Geneeskd 2004; physicians, and other health care professionals can 148(23):1168; author reply 1168. assist parents in their efforts to prevent pediatric overweight by providing information and supporting Robbins H, Hundley V, Osman LM. Minor illness education these key behaviors, while working to create for parents of young children. J Adv Nurs 2003; environments that support healthful lifestyle changes. 44(3):238-47. Abstract: BACKGROUND: A number of previous Rivera HP. Developing collaborations between child welfare studies on minor illness have concentrated on nurse-led agencies and Latino communities. Child Welfare 2002; clinics and the role of nurse practitioners. This study 81(2):371-84. examines the effect of a minor illness education Abstract: Collaborative efforts to achieve permanency programme which aimed to increase parents' planning and family stability for all children in the confidence and knowledge in managing childhood child welfare system are increasing. As Latino children illnesses. AIM: The primary aim of this study was to and families constitute the fastest growing ethnic group evaluate the effectiveness of a home visit and booklet in the child welfare system, it is important to in providing education to parents about minor infant understand how to develop culturally sensitive illnesses. DESIGN: A randomized controlled trial was collaborations with their communities. The purpose of conducted. The intervention involved a home visit to this article is to suggest helpful guidelines for discuss parents' concerns and provide advice and developing collaborations between child welfare information, and a booklet advising parents what to do agencies and Latino communities. and when to consult about infant illnesses. METHOD: A total of 120 parents of 6 week old babies were Rivera-Rivera L, Allen B, Thrasher JF et al. Intra-familial identified over a 6 month period, using health visitors' physical violence among Mexican and Egyptian youth. caseloads, and randomized to an intervention group Rev Saude Publica 2005; 39(5):709-15. (60), that received a visit and a booklet, or a control Abstract: OBJECTIVE: To determine the prevalence of group (60) that received standard care. Groups were 804
- 813. compared on entryto the study and at 7 months, in brain injury in infants and children: association with terms of parental knowledge and confidence about severity of injury and excitotoxicity. Crit Care Med childhood illnesses, the intended use of home care 2001; 29(12):2287-93. activities, intention to consult professionals and actual Abstract: OBJECTIVES: To measure adenosine use of health services. Data were collected by self- concentration in the cerebrospinal fluid of infants and completed questionnaire and case note review. children after severe traumatic brain injury and to FINDINGS: The educational intervention resulted in a evaluate the contribution of patient age, Glasgow reduction in visits to the child health clinic but had Coma Scale score, mechanism of injury, Glasgow little effect on use of other services. Parents in the Outcome Score, and time after injury to cerebrospinal intervention group showed a general trend towards fluid adenosine concentrations. To evaluate the greater certainty about the home care options they relationship between cerebrospinal fluid adenosine and would choose, and a reduction in intention to consult a glutamate concentrations in this population. DESIGN: doctor. However, they also indicated a feeling of Prospective survey. SETTING: Pediatric intensive care reduced confidence and knowledge. CONCLUSION: unit in a university-based children's hospital. The trial showed no effect on use of services but did PATIENTS: Twenty-seven critically ill infants and demonstrate reduction in parents' intentions to consult a children who had severe traumatic brain injury doctor, which appeared to be because of increased (Glasgow Coma Scale < 8), who required placement of certainty about home care. However, it is of concern an intraventricular catheter and drainage of that they indicated feeling less confident and cerebrospinal fluid as part of their neurointensive care. knowledgeable. It is not possible to clarify whether this INTERVENTIONS: None. MEASUREMENTS AND represented anxiety that was constructive, enhancing MAIN RESULTS: Patients ranged in age from 2 decision-making or was destructive. Further work into months to 14 yrs. Cerebrospinal fluid samples (n = the role of education in parental decision-making, 304) were collected from 27 patients during the first 7 anxiety levels and enhancement of confidence is days after traumatic brain injury. Control cerebrospinal required. fluid samples were obtained from lumbar puncture on 21 infants and children without traumatic brain injury Robertson AS, Rivara FP, Ebel BE, Lymp JF, Christakis or meningitis. Adenosine concentration was measured DA. Validation of parent self reported home safety by using high-pressure liquid chromatography. practices. Inj Prev 2005; 11(4):209-12. Adenosine concentration was increased markedly in Abstract: OBJECTIVES: To evaluate the validity of cerebrospinal fluid of children after traumatic brain parents' self reported home safety practices concerning injury vs. controls (p < .001). The increase in smoke detectors, bike helmets, car seats, and water cerebrospinal fluid adenosine was independently heater temperature. SETTING: Parents of children 12 associated with Glasgow Coma Scale < or = 4 vs. > 4 years old and under whose child had made at least one and time after injury (both p < .005). Cerebrospinal visit to a study clinic in the years 2000-2003. fluid adenosine concentration was not independently METHODS: As part of a randomized controlled trial to associated with either age (< or = 4 vs. > 4 yrs), improve patient provider communication and mechanism of injury (abuse vs. other), or Glasgow preventive practices, parents' responses to telephone Outcome Score (good/moderately disabled vs. severely interview were compared with observations of safety disabled, vegetative, or dead). Of the 27 patients practices during a home visit. Home visits were studied, 18 had cerebrospinal fluid glutamate completed within nine weeks of the telephone concentration previously quantified by high-pressure interview. Parents were not told that the visit was part liquid chromatography. There was a strong association of a validation study and home visit observers were between increases in cerebrospinal fluid adenosine and unaware of the interview responses. The authors glutamate concentrations (p < .005) after injury. calculated sensitivities, specificities, positive and CONCLUSIONS: Cerebrospinal fluid adenosine negative predictive values, and their corresponding concentration is increased in a time- and severity- confidence intervals. RESULTS: Sensitivity (0.78 to dependent manner in infants and children after severe 0.98) and positive predictive values (0.75 to 1.00) were head injury. The association between cerebrospinal high for all items. Specificities and negative predictive fluid adenosine and glutamate concentrations may values were more variable and the highest estimates reflect an endogenous attempt at neuroprotection (specificity 0.95 to 1.00, negative predictive value 0.95 against excitotoxicity after severe traumatic brain to 0.97) were for car seat types. CONCLUSIONS: The injury. results suggest that parent self report practice of certain injury prevention behaviors (owning a car seat, hot Robertson JA. Extreme prematurity and parental rights after water temperatures) is reliable, whereas self reports on Baby Doe. Hastings Cent Rep 2004; 34(4):32-9. other practices (working smoke detectors, properly fitting bike helmets) may be overstated. Robeznieks A. Customer service. Click-on baby pix. Hosp Health Netw 2001; 75(4):30. Robertson CL, Bell MJ, Kochanek PM et al. Increased adenosine in cerebrospinal fluid after severe traumatic 805
- 814. Robshaw M, SmithJ. Concerned about confidentiality? The interviews were tape-recorded, transcribed and child protection jigsaw. Paediatr Nurs 2004; 16(5):36- analysed using Atlas.Ti. RESULTS: Several main 8. themes were identified in this study. Firstly, when discussing scheduled health checks for children under Robson A, Beattie A. Diana Children's Community Service one year of age parents expressed more positive and service co-ordination. Child Care Health Dev feelings for the eight-week check which was seen to be 2004; 30(3):233-9; discussion 241. comprehensive and informative rather than the eight- Abstract: BACKGROUND: The Diana Service and the month check which was viewed as bureaucratic and multi-agency service co-ordination project in Leicester, less reassuring. Secondly, parents clearly articulated a Leicestershire and Rutland were established to address need for reassurance and support from health the needs of children with complex needs. The Mary professionals involved in child health surveillance and Seacole Research Centre at De Montfort University in health promotion programmes. Thirdly, a crucial Leicester evaluated the services over a period of professional in the delivery of these programmes was approximately 1 year. METHODS: Predominantly the health visitor. Whilst parents expressed support for qualitative methods were used. Different approaches to the concept of health visitors some health visitors were sampling were employed and in both cases a range of seen as bureaucratic and as making judgements of need data collection tools were utilized, e.g. written based on socio-economic factors. Finally, some parents questionnaires, personal face-to-face interviews, focus spoke of feeling excluded from accessing support as group, non-participant observation and information they were deemed not to be 'in need'. from professional records. RESULTS: The findings CONCLUSIONS: Wider concepts of partnership suggest that both services are making a considerable working between health professionals and parents, and, contribution towards ensuring that effective needs assessment are important to this study. Crucial collaboration within and between services occurs. This elements of the partnership appear to be missing and makes a real difference to the lives of children and this coupled with needs assessments that leave parents families. feeling excluded mean that there are discrepancies between expectations and experiences of parents. Roca I, Simo M, Sanchez de Toledo J. [Clinical impact of These issues require consideration in order to improve PET in pediatrics]. Rev Esp Med Nucl 2004; services and experiences. 23(5):359-68; quiz 369-71. Rodgers CS, Lang AJ, Laffaye C, Satz LE, Dresselhaus TR, Roche B, Cowley S, Salt N et al. Reassurance or judgement? Stein MB. The impact of individual forms of childhood Parents' views on the delivery of child health maltreatment on health behavior. Child Abuse Negl surveillance programmes. Fam Pract 2005; 22(5):507- 2004; 28(5):575-86. 12. Abstract: OBJECTIVE: This study examines the Abstract: BACKGROUND: The first year of a child's unique contribution of five types of maltreatment life is a crucial time for child development. Current (sexual abuse, physical abuse, emotional abuse, guidance about child health surveillance and health physical neglect, emotional neglect) to adult health promotion programmes emphasises a partnership behaviors as well as the additive impact of exposure to approach between health professionals and parents different types of childhood maltreatment. METHOD: when it comes to child health care. Parents' voices have Two hundred and twenty-one women recruited from a been largely absent from discussions about local child VA primary care clinic completed questionnaires health programmes. For partnership working to be assessing exposure to childhood trauma and adult effective and for local services to be able to evolve health behaviors. Regression models were used to test effectively parents' views are vital. OBJECTIVES: the relationship between childhood maltreatment and This study aimed to explore parents' views on the child adult health behaviors. RESULTS: Sexual and physical health surveillance and health promotion programmes abuse appear to predict a number of adverse outcomes; offered during the first year of their child's life. The when other types of maltreatment are controlled, study aimed to be consumer-led through the however, sexual abuse and physical abuse do not involvement of lead parents in all stages of the research predict as many poor outcomes. In addition, sexual, process. METHODS: This study employed a physical, and emotional abuse and emotional neglect in qualitative methodology of focus groups and individual childhood were all related to different adult health interviews. 35 participants were drawn from three behaviors. The more types of childhood maltreatment general practices using a snowball sampling technique. participants were exposed to the more likely they were Eligibility was determined as parents with a child to have problems with substance use and risky sexual under the age of one year or expecting a baby within behaviors in adulthood. IMPLICATIONS: The results the study timescale and registered at one of the 3 indicate that it is important to assess a broad general practices. Focus groups were led by three maltreatment history rather than trying to relate 'parent-researchers' and individual interviews were specific types of abuse to particular adverse health conducted by a researcher. All focus groups and behaviors or health outcomes. 806
- 815. Rodrigues SS, deAlmeida MD. Portuguese household food 7. availability in 1990 and 1995. Public Health Nutr 2001; Abstract: PURPOSE: In the course of a high-risk study 4(5B):1167-71. for alcoholism, the middle-latency auditory evoked Abstract: OBJECTIVE: To examine the changes in potentials (MAEPs) of children of alcoholics were Portuguese household food availability from 1990 to explored. MATERIAL AND METHODS: A series of 1995. DESIGN: Using the DAta Food NEtworking auditory clicks (0.1 ms, 60 dB SL, 1.1/s) were used to (DAFNE) classification scheme for nutritional and record the Pa and Pb peaks of the MAEPs in 15 socio-economic variables, data from the Portuguese children of alcoholics with a multigenerational family Household Budget Surveys collected in 1989/90 and history of alcoholism, and 17 control subjects, ranging 1994/95 were analysed. The mean availability (quantity from 10 to 14 years of age. RESULTS: The latency of person(-1) day(-1)) for the total population, by locality Pb was shorter in the high-risk than in the control and by level of education of the household head, was group, and there was also a significant risk group by computed for each of the main food and beverage age interaction on Pa latency. The amplitude of Pa was groups. SETTING: Portugal, 1989 to 1995. RESULTS: smaller in the children of alcoholics. CONCLUSIONS: Although still among one of the countries with high The characteristics of the MAEPs of the high-risk availability of cereals, pulses, fish and seafood and subjects did not match the pattern of abnormalities olive oil, Portugal is gradually moving away from the previously observed in chronic alcoholics, which are traditional 'Mediterranean diet'. Between 1989 and supposed to be a consequence of the neurotoxic effects 1995, the availability of complex carbohydrates and of ethanol. Nonetheless, the results showed significant olive oil was reduced, while the availability of protein- differences in MAEPs between children of alcoholics supplying food groups increased. Considerable and controls, pointing to an anomalous pattern of disparities can be observed by locality and by the level information transmission from thalamus to cortex that of education of the household head. Households in should be further analyzed using larger samples in a urban areas and of higher socio-economic status are the broader age range. main actors of the changes in 'traditional' food habits. CONCLUSION: Although these findings are based on Rodriguez J, De La Torre A, Miranda CT. [Mental health in household food availability rather than consumption, situations of armed conflict]. Biomedica 2002; 22 they indicate the direction of the changes taking place Suppl 2:337-46. in the Portuguese diet and can be used effectively by Abstract: Mental health is a serious problem in Latin agriculture specialists, nutrition experts and policy America where many communities have been directly makers. affected by armed conflict, communities in which large population groups have been displaced or have sought Rodriguez GM, Luis MA. [Descriptive study of drug use refuge. Research studies and epidemiological statistics among adolescents in higher middle education in are summarized to emphasize the psychosocial Monterrey, Nueva Leon, Mexico]. Rev Lat Am consequences of traumatic events associated with Enfermagem 2004; 12 Spec No:391-7. armed conflict. In addition to specific psychological Abstract: We aimed to establish the consumption disorders, other more generalized are considered such profile of licit and illicit drugs, consumption patterns as fear, affliction, diseases, social disorder, violence and strategies for coping and resisting alcohol, tobacco and psychoactive substance consumption. Finally, the and other drugs among adolescents in higher middle main points of a mental health plan for emergency education. This study was based on concepts developed situations are described which include the following: by specialized authors and considered the subject's (1) preliminary diagnosis, (2) increase, decentralize behavioral, psychological and normative and strengthen mental health public services, (3) characteristics. The non-probabilistic sample consisted psychosocial attention to the prevailing disorders--with of 325 adolescents. Results indicated that 67%, 65% emphasis on childhood problems, (4) initiate training and 7% of the adolescents, respectively, accepted they and use of non-specialized personnel, and (5) had already used alcohol, tobacco and marijuana at identification of special needs requiring attention by some time in their life and that 33%, 38% and 3%, psychologists and psychiatrists. Other aspects respectively, had used these same substances over the emphasized were community education, training, social last month; 65% consider most of their colleagues have communication, community organization, social used these substances; 56% had to reject an offer to participation, interinstitutional coordination, flexibility, consume alcohol, 64% tobacco and 51% marijuana sustainability, and specific actions in accordance with over the last month. On the basis of these findings, we local needs. recommend the implementation of a prevention program aimed at supporting the adolescent's resources Roe KV. Relationship between male infants' vocal responses to resist pressure towards consumption. to mother and stranger at three months and self- reported academic attainment and adjustment measures Rodriguez Holguin S, Corral M, Cadaveira F. Middle- in adulthood. Psychol Rep 2001; 89(2):255-8. latency auditory evoked potentials in children at high Abstract: This study explored whether 3-mo.-old male risk for alcoholism. Neurophysiol Clin 2001; 31(1):40- infants' differential vocal response to mother vs a 807
- 816. female stranger, whichhas been related to cognitive the female and 11% of the male victims above the age and academic functioning up to 12 years of age, is also of 10 years were married or cohabitant. related to adult development. Of the 12 subjects who had been seen from infancy through 12 years, 10 were Rogers EL. Community partnering and coalition located at Ages 21 and 28 years and were asked about development: finding solutions to oral health care their high school grade point average, scores on the problems together. J Dent Educ 2001; 65(9):892-5. SAT, years of schooling, emotional adjustment, substance abuse, and if they were in a stable Roggin KK, Chwals WJ, Tracy TF. Institutional Review relationship by the age 28. Responses showed 3-mo.- Board approval for prospective experimental studies on olds' differential vocal response was related positively infants and children. J Pediatr Surg 2001; 36(1):205-8. to high school grade point average, scores on the SAT, Abstract: BACKGROUND/PURPOSE: The years of completed education by age 28, and stability Declaration of Helsinki requires Institutional Review of relationship by age 28, and negatively related to Board (IRB) approval for experimental studies on substance abuse. No relationship was found between human subjects. The authors questioned whether differential vocal response and reported emotional published prospective surgical experimental studies problems. Results suggest that early infant social document IRB approval for infants and children. interactions may be linked to adult development or METHODS: Prospective studies were identified in 5 adjustment. surgical and 2 major pediatric journals from 1997 through 1999. Documentation of IRB approval was Rogala C, Tyden T. Does pornography influence young recorded. Results were analyzed using Pearson chi(2) women's sexual behavior? Womens Health Issues tests and a multivariate regression model. Statistical 2003; 13(1):39-43. significance was defined as P less than .05. RESULTS: Abstract: Young women (n = 1,000), visiting a family A total of 149 prospective experimental studies on planning clinic in Stockholm, Sweden, answered a pediatric subjects were evaluated; the majority being questionnaire about their sexual behavior and if they interventional or therapeutic studies (105 of 149). More had seen pornography. Four out of five had consumed than 75% were from academic medical centers (125 of pornography, and one-third of these believed that 149), grant-supported (110 of 149), and appeared in pornography had impacted their sexual behavior. As surgical journals (110 of 149). Slightly less than 25% many as 47% had experienced anal intercourse, which of studies (40 of 149) documented IRB approval. was significantly more common among older women Observational studies, grant support, and publication in (51%) than among teenagers (31%). The majority nonsurgical journals all correlated positively with IRB valued anal intercourse as a negative experience. As approval and were statistically significant variables the use of a condom was low (40%) when having anal (P<.001, P<.001, P<.001, respectively). Interventional intercourse, the consequences for the spread of or therapeutic, institutionally or privately-funded sexually transmitted diseases should be considered. studies found in surgical journals were most likely to avoid IRB documentation (P<.001). CONCLUSIONS: Rogde S, Hougen HP, Poulsen K. Asphyxial homicide in The majority of prospective pediatric studies in the two Scandinavian capitals. Am J Forensic Med Pathol surgical journals omit IRB documentation. Strict 2001; 22(2):128-33. requirements for specific IRB approval and Abstract: In the Oslo and Copenhagen capital areas, 94 documentation in compliance with the Declaration of asphyxial homicides were committed in the 10-year Helsinki would allow higher ethical standards for the period 1985-1994, accounting for 22% of all homicides clinical investigation of infants and children. in that period. Sixty-nine (73%) of the asphyxia victims were female. The most common method of Rogowski JA, Staiger DO, Horbar JD. Variations in the asphyxiation was manual strangulation. Seventeen quality of care for very-low-birthweight infants: (18%) of the victims were below the age of 10, implications for policy. Health Aff (Millwood) 2004; accounting for 59% of all homicides in that age group. 23(5):88-97. Whereas 38% of the female victims were killed by Abstract: Much of the decline in childhood mortality their spouse, this was the case for only one male over the past two decades is attributable to victim. The motive was not known in a great improvements in neonatal intensive care for very-low- proportion of cases. Fifty-seven percent of the victims birthweight infants. Yet large and persistent disparities had been subjected to additional violence, and in this persist in the quality of neonatal intensive care across respect there was no difference between the sexes. In hospitals. Improving care for infants now served by 12 of the cases the offender was female; in 9 such cases hospitals with poor outcomes can greatly reduce infant the victim was her offspring. More than half of the mortality, particularly among minority infants who are victims had no blood alcohol. When disregarding the more likely to be very low birthweight and cared for by victims less than 10 years of age, 33% of the male and hospitals with poor outcomes. Referral of high-risk 49% of the female victims had no blood alcohol. The births to hospitals with the best outcomes is another crime scene was the victim's domicile among 72% of promising strategy. female and 52% of male victims. Forty-two percent of 808
- 817. Rogstad KE, HolkarS, Dewdney A. Sexual health needs of absent or sparse in the aganglionic bowel and sparse in the under-16s attending an STI clinic: what are they the transitional zone. The expression of myenteric and are they being addressed? Int J STD AIDS 2003; ICCs in the ganglionic bowel in HD was reduced 14(4):266-9. compared to that in the normal bowel, and they formed Abstract: A retrospective analysis was performed on only sparse networks. Muscular ICCs were found in the case notes of patients aged less than 16 years who aganglionic bowel, transitional zone, and attended a Department of Genito-Urinary Medicine as normoganglionic bowel of HD in a reduced density a new case in 1998. Seventy-four case notes were compared to the normal bowel. CONCLUSION: This reviewed. There was a high rate of sexually transmitted study demonstrates altered distribution of ICCs in the infection (STI) (gonorrhoea six [8%], chlamydia 23 entire resected bowel of HD patients. This finding [31%], genital warts nine [12%], trichomonas seven suggests that persistent dysmotility problems after pull- [10%]) and low condom (30, 41%) and other through operation in HD may be due to altered contraceptive use (21 females [35%], six males [60%]). distribution and impaired function of ICCs. Many female attendees were victims of current or previous sexual abuse (eight, 8%) and/or exploitation, Rosen C. Liberty, privacy, and DNA databases. New and for a further eight (8%) abuse/exploitation was Atlantis 2003; (1):37-52. considered possible; little reference was made to this in Notes: GENERAL NOTE: KIE: KIE Bib: DNA the notes. Thirty-three (45%) attendees were seen by fingerprinting; genetic research junior members of staff, and only 49 (60%) were seen by a health adviser (42 females, seven males [60%]). Rosen L. Conjoined twins: 2000 version. British Supreme Young attendees have a high STI rate, low Court's decision. Assia Jew Med Ethics 2001; 4(1):28- contraceptive use and a significant minority are victims 9. of abuse. Genitourinary medicine clinics need to Notes: GENERAL NOTE: KIE: Rosen, Leora provide a full sexual health service to this vulnerable GENERAL NOTE: KIE: KIE Bib: patient care/minors; group and have guidelines in place to assess for sexual treatment refusal/minors abuse. Recommendations on how to achieve this are GENERAL NOTE: KIE: Case No: B1/2000/2696, given. 22nd September 2000.http://news.findlaw.com/cnn/docs/siamesetwins/s Rohde DL. Learnability, stochastic input, and connectionist iamesetwins1.html networks: a response to Brian MacWhinney's 'A multiple process solution to the logical problem of Rosen LN, O'Sullivan CS. Outcomes of custody and language acquisition'. J Child Lang 2004; 31(4):954-8; visitation petitions when fathers are restrained by discussion 963-8. protection orders: the case of the New York family courts. Violence Against Women 2005; 11(8):1054-75. Rolle U, Piotrowska AP, Nemeth L, Puri P. Altered Abstract: A random sample of custody and visitation distribution of interstitial cells of Cajal in Hirschsprung petitions filed in New York City Family Courts in 1995 disease. Arch Pathol Lab Med 2002; 126(8):928-33. was used to examine outcomes of mothers' Order of Abstract: CONTEXT: Constipation or recurrent Protection (OP) Petitions in relation to parents' custody intestinal dysmotility problems are common after and visitation petitions. Fathers restrained by OPs were definitive surgical treatment in Hirschsprung disease more likely to secure visitation orders (64%) than not. (HD). c-Kit-positive interstitial cells of Cajal (ICCs) In contrast, 80.8% of fathers' custody petitions were play a key role in the motility function and dismissed when they were restrained by OPs. Fathers' development of the gastrointestinal tract. Interstitial custody petitions were most likely to be ordered when cells of Cajal that carry the tyrosine kinase receptor (c- mothers' OP petitions were withdrawn. Mothers were Kit) develop as either myenteric ICCs or muscular most likely to secure custody when their OP petitions ICCs under the influence of the kit ligand, which can were ordered or withdrawn. Courts rarely denied be provided by neuronal and nonneuronal cells, for petitions. Those that did not result in court orders were example, smooth muscle cells. OBJECTIVE: To either withdrawn by the petitioner or dismissed by the investigate the distribution of myenteric and muscular court (most likely because of failure of the petitioner to ICCs in different parts of the colon in HD. appear in court). This pattern has negative implications METHODS: Resected bowel specimens from 8 for battered women who may be vulnerable to pressure patients with rectosigmoid HD were investigated using or threats from abusive ex-partners. combined staining with c-Kit enzyme and fluorescence immunohistochemistry and acetylcholinesterase and Rosenberg AD, Abell SC, Mackie JK. An examination of nicotinamide adenine dinucleotide phosphate the relationship between child sexual offending and (NADPH) histochemistry in whole-mount preparations psychopathy. J Child Sex Abus 2005; 14(3):49-66. and conventional frozen sections. RESULTS: In the Abstract: The participants in this study were adult normal bowel, ICCs formed a dense network males (N = 111) who were accused of various sexual surrounding the myenteric plexus and at the innermost crimes against children 16 years of age or younger, and part of the circular muscle. Myenteric ICCs were 809
- 818. who were evaluatedat a state forensic facility in a large Rosenberg NM, Chumpa A, Pitetti R, Reid SR. Managerial Midwestern state. This study examined the relationship dilemmas. Pediatr Emerg Care 2001; 17(3):208-11. of Psychopathy Checklist-Revised (PCL-R) scores to type of child sexual offender (same sex extrafamilial, Rosenberg NM, Knazik SR, Strait RT, Nadkarni M. opposite sex extrafamilial, and incest offenders), the Controversies in pediatric medicine. Decisions of King presence of violence during the most recent child Solomon. Pediatr Emerg Care 2001; 17(5):364-8. sexual offense, and criminal versatility. Results Notes: GENERAL NOTE: KIE: KIE Bib: allowing to indicated that those sexual offenders who employed die/infants; patient care/minors physical violence against the children they abused were significantly more psychopathic than those who did Rosenblum A, Magura S, Fong C et al. Substance use not. No significant differences were found between among young adolescents in HIV-affected families: types of child sexual offenders or with general criminal resiliency, peer deviance, and family functioning. Subst versatility. Use Misuse 2005; 40(5):581-603. Abstract: This study examines the association of risk Rosenberg DA. Munchausen Syndrome by Proxy: medical and protective factors with substance use among 77 diagnostic criteria. Child Abuse Negl 2003; 27(4):421- early adolescents (11-15 years old) with an HIV- 30. infected parent who were interviewed in 2000-2001 in Abstract: Medical diagnostic criteria for Munchausen the South Bronx, a HIV high-prevalence area of New Syndrome by Proxy are presented. The strength of the York City. The subjects were 49%female, 53% African known facts may vary from case to case, and thus there American, and 30% Hispanic; mean age was 13 years may be different degrees of diagnostic conviction. old. A face-to-face interview was used to administer a Therefore, diagnostic criteria for a definitive diagnosis, battery of instruments representing community, family, and a possible diagnosis of Munchausen Syndrome by peer, and resiliency factors. Forty percent reported ever Proxy are provided. Because the gathering of evidence using tobacco, alcohol or drugs; 71% were aware of in a case may, ultimately, diminish or exclude the their parent's HIV seropositivity. An age-adjusted path diagnosis of Munchausen Syndrome by Proxy, analytic model was constructed which showed: 1) diagnostic criteria for the inconclusive determination family functioning predicted resiliency (a composite and the definitely excluded diagnosis are also measure of psychological adjustment and personal enunciated. competencies); 2)positive community factors and resiliency predicted less affiliation with deviant peers; Rosenberg MF, Anthony JC. Aggressive behavior and and 3) poorer family functioning and affiliation with opportunities to purchase drugs. Drug Alcohol Depend deviant peers predicted substance use. These results 2001; 63(3):245-52. underscore the need for interventions that address Abstract: Robins, Kellam, and others found robust social influence factors among vulnerable early evidence linking youthful aggression and deviance to adolescents with HIV-positive parents. later illicit drug use. Some investigators favor the interpretation that drug use is just one manifestation or Rosenfeld RM. Observation option toolkit for acute otitis complication of a more general problem behavior media. Int J Pediatr Otorhinolaryngol 2001; 58(1):1-8. syndrome or conduct disorder. In this work, we test the Abstract: The observation option for acute otitis media complementary hypothesis that aggressive youth are (AOM) refers to deferring antibiotic treatment of more likely to be approached with offers to buy drugs, selected children for up to 3 days, during which time and found the most aggressive youths were about five management is limited to analgesics and symptomatic times more likely to be offered drugs for purchase. relief. With appropriate follow-up complications are However, this association was much attenuated when not increased, and clinical outcomes compare favorably levels of delinquency were taken into account. In this with routine initial antibiotic therapy. Although used respect, delinquent rather than aggressive behavior commonly in the Netherlands and certain Scandinavian might be more salient. This study's evidence does not countries, this approach has not gained wide contradict previous problem behavior theories, but acceptance in Europe and the United States. This rather prompts new ideas about how aggression, article describes an evidence-based toolkit developed delinquency, and drug use might be linked. One by the New York Region Otitis Project for judicious testable hypothesis is that youths with both aggression use of the observation option. The toolkit is not and delinquency are more likely to enter intended to endorse the observation option as a microenvironments where drug dealing is more preferred method of management, nor is it intended as prevalent. Or, their observable behaviors or physical a rigid practice guideline to supplant clinician appearance might function as signs of apparent judgement. Rather, it presents busy clinicians with the willingness to try drugs. These results add to our tools needed to implement the observation option in understanding of links between aggression, everyday patient care should they so desire. delinquency, and drug use, and introduce a new line of epidemiological inquiry focused upon drug purchase Rosenfield RL, Bernardo LM. Pediatric implications in opportunities. 810
- 819. bioterrorism part II:postexposure diagnosis and immunization levels among preschoolers in medically treatment. Int J Trauma Nurs 2001; 7(4):133-6. underserved communities. Communities with federally Abstract: Bioterrorism is an old tactic used in warfare. designated health professional shortage areas were The use of fatal diseases or man-made poisons to invited to submit proposals, and 4 were selected: subdue others has not been limited to wartime. Trauma Detroit, MI, New York, NY, San Diego, CA, and rural personnel should be aware of commonly used agents, Colorado. OBJECTIVES: To measure immunization the signs and symptoms of their exposure, and coverage among preschool children in the 4 selected recommended treatment. Children can be victims of medically underserved areas and determine predictors terrorists' acts and need special attention because of of coverage levels. DESIGN AND SETTING: Surveys their unique response to exposure, varying dosages of in the 4 areas were based on stratified cluster medications, and lack of active immunity. probability sample designs in which clusters of dwelling units were selected and all households in Rosenfield S, Lennon MC, White HR. The self and mental selected clusters were screened for the presence of health: self-salience and the emergence of internalizing children aged 12 to 35 months. Immunization histories and externalizing problems. J Health Soc Behav 2005; were obtained from parents and providers for these 46(4):323-40. children. For each age-eligible child, the information Abstract: How do schemas about self-salience--the collected on utilization of immunization health services importance of the self versus the collective in social included a listing of all clinics or offices ever used for relations--affect mental health? We propose that self- the child's well-child care and/or for obtaining salience shapes the likelihood of experiencing immunizations. Information was also collected on internalizing or externalizing problems. Schemas that whether the child currently had health insurance privilege others over the self increase the risk of (public and/or private) and whether the child had a internalizing symptoms, including depressive medical home. A child was classified as having a symptoms and anxiety, whereas those that privilege the medical home if the survey respondent reported a self over others predispose individuals to externalizing source of well care that was the same as the source of behaviors of antisocial behavior and substance abuse. sick care and that this place was not an emergency Furthermore, we propose that these schemas contribute department. PARTICIPANTS: Children 12 to 35 to the gender differences that exist in these problems. months of age in Detroit, New York, San Diego, and We test these predictions with data from adolescents, rural Colorado. OUTCOME MEASURE: Community- the stage at which these problems and the gender wide up-to-date (UTD) immunization coverage levels differences in them arise. Results show that self- at 19 to 35 months of age, defined as receipt of 4 doses salience underlies both internalizing and externalizing of diphtheria and tetanus toxoids and pertussis vaccine, problems. In addition, schemas about self-salience help 3 doses of poliovirus vaccine, 1 dose of measles, explain the gender differences found in mental health mumps, and rubella vaccine, 3 doses of Haemophilus problems. influenzae type B vaccine, and 3 doses of hepatitis B vaccine (the 4:3:1:3:3 series). ANALYSIS: We Rosenthal J, Rodewald L, McCauley M et al. Immunization examined the association between coverage level and coverage levels among 19- to 35-month-old children in independent variables and performed chi2 and t tests to 4 diverse, medically underserved areas of the United determine whether differences observed within and States. Pediatrics 2004; 113(4):e296-302. between groups and sites were significant. RESULTS: Abstract: BACKGROUND: The National The overall response rate for eligible children ranged Immunization Survey demonstrates that national from 79.4% to 88.1%. Coverage levels for most immunization coverage in 2002 remained near the all- individual vaccines were >90% in all sites except time highs achieved in 2000. However, that survey Detroit. Coverage for the 4:3:1:3:3 series was cannot detect whether coverage is uniformly high significantly higher for children in New York (84%) within relatively small areas or populations. The and San Diego (86%) than for children in Detroit measles resurgence in the early 1990s revealed that (66%) and rural Colorado (75%). Demographic risk coverage was low in some areas, particularly among factors related to UTD immunization status varied by inner-city children from racial and ethnic minority site. Although differences in coverage levels by groups. Today, identifying areas with low childhood- ethnicity varied by site, differences were not vaccination coverage remains important, particularly if significant. In Colorado and New York, coverage was these areas are at risk for the introduction of disease. In slightly lower among Hispanic than white children 1995, the Centers for Disease Control and Prevention (71% vs 76% and 83% vs 91%, respectively). In San launched a congressionally mandated demonstrated Diego, coverage was lower among whites, compared project now called the Childhood Immunization with Hispanics (76% vs 85%). Coverage was also Demonstration project of Community Health lower for African American than white children only in Networks. This mandate specified an assessment to New York (75% vs 91%). However, in San Diego and determine whether a network of primary care providers Colorado, children receiving their vaccinations from affiliated with university teaching hospitals could private providers had lower coverage levels than assume a public health responsibility for raising children receiving their vaccinations from other 811
- 820. providers (78% vs91% and 71% vs 57%, programs. First, the nation's vital records system must respectively). Ictively). In all 4 sites, children for be reengineered to ensure that this key information whom respondents reported having an immunization asset can be integrated into other child health card at the time of the interview were more likely to information systems. Second, through an appropriate have higher series coverage levels than children for governance structure, the key stakeholders in child whom a parent-held card was not available. Also, health should endorse standards and requirements that children who were UTD at 3 months of age had define a longitudinal health record for children. Third, significantly higher vaccination-series coverage levels public health agencies should develop a thorough than children who were not UTD at 3 months of age. In business case/value proposition that drives mutually addition, the vaccination coverage was lower for developed and mutually endorsed requirements for the children in Detroit whose parents reported problems integration of presently fragmented systems. Fourth, accessing the health care system because lack of public health should take the lead in ensuring that transportation (46%), compared with those who did not parents have convenient access to information that can report such problems (65%); however, this difference support the coordination of their child's care and did not reach significance (chi2 = 6.0). In Colorado, the development. And fifth, provider groups and public small proportion of children in families without a health agencies should join research networks to study phone had a lower vaccination coverage level (58%) how information supports positive changes to than those in households with a phone (75%) (chi2 = children's health. 6.3). In all sites, children who were UTD at 3 months of age and had a parent-held vaccination card were Ross LF. Predictive genetic testing for conditions that more likely to be UTD at 19 to 35 months of age. present in childhood. Kennedy Inst Ethics J 2002; CONCLUSIONS: Preschoolers in these medically 12(3):225-44. underserved areas were not at uniform risk for Notes: GENERAL NOTE: KIE: 58 refs. underimmunization. Because they were designated as GENERAL NOTE: KIE: KIE Bib: genetic screening; health professional shortage areas, the 4 sites in this mass screening study were expected to have low immunization- Abstract: There is a general consensus in the medical coverage rates. However, this was not the case. In fact, and medical ethics communities against predictive coverage in 3 of the 4 areas was quite high compared genetic testing of children for late onset conditions, but with US national figures (73%); only Detroit had a minimal consideration is given to predictive testing of much lower UTD rate (66%). Efforts are needed to asymptomatic children for disorders that present later improve methods to identify areas with low in childhood when presymptomatic treatment cannot immunization coverage so that resources can be influence the course of the disease. In this paper, I directed to places where interventions are needed. Our examine the question of whether it is ethical to perform results reveal that an area's need for childhood predictive testing and screening of newborns and immunization interventions is not well predicted by a young children for conditions that present later in low number of providers per capita. Other criteria must childhood. I consider the risks and benefits of (1) be developed to predict areas or populations with low predictive testing of children from high-risk families; immunization coverage. Understanding more about the (2) predictive population screening for conditions that characteristics of children/provider pairs for children are untreatable; and (3) predictive population screening who are UTD at 3 months and more about the role of for conditions in which the efficacy of presymptomatic parental hand-held cards, along with finding strategies treatment is equivocal. I conclude in favor of parental to improve immunization delivery by providers in discretion for predictive genetic testing, but against Vaccines for Children Program facilities, suggest state-sponsored predictive screening for conditions that potentially productive avenues for increasing and do not fulfill public health screening criteria. sustaining high coverage levels. Ross LT, Hill EM. Comparing alcoholic and nonalcoholic Ross DA, Hinman AR, Saarlas KN, Lloyd-Puryear MA, parents on the family unpredictability scale. Psychol Downs SJ. The near-term future for child health Rep 2004; 94(3 Pt 2):1385-91. information systems. J Public Health Manag Pract Abstract: Research findings and clinical observations 2004; Suppl:S99-104. suggest that families with an alcoholic parent are more Abstract: The developmental process in children offers unpredictable. Alcoholic parents (n=25, 68% men, 68% an opportunity to influence their health and well-being Euro-American, M age=38.6 yr.) and community as adults. The information infrastructure of the future parents (n=27, 52% men, 70% Euro-American, M needs to support the multiple partners responsible for age=38.8 yr.) completed the self-report Family providing elements of the health protection and health Unpredictability Scale of Ross and Hill. Alcoholic care of children. In this partnership, public health plays parents reported significantly higher (less simultaneously a supportive role and a leadership role. predictability) scores on the subscales of Nurturance, Five tasks need to guide near-term information systems Finances, and Discipline, as well as on the Total thinking with respect to establishing a basis for Family Unpredictability Scale (ps<.01). This appears to building electronic linkages among various child health be the first study on family unpredictability and 812
- 821. parental alcoholism inwhich parental reports of is associated with focal premature capillary fusion. multiple dimensions of unpredictability are used. We provide suggestions for research and clinical uses of Roth TL, Sullivan RM. Memory of early maltreatment: the scale, especially pertaining to families with an neonatal behavioral and neural correlates of maternal alcoholic parent. maltreatment within the context of classical conditioning. Biol Psychiatry 2005; 57(8):823-31. Roth D, Boyle E, Beer D, Malik A, deBruyn J. Depressing Abstract: BACKGROUND: While children form an research. Lancet 2004; 363(9426):2087. attachment to their abusive caregiver, they are Notes: GENERAL NOTE: KIE: 4 refs. susceptible to mental illness and brain abnormalities. GENERAL NOTE: KIE: KIE Bib: biomedical To understand this important clinical issue, we have research; fraud and misconduct developed a rat animal model of abusive attachment Abstract: Suppression of the publication of negative where odor paired with shock paradoxically produces trials of serotonin-selective reuptake inhibitors (SSRI) an odor preference. Here, we extend this model to a in children (Apr 24, p 1335) is more than just a matter seminaturalistic paradigm using a stressed, "abusive" of "confusion, manipulation, and institutional failure". mother during an odor presentation and assess the It is a crime. To blandly illustrate its severity, we can underlying learning neural circuit. METHODS: We analogise the situation as follows: would you be used a classical conditioning paradigm pairing a novel concerned if a colleague prescribed penicillin to a child odor with a stressed mother that predominantly abused who had an uncomplicated upper respiratory tract pups to assess olfactory learning in a seminaturalistic infection of viral aetiology? Would you be more environment. Additionally, we used Fos protein concerned if you heard that this child had a serious immunohistochemistry to assess brain areas involved anaphylactic reaction to the penicillin at home? And in learning this pain-induced odor preference within a how much more concerned would you be if you found more controlled maltreatment environment (odor-shock out that the prescribing doctor was previously aware of conditioning). RESULTS: Odor-maternal maltreatment the child's severe penicillin allergy? The latter scenario pairings within a seminatural setting and odor-shock could be deemed malpractice. How, then, is it pairings both resulted in paradoxical odor preferences. acceptable for pharmaceutical companies to suppress Learning-induced gene expression was altered in the publication of SSRI studies that showed a lack of olfactory bulb and anterior piriform cortex (part of efficacy and an increased risk of serious adverse events olfactory cortex) but not the amygdala. in the children and adolescents in experimental trial CONCLUSIONS: Infants appear to use a unique brain groups (other than for fluoxetine)? Intentional circuit that optimizes learned odor preferences concealment of these data, an accusation for which necessary for attachment. A fuller understanding of there is already public evidence, must be considered a infant brain function may provide insight into why form of corporate violence. early maltreatment affects psychiatric well-being. Roth-Kleiner M, Berger TM, Tarek MR, Burri PH, Schittny Rothenberger A, Danckaerts M, Dopfner M, Sergeant J, JC. Neonatal dexamethasone induces premature Steinhausen HC. EINAQ -- a European educational microvascular maturation of the alveolar capillary initiative on Attention-Deficit Hyperactivity Disorder network. Dev Dyn 2005; 233(4):1261-71. and associated problems. Eur Child Adolesc Psychiatry Abstract: Postnatal glucocorticoid treatment of preterm 2004; 13 Suppl 1:I31-5. infants was mimicked by treating newborn rats with Abstract: BACKGROUND: Continuing Medical dexamethasone (0.1-0.01 microg/g, days 1-4). This Education (CME) plays an important role in quality regimen has been shown to cause delayed management, especially as quality assurance, for the alveolarization. Knowing that microvascular improvement of healthcare in child and adolescent maturation (transformation of double- to single-layered psychiatry. This requires responsibility regarding capillary networks in alveolar septa) and septal quality standards of clinical practice throughout Europe thinning prevent further alveolarization, we measured as outlined by the European Union of Medical septal maturation on electron photomicrographs in Specialists (UEMS). OBJECTIVE: Therefore, steps treated and control animals. In treated rats and before should be undertaken to improve specialists' medical day 10, we observed a premature nonreversing care and harmonize it in Europe. Attention-Deficit microvascular maturation and a transient septal Hyperactivity Disorder (ADHD) with its many co- thinning, which both appeared focally. In vascular casts existing developmental disorders/problems is the of both groups, we observed contacts between the two central healthcare problem in child and adolescent capillary layers of immature alveolar septa, which were psychiatry with high impact on society. Therefore, it predictive for capillary fusions. Studying serial electron was chosen as the target. METHOD: A European microscopic sections of human lungs, we were able to Interdisciplinary Network for ADHD Quality confirm the postulated fusion process for the first time. Assurance (EINAQ) was founded, didactic material We conclude that alveolar microvascular maturation was developed and a faculty of experts from several indeed occurs by capillary fusion and that the European countries established to offer all over Europe dexamethasone-induced impairment of alveolarization harmonized courses on ADHD and associated 813
- 822. problems. RESULTS: Pilotcourses were given in intervention condition compared with those attending Germany in 2003/2004 and were highly appreciated by the control condition. Following the "Act Safe" the participants. Further courses in Germany and other module, youths who attended the intervention European countries will take place in 2004. condition reported 82% fewer unprotected sexual acts, CONCLUSION: EINAQ seems to be on the right track 45% fewer sexual partners, 50% fewer HIV-negative to be part of CME and specialized networks for sexual partners, and 31% less substance use, on a healthcare in ADHD to improve the provision for weighted index, than those in the control condition. mental health problems in children and adolescents in CONCLUSIONS: Prevention programs can effectively Europe. Cooperative projects with official European reduce risk acts among HIV-infected youths. bodies like the UEMS -- Section on Child and Alternative formats need to be identified for delivering Adolescent Psychiatry/Psychotherapy and the interventions (e.g., telephone groups, individual European Society of Child and Adolescent Psychiatry sessions). could strengthen the impact of EINAQ. Rousseau C, Machouf A. A preventive pilot project Rotheram-Borus MJ, Lee M, Leonard N et al. Four-year addressing multiethnic tensions in the wake of the Iraq behavioral outcomes of an intervention for parents war. Am J Orthopsychiatry 2005; 75(4):466-74. living with HIV and their adolescent children. AIDS Abstract: This article describes a school-based 2003; 17(8):1217-25. preventive pilot project for recent immigrant children, Abstract: OBJECTIVE: The adjustment of parents designed to decrease anxiety and intergroup tensions living with HIV (PLH) and their adolescent children associated with the Iraq war. Results suggest that was examined over 4 years in response to an clinicians should address the multiplicity of meanings intervention. Outcomes at 2 years had been previously associated with international events when planning a published. METHODS: A randomized controlled trial prevention program in multiethnic schools to help was conducted, with a representative sample from New children to cope with the increasingly common gap York City. RESULTS: In the intervention condition, between the ways traumatic events covered by the fewer adolescents became teenage parents, and conduct media are understood at home and at school. problems tended to be lower over 4 years than in the standard care condition. Fewer parents were drug Rovers MM, Straatman H, Ingels K, van der Wilt GJ, van dependent and tended to relapse into substance use or den Broek P, Zielhuis GA. Generalizability of trial use passive coping styles compared with the standard results based on randomized versus nonrandomized care condition over 4 years. The time-trend analysis allocation of OME infants to ventilation tubes or showed that the significant reductions in problem watchful waiting. J Clin Epidemiol 2001; 54(8):789- behaviors and emotional distress previously observed 94. over 15-24 months in the intervention condition, then Abstract: The objective was to study the eroded over time and were non-significant at 48 generalizability of trial results by comparing months. CONCLUSIONS: Ongoing support and skills randomized patients to eligible but nonrandomized are needed to maintain intervention effects over longer patients who received the same management. periods. Implementation of trial results is only justifiable when the results can be generalized to the total domain Rotheram-Borus MJ, Lee MB, Murphy DA et al. Efficacy of population. The design was a multicentre randomized a preventive intervention for youths living with HIV. controlled trial on the effect of early screening and Am J Public Health 2001; 91(3):400-5. treatment with ventilation tubes on infants with otitis Notes: CORPORATE NAME: Teens Linked to Care media with effusion. Randomized (n = 187) and Consortium nonrandomized eligible patients (n = 133) were Abstract: OBJECTIVES: HIV transmission behaviors followed up. The study population comprised children and health practices of HIV-infected youths were who were detected by auditory screening at the age of examined over a period of 15 months after they 9-12 months and who were subsequently diagnosed received a preventive intervention. METHODS: HIV- with persistent bilateral otitis media with effusion for infected youths aged 13 to 24 years (n = 310; 27% 4-6 months. A significant difference was found in the African American, 37% Latino) were assigned by distribution of some prognostic factors: more small cohort to (1) a 2-module ("Stay Healthy" and randomized children had older siblings, did not attend "Act Safe") intervention totaling 23 sessions or (2) a day care and had mothers with a lower educational control condition. Among those in the intervention level than the nonrandomized children. These factors, condition, 73% attended at least 1 session. RESULTS: however, did not modify the outcome. No differences Subsequent to the "Stay Healthy" module, number of were found in mean hearing levels between the positive lifestyle changes and active coping styles randomized and nonrandomized children: in both the increased more often among females who attended the randomized and nonrandomized children ventilation intervention condition than among those in the control tubes improved the hearing level, especially after 6 condition. Social support coping also increased months. However, in the long term (12 months), the significantly among males and females attending the hearing levels were equal again. The results of the 814
- 823. randomized and nonrandomizedpatients were peers and to leadership in boys with nondeviant peers. comparable. The results of this trial appear to be CONCLUSIONS: The results are consistent with the generalizable to the total domain population. The hypothesis that testosterone relates to social procedure of following up both randomized and dominance, with the assumption that behaviors nonrandomized patients is recommended when there is associated with dominance differ according to social concern about selective participation and reduced context. generalizability. Rowling AJ, Kvalsvig AJ, Sharples PM, Foot AB, Unsworth Rowe J. A room of their own: the social landscape of infant DJ. Pneumocystis carinii, cytomegalovirus, and severe sleep. Nurs Inq 2003; 10(3):184-92. transient immunodeficiency. J Clin Pathol 2003; Abstract: This paper draws on findings of a study in 56(9):718-9. which new and experienced mothers' caregiving Abstract: Pneumocystis carinii infection is rare in practices were investigated, in order to examine social infants, and raises strong concerns of immune perspectives of infant sleep. Health professionals who deficiency. This report describes the unusual case of a work to support early parenting and promote child male infant with concurrent chest infections caused by health and well-being provide guidance to their clients P carinii and cytomegalovirus. Investigation was concerning infant sleep cares. Currently, advice is complicated by the strong suspicion of non-accidental predominantly informed by understandings and injury, including subdural haematomas. The case strategies derived from Sudden Infant Death Syndrome illustrates how to investigate for possible (SIDS) risk reduction campaigns and behavioural immunodeficiency. Low immune function tests at training models. The social context of caregiving is a presentation slowly improved and have remained significant if somewhat neglected perspective. The normal on longterm follow up. Possible explanations analysis presented in this paper suggests that in sleep for the transient severe clinical immunodeficiency in arrangements, a complex social locale is revealed, an this case are discussed. elaboration of carers' values and understandings about infants as developing persons, juxtaposed with their Roy A. Childhood trauma and impulsivity. Possible own desires and needs. Tensions between child-centred relevance to suicidal behavior. Arch Suicide Res 2005; nurturing and adult-focused concerns are expressed and 9(2):147-51. reconciled in caregiving. These understandings may Abstract: Social factors are thought to contribute to assist health professionals to develop proactive and impulsivity. As childhood traumas predispose to responsive practices in the area of early childrearing suicidal behavior it was decided to examine whether support. they may be a determinant of impulsivity, a personality dimension often associated with suicidal behavior. Rowe R, Maughan B, Worthman CM, Costello EJ, Angold Thus 268 abstinent drug dependent patients completed A. Testosterone, antisocial behavior, and social both the Childhood Trauma Questionnaire (CTQ) and dominance in boys: pubertal development and the Barratt Impulsivity Scale (BIS). The results showed biosocial interaction. Biol Psychiatry 2004; 55(5):546- that there were significant relationships, albeit small, 52. between CTQ scores and BIS impulsivity scores. These Abstract: BACKGROUND: Studies linking results suggest that childhood trauma may be one testosterone and antisocial behavior in humans have determinant of impulsivity as an adult. produced mixed results. Adolescence offers a promising period to study this relationship; circulating Roy A. Relationship of childhood trauma to age of first testosterone increases dramatically in boys during suicide attempt and number of attempts in substance puberty, and antisocial behavior increases during the dependent patients. Acta Psychiatr Scand 2004; same period. METHODS: Our analyses were based on 109(2):121-5. boys aged 9-15 years who were interviewed during the Abstract: OBJECTIVE: To examine whether childhood first three waves of the Great Smoky Mountains Study. trauma effect the age of first attempting suicide and the Measures included interview assessment of DSM-IV number of attempts. METHOD: One thousand twelve conduct disorder (CD) symptoms and diagnosis, blood hundred and eighty substance dependent patients were spot measurement of testosterone, Tanner staging of interviewed about whether or not they had ever pubertal development, and assessment of leadership attempted suicide, the age of first attempt and the behaviors and peer deviance. RESULTS: The number of attempts. Patients completed the Childhood adolescent rise in CD was primarily attributable to an Trauma Questionnaire - 34 item version. RESULTS: increase in nonphysically aggressive behaviors. Five hundred and thirty-eight patients (42%) had Increasing levels of circulating testosterone and attempted suicide. Significantly more of the patients association with deviant peers contributed to these age who had attempted suicide were female. Patients who trends. There was no evidence that physical aggression had made three or more attempts had significantly was related to high testosterone. Evidence of biosocial higher childhood trauma scores than patients who had interactions was identified; testosterone was related to made two attempts, who had higher scores than nonaggressive CD symptoms in boys with deviant 815
- 824. patients who hadmade one attempt, who had higher olds and adults. BMC Neurosci 2004; 5(1):39. scores than patients who had never attempted. Patients Abstract: BACKGROUND: Tasks involving conflict who first attempted suicide before the age of 20 years are widely used to study executive attention. In the had significantly higher childhood trauma scores than flanker task, a target stimulus is surrounded by patients who first attempted after 20 years of age. distracting information that can be congruent or CONCLUSION: Childhood trauma may be a incongruent with the correct response. Developmental determinant of the age of onset of suicidal behavior and differences in the time course of brain activations of the number of suicide attempts. involved in conflict processing were examined for 22 four year old children and 18 adults. Subjects Roy A, Janal M. Family history of suicide, female sex, and performed a child-friendly flanker task while their childhood trauma: separate or interacting risk factors brain activity was registered using a high-density for attempts at suicide? Acta Psychiatr Scand 2005; electroencephalography system. RESULTS: General 112(5):367-71. differences were found in the amplitude and time Abstract: OBJECTIVE: Female sex, childhood trauma, course of event-related potentials (ERPs) between and a family history of suicidal behavior are three well children and adults that are consistent with their established risk factors for attempting suicide. differences in reaction time. In addition, the However, interactions between these three factors in congruency of flankers affected both the amplitude and attempting suicide have been little studied. METHOD: latency of some of the ERP components. These effects One thousand eight hundred and eighty-nine abstinent were delayed and sustained for longer periods of time substance dependent patients were interviewed about in the children compared to the adults. their lifetime and family history of suicidal behavior CONCLUSIONS: These differences constitute neural and completed the Childhood Trauma Questionnaire correlates of children's greater difficulty in monitoring (CTQ). Gender, family history of suicidal behavior, and resolving conflict in this and similar tasks. and CTQ scores--and their interaction--were examined in relation to suicidal behavior. RESULTS: Each of the Rueda MR, Rothbart MK, McCandliss BD, Saccomanno L, three risk factors was associated with at least a Posner MI. Training, maturation, and genetic doubling of the risk for an attempt at suicide. There influences on the development of executive attention. were no significant interactions in relation to the risk of Proc Natl Acad Sci U S A 2005; 102(41):14931-6. making an attempt. However, female sex and higher Abstract: A neural network underlying attentional levels of childhood trauma each discriminated patients control involves the anterior cingulate in addition to at risk for both a younger age of first attempting lateral prefrontal areas. An important development of suicide and for making more attempts. this network occurs between 3 and 7 years of age. We CONCLUSION: Female sex, childhood trauma, and a have examined the efficiency of attentional networks family history of suicidal behavior are each across age and after 5 days of attention training independent, and non-interacting, risk factors for (experimental group) compared with different types of attempting suicide. Additionally, female sex and high no training (control groups) in 4-year-old and 6-year- childhood trauma are independent risk factors for both old children. Strong improvement in executive an early onset of first attempting suicide and for attention and intelligence was found from ages 4 to 6 making more attempts. years. Both 4- and 6-year-olds showed more mature performance after the training than did the control Rube DM, Kibel RN. The Jewish child, adolescent, and groups. This finding applies to behavioral scores of the family. Child Adolesc Psychiatr Clin N Am 2004; executive attention network as measured by the 13(1):137-47. attention network test, event-related potentials recorded Abstract: This brief review addresses the history, from the scalp during attention network test beliefs, and practices of Jewish families that have performance, and intelligence test scores. We also implications for clinical management of the problems documented the role of the temperamental factor of and disorders of children and adolescents. It focuses effortful control and the DAT1 gene in individual primarily on the problems of the Orthodox family due, differences in attention. Overall, our data suggest that in part, to the limitations of space. There remains, the executive attention network appears to develop however, little doubt that the clinician must be aware under strong genetic control, but that it is subject to of the impact that Jewish heritage may have on the educational interventions during development. clinical issues at hand. This impact is significant whether the worldview of the family is characterized Ruess L, Uyehara CF, Shiels KC et al. Digitizing pediatric by strict Orthodoxy or is primarily that of an ethnic chest radiographs: comparison of low-cost, commercial identification with less concern for belief and practice. off-the-shelf technologies. Pediatr Radiol 2001; 31(12):841-7. Rueda MR, Posner MI, Rothbart MK, Davis-Stober CP. Abstract: OBJECTIVE: To compare low-cost, off-the- Development of the time course for processing shelf technology for digitizing pediatric chest conflict: an event-related potentials study with 4 year radiographs. MATERIALS AND METHODS: Forty pediatric chest radiographs (hard copy), each with a 816
- 825. single abnormality, weredigitized using a commercial pediatric rheumatology: the PRINTO perspective. Curr film digitizer and two low-cost METHODS: a digital Opin Rheumatol 2004; 16(5):566-70. camera and a flatbed scanner. A stratified, randomized, Abstract: PURPOSE OF REVIEW: The purpose of this block design was used where 20 readers evaluated 40 review is to highlight the problems and possible different images to determine the ability to accurately solutions for the conduct of international collaborative detect the abnormality. Readers then rated all 160 research for pediatric rheumatic diseases. RECENT images (40 images x 4 methods) for conspicuity of the FINDINGS: Pediatric rheumatic diseases are rare abnormality and overall image quality. RESULTS: conditions associated with important sequelae on the Abnormalities were correctly identified on 82.3 % of quality of life and long-term outcome. The research hard copy images, 82.9 % of flatbed scanner images, aimed at studying new therapeutic approaches is 74.3 % of film digitizer images, and 69.7 % of digital difficult because of logistic, methodological, and camera images (p < 0.05) when compared to hard copy ethical problems. To face these problems, two or flatbed scanner images. Lesion conspicuity was international networks have been founded: the rated higher on hard copy (p < 0.05) than all digitized Pediatric Rheumatology Collaborative Study Group (or images. Conspicuity ratings were similar for flatbed PRCSG) and the Paediatric Rheumatology scanner and film digitizer images, but lower in digital international Trials Organization (or PRINTO). The camera images (p < 0.05). For overall image quality, two networks have the goal to promote, facilitate, and all were rated significantly different from each other (p conduct high-quality research into pediatric rheumatic < 0.05), with hard copy > flatbed scanner > film diseases. In particular they have been able to digitizer > digital camera images. CONCLUSION: A standardize the evaluation of response to therapy in low-cost flatbed scanner yielded digital pediatric chest juvenile idiopathic arthritis, juvenile systemic lupus images which were significantly superior to digital erythematosus, and juvenile dermatomyositis; to draft camera images While flatbed scanner images were clinical remission criteria in juvenile idiopathic interpreted with the equivalent diagnostic accuracy of arthritis; and to provide cross-cultural adapted and hard copy images, they were rated lower for image validated quality-of-life instruments like the Childhood quality and lesion conspicuity. Health Assessment Questionnaire and the Child Health Questionnaire in 32 different languages. SUMMARY: Ruiz RJ, Brown CE, Peters MT, Johnston AB. Specialized The creation of large international trial networks such care for twin gestations: improving newborn outcomes as PRINTO and PRCSG, the definition of and reducing costs. J Obstet Gynecol Neonatal Nurs internationally recognized and standardized outcome 2001; 30(1):52-60. measures and definitions of improvement, the Abstract: OBJECTIVE: To compare newborn validation of quality-of-life instruments, and the outcomes and costs of hospital stays for twins born to adoption of adequate legislative measures (pediatric mothers receiving care in a specialized twin clinic with rule) have created the basic premises for the best future a research-based care protocol and one consistent assessment of pediatric rheumatic diseases. This caregiver versus twins whose mothers received progress now affords children with pediatric rheumatic standard prenatal care. DESIGN AND SETTING: A diseases the same opportunities as adults to be treated retrospective, historical cohort study conducted in a with drugs whose safety and efficacy have been high-risk obstetric clinic in central Texas. PATIENTS: assessed through legitimate scientifically valid Thirty women pregnant with twins received specialized investigations. care. The comparison group consisted of 41 women pregnant with twins who received standard care. Rusch MD, Gould LJ, Dzwierzynski WW, Larson DL. INTERVENTIONS: An advanced practice nurse Psychological impact of traumatic injuries: what the provided prenatal care, which included weekly clinic surgeon can do. Plast Reconstr Surg 2002; 109(1):18- visits, home visits, and 24-hour availability for phone 24. support. OUTCOME MEASURES: Gestational age at Abstract: In their treatment of accident and assault birth, birth weight, length of stay in the neonatal victims, plastic surgeons have unique opportunities to intensive-care unit (NICU), and hospital charges for identify and refer patients with posttraumatic stress the newborns. RESULTS: No newborns of less than 30 symptoms. This article describes brief assessments that weeks gestation were born to women in the specialized surgeons or their clinic staff can use to evaluate care group, the mean birth weight was 249 g (SD +/- traumatically injured adults and children for trauma- 77) higher, days in the NICU were reduced from a related psychological symptoms. An immediate mean of 17 to 7, and hospital charges were $30,000 postinjury evaluation (within 10 days of the trauma) less per infant. CONCLUSIONS: Newborn outcomes consists of 11 questions to determine the presence of were improved and length of stay and hospital charges the following risk factors for posttrauma were significantly reduced for newborns whose maladjustment: panic during or immediately after the mothers had received care in the specialized twin trauma, reexperiencing symptoms, avoidance, sleep clinic. disturbance, injury from an assault, previous trauma and psychiatric history, and blaming someone else for Ruperto N, Martini A. International research networks in the injury. The seven follow-up interview questions 817
- 826. assess reexperiencing symptoms,avoidance, trauma- seen a suspicious case of child physical abuse, of related phobias, depression, irritability, and increased which 47% (n = 201) had reported it. Ability and substance use, all of which, if present, suggest willingness to recognize and report abuse varied across psychological impairment. Questions recommended for the three professions. The findings suggest a the evaluation of younger children assess changes in professional reluctance to engage in recognizing and play and recreational activity, sleep disturbance, night reporting abuse. The barriers could be reduced by terror, aggression, irritability, avoidance, emergence of providing multi-professional and inter-agency training, new fears, and loss of recently acquired developmental support for the primary health professionals in practice, skills. The assessments require less than 2 minutes and as well as higher education programmes at are easily integrated into the hospital or clinic undergraduate and postgraduate levels for nursing, examinations of these patients. dentistry and medicine. Rushton CH. A framework for integrated pediatric palliative Russoniello CV, Skalko TK, O'Brien K, McGhee SA, care: being with dying. J Pediatr Nurs 2005; 20(5):311- Bingham-Alexander D, Beatley J. Childhood 25. posttraumatic stress disorder and efforts to cope after Abstract: Recent studies highlight the need for an Hurricane Floyd. Behav Med 2002; 28(2):61-71. integrated model for palliative and end-of-life pediatric Abstract: The authors report on the level of care. About 55,000 children die each year in the United posttraumatic stress disorder (PTSD) experienced by States and, on any given day, about 8,600 children fourth-grade children 6 months after Hurricane Floyd could benefit from care that acknowledges their limited and describe the children's efforts to cope with their life expectancy and severity of illness. Two case stress. All of the children they studied were directly studies of children illustrate different approaches-one affected by the hurricane, secondary to the destruction that aggressively applies all possible technologies to of their school by floodwaters. The homes of 37% of maximize chances of survival and another that focuses these children were also flooded. Ninety-five percent on the patient's overall quality of life and on healing of the children experienced at least mild symptoms of rather than curing. The cases highlight characteristics PTSD, and 71% had symptoms that were moderate to of an integrated model of palliative care to address very severe. Children who reported that their homes clinical, moral, and ethical uncertainties. This model were flooded were 3 times more likely to report integrates being with doing, provides for developing symptoms than those whose homes were not flooded, attunement and presence as capacities for being with and the girls were twice as likely as the boys to report children and their parents, and addresses challenges in symptoms. The high PTSD prevalence rates are the healthcare environment. Strategies for integrating comparable to findings from other studies involving palliative care into pediatric practice include listening, violence in which 94% of the victims reported fostering respect for the child and parents across the experiencing symptoms. For further analyses, the organization, nurturing collaborative connections, authors used symptom clusters of hyperarousal, managing uncertainty, tolerating ambiguity, making numbing/avoidance, and reexperiencing symptoms. peace with conflict, and committing to self-care. Every pediatric nurse can play a role in making the vision of Rutherford MS, Roux GM. Health beliefs and practices in palliative care a reality integrated into the fabric of rural El Salvador: an ethnographic study. J Cult Divers pediatric practice. 2002; 9(1):3-11. Abstract: OBJECTIVE: To investigate the health Rushton DI. Neonatal shaken baby syndrome--historical practices and lifeways of rural villagers in a remote inexactitudes. Arch Dis Child Fetal Neonatal Ed 2003; area of El Salvador who had been displaced by the 88(2):F161; author reply F161-2. recent civil war. The purpose of the study was to explore their view on health and experiences of loss Russell-Johnson H. Child protection: defining 'harm'. during the war. DESIGN: Ethnography (Spradley, Paediatr Nurs 2003; 15(9):42-3. 1980, 1999; Agar, 1996). METHOD: The participants included any resident of three rural Salvadoran villages Russell M, Lazenbatt A, Freeman R, Marcenes W. Child who were 18 years of age and over. Participants physical abuse: health professionals' perceptions, included nine families, with a total of twelve diagnosis and responses. Br J Community Nurs 2004; participants. Data collection included participant 9(8):332-8. observation, audiotaped interviews, demographic Abstract: The objectives of this cross-sectional survey information, and field notes. One of the Spanish- were to assess primary health professionals' speaking key informants acted as the interpreter. The perceptions of and ability to recognize child physical content of all data was analyzed for recurrent themes. abuse in their practice. A random sample was taken of FINDINGS: All nine families were displaced to 979 nurses, doctors, and dentists working in primary refugee camps in Honduras during the civil war. Two care in Northern Ireland. The response rate was 44%, cultural themes that emerged from the data were: 1) and the results showed that 59% of respondents had War: "We lost everything; we had to leave running," and 2) Health: "It's in God's hands." CONCLUSIONS: 818
- 827. It is achallenge to encourage culture-specific care that deduced, from this analysis of autonomy disturbance, acknowledges Salvadoran herbal remedies, strength of and these in turn have appeared as the cornerstones of spirit, and a belief that a Supreme Being controls their effective treatments for BPD. lives. The health practices of the participants were shaped by their experiences of suffering from loss of Rzucidlo SE, Shirk BJ. Trauma nursing: pediatric patients. family members during the war, displacement from RN 2004; 67(6):36-41; quiz 42. their homes, and lack of potable water and environmental sanitation. IMPLICATIONS: To make a Sa RC, Verbandt Y. Automated breath detection on long- positive impact and effect change on health services in duration signals using feedforward backpropagation these rural areas, efforts should be directed toward artificial neural networks. IEEE Trans Biomed Eng democratic and community-based social and economic 2002; 49(10):1130-41. development within the context of the cultural system. Abstract: A new breath-detection algorithm is Recent earthquakes (2001) have intensified the need presented, intended to automate the analysis of for improvement in environmental factors including respiratory data acquired during sleep. The algorithm is potable water. based on two independent artificial neural networks (ANN(insp) and ANN(expi)) that recognize, in the Ruths S, Steiner H. Psychopharmacologic treatment of original signal, windows of interest where the onset of aggression in children and adolescents. Pediatr Ann inspiration and expiration occurs. Postprocessing 2004; 33(5):318-27. consists in finding inside each of these windows of Abstract: Knowledge regarding psychopharmacology interest minimum and maximum corresponding to each is increasingly based on clinical trials and rational inspiration and expiration. The ANN(insp) and algorithms. Medications are increasingly regarded as ANN(expi) correctly determine respectively 98.0% and useful adjuncts in the treatment of maladaptive 98.7% of the desired windows, when compared with aggression, whether it appears as a target symptom or 29,820 inspirations and 29,819 expirations detected by as a complication of a whole range of a human expert, obtained from three entire-night psychopathology. Properly integrated into a treatment recordings. Postprocessing allowed determination of package that uses psychotherapies and environmental inspiration and expiration onsets with a mean manipulation, medications can provide relief from one difference with respect to the same human expert of of the most destructive forms of psychopathology. Still, (mean +/- SD) 34 +/- 71 ms for inspiration and 5 +/- 46 more controlled clinical trials are needed, especially ms for expiration. The method proved to be effective in those comparing active interventions and those testing detecting the onset of inspiration and expiration in full the synergistic and antagonistic effects of different night continuous recordings. A comparison of five treatment modalities. human experts performing the same classification task yielded that the automated algorithm was Ryan G. Undefined use of the terms "child sexual touching" undifferentiable from these human experts, falling and "child sexual contact". Child Abuse Negl 2002; within the distribution of human expert results. Besides 26(1):3-4; author reply 5-10. being applicable to adult respiratory volume data, the presented algorithm was also successfully applied to Ryan RM. The developmental line of autonomy in the infant sleep data, consisting of uncalibrated rib cage etiology, dynamics, and treatment of borderline and abdominal movement recordings. A comparison personality disorders. Dev Psychopathol 2005; with two previously published algorithms for breath 17(4):987-1006. detection in respiratory volume signal shows that the Abstract: Borderline personality disorder (BPD) is presented algorithm has a higher specificity, while considered as a disorder of autonomy, and is related to presenting similar or higher positive predictive values. both predisposing vulnerabilities and social relationships that fail to support basic psychological Saarlas KN, Hinman AR, Ross DA et al. All Kids Count needs. Autonomy, which is defined within the self- 1991-2004: developing information systems to improve determination theory as the capacity for self-endorsed child health and the delivery of immunizations and action based on integrative, reflective awareness, is preventive services. J Public Health Manag Pract 2004; discussed as a developmental line that is dependent on Suppl:S3-15. specific supports from caregivers. Unresponsiveness, Abstract: The All Kids Count program began in late invalidation, or abuse by caregivers is argued to impair 1991 with funding from The Robert Wood Johnson the capacity for autonomy and to catalyze an array of Foundation. The purpose was to improve child health processes, both biological and psychological, which and the delivery of immunizations and preventive impact subsequent development and, in vulnerable services through the development of health information individuals, can lead to BPD. Aspects of treatment, systems. All Kids Count concluded in mid-2004 having including the emphases on validation and acceptance of worked directly with 38 state and local health agencies the patient's experience, and the cultivation of more through its grant and Connections program. The reflective or mindful regulation of behavior, can be lessons learned from the 13-year program are 819
- 828. applicable to otherpublic health and medical care 26.22), being wounded (AOR, 3.22; 95% CI, 0.95- initiatives. Health information systems projects should: 10.89), and experiencing 7 to 12 traumatic events (1) involve stakeholders from the beginning, (2) (AOR, 2.67; 95% CI, 1.14-6.27) and 13 to 19 traumatic recognize the complexity of establishing a population- events (AOR, 2.26; 95% CI, 0.65-7.89). Elevated based information system, (3) develop the symptoms of depression were associated with being a policy/business/value case for information systems, (4) woman (AOR, 3.64; 95% CI, 1.47-9.04), being define the requirements of the system to support users' widowed (AOR, 27.55; 95% CI, 2.54-299.27), being needs, (5) develop information systems according to married (AOR, 1.93; 95% CI, 0.59-6.33), witnessing current standards, (6) address common problems disappearances (AOR, 2.68; 95% CI, 1.16-6.19), collaboratively, (7) plan for change, (8) plan boldly but experiencing 7 to 12 traumatic events (AOR, 1.57; build incrementally, (9) develop a good 95% CI, 0.64-3.88), or experiencing 13 to 19 traumatic communications strategy, and (10) use the information events (AOR, 7.44; 95% CI, 2.18-25.37). (even if not perfect). Opportunities exist for public CONCLUSION: Psychiatric morbidity related to health agencies to share their experiences from human rights violations, traumatic events, and refugee developing immunization registries and integrated status was common among Guatemalan refugees child health information systems and to develop surveyed 20 years after the Guatemalan civil conflict. collaborative approaches to improving the nation's health information infrastructure. Sabol WJ, Coulton CJ, Korbin JE. Building community capacity for violence prevention. J Interpers Violence Sabin M, Lopes Cardozo B, Nackerud L, Kaiser R, Varese 2004; 19(3):322-40. L. Factors associated with poor mental health among Abstract: The capacity of communities to prevent Guatemalan refugees living in Mexico 20 years after violence is examined from three perspectives: youth civil conflict. JAMA 2003; 290(5):635-42. violence, child maltreatment, and intimate partner Abstract: CONTEXT: From 1981 to 2001, 46 000 violence. The analysis suggests that community social refugees who fled the 36-year civil conflict in control and collective efficacy are significant Guatemala for Chiapas, Mexico were under the protective factors for all three types of violence, but protection of the United Nations High Commissioner these need to be further distinguished for their for Refugees. OBJECTIVES: To estimate the relationships to private, parochial, and state controls. It prevalence of mental illness and factors associated with is argued that strong interpersonal ties are not the only poor mental health of underserved Guatemalan refugee contributor to collective efficacy and violence communities located in Chiapas, Mexico, since 1981 prevention. Weak ties, including those outside the and to assess need for mental health services. DESIGN, community, and organizational ties are also seen as SETTING, AND PARTICIPANTS: Cross-sectional necessary. Violence prevention programs should be survey of 183 households in 5 Mayan refugee camps in structured in ways that contribute to the communities' Chiapas representing an estimated 1546 residents own capacity to prevent violence. (adults and children) conducted November-December 2000. MAIN OUTCOME MEASURES: Symptom Sachs BC, Gaillard WD. Organization of language networks criteria of Posttraumatic Stress Disorder (PTSD), in children: functional magnetic resonance imaging anxiety, and depression as measured by the Harvard studies. Curr Neurol Neurosci Rep 2003; 3(2):157-62. Trauma Questionnaire and Hopkins Symptom Abstract: Functional magnetic resonance imaging Checklist-25 (Hopkins-25). RESULTS: One adult (fMRI) is a relatively new neuroimaging procedure that (aged > or =16 years) per household (n = 170 has been used to study a wide variety of cognitive respondents) who agreed to participate was included in phenomena in adults, including attention, language, the analysis, representing an estimated 93% of and memory. More recently, this technique has been households. All respondents reported experiencing at successfully applied to pediatric populations as well. In least 1 traumatic event with a mean of 8.3 traumatic particular, many investigators have employed fMRI as events per individual. Of the respondents, 20 (11.8%) a tool to study language development in normal had all symptom criteria for PTSD. Of the 160 who children. This paper reviews the current imaging completed the Hopkins Symptom Checklist-25, 87 research on the identification of cortex subserving (54.4%) had anxiety symptoms and 62 (38.8%) had components of language processing in young children. symptoms of depression. Witnessing the disappearance The literature suggests that fMRI can successfully of family members (adjusted odds ratio [AOR], 4.58; identify regions of language cortex in children in much 95% confidence interval [CI], 1.35-15.50), being close the same capacity as it can with adults, and that to death (AOR, 4.19, 95% CI, 1.03-17.00), or living generally, adults and children show fundamental with 9 to 15 persons in the same home (AOR, 3.69; similarities in the patterns of activation. However, 95% CI, 1.19-11.39) were associated with symptoms of special considerations with pediatric imaging, PTSD. There was a protective factor found for lacking paradigm design, and image analysis are also sufficient food (AOR, 0.08; 95% CI, 0.01-0.59). discussed. Elevated anxiety symptoms were associated with witnessing a massacre (AOR, 10.63; 95% CI, 4.31- 820
- 829. Saeed MU, ParmarDN, Ohri R. The role of an exacerbations. ophthalmologist in suspected non-accidental injury. Eye 2003; 17(1):93-5. Salati R, Schiavulli O, Giammari G, Borgatti R. Checklist for the evaluation of low vision in uncooperative Sahu G, Mohanty S, Dash JK. Vulnerable victims of sexual patients. J Pediatr Ophthalmol Strabismus 2001; assault. Med Sci Law 2005; 45(3):256-60. 38(2):90-4. Abstract: Sexual assault is one of the heinous crimes of Abstract: PURPOSE: To present a checklist for the present day society. Although it has always been evaluation of low vision in uncooperative patients; in evident, in recent times there has been a steady this specific case, children with neurological deficits. increase in the rate of sexual assault cases. The aim of METHOD: The checklist includes several behavioral this study was to identify the groups most at risk. indicators obtainable with a standard clinical Therefore it includes only cases of sex offences and sex examination. Each test is assigned a score (0=failure, offences with kidnapping. Information was obtained by 1=success). The final visual quotient score is obtained interviewing the victims and accompanying persons, by dividing the partial score by the total number of and from records submitted by the investigating tests performed. Eleven children with cerebral visual officers. Our study reveals sexual assault commonly impairment were studied using behavioral and occurs among the age group of 16-19 years (60.8%), preferential looking techniques. RESULTS: Visual mostly at night (53.23%), inside the house (87%) and quotient was >0 in all patients, indicating that residual usually by a close acquaintance (61%). The majority of visual function was always detectable. Average visual the victims were unmarried (84.7%), lived in rural quotient was 0.74. CONCLUSION: Visual quotient areas (65.2%), were unemployed (93.5%), of less can be useful both for follow-up examinations and educated or illiterate groups (88%) and found to be comparison and integration with other evaluation mentally fit (97%). The victims were mostly drawn methods (behavioral and instrumental) of residual from low socio-economic groups. visual capacity. In particular, if combined with preferential looking techniques, visual quotient testing Salamzadeh J, Wong IC, Hosker HS, Patel MG, Chrystyn H. permits characterization of the entire spectrum of low The relationship between the quality of prescribing and vision. practice appointment rates with asthma management data in those admitted to hospital due to an acute Salazar JC. Pediatric clinical trial experience: government, exacerbation. Respir Med 2005; 99(6):735-41. child, parent and physician's perspective. Pediatr Infect Abstract: Specific targeting of patients with a previous Dis J 2003; 22(12):1124-7. asthma hospitalisation could be more focused if Abstract: In contrast to investigations in adults, predictors could be identified. This study was an investigation of drugs via clinical trials has been observational retrospective analysis using ridge and lacking in the pediatric population. Until recently there linear multivariate regression analysis. Patient asthma was little incentive on the part of the pharmaceutical management data were extracted from the hospital and industry to conduct clinical trials of new drugs in general practice notes of those that had been admitted children. However, government legislation approved in with an acute exacerbation of their asthma over a 5- the late 1990s has promoted efforts to investigate the year period. From the prescribing data, the annual effects of drugs in the treatment of a variety of doses of preventer (P) and reliever (R) medication were children's diseases. Such data provide important and converted to defined daily doses then divided to give a needed information on appropriate dosing, rates and P:R ratio. Preliminary statistical analysis was used to types of adverse reactions and efficacy for treatment of identify any association between either the P:R ratio or pediatric illnesses. The conduct of clinical trials in for the number of general practitioner (GP) practice children is dependent on a careful dialogue between the appointments (PA) and their asthma management data. investigator, child and guardians wherein a detailed Multivariate regression analysis was applied to the P:R description of benefits vs. risks is conveyed. The focus ratio and to PA to determine a model between each of of this paper is to summarize various perspectives on these and asthma management data/events. GPs gave conducting clinical trials in children, including those of consent to access the data of 115 (out of 440) the government, the child, the parents or guardians and asthmatics, age >5 years, admitted to a district general the investigator. Although children now have access to hospital for asthma exacerbations between 1994 and new medicines during the development process, their 1998. The multivariate analysis revealed that PA was participation in clinical trials must still protect them associated with oral prednisolone rescue courses from undue risk and secure their well being. (PRCs) and age whilst the P:R ratio was associated to PRCs and more reliever usage but not preventers. Salib E, Appleton T, Pembleton A. Elder abuse and elderly Patients with low preventer usage with respect to their abusers. Med Sci Law 2002; 42(2):147-8. reliever medication should be targeted for medication review as these were the patients prescribed more Salloum A, Avery L, McClain RP. Group psychotherapy for prednisolone courses and their increased PAs reflect adolescent survivors of homicide victims: a pilot study. this. This could decrease visits to the doctor and acute 821
- 830. J Am AcadChild Adolesc Psychiatry 2001; balance individual freedoms with public good by 40(11):1261-7. considering the sincerity of beliefs and requiring Abstract: OBJECTIVE: To conduct an exploratory parents considering exemptions to attend individual study designed to evaluate the effectiveness of a time- educational counseling. limited psychotherapy group model to decrease traumatic symptoms among adolescent survivors of Saluja G, Iachan R, Scheidt PC, Overpeck MD, Sun W, homicide victims. METHOD: Forty-five inner-city Giedd JN. Prevalence of and risk factors for depressive adolescents between the ages of 11 and 19 years symptoms among young adolescents. Arch Pediatr participated in community-based, time-limited therapy Adolesc Med 2004; 158(8):760-5. groups that were specifically designed for youths who Abstract: OBJECTIVE: To determine the prevalence, had a loved one die because of violence. The therapy risk factors, and risk behaviors associated with groups were based on a 10-week treatment model for depressive symptoms in a nationally representative, adolescent survivors of homicide victims with the goals cross-sectional sample of young adolescents. DESIGN: of providing grief education, facilitating thoughts and A school-based survey collected through self- feelings about grief, and reducing traumatic symptoms. administered questionnaires in grades 6, 8, and 10 in RESULTS: On completion of group therapy, the 1996. SETTING: Schools in the United States. adolescent participants reported an overall significant PARTICIPANTS: 9863 students in grades 6, 8, and 10 decrease in traumatic symptoms on an index of (average ages, 11, 13, and 15). MAIN OUTCOME posttraumatic stress, especially in the areas of MEASURES: Depressive symptoms, substance use, reexperiencing and avoidance symptoms. The mean somatic symptoms, scholastic behaviors, and difference between pre- and posttest was a 10.03 involvement in bullying. RESULTS: Eighteen percent decrease in the sum of the Child PTSD Reaction Index of youths reported symptoms of depression. A higher scores (sig = .001). CONCLUSION: The results of this proportion of females (25%) reported depressive pilot study indicate that group therapy may be helpful symptoms than males (10%). Prevalence of depressive in reducing PTSD symptoms among inner-city, symptoms increased by age for both males and African-American adolescent survivors of homicide females. Among American Indian youths, 29% victims. Although validity is limited by the lack of a reported depressive symptoms, as compared with 22% comparison group, the authors suggest that such a brief of Hispanic, 18% of white, 17% of Asian American, trauma/grief psychotherapy group may be applicable and 15% of African American youths. Youths who for suburban and rural adolescent survivors of were frequently involved in bullying, either as homicide victims as well. . perpetrators or as victims, were more than twice as likely to report depressive symptoms than those who Salmon DA, Siegel AW. Religious and philosophical were not involved in bullying. A significantly higher exemptions from vaccination requirements and lessons percentage of youths who reported using substances learned from conscientious objectors from reported depressive symptoms as compared with other conscription. Public Health Rep 2001; 116(4):289-95. youths. Similarly, youths who reported experiencing Notes: GENERAL NOTE: KIE: 22 refs. somatic symptoms also reported significantly higher GENERAL NOTE: KIE: KIE Bib: immunization; proportions of depressive symptoms than other youths. public health; treatment refusal/minors CONCLUSIONS: Depression is a substantial and Abstract: All jurisdictions in the US require proof of largely unrecognized problem among young vaccination for school entrance. Most states permit adolescents that warrants an increased need and non-medical exemptions. Public health officials must opportunity for identification and intervention at the balance the rights of individuals to choose whether or middle school level. Understanding differences in not to vaccinate their children with the individual and prevalence between males and females and among societal risks associated with choosing not to vaccinate racial/ethnic groups may be important to the (i.e., claiming an exemption). To assist the public recognition and treatment of depression among youths. health community in optimally reaching this balance, this analysis examines the constitutional basis of non- Saluja G, Kotch J, Lee LC. Effects of child abuse and medical exemptions and examines policies governing neglect: does social capital really matter? Arch Pediatr conscientious objection to conscription as a possible Adolesc Med 2003; 157(7):681-6. model. The jurisprudence that the US Supreme Court Abstract: OBJECTIVE: To explore whether social has developed in cases in which religious beliefs capital and social support moderate the relationship conflict with public or state interests suggests that between child maltreatment and emotional and mandatory immunization against dangerous diseases behavioral outcomes such as depression-anxiety and does not violate the First Amendment right to free aggression in 6-year-old children. DESIGN: Data from exercise of religion. Accordingly, states do not have a Longitudinal Studies of Child Abuse and Neglect were constitutional obligation to enact religious exemptions. used. Data were collected through interviews and Applying the model of conscientious objectors to questionnaires at the child's birth and at the age of 6 conscription suggests that if states choose to offer years. SETTING: General community. nonmedical exemptions, they may be able to optimally PARTICIPANTS: Two hundred fifteen maternal 822
- 831. caregivers of childrenat high risk for child abuse and the proptosis values in the two groups of patients were neglect were included in this study. MAIN OUTCOME not related to smoking. The neural network correctly MEASURES: Depression-anxiety and aggression were classified 78.3% of 115 eyes (87 patients) and measured through the Child Behavior Checklist. predicted TAO progression in 69.2% of 39 eyes (28 RESULTS: Among 5 potential effect modifiers (3 patients). CONCLUSIONS: In our opinion, neural social capital constructs and 2 measures of social network analysis can be successfully applied for support), only 1 (instrumental support) significantly classifying TAO and predicting progression at the first modified the relationship between maltreatment and clinical examination. child aggression. CONCLUSIONS: Social capital did not modify the relationship between child maltreatment Samms-Vaughan ME, Jackson MA, Ashley DE. Urban and either aggression or depression-anxiety. This might Jamaican children's exposure to community violence. be related to the fact that many previous studies looked West Indian Med J 2005; 54(1):14-21. at social capital ecologically, whereas this study uses Abstract: Exposure to violence in childhood is individuals as the unit of analysis. The results of this associated with aggression in adulthood. The high level study might also indicate that previous studies of social of community violence in Jamaica is likely to expose capital and health outcomes might actually be using Jamaican children to violence. There has been no social capital as a proxy for social support. detailed study of the exposure of Jamaican children to violence in their daily lives. Some 1674 urban 11-12- Salvi M, Dazzi D, Pellistri I, Neri F, Wall JR. Classification year-old children, previously part of a national birth and prediction of the progression of thyroid-associated cohort study, completed a questionnaire detailing their ophthalmopathy by an artificial neural network. exposure to violence as witnesses, victims and Ophthalmology 2002; 109(9):1703-8. aggressors. Their parents completed a socio-economic Abstract: OBJECTIVE: We have used an artificial questionnaire. Jamaican children had high levels of neural network in an attempt to classify and predict the exposure to physical violence. A quarter of the children progression of thyroid-associated ophthalmopathy had witnessed severe acts of physical violence such as (TAO) at the first clinical examination. DESIGN: This robbery, shooting and gang wars, a fifth had been retrospective comparative case series included a group victims of serious threats or robbery and one in every of patients examined by the ophthalmologist only once twelve had been stabbed. Children reported being least because of the absence of signs of progressive disease exposed to sexual violence and to being shot at. (GR1), as subsequently monitored by an Robbery was an almost universal experience affecting endocrinologist, and a group of patients on follow-up children from all schools and socio-economic groups. because of progressive disease (GR2). The single commonest experience as a victim of PARTICIPANTS AND METHODS: We examined violence was the loss of a family member or close 242 patients, of whom 207 were women and 35 were friend to murder, affecting 36.8% of children. men. GR1 included 129 patients (257 eyes) who, on Children's experiences of witnessing violence occurred ophthalmologic assessment, were further classified as chiefly in their communities but their personal having no TAO (n = 53; GR1a) and only lid signs or experiences of violence occurred at school. Boys and inactive, stable TAO (n = 76; GR1b). GR2 included children attending primary school had greater exposure 113 patients (219 eyes). One hundred three normal to violence as witnesses and victims. Socio-economic subjects (205 eyes), 50 women and 53 men, were tested status discriminated exposure to physical violence as to provide normal ranges for proptosis values. We witnesses but not as victims. Intervention strategies to applied a model of back propagation neural network reduce children's exposure to violence should include with 17 input variables, a training matrix of 414 community education on the impact of exposure to observations, a randomly selected test group of 115 violence on children, particularly the loss of a observations, and, as output, the progression of disease. significant person, and the development of a range of The ophthalmologic assessment included (1) lid fissure school-based violence prevention programmes. measurement, (2) Hertel, (3) color vision, (4) cover test and Hess screen, (5) visual acuity, (6) tonometry, (7) Samuel PR, Ranta M. A paediatric otolaryngology pre- fundus examination, (8) visual field, and (9) orbital admission assessment clinic audited. J Laryngol Otol computed tomography scan or ultrasonography. Other 2001; 115(9):723-6. parameters included in the neural analysis were gender Abstract: Pre-admission clinics are becoming and age of the patients, their cigarette smoking, and the increasingly popular for surgical specialties with a interval between follow-up visits. RESULTS: The quick turnover as they aid waiting list management and prevalence of smokers among patients without TAO reduce non-attender rates for surgery. As paediatric was significantly lower than that among those with patients have a high rate of non-attendance, we TAO (P < 0.03). Mean proptosis values (Hertel) were performed a retrospective audit of otolaryngology significantly different in GR1, in GR2, and in a group paediatric pre-admission assessment clinic notes for of normal eyes (P < 0.0001), and the changes of values June to October 1998 (n = 363). The attendance rate for in consecutive measurements were associated with the clinic was 97 per cent. Of the children who progression of the disease (P < 0.01). Differences of attended the clinic, 90 per cent had their operation as 823
- 832. planned, complications occurredin 2.9 per cent. The among nouns in the early productive vocabulary. Data operation date was delayed in 20 patients, in 11 from a 4-layer Hopfield network suggested that the patients no cause for the delay was given in the case statistical regularities in the early noun vocabulary are notes. As a result of this audit, the Senior House strong enough to create a shape bias, and that the shape Officer sees the patient on the day of admission rather bias is overgeneralized to nonsolid stimuli. A 2nd than in the pre-admission clinic, which is staffed by simulation suggested that this overgeneralization is due nurses. to the dominance of names for shape-based categories in the early noun vocabulary. Two subsequent Samuelson JL, Buehler JW, Norris D, Sadek R. Maternal longitudinal experiments tested whether it is possible to characteristics associated with place of delivery and create word learning biases in children. Children 15-20 neonatal mortality rates among very-low-birthweight months old were given intensive naming experiences infants, Georgia. Paediatr Perinat Epidemiol 2002; with 12 noun categories typical of the types of 16(4):305-13. categories children learn to name early. The children Abstract: To determine whether the Healthy People developed a precocious shape bias that was 2000 objective to deliver very-low-birthweight overgeneralized to naming nonsolid substances; they (VLBW) infants at subspecialty perinatal care centres also showed accelerated vocabulary development. was met, and if improvements in the regional perinatal Children taught an atypical set of nouns or no new care system could reduce neonatal mortality further for nouns did not develop a shape bias and did not show 2010, we examined place of delivery for VLBW accelerated vocabulary development. infants, associated maternal characteristics and the potential impact on neonatal mortality. We used linked Sanchez-Gimeno J, Martin-Carpi J, Martinez-Laborda S, birth and death records for the 1994-96 Georgia Carrasco-Lorente S, Abenia-Uson P, Lopez-Pison J. VLBW (i.e. 500-1499 g) birth cohorts. Among 4770 [Lumbar puncture and early neuroimaging in complex VLBW infants, 77% were delivered at hospitals febrile seizures. Report of a case of shaken infant providing subspecialty perinatal care. The strongest syndrome]. Rev Neurol 2003; 36(4):351-4. predictor of birth hospital level was the mother's Abstract: INTRODUCTION: Febrile convulsions are county of residence, defined using three levels: one of the most frequent pathologies seen in paediatric residence in a county with a subspecialty hospital, emergencies. The diagnosis of febrile seizures is residence in a county adjacent to one with such a clinico evolutionary and is easily established once the hospital or residence in a non-adjacent county. Eighty- acute process is overcome and a normal state is nine per cent of infants born to women who resided in restored in the child. The differential diagnosis is counties with subspecialty care hospitals delivered at established with the processes that associate fever and such hospitals, compared with 53% of infants born to convulsions in children between the ages of 1 month women who resided in a non-adjacent county. Women and 6 years, many of which require specific treatment. were also more likely to deliver outside subspecialty Certain complementary examinations, essentially a care if they had less than adequate prenatal care blood test, lumbar puncture and neuroimaging, are [adjusted odds ratio (AOR) 1.5, P-value = 0.0001]. The needed to identify them. Shaken infant syndrome is a neonatal mortality rate varied by level of perinatal care form of physical abuse which includes the presence of at the birth hospital from 132.1/1000 to 283/1000 live intracranial traumatic injury, retinal haemorrhage and, births, with the highest death rate for infants born at in general, the absence of other physical signs of hospitals offering the lowest level of care. Assuming traumatic injury in the child. CASE REPORT: An 8 that the differences in mortality were due to care level month old infant who presented a convulsive seizure of the birth hospital, potentially 16-23% of neonatal on the left side of the body which coincided with an deaths among VLBW infants could have been axillary temperature of 38 C that remitted with prevented if 90% of infants born outside subspecialty intravenous diazepam 40 minutes after onset. An early care were delivered at the recommended level. These cranial computerised tomography (CT) scan led to a findings suggest that a state's support of strong, diagnosis of shaken infant syndrome. DISCUSSION: collaborative, regional perinatal care networks is This case constitutes an argument in favour of required to ensure that high-risk women and infants performing an early cranial CT scan in complex febrile receive optimal health care. Improved access to convulsions and in prolonged or partial non provoked recommended care levels should further reduce seizures. We highlight the risks involved in performing neonatal mortality until interventions are identified to a lumbar puncture in the absence of suspected non prevent VLBW births. complicated acute bacterial meningitis. The diagnostic usefulness of an early CT scan in diagnosing such an Samuelson LK. Statistical regularities in vocabulary guide important problem as shaken infant syndrome must language acquisition in connectionist models and 15- also be noted, due to the risk of repetition and its high 20-month-olds. Dev Psychol 2002; 38(6):1016-37. morbidity and mortality rates. Abstract: This research tested the hypothesis that young children's bias to generalize names for solid Sanders LM, Robinson TN, Forster LQ, Plax K, Brosco JP, objects by shape is the product of statistical regularities Brito A. Evidence-based community pediatrics: 824
- 833. building a bridgefrom bedside to neighborhood. benzodiazepines. In terms of illicit drugs, males Pediatrics 2005; 115(4 Suppl):1142-7. preferred cocaine and marijuana, while females only Abstract: The American Academy of Pediatrics policy reported amphetamine use. An analysis of adolescent statement "The Pediatrician's Role in Community functioning showed differences among alcohol users Pediatrics" encourages all pediatricians to partner with and nonusers in behavior patterns and peer their communities to create and disseminate innovative relationships. However, no significant differences were programs that improve child health. This article found regarding rebellion, depression, and social describes 4 pillars of a bridge to evidence-based isolation. The implications of these results are community pediatrics for pediatricians interested in discussed, along with the importance of enhancing pursuing effective community action: (1) collaborate prevention, as well as early detection and intervention. with the community to establish a specific, short-term, health-related goal; (2) identify evidence-based best Sandoval-Priego AA, Reyes-Morales H, Perez-Cuevas R, practice(s) for achieving the shared goal; (3) Abrego-Blas R, Orrico-Torres ES. [Family life collaborate with the community to adapt this best strategies and their relation with malnutrition in practice to the community's unique assets and children under 2 years old]. Salud Publica Mex 2002; constraints; and (4) evaluate the project by using 44(1):41-9. appropriate expertise. Practical elements of each pillar Abstract: OBJECTIVE: To identify the role of family are described and illustrated by specific examples from life strategies on malnutrition in children aged 6-23 community-based efforts of pediatricians and are months of age. MATERIAL AND METHODS: This accompanied by specific resources to aid pediatricians case-control study was conducted in 1998 in the in their future community health work. municipality of Teolocholco, State of Tlaxcala, Mexico, among families with children aged 6-23 Sanders MR. Parenting interventions and the prevention of months of age. The sample was conformed by 105 serious mental health problems in children. Med J Aust cases and 210 controls. Family life strategies were 2002; 177 Suppl:S87-92. grouped into five types: family composition, means Abstract: The reduction of coercive or inadequate and distribution of family income, family and social parenting is essential if the mental health status of networks, and life preservation strategies. Malnutrition Australian children and adolescents is to be improved. was classified according to height for age. Data were Of the available approaches that address parenting analyzed using logistic regression to obtain odds ratios practices, behavioural family interventions have the and 95% confidence intervals. RESULTS: Data were strongest empirical support and are effective in collected from 605 families, for a total of 445 controls reducing parenting practices that contribute to the and 160 cases. The predictive model included mother's development of behavioural and emotional problems in schooling, overcrowding, time elapsed between children. However, only a small proportion of parents childbirths, per capita monthly income, and time access such interventions. A comprehensive multilevel, devoted to child-rearing activities. CONCLUSIONS: evidence-based parenting and family support strategy Family life strategies determine children's nutritional needs to be implemented on a wide scale to reduce the status; understanding the influence of the family on the prevalence of mental health problems in children and children's health status is necessary to develop effective youth. The Triple P - Positive Parenting Program is an programs aimed at improving the nutritional status of example of a population-level strategy that can be used children. to improve the mental health status of children and their parents. Sankoorikal T. Using scientific advances to conceive the "perfect" donor: the Pandora's box of creating child Sandi L, Diaz A, Uglade F. Drug use and associated factors donors for the purpose of saving ailing family among rural adolescents in Costa Rica. Subst Use members. Seton Hall Law Rev 2003; 32(3):581-615. Misuse 2002; 37(5-7):599-611. Abstract: The objectives of this study, carried out in Sant'Anna A, Aerts D, Lopes MJ. [Adolescent homicide 1995, were to assess both licit and illicit substance use victims in Southern Brazil: situations of vulnerability among rural male and female Costa Rican adolescents, as reported by families]. Cad Saude Publica 2005; and associated health, psychological, and psychosocial 21(1):120-9. problems. A sample of 304 students from rural schools Abstract: This study focused on homicide deaths of was randomly selected. The mean age for females was adolescents (ages 10 to 19 years) in Porto Alegre, Rio 14.7 years (S.D. = 1.71), and for males was 14.4 years Grande do Sul, Brazil, in 1997. Data were obtained (S.D. = 1.62). The data were collected using the Latin- from the Mortality Information System (SIM) of the American version of Drug Use Screening Inventory Municipal Health Department. Families were visited at (DUSI). Results showed a high prevalence of past-year the addresses found on death certificates and were alcohol use for both males and females (56.6% and interviewed by two researchers. Of the 68 cases 47.4%, respectively), and a lower prevalence of past- selected, 57 families were visited; eight families year tobacco use (44.0% and 7.7%). There results also refused to be interviewed, and three addresses were not showed a low level of use of solvent inhalants and 825
- 834. found. Most ofthe adolescents were socially assistance), eight were placed in a school for children vulnerable, as indicated by low per capita income and with learning disabilities, nine children attended other parental educational level; 78.9% had dropped out of special schools. Social contact problems and anxious school. Males were the predominant victims of behaviour were reported as the most prominent adolescent homicide deaths (91.2%). Behavioral characteristics of children with Sotos syndrome. Some vulnerability was demonstrated as follows: 40.4% of implications for psychological counselling and the adolescents consumed alcoholic beverages and educational support are discussed. 45.6% illicit drugs, and 58.6% had criminal records or a history of custody at FEBEM (the State Juvenile Sariola H. [Has sexual abuse of children increased?]. Custody Facilities) or police arrests. The study Duodecim 2005; 121(20):2135-7. highlights the importance of coordinating actions among different sectors to reach adolescents both at Sarna K. Female foeticide on the rise in India. Nurs J India home and in the schools and communities. 2003; 94(2):29-30. Sant'Anna AR, Lopes MJ. Homicides among teenagers in Sarnaik AP, Daphtary K, Sarnaik AA. Ethical issues in the city of Porto Alegre, Rio Grande do Sul State, pediatric intensive care in developing countries: Brazil: vulnerability, susceptibility, and gender combining western technology and eastern wisdom. cultures. Cad Saude Publica 2002; 18(6):1509-17. Indian J Pediatr 2005; 72(4):339-42. Abstract: The authors present a quantitative and Abstract: Application of traditional ethical principles in qualitative study on homicides among teenagers in developing countries may not, indeed should not, Porto Alegre, Rio Grande do Sul State, Brazil, based conform to the western philosophy and ideology. The on a historical series during the 1990s and the life and principle of distributive justice is of utmost importance death histories in this group, with a special focus on when critical resources are scarce. There is no ethical 1997. In that year there were 68 homicides in which the imperative, nor is one followed even in the most victims were from 10 to 19 years old. Of the 68, 62 advanced countries, that every citizen is entitled to the were males and only 6 females, or a ratio of 10:1, very best available care. However, a society must showing that young males are more vulnerable and establish a uniform code of ethics that can be applied susceptible to being murdered. The data indicate that nationally, whereby all citizens are eligible for a cause of death is influenced by gender culture and that minimum acceptable level of care. The traditional homicides are based on power and status symbols principles of autonomy, beneficence, nonmaleficence characterizing a kind of virility. This expression of and justice are still applicable in structuring an ethical virility in the shaping of violence also appears in the framework that is most suited for the country's needs domination of the female body observed in homicides and resources. with young women as the victims. The life and death histories of these teenagers highlight the pertinence of Sass JO, Crazzolara R, Heinz-Erian P. Mechanisms of brain the gender-based analysis as a theoretical-analytical injury in infantile child abuse. Lancet 2001; category, in addition to analyses considering 358(9298):2082-3. socioeconomic aspects and social inequity. Satcher D, Fryer GE Jr, McCann J, Troutman A, Woolf SH, Santos y Vargas L. [Casuistic-inductive approximation to Rust G. What if we were equal? A comparison of the bioethics]. P R Health Sci J 2001; 20(3):277-82. black-white mortality gap in 1960 and 2000. Health Aff (Millwood) 2005; 24(2):459-64. Saraswat A. Child abuse and trichotillomania. BMJ 2005; Abstract: The United States has made progress in 330(7482):83-4. decreasing the black-white gap in civil rights, housing, education, and income since 1960, but health Sarimski K. Behavioural and emotional characteristics in inequalities persist. We examined trends in black-white children with Sotos syndrome and learning disabilities. standardized mortality ratios (SMRs) for each age-sex Dev Med Child Neurol 2003; 45(3):172-8. group from 1960 to 2000. The black-white gap Abstract: In contrast to physical characteristics, the measured by SMR changed very little between 1960 developmental and behavioural characteristics of and 2000 and actually worsened for infants and for children with Sotos syndrome are not well African American men age thirty-five and older. In documented. Data from a survey of 27 children (17 contrast, SMR improved in African American women. males and 10 females; mean age 10 years 7 months; Using 2002 data, an estimated 83,570 excess deaths range 6 to 15 years) with mild and moderate learning each year could be prevented in the United States if disabilities were obtained concerning school this black-white mortality gap could be eliminated. placement, social networks, adaptive competence, and behavioural problems and compared with a control Sathiaseelan S, Rayar U. The mystery of the broken bones. group matched for cognitive level and age. Ten CMAJ 2003; 169(11):1189-90. children attended a mainstream school (with remedial 826
- 835. Saunders RP, AbrahamMR, Crosby MJ, Thomas K, the supermarket fluency task, the number of categories Edwards WH. Evaluation and development of sampled increased from 11 to 12 years, but efficient potentially better practices for improving family- semantic exploitation occurred only after the age of 13- centered care in neonatal intensive care units. 14 years. These results are discussed in terms of the Pediatrics 2003; 111(4 Pt 2):e437-49. development of strategic retrieval components and Abstract: OBJECTIVE: Technological and scientific categorical knowledge. advances have progressively decreased neonatal morbidity and mortality. Less attention has been given Savulescu J. Is there a "right not to be born"? Reproductive to meeting the psychosocial needs of the infant and decision making, options and the right to information. J family than on meeting the infant's physical needs. Med Ethics 2002; 28(2):65-7. Parents' participation in making decisions and caring Notes: GENERAL NOTE: KIE: 9 refs. for their child has often been limited. Environments GENERAL NOTE: KIE: KIE Bib: wrongful life designed for efficient technological care may not be optimal for nurturing the growth and development of Savulescu J. Is there a "right not to be born"? Reproductive sick neonates or their families. Eleven centers decision making, options and the right to information. collaborating on quality improvement tried to make the Arch Dis Child Fetal Neonatal Ed 2002; 87(2):F72-4. care of families better by focusing on understanding and improving family-centered care. METHODS: Savvidou I, Bozikas VP, Hatzigeleki S, Karavatos A. Through internal process analysis, review of the Narratives about their children by mothers hospitalized evidence, collaborative learning, and benchmarking on a psychiatric unit. Fam Process 2003; 42(3):391- site visits to centers of excellence in family-centered 402. care, a list of potentially better practices was Abstract: The diagnosis of "mental illness" is developed. Choice of which practices to implement and accompanied by negative implications regarding a methods of implementation were center specific. person's competence. Self- and other-descriptions Improvement goals were in 3 areas: parent-reported about the "patient" are embedded within broader outcomes, staff beliefs and practices, and clinical cultural and societal discourses, influencing his/her outcomes in length of stay and feeding practices. relationships. The parental role seems to be one of the Measurement tools for the first 2 areas were developed most sensitive, especially for women. Mothers and pilots were conducted. RESULTS: Length of stay hospitalized in psychiatric units often have to separate and feeding outcomes were not different before the themselves from their children either temporarily, collaboration (1998) and at the formal end of the during hospitalization, or permanently, after a loss of collaboration (2000). CONCLUSIONS: Prospective custody. However, many studies have shown that parent-reported outcomes are being collected, and the mothering remains important for them. We interviewed staff beliefs and practices questionnaire will be 20 women, inpatients on a psychiatric unit and mothers repeated in all centers to determine the impact of the of 3.5-18-year-old children, recording their narratives project in those areas. about their children and exploring their thoughts and understanding of the concepts of motherhood and Sauzeon H, Lestage P, Raboutet C, N'Kaoua B, Claverie B. mental illness. We also explored the way in which the Verbal fluency output in children aged 7-16 as a mother-child dyad interacted with the family and its function of the production criterion: qualitative social context. Most mothers had a consistent and analysis of clustering, switching processes, and coherent narrative about their children and they had semantic network exploitation. Brain Lang 2004; certain expectations of them. The mother-child bond 89(1):192-202. was strong, even when the children had been removed Abstract: Developmental changes in children's verbal from their mothers' custody. However, mothers were fluency were explored in this study. One hundred and facing great difficulties with their partner and with the forty children aged from 7 to 16 completed four verbal broader family context. Also, the social discourses fluency tasks, each with a different the production regarding mental illness, (e.g., violence and criterion (letter, sound, semantic, and free). The age incapability for mothering), were extremely oppressive differences were analyzed both in terms of number of for these women. They felt that they were the victims words produced, and clustering, switching, and of societal attitudes even before they became pregnant. semantic network exploration. Analysis of the number These findings suggest the importance of listening to of words produced showed a larger difference between the voices of these women; acknowledging their the 7-8- and the 9-10-year-olds in semantic than in competence in the therapeutic context; involving them letter fluency, but this difference gradually disappeared with their families, and in legal and social contexts; with increasing age for semantic fluency while and in planning supportive programs for them. remaining constant for letter fluency. In letter fluency production, age modified both the number of switches Sawday JN. Separating conjoined twins: legal reverberations and clusters formed whereas in semantic fluency tasks, of Jodie and Mary's predicament. Loyola Los Angel Int only cluster size changed with age. Concerning the Comp Law J 2002; 24(1):65-86. semantic network exploration indicators derived from 827
- 836. Notes: GENERAL NOTE: KIE: 224 fn. survivability for reasonable medical judgment. Indeed, GENERAL NOTE: KIE: KIE Bib: patient care/minors under a straightforward reading of the instruction, a family member could conceivably trigger an Saxton R. Psychiatry's missing link--mental injury. Aust investigation after observing a relative deliver a 20- Fam Physician 2002; 31(12):1122, 1125. week fetus who maintains a heartbeat for an hour before its death. Most physicians would not consider Sayeed SA. Baby doe redux? The Department of Health and this an emergency medical condition and, rather than Human Services and the Born-Alive Infants Protection perform a screening examination, would provide Act of 2002: a cautionary note on normative neonatal comfort for the newborn and support for the family. practice. Pediatrics 2005; 116(4):e576-85. The guideline, however, does not state that professional Abstract: The Born-Alive Infants Protection Act acumen trumps the layperson's observations in these (BAIPA), passed by Congress in 2002, has attracted instances; thus, physicians are left unclear about little publicity. Its purposes were, in part, "to repudiate whether screening examinations are required for all the flawed notion that a child's entitlement to the newborns regardless of a priori, reasoned protections of the law is dependent on whether that considerations of survivability. In this context, the NRP child's mother or others want him or her." Understood Steering Committee opinion states that "at the time of as antiabortion rhetoric, the bill raised little concern delivery... the medical condition and prognosis of the among physicians at the time of legislative hearings newly born infant should be assessed. At that point and passed in both Houses by overwhelming decisions about withholding or discontinuing medical majorities, hardly suggesting contentious legislation. treatment that is considered futile may be considered After its signing into law, the Neonatal Resuscitation by... providers in conjunction with the parents acting in Program (NRP) Steering Committee issued an opinion the best interest of their child." However, most stating that "[BAIPA] should not in any way affect the pediatricians skilled in screening and resuscitation are approach that physicians currently follow with respect not currently called on to perform this function when to the extremely premature infant." This interpretation the gestational age of a nonviable fetus is reasonably of the law, however, may have been short sighted. In certain before delivery. If under the law screening is April 2005, the US Department of Health and Human now required at any gestational age, professional Services (DHHS) brought life to the BAIPA, procedure immediately after previable births may need announcing: "As a matter of law and policy, [DHHS] modification. More worrisome, threatened aggressive will investigate all circumstances where individuals investigations of alleged EMTALA violations at the and entities are reported to be withholding medical care soft edges of viability, where futility remains a matter from an infant born alive in potential violation of of debate, jeopardize the normative ethical practice of federal statutes." The agency issued instructions to offering discretionary palliative care. The DHHS sent state officials on how the definitional provision within its other instruction to state child protective services the BAIPA interacts with the Emergency Medical agencies responsible for implementing CAPTA Treatment and Labor Act (EMTALA) and the Child regulations; it reiterates the limited situations in which Abuse Prevention and Treatment Act (CAPTA). These physicians may withhold medical treatment from interagency memoranda potentially resurrect dormant infants and reemphasizes the local role of "individuals governmental oversight of newborn-treatment within health care facilities" to notify authorities of decisions and thus may have influence over normative suspected infractions. Its real import, however, is neonatal practice. Under the BAIPA, the DHHS insistence on local execution of legal remedies to interprets EMTALA to protect all "born-alive" infants; prevent nontreatment decisions deemed impermissible hospitals and physicians violating regulatory by the 1984 Baby Doe rules. Because this new requirements face agency-sanctioned monetary directive encourages governmental oversight of penalties or a "private right of action by any individual treatment decisions involving imperiled newborns, a harmed as a direct result." According to its period of benign regulatory neglect seems to be over. memorandum, the DHHS will investigate allegations of The federal CAPTA rules arguably remove quality-of- EMTALA violations whenever it finds evidence that a life considerations from the decision-making calculus newborn was not provided with at least a medical and therefore may conflict with the best-interests screening examination under circumstances in which a paradigm advocated by the American Academy of "prudent layperson observer" could conclude from the Pediatrics and NRP. How courts will respond to the infant's "appearance or behavior" that it was "suffering DHHS interpretation of EMTALA and CAPTA under from an emergency medical condition." The the BAIPA remains unclear. Federal courts have yet to memorandum fails to clarify which observers qualify authoritatively examine alleged EMTALA violations as prudent, what infant appearance or behavior is involving newborn treatment decisions at the limits of relevant, or what defines an emergency medical viability. The Wisconsin Supreme Court has permitted condition. Because these evaluative criteria are not an EMTALA claim to go to trial where physicians constrained by reference to relevant standards of allegedly did not screen or resuscitate a 22-week medical care, the agency arguably substitutes a newborn delivered in an emergency department, and a nonprofessional's presumed sagacious assessment of lower appellate court has relied on CAPTA to hold that 828
- 837. parents do notpossess the right to choose against approach to epidemic analysis. Scand J Infect Dis resuscitating an extremely premature newborn. The 2005; 37(1):55-60. Texas Supreme Court recently granted physicians the Abstract: A new explanatory model for epidemic paternalistic prerogative to resuscitate imperiled analysis is presented; it has a knowledge based newborns without attention to parental preference component and a probabilistic computational under a common law doctrine of "emergent component. The former assembles details of household circumstances." These judicial decisions undermine the characteristics, social networks and connectivity in the ethical discretion parents are typically afforded in community--'knowledge'--which is used to determine decision-making before and after delivery in these the structure of the computational component. The morally complex situations. The DHHS interpretation latter links individuals and households through of the BAIPA may encourage jurisdictional creep of statistically-defined opportunities for contacts and, by these kinds of pronouncements as the agency seeks to repeated trials, determines an average longitudinal time expand legal protections for born-alive infants. The US course (epidemic curve) of the simulated infection as it Supreme Court has stated that "courts must presume spreads through the community from inception to that a legislature says in a statute what it means and extinction of the epidemic. The model thus aims to means in a statute what it says there"; thus, judges describe the epidemic itself, rather than any abstraction interpret law by analyzing "concrete statutory of it. In application to a 1955-56, self-contained language, not by reference to abstract notions of epidemic of an SIR disease, variola minor, the model generalized legislative intent." The BAIPA generates 1 dominant longitudinal pattern that matches indiscriminately defines "born alive" to include an closely the epidemic curve of observed daily case rates; infant "at any stage of development... regardless of it is suggested that other patterns indicate different whether the expulsion or extraction occurs as a result ways in which the epidemic might have evolved. The of natural or induced labor, cesarean section, or model can be used to show how differing community induced abortion," and it makes no reference to characteristics would affect the simulated epidemic. standards of care or best interests, nor does it specifically protect a parent's decision-making Sazonov E, Sazonova N, Schuckers S, Neuman M. Activity- authority. Under the law's strict logic, an 18-week based sleep-wake identification in infants. Physiol miscarried fetus with a detectable heart beat after Meas 2004; 25(5):1291-304. delivery is entitled to the full protections of the law as Notes: CORPORATE NAME: CHIME Study Group determined by "any Act of Congress, or any ruling, Abstract: Actigraphy offers one of the best-known regulation, or interpretation of the various alternatives to polysomnography for sleep-wake administrative bureaus and agencies." Before identification. The advantages of actigraphy include concluding that the BAIPA would not affect normative high accuracy, simplicity of use and low intrusiveness. neonatal practice, the NRP Steering Committee should These features allow the use of actigraphy for have analyzed the act's actual statutory language and determining sleep-wake states in such highly sensitive avoided relying heavily on imprecise legislative intent. groups as infants. This study utilizes a motion sensor The BAIPA's congressional sponsors did claim that the (accelerometer) for a dual purpose: to determine an law "will not mandate medical treatment where none is infant's position in the crib and to identify sleep-wake currently indicated," but such political rhetoric is often states. The accelerometer was positioned over the not sufficient to render law innocuous years after sacral region on the infant's diaper, unlike commonly separation from its legislative history. Besides, used attachment to an ankle. Opposed to broadly used nowhere in the House record does the majority discriminant analysis, this study utilized logistic explicitly acknowledge that discretion to decide the regression and neural networks as predictors. The fate of imperiled newborns invests in parents, in accuracy of predicted sleep-wake states was consultation with physicians; indeed, the bill's stated established in comparison to the sleep-wake states purpose was to repudiate that notion. At best, recorded by technicians in a polysomnograph study. legislators recognized that physicians disagree about Both statistical and neural predictors of this study the efficacy of resuscitating at the limits of viability, provide an accuracy of approximately 77-92% which is and therefore the current standard of care permits comparable to similar studies achieving prediction doctors to deem resuscitation a futile endeavor. rates of 85-95%, thus validating the suggested However, judges may resist characterizing methodology. The results support the use of body resuscitation as futile, given its poor analytical fit, and motion as a simple and reliable method for determining substantial public-policy concerns regarding sleep-wake states in infants. Nonlinear mapping discrimination against future disabled individuals could capabilities of the neural network benefit the accuracy easily tip a court to preserve incipient, at least, of sleep-wake state identification. Utilization of the physiologic life under the BAIPA's all-encompassing accelerometer for the dual purpose allows us to definition of born alive. minimize intrusiveness of home infant monitors. Sayers BM, Angulo J. A new explanatory model of an SIR Scaldo SA. The Born-Alive Infants Protection Act: baby disease epidemic: a knowledge-based, probabilistic steps toward the recognition of life after birth. Nova 829
- 838. Law Rev 2002; 26(2):485-510. Analysis was done using the constant comparative Notes: GENERAL NOTE: KIE: 147 fn. method. The basic social problem identified was the GENERAL NOTE: KIE: KIE Bib: abortion/legal escalating behavior of the child. The child's behavior aspects; personhood included self-injurious behavior or violence toward others. The core concept was "hospitalization, the last Scerif G, Karmiloff-Smith A. The dawn of cognitive resort." Parents' management of the experience varied genetics? Crucial developmental caveats. Trends Cogn based on many factors including whether this was the Sci 2005; 9(3):126-35. child's first psychiatric hospitalization, the distance Abstract: Attempts to bridge genetics and cognition are from the hospital to their home, their trust of staff rapidly coming to the forefront of cognitive members, sources of support, and their definition of the neuroscience. It is therefore crucial to evaluate the situation. current state of knowledge about disorders of known genetic origin as a way of assessing whether, and if so Scharff JL, Broida JP, Conway K, Yue A. The interaction of how, links between genotype and cognitive phenotype parental alcoholism, adaptation role, and familial can be drawn, however indirect these links might be. dysfunction. Addict Behav 2004; 29(3):575-81. We review recent empirical findings from research on Abstract: Many people believe that parental alcoholism genetic disorders at three levels of description-- has adverse consequences on children-some research cognitive, neural systems, and cellular--that caution fails to support this hypothesis. Familial dysfunction is against simple genotype-phenotype mappings at all often regarded as having a more important impact on levels. Most importantly, interdisciplinary efforts to adults, perhaps because of a failure to recognize that integrate human genetics and cognition will need to adult children of alcoholics (ACOAs) may have operationalize the mechanisms driving both typical and adopted more than one coping strategy. The present atypical developmental processes over time. study investigated within-group differences in psychological symptomology as measured by the Schaeffer CM, Petras H, Ialongo N, Poduska J, Kellam S. Millon Clinical Multiaxial Inventory (MCMI). Modeling growth in boys' aggressive behavior across ACOAs, were compared by roles (Hero, Mascot, Lost elementary school: links to later criminal involvement, Child, and Scapegoat) to non-ACOAs as measured by conduct disorder, and antisocial personality disorder. familial dysfunction and roles. MANOVA indicated Dev Psychol 2003; 39(6):1020-35. significant main effects of dysfunction, role, ACOA, Abstract: The present study used general growth and an interaction of role and ACOA. Failures to mixture modeling to identify pathways of antisocial recognize the impact of parental alcoholism may be behavior development within an epidemiological caused by multiple adaptation strategies. sample of urban, primarily African American boys. Teacher-rated aggression, measured longitudinally Schechter DS, Zeanah CH Jr, Myers MM et al. from 1st to 7th grade, was used to define growth Psychobiological dysregulation in violence-exposed trajectories. Three high-risk trajectories (chronic high, mothers: salivary cortisol of mothers with very young moderate, and increasing aggression) and one low-risk children pre- and post-separation stress. Bull trajectory (stable low aggression) were found. Boys Menninger Clin 2004; 68(4):319-36. with chronic high and increasing trajectories were at Abstract: To understand the determinants of increased risk for conduct disorder, juvenile and adult frightening/frightened and other atypical maternal arrest, and antisocial personality disorder. behavior, the authors studied a sample of 41 inner-city Concentration problems were highest among boys with mothers of very young children (ages 8-50 months), the a chronic high trajectory and also differentiated boys mothers of whom had lifetime histories of interpersonal with increasing aggression from boys with stable low violent trauma (i.e., physical or sexual abuse, and aggression. Peer rejection was highest among boys domestic violence) and related posttraumatic stress. with chronic high aggression. Interventions with boys METHOD: The authors measured (1) maternal salivary with distinct patterns of aggression are discussed. cortisol levels before and 30 minutes after a videotaped play paradigm with their children, involving two Schaffer M. More cover-ups, more shame. US News World separations and reunions; and (2) cortisol reactivity 30 Rep 2002; 132(19):46, 48. minutes after separation stress. Data were analyzed using Pearson bivariate correlations, ANOVA, and Scharer K, Jones DS. Child psychiatric hospitalization: the multiple linear regressions. RESULTS: Salivary last resort. Issues Ment Health Nurs 2004; 25(1):79- cortisol "baseline" values were significantly negatively 101. correlated with childhood interpersonal violent trauma Abstract: The purpose of this study was to describe severity (i.e., trauma severity prior to age 16). how parents manage the experience of hospitalizing However, cortisol reactivity was not significantly their school-aged child in a psychiatric unit. Grounded correlated with interpersonal violent trauma severity at theory methodology was used. Thirty-eight parents this level of analysis. Although baseline salivary participated. Data were collected by interviews. cortisol values were not significantly correlated with current overall psychiatric or depressive symptoms, 830
- 839. they were negativelycorrelated with severity of current affected thousands of children psychologically, posttraumatic stress symptoms (PTSS) and with necessitating the mobilization of multifaceted mental dissociative symptoms. Neither dimensions of health interventions in an ecological context. This negativity nor distortion of maternal attributions paper reviews the major role of large and small group showed any significant association with prestress or modalities in this challenging effort, with many of poststress salivary cortisol levels. Salivary cortisol them based on earlier group work with child-victims of baseline was negatively correlated with atypical trauma. maternal behavior via measurement of the level of disrupted communication, at a trend-level of Schenarts PJ. Three-year-old boy with burn wound sepsis: a significance. CONCLUSIONS: Violent trauma- challenge to the ethics of a responsible surgeon. Curr associated dysregulation of the hypothalamic-pituitary- Surg 2004; 61(3):245-6. adrenal (HPA) axis may be a marker for increased risk Notes: GENERAL NOTE: KIE: KIE Bib: patient for intergenerational transmission via parenting care/minors behavior with young children. Low salivary cortisol prior to separation stress and blunted cortisol reactivity Schetinin V, Schult J. The combined technique for detection to separation may also be markers for posttraumatic of artifacts in clinical electroencephalograms of stress. sleeping newborns. IEEE Trans Inf Technol Biomed 2004; 8(1):28-35. Scheeringa MS, Zeanah CH, Myers L, Putnam F. Heart Abstract: In this paper, we describe a new method period and variability findings in preschool children combining the polynomial neural network and decision with posttraumatic stress symptoms. Biol Psychiatry tree techniques in order to derive comprehensible 2004; 55(7):685-91. classification rules from clinical Abstract: BACKGROUND: Traumatic experiences for electroencephalograms (EEGs) recorded from sleeping young children might result in profound newborns. These EEGs are heavily corrupted by neurodevelopmental changes, compared with adults. cardiac, eye movement, muscle, and noise artifacts and, Our aim was to examine autonomic control of heart as a consequence, some EEG features are irrelevant to rate in traumatized young children. METHODS: Sixty- classification problems. Combining the polynomial two children who had suffered traumas and 62 network and decision tree techniques, we discover nontraumatized control children, aged 20 months to 6 comprehensible classification rules while also years, were assessed for posttraumatic stress disorder attempting to keep their classification error down. This (PTSD) symptoms, interbeat interval, respiratory sinus technique is shown to out-perform a number of arrhythmia (RSA), family rehearsal of the trauma, and commonly used machine learning technique applied to parent-child relationship quality. RESULTS: automatically recognize artifacts in the sleep EEGs. Traumatized children with PTSD and traumatized children without PTSD both had decreased heart period Schiff M, McKay MM. Urban youth disruptive behavioral in response to a trauma stimulus relative to the difficulties: exploring association with parenting and nontraumatized group (both p < .0167). there was no gender. Fam Process 2003; 42(4):517-29. main effect for RSA change scores, however, there was Abstract: The current study will examine behavioral a significant interaction effect between parental difficulties among a sample of African American urban positive discipline with PTSD symptoms and RSA. youth who were exposed to violence. Possible gender The most sympathetic children had decreased RSA differences in disruptive behavioral difficulties, as well during the trauma stimulus when they had caregivers as possible associations between parental practices, with less positive discipline during a clean-up nd family relationships, and youth disruptive behavioral family rehearsal with PTSD symptoms. difficulties are examined. A secondary data analysis CONCLUSIONS: These findings underscore that from baseline data for 125 African American urban psychopathology in young children ought to be mothers and their children collected as part of a large- assessed in the context of psychophysiology and scale, urban, family-based, HIV prevention research parent-child relationship to optimally understand the study was analyzed. Findings reveal that externalizing mechanisms of maladaptation during this complex behavioral problems in youth are associated with developmental period. exposure to violence. Girls displayed significantly higher levels of externalizing behavioral difficulties Scheibner V. Response to Leask and McIntyre's attack on than boys. Mothers' parenting practices and family myself as a public opponent of vaccination. Vaccine relationships were associated with youths' externalizing 2003; 22(1):vi-ix. behavior problems. Implications for interventions to reduce youths' exposure to violence and to develop Scheidlinger S, Kahn GB. In the aftermath of September 11: gender sensitive interventions for youth and supportive group interventions with traumatized children revisited. interventions for their parents are discussed. Int J Group Psychother 2005; 55(3):335-54. Abstract: The terrorist attacks of September 11, 2001, Schiller C, Allen PJ. Follow-up of infants prenatally exposed 831
- 840. to cocaine. PediatrNurs 2005; 31(5):427-36. disorder (BPD) is a common psychiatric disorder that Abstract: Maternal cocaine use during pregnancy is often linked to early stressors. One particularly continues to be of great concern for health care salient feature of the disorder is fear of abandonment. professionals. Research in this area has increased as This pilot study was conducted to measure neural investigators examine the effects of prenatal cocaine correlates of memories of abandonment in women with exposure in the infant/young child. This paper will and without BPD. METHODS: Twenty women with a critically review the literature, identify the primary care history of childhood sexual abuse underwent needs of infants and young children with a known measurement of brain blood flow with positron history of prenatal cocaine exposure, and present emission tomography imaging while they listened to guidelines for the primary care practitioner to monitor scripts describing neutral and personal abandonment the infant's physiologic and developmental sequelae events. Brain blood flow during exposure to during the first 3 years of life. Findings in the literature abandonment and neutral scripts was compared among demonstrate inconsistencies in regard to the women with and without BPD. RESULTS: Memories physiologic and developmental outcomes of of abandonment were associated with greater increases infants/young children prenatally exposed to cocaine. in blood flow in bilateral dorsolateral prefrontal cortex Further research is warranted, as it is evident from (middle frontal gyrus, Brodmann's areas 9 and 10) as studies that not all investigators are controlling for well as right cuneus (area 19) in women with BPD than confounding variables such as poly-drug use, which is in women without BPD. Abandonment memories were necessary in isolating cocaine's effects. Subtle effects, associated with greater decreases in right anterior however, have been reported from well-controlled cingulate (areas 24 and 32) in women with BPD than in studies and, thus, particular attention needs to be paid women without BPD. CONCLUSIONS: These to early identification and interventions by primary findings implicate dysfunction of dorsolateral and care practitioners to prevent negative health outcomes. medial prefrontal cortex including anterior cingulate, The guidelines proposed assist the practitioner with a left temporal cortex, and visual association cortex in thorough and focused approach to assessing the memories of abandonment in women with BPD. These physiologic and developmental effects that are brain areas may mediate symptoms of BPD. currently known to occur in the infant/young child prenatally exposed to cocaine. Schmeck K, Poustka F. Temperament and disruptive behavior disorders. Psychopathology 2001; 34(3):159- Schlesinger LB. The contract murderer: patterns, 63. characteristics, and dynamics. J Forensic Sci 2001; Abstract: In several studies on children with conduct 46(5):1119-23. disorder, difficult temperament in infancy was one of Abstract: A case of an independent professional the major variables in the explanation of later contract murderer, who killed over 100 people, is aggressive behavior. According to these studies, reported. After eluding law enforcement for 30 years, subjects with a combination of high novelty seeking, the subject killed several associates who he believed low harm avoidance and low reward dependence (NS could implicate him in various crimes. These high, HA + RD low) should be most at risk for the homicides eventually led to his arrest, since the victims development of disruptive behavior disorders. The were individuals who could be linked to him. This hit Junior Temperament and Character Inventory was man had a background of poverty and childhood abuse given to a clinical sample of 65 adolescent patients of but, as an adult, had pursued a middle-class lifestyle both sexes with the diagnoses of conduct disorder (with and kept his family totally separate from his criminal and without attention deficit hyperactivity disorder), career. In addition, he had a number of characteristics emotional disorder (anxiety disorder, obsessive- that helped him carry out his crimes in a highly compulsive disorder, depressive disorder), eating planned, methodical, and organized manner: he had disorder (anorexia, bulimia) or personality disorder adept social judgment; personality traits of orderliness, (borderline and narcissistic personality disorder). High control, and paranoid vigilance; useful defense novelty seeking and low harm avoidance were mechanisms of rationalization and reframing; and an significantly correlated with externalizing symptoms exceptional ability to encapsulate emotions. This case like aggression and delinquency. In conduct-disordered is discussed within the context of contract murder, a children and adolescents, we found significantly higher crime that occurs relatively frequently and is probably scores of NS compared to the other clinical groups and increasing; yet it often goes undetected, the arrest rate the normative population, and significantly lower is low, and the offender is rarely studied. scores of harm avoidance compared to the other clinical groups, but not compared to the normative Schmahl CG, Elzinga BM, Vermetten E, Sanislow C, population. The relative risk of having a conduct McGlashan TH, Bremner JD. Neural correlates of disorder was markedly higher in those children and memories of abandonment in women with and without adolescents with elevated scores of novelty seeking. borderline personality disorder. Biol Psychiatry 2003; 54(2):142-51. Schmidt C. Mothers' perceptions of self-care in school-age Abstract: BACKGROUND: Borderline personality children with diabetes. MCN Am J Matern Child Nurs 832
- 841. 2003; 28(6):362-70. Measures of symptomatology indicated that children Abstract: PURPOSE: To describe mothers' perceptions reported low levels of depressive symptoms, whereas of the diabetes-related self-care abilities and practices caregivers reported the children were experiencing of their school-age children with Type 1 diabetes. significant psychological problems. Children used STUDY DESIGN AND METHOD: Qualitative study avoidant coping strategies more often than emotion- using the naturalistic inquiry method. Mothers of focused coping strategies, which, in turn, were used school-age children with diabetes were interviewed by more than problem-focused coping strategies. Results means of a semi-structured interview guide. The are discussed in terms of helping children cope with children were between the ages of 11 and 12 and had parental loss. been diagnosed with diabetes for a minimum of 2 years. Twelve mothers were interviewed, generating 20 Schnitzer PG, Ewigman BG. Child injury deaths: comparing hours of qualitative data. RESULTS: Mothers reported prevention information from two coding systems. J that their children with diabetes had learned skills in a Pediatr Psychol 2005; 30(5):413-23. predictable sequence, were usually motivated by events Abstract: OBJECTIVES: The International in the here and now, and did not consistently perform Classification of Disease (ICD) external cause of injury all diabetes-related skills of which they were capable. E-codes do not sufficiently identify injury Most of the children were becoming embarrassed about circumstances amenable to prevention. The researchers having diabetes. There were considerable gender developed an alternative classification system (B- differences in the children's self-care codes) that incorporates behavioral and environmental development.CLINICAL IMPLICATIONS: Nurses factors, for use in childhood injury research, and can use this study to help with anticipatory guidance compare the two coding systems in this paper. for parents. It may be helpful for parents to know the METHODS: All fatal injuries among children less than sequence in which many children learn diabetes-related age five that occurred between January 1, 1992, and skills, and to learn that even though a child is capable December 31, 1994, were classified using both B-codes of task performance, he or she may not necessarily be and E-codes. RESULTS: E-codes identified the most ready for the independent practice or daily execution of common causes of injury death: homicide (24%), fires the skill. Encouraging parents to stay involved with (21%), motor vehicle incidents (21%), drowning their children's self-care practices past the early (10%), and suffocation (9%). The B-codes further adolescent years may be effective in improving self- revealed that homicides (51%) resulted from the child care practices, and helping children to identify reasons being shaken or struck by another person; many fires to meet the self-care demands associated with diabetes deaths (42%) resulted from children playing with can be beneficial. matches or lighters; drownings (46%) usually occurred in natural bodies of water; and most suffocation deaths Schmidt LS, Nielsen JE, Blichfeldt SS, Lund AM. (68%) occurred in unsafe sleeping arrangements. [Metabolic disease or shaken baby syndrome?]. Ugeskr CONCLUSIONS: B-codes identify additional Laeger 2003; 165(35):3323-4. information with specific relevance for prevention of Abstract: We describe two children with subdural childhood injuries. haematoma and glutaricacidaemia type 1, who were diagnosed late because of initial suspicion of shaken Schoenhofer SO. Choosing personhood: intentionality and baby syndrome. the theory of nursing as caring. Holist Nurs Pract 2002; 16(4):36-40. Schneider BA. Child welfare: court may determine whether Abstract: Drawing on a story of a nursing situation for life-sustaining treatment should be withdrawn. J Law practical context, this article explores the meaning of Med Ethics 2003; 31(2):316-7. intentionality within the theoretical context of Nursing as Caring. May's definition of intentionality as the Schneider JA. Janus-faced resilience in the analysis of a structure that gives meaning to experience is severely traumatized patient. Psychoanal Rev 2003; interwoven with the concepts of the theory of Nursing 90(6):869-87. as Caring to explore the topic. Mayeroff's concepts of hope and commitment contribute to an understanding Schneider KM, Phares V. Coping with parental loss because of intentionality in relation to Nursing as Caring. The of termination of parental rights. Child Welfare 2005; major thesis of this article, that intentionality is 84(6):819-42. consistently choosing personhood as a way of life and Abstract: This article addresses the process by which the aim of nursing, is demonstrated in the practice children and adolescents cope with severe acute stress situation. of parental loss from causes other than divorce or death. Participants were 60 children and adolescents Schoening AM, Greenwood JL, McNichols JA, Heermann from a residential treatment facility. Most had JA, Agrawal S. Effect of an intimate partner violence experienced neglect, physical abuse, and sexual abuse, educational program on the attitudes of nurses. J Obstet and their parents had their parential rights terminated. Gynecol Neonatal Nurs 2004; 33(5):572-9. 833
- 842. Abstract: OBJECTIVE: Toexamine the effect of an eighth decade. There was no significant difference in intimate partner violence (IPV) educational program on incidence by gender. The average annual rate of OAG the attitudes of nurses toward victims. DESIGN: A in the last 2 years of the study was 27.7 compared with quasi-experimental study utilizing a pretest and 12.3 before 1979. This difference is suggestive of the posttest. SETTING: An urban health care system. effect of the introduction of a new medical therapy PARTICIPANTS: Fifty-two inpatient nurses (timolol) for OAG during the last 2 years. completed both the pretest and posttest. CONCLUSIONS: The incidence rates of OAG INTERVENTION: One-hour and 3-hour IPV increase markedly with advancing age, and screening educational programs. MAIN OUTCOME efforts should be targeted at both men and women in MEASURES: Change in attitude was determined by the older age groups. The advent of new diagnostic and scores from the Public Health Nurses' Response to therapeutic modalities can have an effect on incidence Women Who Are Abused (PHNR), a standardized rates. questionnaire that measures nurses' reactions to an IPV scenario. Parallel forms, each with a different scenario, Scholle SH, Gardner W, Harman J, Madlon-Kay DJ, Pascoe were administered before and 2 months after the 1-hour J, Kelleher K. Physician gender and psychosocial care and 3-hour educational sessions. Scores were analyzed for children: attitudes, practice characteristics, using a repeated measures analysis of variance identification, and treatment. Med Care 2001; followed by multiple comparisons with Bonferroni 39(1):26-38. adjustments. RESULTS: Nurses' PHNR scores Abstract: OBJECTIVE: To examine differences by increased significantly after attending the 1-hour physician gender in the identification and treatment of session if they had previous IVP education and after childhood psychosocial problems. DESIGN: Survey of the 3-hour session if they had no previous IVP patients (n = 19,963) and physicians (n = 366) in education. CONCLUSION: Educational offerings primary care offices in 2 large, practice-based research should be tailored for nurses. For nurses with previous networks. Multivariate regressions were used to control IVP education, offer a 1-hour update. For nurses with for patient, physician, and visit characteristics, with a no previous IVP education, provide a 3-hour correction for the clustered sample. SUBJECTS: educational session. Further study is needed to Children ages 4 to 15 years seen consecutively for determine if change in nurses' attitudes translates into nonemergent care. MEASURES: Physician report of improved screening, identification, and intervention for attitudes, training, practice factors, and identification IPV victims. and treatment of psychosocial problems. Parental report of demographics and behavioral symptoms. Schoff EO, Hattenhauer MG, Ing HH et al. Estimated RESULTS: Compared with male physicians, female incidence of open-angle glaucoma in Olmsted County, physicians were less likely to view care for Minnesota. Ophthalmology 2001; 108(5):882-6. psychosocial problems as burdensome. They were Abstract: PURPOSE: To determine the incidence rates more likely to see children who were female, younger, of open-angle glaucoma (OAG) in Olmsted County, black or Hispanic, in single-parent households, MINNESOTA: DESIGN: Retrospective population- enrolled in public or managed health plans, and with based estimate of incidence. PARTICIPANTS: From physical health limitations. Children seen by male the medical histories of 60,666 residents of Olmsted physicians had higher symptom counts. Male County, Minnesota, who had ocular diagnoses during physicians were more likely to report having primary the study period, 114 subjects with newly diagnosed care responsibility for their patient and that parents OAG were identified. METHODS: The database of the agree with their care plan. Female physicians spent Rochester Epidemiology Project was used to identify more time with patients. After controlling for these all Olmsted County residents with a coded diagnosis of differences, female physicians did not differ from male OAG, glaucoma suspect, or ocular hypertension during physicians in identification or treatment of childhood the period 1965 to 1980. Subjects newly diagnosed psychosocial problems. CONCLUSIONS: Male and with and treated for OAG who also had documented female physicians see different kinds of children for clinical evidence of elevated intraocular pressure, optic different visit purposes and have different kinds of nerve damage, and/or visual field loss consistent with relationships with their patients. After controlling for glaucoma were included as incident cases. Population these factors, management of childhood psychosocial data for Olmsted County were drawn from United problems does not differ by physician gender. States Census data. Crude incidence data were adjusted Improving management of psychosocial conditions to the age and gender distribution of the 1990 United depends on identifying modifiable factors that affect States white population. MAIN OUTCOME diagnosis and treatment; our work suggests that MEASURES: Estimated incidence rates of OAG. characteristics of the practice environment, physician- RESULTS: The overall age- and gender-adjusted patient relationship, and patient self-selection deserve annual incidence rate of OAG in a predominantly more research. Caucasian population is conservatively estimated to be 14.5 per 100,000 population. The rates increased with Scholz BC. Gold's theorems and the logical problem of age from 1.6 in the fourth decade of life to 94.3 in the language acquisition. J Child Lang 2004; 31(4):959-61; 834
- 843. discussion 963-8. children in 2-parent families decreased from 85% to 69%, and more than one quarter (26%) of all children Schor EL. Family pediatrics: report of the Task Force on the live with a single parent, usually their mother. Most of Family. Pediatrics 2003; 111(6 Pt 2):1541-71. this change reflects a dramatic increase in the rate of Notes: CORPORATE NAME: American Academy of births to unmarried women that went from 5.3% in Pediatrics Task Force on the Family 1960 to 33.2% in 2000. Another factor in this change is Abstract: WHY A TASK FORCE ON THE FAMILY? a slowly decreasing but still high divorce rate that is The practice of pediatrics is unique among medical roughly double what it was in the mid-1950s. Family specialties in many ways, among which is the nearly income is strongly related to children's health, and the certain presence of a parent when health care services financial resources that families have available are are provided for the patient. Regardless of whether closely tied to changes in family structure. Family parents or other family members are physically present, income in real dollars has trended up for many their influence is pervasive. Families are the most decades, but the benefits have not been shared equally. central and enduring influence in children's lives. For example, the median income of families with Parents are also central in pediatric care. The health married parents has increased by 146% since 1970, but and well-being of children are inextricably linked to female-headed households have experienced a growth their parents' physical, emotional and social health, of 131%. More striking is that in 2000, the median social circumstances, and child-rearing practices. The income of female-headed households was only 47% of rising incidence of behavior problems among children that of married-couple families and only 65% of that of attests to some families' inability to cope with the families with 2 married parents in which the wife was increasing stresses they are experiencing and their need not employed. Not surprising, the proportion of for assistance. When a family's distress finds its voice children who live in poverty is approximately 5 times in a child's symptoms, pediatricians are often parents' greater for female-headed families than for married- first source for help. There is enormous diversity couple families. The comped families than for married- among families-diversity in the composition of couple families. The composition of children's families families, in their ethnic and racial heritage, in their and the time parents have for their children affect child religious and spiritual orientation, in how they rearing. Consequent to the increase in female-headed communicate, in the time they spend together, in their households, rising economic and personal need, and commitment to individual family members, in their increased opportunities for women, the proportion of connections to their community, in their experiences, mothers who are in the workforce has climbed steadily and in their ability to adapt to stress. Within families, over the past several decades. Currently, approximately individuals are different from one another as well. two thirds of all mothers with children younger than 18 Pediatricians are especially sensitive to differences years are employed. Most families with young children among children-in their temperaments and depend on child care, and most child care is not of personalities, in their innate and learned abilities, and good quality. Reliance on child care involves longer in how they view themselves and respond to the world days for children and families, the stress imposed by around them. It is remarkable and a testament to the schedules and created by transitions, exposure to effort of parents and to the resilience of children that infections, and considerable cost. An increasing most families function well and most children succeed number and proportion of parents are also devoting in life. Family life in the United States has been time previously available to their children to the care of subjected to extensive scrutiny and frequent their own parents. The so-called "sandwich generation" commentary, yet even when those activities have been of parents is being pulled in multiple directions. The informed by research, they tend to be influenced by amount and use of family time also has changed with a personal experience within families and by individual lengthening workday, including the amount of and cultural beliefs about how society and family life commuting time necessary to travel between work and ought to be. The process of formulating home, and with the intrusion of television and recommendations for pediatric practice, public policy, computers into family life. In public opinion polls, professional education, and research requires reaching most parents report that they believe it is more difficult consensus on some core values and principles about to be a parent now than it used to be; people seem to family life and family functioning as they affect feel more isolated, social and media pressures on and children, knowing that some philosophic disagreements enticements of their children seem greater, and the will remain unresolved. The growing multicultural world seems to be a more dangerous place. Social and character of the country will likely heighten awareness public policy has not kept up with these changes, of our diversity. Many characteristics of families have leaving families stretched for time and stressed to cope changed during the past 3 to 5 decades. Families and meet their responsibilities. What can and what without children younger than 18 years have increased should pediatrics do to help families raise healthy and substantially, and they are now the majority. The well-adjusted children? How can individual average age at marriage has increased, and a greater pediatricians better support families? FAMILY proportion of births is occurring to women older than PEDIATRICS: The American Academy of Pediatrics 30 years. Between 1970 and 2000, the proportion of (AAP) Board of Directors appointed the Task Force on 835
- 844. the Family tohelp guide the development of public functioning that implicitly guided the task force is the policy and recommend how to assist pediatricians to family stress model (Fig 1). Stress of various sorts (eg, promote well-functioning families (see Appendix). The financial or health problems, lack of social support, magnitude of the assigned work required task force unhappiness at work, unfortunate life events) can cause members to learn a great deal from research and parents emotional distress and cause couples conflict researchers in the fields of social and behavioral and difficulty with their relationship. These responses sciences. A review of some critical literature was to stress then disrupt parenting and the interactions completed by a consultant to the task force and between parent and child and can lead to short-term or accompanies this report. That review identified a lasting poor outcomes. The earlier these events convergence of pediatrics and research on families by transpire and the longer that the disruption lasts, the other disciplines. The task force found that a great deal worse the outcomes for children. The task force favors is known about family functioning and family efforts to encourage and support marriage yet circumstances that affect children. With this recognizes that every family constellation can produce knowledge, it is possible to provide pediatric care in a good outcomes for children and that none is certain to way that promotes successful families and good yield bad ones. (ABSTRACT TRUNCATED) outcomes for children. The task force refers to that type of care as "family-oriented care" or "family pediatrics" Schreier H. Munchausen by proxy defined. Pediatrics 2002; and strongly endorses policies and practices that 110(5):985-8. promote the adoption of this 2-generational approach as a hallmark of pediatrics. During the past decade, Schreier HA, Ayoub CC. Casebook companion to the family advocates have successfully promoted family- definitional issues in Munchausen by proxy position centered care, "the philosophies, principles and paper. Child Maltreat 2002; 7(2):160-5. practices that put the family at the heart or center of services; the family as the driving force." Most Schuiling GA. Honor your father and your mother. J pediatricians report that they involve families in the Psychosom Obstet Gynaecol 2001; 22(4):215-9. decision making regarding the health care of their child Abstract: While on the one hand there is much mutual and make an effort to understand the needs of the love and care in the relationship between parents and family as well as the child. Family pediatrics, like their offspring, there may, on the other hand, be also family-centered care, requires an active, productive much mutual 'sound and fury', which sometimes is far partnership between the pediatrician and the family. from 'signifying nothing' (William Shakespeare, But family pediatrics extends the responsibilities of the Macbeth). Indeed, from conception on, individuals are pediatrician to include screening, assessment, and confronted with parent-offspring conflicts of all kinds. referral of parents for physical, emotional, or social Initially these conflicts concern physiological matters problems or health risk behaviors that can adversely (implantation, nutrition, weaning, etc.), but later in life affect the health and emotional or social well-being of the accent is on psychological ('you must this', 'you their child. FAMILY CONTEXT OF CHILD must that', 'don't do that' etc.) and social affairs, and HEALTH: The power and importance of families to phenomena such as child abuse, infanticide and incest children arises out of the extended duration for which may occur. It is, therefore, certainly not self-evident children are dependent on adults to meet their basic that children honor their parents. To reinforce their needs. Children's needs for which only a family can position, parents (societies) may appeal to a 'divine' provide include social support, socialization, and commandment which helps them make their children coping and life skills. Their self-esteem grows from suppress any tendency to conflict toward them (and being cared for, loved, and valued and feeling that they hence to their culture), so that children conform to their are part of a social unit that shares values, parents' norms and values. When such psychological communicates openly, and provides companionship. and sociological parent-offspring conflicts are not Families transmit and interpret values to their children resolved satisfactorily, it can be suggested, children and often serve as children's connection to the larger may (consciously or unconsciously) have aggressive world, especially during the early years of life. feelings toward their parents: Freud's 'Oedipus Although schools provide formal education, families complex'. This complex, it is argued, can also be seen teach children how to get along in the world. Often, as a parent-offspring conflict. Given their biological efforts to discuss families and make recommendations basis, parent-offspring conflicts can hardly be regarding practice or policy stumble over considered as abnormal. Conflicts between adults and disagreements about the definition of a family. The their offspring have always existed and will always task force recognized the diversity of families and exist, simply because it is inherent in our genetic make- chose not to operate from the position of a fixed up: parents and offspring of sexually reproducing definition. Rather, the task force, which was to address species--humans included--are only about 50% pediatrics, decided to frame its deliberations and genetically related and hence have different interests at recommendations around the functions of families and all levels of being. Indeed, parent-offspring conflicts how various aspects of the family context influence are such stuff as we are made on, and our little life is child rearing and child health. One model of family 836
- 845. rounded with itsconsequences (adapted from William from 6 to 18 months by trained lay visitors. Shakespeare, The Tempest). PARTICIPANTS: One hundred eight low-income, inner-city, drug-exposed children (control, 54; Schuler ME, Nair P. Witnessing violence among inner-city intervention, 54) who underwent developmental testing children of substance-abusing and non-substance- at 6, 12, and 18 months post partum and who remained abusing women. Arch Pediatr Adolesc Med 2001; with their biological mothers through 18 months. 155(3):342-6. MAIN OUTCOME MEASURES: Infant scores from Abstract: OBJECTIVES: To determine if children of the Bayley Scales of Infant Development (BSID) at 6, substance-abusing mothers witness more violence than 12, and 18 months post partum. Maternal report of drug children of non-substance-abusing (control) mothers, use during the pregnancy and ongoing drug use and to determine if children who witness violence have through 18 months post partum was assessed. more behavioral problems and higher stress scores than RESULTS: In the repeated-measures analyses, children who do not witness violence. DESIGN: Cross- intervention infants had significantly higher BSID sectional research design comparing exposure to Mental Developmental Index (MDI) and Psychomotor violence among children of substance-abusing mothers Developmental Index scores than control infants. and control mothers of low socioeconomic status. Ongoing maternal cocaine and/or heroin use was SETTING: An inner-city pediatric clinic. associated with lower MDI scores. Finally, MDI scores PARTICIPANTS: Forty substance-abusing mothers decreased significantly in both groups. and their children, and 40 non-substance-abusing CONCLUSIONS: Ongoing maternal drug use is mothers and their children, examined when the associated with worse developmental outcomes among children were 6 years old. MAIN OUTCOME a group of drug-exposed infants. A home intervention MEASURES: Maternal report of children's exposure to led to higher BSID scores among drug-exposed infants. violence was assessed using the Exposure to Violence However, BSID MDI scores decreased during the first Interview and the Conflict Tactics Scale. Maternal 18 months post partum among inner-city, low- report of children's behavior was assessed using the socioeconomic-status infants in the present study. Child Behavior Checklist and the Children's Response to Stress Inventory. RESULTS: Children of substance- Schulting AB, Malone PS, Dodge KA. The effect of school- abusing mothers did not witness more violence than the based kindergarten transition policies and practices on control children (P>.05). However, 6-year-old inner- child academic outcomes. Dev Psychol 2005; city children in the present study witnessed a high rate 41(6):860-71. of violence: 43% had seen someone beaten up, 13% Abstract: This study examined the effect of school- had seen someone threatened with a knife, and 7% had based kindergarten transition policies and practices on seen someone stabbed or shot. Children witnessing child outcomes. The authors followed 17,212 children violence had significantly higher aggressive, from 992 schools in the Early Childhood Longitudinal delinquent, anxious/depressed, withdrawn, attention, Study-Kindergarten sample (ECLS-K) across the and social problems (P<.05) on the Child Behavior kindergarten school year. Hierarchical linear modeling Checklist, and higher stress scores (P =.05) on the revealed that the number of school-based transition Children's Response to Stress Inventory. practices in the fall of kindergarten was associated with CONCLUSIONS: More than half of the 6-year-old more positive academic achievement scores at the end inner-city children in the present study witnessed some of kindergarten, even controlling for family form of violence. Witnessing violence was associated socioeconomic status (SES) and other demographic with more behavioral problems and higher stress scores factors. This effect was stronger for low- and middle- as assessed through maternal report. Subsequent SES children than high-SES children. For low-SES research should examine the long-term effects of this children, 7 transition practices were associated with a exposure to violence among young children. .21 standard deviation increase in predicted achievement scores beyond 0 practices. The effect of Schuler ME, Nair P, Kettinger L. Drug-exposed infants and transition practices was partially mediated by an developmental outcome: effects of a home intervention intervening effect on parent-initiated involvement in and ongoing maternal drug use. Arch Pediatr Adolesc school during the kindergarten year. The findings Med 2003; 157(2):133-8. support education policies to target kindergarten Abstract: OBJECTIVE: To evaluate the effects of a transition efforts to increase parent involvement in low- home intervention and ongoing maternal drug use on SES families. the developmental outcome of drug-exposed infants. DESIGN: Longitudinal randomized cohort study of a Schultz ST, Shenkin JD, Horowitz AM. Parental perceptions home intervention with substance-abusing mothers and of unmet dental need and cost barriers to care for their infants. Mother-infant dyads were randomly developmentally disabled children. Pediatr Dent 2001; assigned to a control or intervention group at 2 weeks' 23(4):321-5. post partum. Control families received brief monthly Abstract: PURPOSE: The purpose of this investigation tracking visits. Intervention families received weekly was to describe and assess the disparities, if any, in home visits from 0 to 6 months and biweekly visits parental perceived cost barriers to oral health care 837
- 846. among developmentally disabledchildren using a community notification schemes are civil and not national data set. METHODS: Data from the 1997 criminal in nature. The article concludes with a National Health Interview Survey (NHIS) were discussion of possible implications for clinicians analyzed using a SUDAAN statistical package. involved in evaluating or treating sex offenders. RESULTS: After adjusting for age and sex, parental perception of unmet need was significantly associated Scott D. A promise unfulfilled on child abuse. Aust N Z J with developmentally disabled children 2-17 years in Public Health 2002; 26(5):415-6. lower socioeconomic groups. CONCLUSIONS: Though most children from lower socioeconomic Scott D, Brady S, Glynn P. New mother groups as a social groups are eligible for Medicaid coverage, parents of network intervention: consumer and maternal and child these children perceive cost barriers to dental care. health nurse perspectives. Aust J Adv Nurs 2001; Children with developmental disabilities face even 18(4):23-9. more perceived barriers to care based on family Abstract: Maternal and child health nurses in two outer income. urban local government areas in Melbourne, Australia were interviewed about how they facilitated first-time Schutte AR, Spencer JP, Schoner G. Testing the dynamic parent groups. Groups were offered to all first time field theory: working memory for locations becomes mothers and almost two thirds of mothers joined a more spatially precise over development. Child Dev group. The groups ran for approximately eight sessions 2003; 74(5):1393-417. and provided infant-focussed parent education and Abstract: The dynamic field theory predicts that biases social contact. Women who joined the groups were toward remembered locations depend on the separation followed up 18 months to two years later to determine between targets, and the spatial precision of the degree to which these groups continued to meet on interactions in working memory that become enhanced their own accord and the extent to which they had over development. This was tested by varying the become self-sustaining social networks. The study separation between A and B locations in a sandbox. found a very high level of continuation, suggesting that Children searched for an object 6 times at an A providing such programs may be an important vehicle location, followed by 3 trials at a B location. Two- and for enhancing social support during the transition to 4-year-olds', but not 6-year-olds', responses were parenthood and thus be a useful primary prevention biased toward A when A and B were 9-in. and 6-in. strategy. apart. When A and B were separated by 2 in., however, 4- and 6-year-olds' responses were biased toward A. Scourfield J, Van den Bree M, Martin N, McGuffin P. Thus, the separation at which responses were biased Conduct problems in children and adolescents: a twin toward A decreased across age groups, supporting the study. Arch Gen Psychiatry 2004; 61(5):489-96. predictions of the theory. Abstract: BACKGROUND: Evidence supports a genetic influence on conduct problems as a continuous Schutzer SE, Budowle B, Atlas RM. Biocrimes, microbial measure of behavior and as a diagnostic category. forensics, and the physician. PLoS Med 2005; However, there is a lack of studies using a genetically 2(12):e337. informative design combined with several different informants and different settings. OBJECTIVES: To Scott C. Who is responsible for child protection? Prof Nurse examine genetic and environmental influences on 2003; 18(5):242. conduct problems rated by parent and teacher reports and self-reports and to determine whether their ratings Scott CL, Gerbasi JB. Sex offender registration and reflect a common underlying phenotype. DESIGN: A community notification challenges: the Supreme Court twin study design was used to examine conduct continues its trend. J Am Acad Psychiatry Law 2003; problem scores from ratings by teachers, parents, and 31(4):494-501. twins themselves. SETTING: General community. Abstract: All states and the District of Columbia have PARTICIPANTS: Twins aged 5 to 17 years passed sex offender registration and community participating in the Cardiff Study of All Wales and notification laws. While the specific provisions of these North England Twins (CaStANET) project. MAIN statutes vary, all have public safety as a primary goal. OUTCOME MEASURES: Conduct problem scale The authors discuss two recent cases heard by the from the Strengths and Difficulties Questionnaire. United States Supreme Court that challenged the RESULTS: Conduct problem scores were significantly constitutionality of Alaska's and Connecticut's statutes. heritable based on parent and teacher reports and self- The laws were challenged as violations of the United reports. Combining data from all 3 informants showed States Constitution's prohibition on ex post facto laws that they are rating a common underlying phenotype of and its Fourteenth Amendment guarantee of procedural pervasive conduct problems that is entirely genetic, due process. In both cases, the statutes were upheld. As while teacher ratings show separate genetic influences it has found in challenges to sexually violent predator that are not shared with other raters. CONCLUSIONS: statutes, the Court emphasized that the registration and Conduct problems are significantly heritable based on 838
- 847. parent and teacherreports and self-reports, and are also higher risk youths using assessments indirectly related influenced by environmental effects that impinge or nonlinearly associated to adolescent drug use and uniquely on children from the same family. There is a dependence but less sensitive to survey-related cross-situational conduct problems' phenotype, response tendencies. underlying the behavior measured by all informants, that is wholly genetic in origin. No significant Sebre S, Sprugevica I, Novotni A et al. Cross-cultural influence of shared environmental effects was found. comparisons of child-reported emotional and physical abuse: rates, risk factors and psychosocial symptoms. Seals D, Young J. Bullying and victimization: prevalence Child Abuse Negl 2004; 28(1):113-27. and relationship to gender, grade level, ethnicity, self- Abstract: OBJECTIVES: This study was designed to esteem, and depression. Adolescence 2003; assess the incidence of child emotional and physical 38(152):735-47. abuse, associated risk factors and psychosocial Abstract: This study investigated the prevalence of symptoms in a cross-cultural comparison between post- bullying and victimization among students in grades 7 communist bloc countries. Method: One-thousand one- and 8. It also explored the relationship of bullying and hundred forty-five children ages 10-14 from Latvia (N victimization to gender, grade level, ethnicity, self- = 297), Lithuania ( N = 300), Macedonia (N = 302), esteem, and depression. Three survey instruments were and Moldova (N = 246) participated in the study. They used to obtain data from a convenience sample of 454 completed questionnaires assessing their experience of public school students. Twenty-four percent reported emotional or physical abuse, and provided information bullying involvement. Chi-square tests indicated about family risk-factors and psychosocial symptoms, significantly more male than female bullying including PTSD-related symptoms. RESULTS: involvement, seventh graders reported more Incidence rates of maltreatment differed by country, as involvement than did eighth graders, and there were no did levels of reported psychosocial symptoms. statistically significant differences in involvement Incidence of emotional and physical abuse differed by based on ethnicity. Both bullies and victims manifested region, with higher levels of abuse reported in the rural higher levels of depression than did students who were regions. In all four countries, a similar association neither bullies nor victims. There were no significant between emotional/physical abuse and psychosocial differences between groups in terms of self-esteem. symptoms was found, with the uniformly largest correlation between emotional abuse and anger. When Sears ES, Anthony JC. Artificial neural networks for examining the combined scores of emotional and adolescent marijuana use and clinical features of physcial abuse, even higher correlation's were found, marijuana dependence. Subst Use Misuse 2004; particularly in relation to anger and depression. In all 39(1):107-34. four countries, parental overuse of alcohol was Abstract: This article compares the performance of associated with emotional and/or physical abuse. multiple logistic regression (MLR) with feed-forward, CONCLUSIONS: Findings show differences by artificial neural network (ANN) models for the country in child-reported levels of emotional and assessment of adolescent marijuana use and clinical physical abuse, but similar patterns of correlation with features of dependence based on self-evaluation from psychosocial symptoms and the risk factors of parental recent National Household Surveys on Drug Abuse alcohol overuse and living in a rural area. (NHSDA). The effect of training and testing the neural networks with randomly selected data was compared to Seidman LJ, Valera EM, Makris N. Structural brain imaging data selected as a function of survey year. The of attention-deficit/hyperactivity disorder. Biol technical aim of the study was to account for Psychiatry 2005; 57(11):1263-72. adolescent marijuana use and features of marijuana Abstract: Many investigators have hypothesized that dependence based on experiences with alcohol and attention-deficit/hyperactivity disorder (ADHD) tobacco. Similarities observed in MLR and ANN involves structural and functional brain abnormalities model performance may indicate no major complex or in frontal-striatal circuitry. Although our review nonlinear relationships in cross-sectional suggests that there is substantial support for this epidemiological data selected to model adolescent drug hypothesis, a growing literature demonstrates use and dependence in this specific application. We widespread abnormalities affecting other cortical concluded that ANNs should be further studied in regions and the cerebellum. Because there is only one future longitudinal research, perhaps with modeling of report studying adults with ADHD, this summary is recursive networks, allowing feedback from drug based on children. A key limitation of the literature is dependence to levels of marijuana use. The ANN that most of the studies until recently have been models also have the potential to model drug use and underpowered, using samples of fewer than 20 subjects dependence based on input parameters with no obvious per group. Nevertheless, these studies are largely direct link to drug involvement--e.g., polymorphisms consistent with the most comprehensive and definitive associated with "openness to experience" or other study (Castellanos et al 2002). Moreover, studies differ personality traits hypothesized to function as distal in the degree to which they address the influence of antecedents, and could thus be implemented to identify medications, comorbidities, or gender, and most have 839
- 848. not addressed potentiallyimportant sources of Seitz V. Re: negative strategies and psychopathology in heterogeneity such as family history of ADHD, urban, African-American young. Child Abuse Negl subtype, or perinatal complications. Despite these 2002; 26(12):1209-10. limitations, a relatively consistent picture has emerged. The most replicated alterations in ADHD in childhood Seker H, Evans DH, Aydin N, Yazgan E. Compensatory include significantly smaller volumes in the fuzzy neural networks-based intelligent detection of dorsolateral prefrontal cortex, caudate, pallidum, abnormal neonatal cerebral Doppler ultrasound corpus callosum, and cerebellum. These results suggest waveforms. IEEE Trans Inf Technol Biomed 2001; that the brain is altered in a more widespread manner 5(3):187-94. than has been previously hypothesized. Developmental Abstract: Compensatory fuzzy neural networks studies are needed to address the evolution of this brain (CFNN) without normalization, which can be trained disorder into adulthood. with a backpropagation learning algorithm, is proposed as a pattern recognition technique for intelligent Seifer R, LaGasse LL, Lester B et al. Attachment status in detection of Doppler ultrasound waveforms of children prenatally exposed to cocaine and other abnormal neonatal cerebral hemodynamics. Doppler substances. Child Dev 2004; 75(3):850-68. ultrasound signals were recorded from the anterior Abstract: Attachment status of children exposed in cerebral arteries of 40 normal full-term babies and 14 utero to cocaine, opiates, and other substances was mature babies with intracranial pathology. The features examined at 18 months (n=860) and 36 months of normal and abnormal groups as inputs to pattern (n=732) corrected age. Children exposed to cocaine recognition algorithms were extracted from the and opiates had slightly lower rates of attachment maximum velocity waveforms by using principal security (but not disorganization), and their insecurity component analysis. The proposed technique is was skewed toward ambivalent, rather than avoidant, compared with the CFNN with normalization and other strategies. Continued postnatal alcohol use was pattern recognition techniques applied to Doppler associated with higher rates of insecurity and ultrasound signals from various arteries. The results disorganization at 18, but not 36, months of age. show that the proposed method is superior to the Stability of attachment across the 18-month period was others, and can be a powerful technique to be used in barely above chance expectation. Attachment status at analyzing Doppler ultrasound signals from various 18 months was associated with child temperament and arteries. caregiver-child interaction; at 36 months, attachment was associated with child temperament, child behavior Sekhobo JP, Druschel CM. An evaluation of congenital problems, and caregivers' parenting self-esteem. malformations surveillance in New York State: an application of Centers for Disease Control and Seipp CM, Johnston C. Mother-son interactions in families Prevention (CDC) guidelines for evaluating of boys with Attention-Deficit/Hyperactivity Disorder surveillance systems. Public Health Rep 2001; with and without oppositional behavior. J Abnorm 116(4):296-305. Child Psychol 2005; 33(1):87-98. Abstract: Established in 1982, the New York State Abstract: Parenting responsiveness and over-reactivity Congenital Malformations Registry (NYCMR) is one were assessed among 25 mothers of 7-9-year-old sons of the largest statewide, population-based birth defects with Attention-Deficit/Hyperactivity Disorder (ADHD) registries in the nation. In this article, we evaluate the and oppositional behavior (Oppositional Defiant, OD), surveillance of congenital malformations in New York 24 mothers of sons with ADHD only, and 38 mothers State using the Centers for Disease Control and of nonproblem sons. Responsiveness was observed Prevention (CDC) guidelines for evaluating public during mother-son play and clean-up interactions and health surveillance systems. In addition to the over-reactivity was assessed using self-reports of evaluation of selected qualitative and quantitative parenting in discipline situations. Mothers of sons with system attributes, we assess the public health ADHD/OD were less responsive and more over- significance and usefulness of the surveillance system reactive than mothers of nonproblem sons, and mothers and how well it is meeting its stated objectives. The of sons with ADHD only did not differ from the other NYCMR uses passive case ascertainment, relying on groups. Mothers of sons with ADHD/OD reported reports from hospitals and physicians. A congenital more hostility than mothers of nonproblem sons, and malformation is defined as any structural, functional, or controlling for maternal hostility eliminated the biochemical abnormality determined genetically or significant group differences in responsiveness during induced during gestation and not due to birthing events. clean-up and in over-reactivity. Controlling for the In addition to being the primary source of congenital child's ADHD subtype did not alter the pattern of malformations surveillance data in New York State, the results. The implications for addressing responsiveness NYCMR also provides cases for traditional and over-reactivity as components of parent-mediated epidemiological studies to determine risk factors for behavioral treatments for ADHD are considered. specific congenital malformations. The NYCMR has been working to meet its stated objectives while striving to improve its qualitative and quantitative 840
- 849. attributes. Registry personnelhave implemented office. Most patients (89%) who were evaluated and/or several measures designed to enhance the simplicity of treated by a physician were subsequently released, the data collection and data entry processes, as well as while three children were admitted to the hospital, all to maintain the acceptability of the surveillance system three with respiratory or cardiac chief complaints. to the reporting sources. Because it is a statewide, CONCLUSIONS: Children whose parents refused population-based surveillance system, by far the EMS transport received medical follow-up in the strongest quantitative attribute of the NYCMR is majority of cases, with a small group requiring representativeness. The sensitivity of the NYCMR is admission. difficult to evaluate. Available estimates suggest, however, that the NYCMR identifies a large proportion Semansky RM, Koyanagi C, Vandivort-Warren R. of children born with congenital malformations in New Behavioral health screening policies in Medicaid York State and diagnosed from birth through two years programs nationwide. Psychiatr Serv 2003; 54(5):736- of life. Finally, the NYCMR has in recent years been 9. able to publish and disseminate annual reports Abstract: Under the Early and Periodic Screening, describing the distribution of specific malformations in Diagnosis, and Treatment (EPSDT) mandate, states are New York State on a timely basis. required to screen Medicaid-insured children for mental health and substance use disorders. This Selbst SM. Pediatric emergency medicine: legal briefs. national study found that states vary considerably in Pediatr Emerg Care 2004; 20(11):786-90. their policies. Nearly half the states (23 in total) have not addressed behavioral health issues in their EPSDT Selinske J, Naughton D, Flanagan K, Fry P, Pickles A. screening tools at all. More states have screening tools Ensuring the best interest of the child in intercountry that address mental health than substance use disorders. adoption practice: case studies from the United Most states have created their own screening tools, Kingdom and the United States. Child Welfare 2001; which suggests discomfort with or a lack of awareness 80(5):656-67. of the standard tools available. Screening policy Abstract: Each year, thousands of children who cross options to increase behavioral health screening rates international borders are destined for homes with are discussed. adoptive families. For most, this journey from their homeland brings them to loving new homes where they Senn CY, Desmarais S. Impact of interaction with a partner will thrive and prosper. For others, the journey is or friend on the exposure effects of pornography and hazardous and the destination uncertain. erotica. Violence Vict 2004; 19(6):645-58. Abstract: Past studies on the effects of sexually explicit Seltzer AG, Vilke GM, Chan TC, Fisher R, Dunford JV. materials on women have tended to study them alone, Outcome study of minors after parental refusal of in pairs, or in groups of strangers. By contrast, our paramedic transport. Prehosp Emerg Care 2001; study randomly assigned women to bring either a 5(3):278-83. same-sex friend or a male partner to reflect more Abstract: OBJECTIVE: Patient refusal of paramedic natural viewing conditions. Discussion between the transport against medical advice (AMA) has significant participant and her companion followed exposure to medical-legal implications. Previous studies have the sexual images. Women who viewed pornography investigated patient outcomes after refusal of transport, maintained their (quite high) level of negative mood, but none has focused on these events in minors. This whereas women who viewed erotica experienced a study was performed to evaluate the outcomes of this substantial improvement in mood. The sex of the patient population after refusal of transport as well as companion did not have a direct influence on the significance of base hospital physician discussion participants' mood, with discussion improving mood with parents in the decision to refuse transport. across the board. However, participants' ratings of their METHODS: This was a retrospective telephone satisfaction with the discussion were significantly follow-up survey involving parents of minors for influenced by the sex of their companion. We suggest whom transport was refused after accessing emergency that future research should focus more on the medical services (EMS) via the 911 system. Data were interpersonal aspects of male-female relationships initially obtained from paramedic run records and each when exploring the effects of sexually explicit family was subsequently contacted by telephone and materials on heterosexual women. surveyed with regard to their experiences with the field medics in addition to the medical follow-up sought for Sera MD, Elieff C, Forbes J, Burch MC, Rodriguez W, their child and patient outcomes. RESULTS: Eighty- Dubois DP. When language affects cognition and when nine patients met criteria for survey. Telephone contact it does not: an analysis of grammatical gender and was made with 44 parents, of whom 32 (73% of those classification. J Exp Psychol Gen 2002; 131(3):377-97. contacted, 36% overall) participated. Twenty-seven Abstract: The focus of this work was on the relation (84%) received medical follow-up, either at an between grammatical gender and categorization. In one emergency department or in a private physician's set of studies, monolingual English-, Spanish-, French-, 841
- 850. and German-speaking childrenand adults assigned ANN and 87 to validate it. We calculated the male and female voices to inanimate objects. Results sensitivity, specificity, positive (PPV) and negative from Spanish and French speakers indicated effects of predictive values (NPV), and the success rate (%) of grammatical gender on classification; results from the system. RESULTS: In the training group the ANN German speakers did not. A connectionist model gave a sensitivity of 86.4%, a specificity of 89.5%, a simulated the contradicting findings. The connectionist PPV of 76% and NPV of 94%, with a success rate of networks were also used to investigate which aspect of 88.6%. In the same training group logistic regression grammatical gender was responsible for the different (LR) gave respective values of 68.2%, 58.8%, 39%, pattern of findings. The predictions from the 82.7% and 61.4%. In the validation group the connectionist simulations were supported by the results respective values for the ANN were 71.4%, 81.6%, from an artificial language-learning task. The results 58.8%, 88.6% and 78.9%, and in the same validation from this work demonstrate how connectionist group the LR gave 64.4%, 50%, 32.1%, 79.2% and networks can be used to identify the differences 53.9%. The Wilcoxon test confirmed the independence between languages that affect categorization. of both methods (P < 0.001). CONCLUSION: The ANN is an effective tool for assisting the urologist in Sergi C, Linderkamp O. Pathological case of the month: indicating and applying endoscopic treatments for classic rickets in a setting of significant psychosocial VUR. deprivation. Arch Pediatr Adolesc Med 2001; 155(8):967-8. Sevecke K, Krischer MK, Schonberg T, Lehmkuhl G. [The psychopathy-concept and its psychometric evaluation Serhatlioglu S, Hardalac F, Guler I. Classification of in childhood and adolescence]. Prax Kinderpsychol transcranial Doppler signals using artificial neural Kinderpsychiatr 2005; 54(3):173-90. network. J Med Syst 2003; 27(2):205-14. Abstract: In accordance with Robert Hare's concept, Abstract: Transcranial Doppler signals, recorded from over twenty years the word psychopathy is used to the temporal region of brain on 110 patients were describe a specific combination of affective and transferred to a personal computer by using a 16-bit interpersonal traits in adults as subtype of antisocial sound card. The fast Fourier transform (FFT) method personality disorder. Recently in North America was applied to the recorded signal from each patient. personality traits of psychopathy have also been Since FFT method inherently can not offer a good studied in juveniles (and children). The Psychopathy spectral resolution at jet blood flows, it sometimes Checklist: Youth Version (PCL-YV) was developed to causes wrong interpretation of transcranial Doppler take the special conditions of adolescents into account signals. To do a correct and rapid diagnosis, and focuses on assessing personality dimensions from transcranial Doppler blood flow signals were age 12 upwards. In juveniles with a high score, statistically arranged so that they were classified in research with the PCL-YV demonstrated for example a artificial neural network. Back propagation neural lack of empathy, impulsivity and social adjustment network and self-organization map algorithms of disorder. Furthermore, researchers found associations artificial neural network were used for training, between the number and severity of violent offences, whereas momentum and delta-bar-delta algorithms early drug abuse and heightened recidivism. This paper were used for learning. The results of these algorithms discusses the concept of psychopathy for adolescents were compared in the case of classification and on the basis of 3 case reports. Biological determinants, learning. experimental results and diagnostic aspects are described. Serrano-Durba A, Serrano AJ, Magdalena JR et al. The use of neural networks for predicting the result of Sewell AC, Gebhardt B, Herwig J, Rauterberg EW. endoscopic treatment for vesico-ureteric reflux. BJU Acceptance of extended newborn screening: the Int 2004; 94(1):120-2. problem of parental non-compliance. Eur J Pediatr Abstract: OBJECTIVE: To create an artificial neural 2004; 163(12):755-6. network (ANN) to aid in predicting the results of Notes: GENERAL NOTE: KIE: 7 refs. endoscopic treatment for vesico-ureteric reflux (VUR). GENERAL NOTE: KIE: KIE Bib: genetic screening; MATERIALS AND METHODS: During 1999-2001 mass screening; treatment refusal/minors we used endoscopic treatment in 261 ureteric units with VUR of all grades and causes. An ANN based on Shaham R. Revealing the secrets of the body: medical tests multilayer perceptron architecture was created using an as legal evidence in personal status disputes in modern 11 x 6 x 1 structure, taking the following as variables: Egypt. Med Law 2003; 22(1):131-54. the cause and grade of VUR, the patient's age and sex, Abstract: The study seeks to answer the following the type of implanted substance and its volume, the question: In the field of personal status, what kinds of number of treatments, the affected ureter, the medical tests have been considered reliable and endoscopic findings, and the type of cystography used. acceptable by Egyptian courts of law, what kinds have In all, 174 cases were used as training samples for the been less accepted, and why? The main finding is that, 842
- 851. on the onehand, the judges (qadis) have welcomed the rule rather than the exception. However, the tests that seek to determine age or to discover physical available literature on mass trauma suggests that diseases and/or mental disorders. On the other hand, certain factors may provide clues to identifying persons they have been reluctant to introduce tests to determine at greater risk for posttraumatic stress disorder (PTSD). virginity and pregnancy tests, and even more so to The severity of the trauma and the accessibility of introduce paternity tests that might bring into light support systems may affect long-term outcome. In manifestations of moral laxity within Egyptian society industrialized countries, mass violence caused by and jeopardize the future of illegitimate children. In malicious human intent may be a more virulent conclusion, the main resistance to the reliance on precursor to PTSD than other types of mass trauma, modern medical evidence has not been the lack of such as technological or natural disasters. School-aged modern knowledge and technologies or opposition to children, women, persons with existing psychiatric this, but rather traditional moral and social perceptions. illness, those who experienced significant losses or threat to life, those who have insufficient psychological Shaker I, Scott JA, Reid M. Infant feeding attitudes of and social support systems, and persons who exhibit expectant parents: breastfeeding and formula feeding. J symptoms of functional impairment may be at greater Adv Nurs 2004; 45(3):260-8. risk for PTSD. The findings of a population study of 2 Abstract: BACKGROUND: Research has indicated traumatized communities are discussed. Early that parental attitudes are strong predictors of choice of intervention in communities suffering mass trauma infant feeding. Identification and understanding of the should consist of general support and bolstering of the infant feeding attitudes of mothers and their social recovery environment rather than psychological networks should be an early step in the design and treatment; some forms of early psychological implementation of breastfeeding interventions. AIM: interventions may worsen outcome. There is a great To compare the infant feeding attitudes of parents of unmet need for treatment and intervention guidelines breastfed infants with those of parents of formula fed for victims of mass trauma, and well-designed studies infants. METHODS: A survey was carried out with a are warranted. convenience sample of pregnant women (gestational age 8-12 weeks) attending three maternity clinics in Shapiro C. Organ transplantation in infants and children-- Scotland in 2000. Expectant mothers and their partners necessity or choice: the case of K'aila Paulette. Pediatr (n = 108 couples) completed the 17 item Iowa Infant Nurs 2005; 31(2):121-2. Feeding Attitude Scale. Demographic information was Notes: GENERAL NOTE: KIE: KIE Bib: organ and collected by face-to-face interview and the method of tissue transplantation; treatment refusal/minors feeding at discharge from hospital was obtained from medical records. RESULTS: Parents of breastfed Sharav VH. The impact of the Food and Drug infants had more positive attitudes towards Administration Modernization Act on the recruitment breastfeeding than parents of formula fed infants, and of children for research. Ethical Hum Sci Serv 2003; were more knowledgeable about the health benefits and 5(2):83-108. nutritional superiority of breastfeeding. Fathers of both Notes: GENERAL NOTE: KIE: 159 refs. breastfed and formula fed infants were more likely than GENERAL NOTE: KIE: KIE Bib: human their partners to disapprove of women breastfeeding in experimentation/minors; human public. Parents considered their chosen method of experimentation/regulation feeding to be the more convenient alternative. Mothers Abstract: This article argues that contrary to the claims of formula fed infants were more likely to think that made by research stakeholders in industry, academia women who occasionally drink alcohol should not and government, the shift in public policy since the breastfeed. CONCLUSION: Parents of formula fed enactment of the Food and Drug Administration infants had several misconceptions about Modernization Act (FDAMA) of 1997 and its financial breastfeeding. Use of the Iowa Infant Feeding Attitude incentives to industry to test drugs on children, has had Scale could help health professionals identify and a deleterious impact on children's dignity, health and address these in infant feeding discussions in the early welfare. Those lucrative incentives offered an antenatal period. Efforts should be made to include opportunity to accelerate the pace of FDA approval for fathers in these infant-feeding discussions. pediatric drug marketing. FDAMA resulted in a radical shift in federal policy to accommodate an expansion of Shalev AY, Tuval-Mashiach R, Hadar H. Posttraumatic pediatric trials. Children who are precluded from stress disorder as a result of mass trauma. J Clin exercising a human adult's right to informed consent to Psychiatry 2004; 65 Suppl 1:4-10. research are increasingly sought as test subjects even Abstract: There is a large body of literature on the when the trials offer no potential benefit for them. Prior psychological consequences of trauma experienced by to FDAMA children were protected under federal individuals, but there are few studies of the acute and regulations that prohibited their recruitment for long-term effects of mass trauma on victimized experiments that were not in their best interest. This communities. Acute stress reactions are expected, and article discusses eight cases and controversies overall resilience in the aftermath of major disasters is demonstrating that children have been subjected to 843
- 852. experiments that exposedthem to pain, discomfort, and protocols and special facilities for research; a set of serious risks of harm. Babies have died testing a lethal common Policy Statements governing clinical practice heartburn drug; children have been subjected to "forced for European cleft teams, Practice Guidelines dose titration" in antidepressant drug trials that resulted describing minimum recommendations for care that all in several suicide attempts. Toddlers are currently European children with clefts should be entitled to and being subjected to methylphenidate dose tolerance tests recommendations for Documentation governing without evidence of any pathological condition. minimum records that cleft teams should maintain; Healthy teenagers are being exposed to antipsychotic encouraging initial efforts to compare outcomes drugs known to induce severe pathological side effects (results) of care between centres. A survey showed a in speculative "schizophrenia prevention" experiments. wide diversity in models of care and national policies as well as clinical practices in Europe. Of the 201 Shaw DS, Criss MM, Schonberg MA, Beck JE. The centres that registered with the network, the survey development of family hierarchies and their relation to showed 194 different protocols being followed for only children's conduct problems. Dev Psychopathol 2004; unilateral clefts. CONCLUSION: Cleft services, 16(3):483-500. treatment and research have undoubtedly suffered from Abstract: Despite the intuitive richness of family haphazard development across Europe. Attainment of systems theory, relatively little research has sought to even minimum standards of care remains a major test the validity of constructs theorized to be critical in challenge in some communities and both the will to the development of children's adjustment. One such reform and a basic strategy to follow are overdue. It is cornerstone of structural and strategic family therapy is hoped that the Eurocleft Consensus Recommendations the family hierarchy. The present study investigated reached during the present project will assist in both the development of hierarchical structure in improving the opportunities for tomorrow's patients. It families from infancy to late middle childhood and is also hoped that the collaborative research now relations between strong hierarchical structure and beginning under the European Commission's children's conduct problems. Using structural equation Framework V Programme will provide a focus for modeling, direct pathways to low hierarchical structure European researchers wishing to improve were evident for early caregiving behavior and parent- understanding, treatment and prevention of clefts of the child conflict, with indirect associations present for lip, alveolus and palate in the years ahead. parental adjustment, marital functioning, negative child behavior, and ecological disadvantage. In turn, family Sheehan K, Kim LE, Galvin JP Jr. Urban children's hierarchies were associated with youth antisocial perceptions of violence. Arch Pediatr Adolesc Med behavior, an effect that was moderated by ethnic and 2004; 158(1):74-7. neighborhood context. The results are discussed in Abstract: OBJECTIVE: To determine how reference to family systems' theory and implications for preadolescent urban children conceptualize and prevention and intervention. experience violence in their lives. DESIGN: This qualitative study reports the results of focus groups Shaw JA. The legacy of child sexual abuse. Psychiatry 2004; designed to examine perceptions of violence among 67(3):217-21. preadolescent urban children. Program directors were trained to conduct the sessions using a semistructured Shaw WC, Semb G, Nelson P et al. The Eurocleft project script. All groups were audiotaped or videotaped. The 1996-2000: overview. J Craniomaxillofac Surg 2001; summaries were analyzed for recurring themes. 29(3):131-40; discussion 141-2. SETTING: A community-based visual arts program for Abstract: INTRODUCTION: The original Eurocleft children designed to be a secondary violence- project, a European intercentre comparison study, prevention program. PARTICIPANTS: There were 12 revealed dramatic differences in outcome, which were focus groups of volunteer participants. Each consisted a powerful stimulus for improvement in the services of of 3 to 6 children aged 8 to 12 years, separated by sex respective teams. The study developed a preliminary and age. Fifty children participated: 27 boys and 23 methodology to compare practices and the potential for girls. RESULTS: These children defined violence in a wider European collaboration including opportunities broader way than most adults would. Not only did the for the promotion of clinical trials and intercentre children identify shootings and stabbings as examples comparison was recognized by the European of violence, but they also considered violence to be any Commission. Therefore, the project: 'Standards of Care act that might hurt someone's feelings (such as cheating for Cleft Lip and Palate in Europe: Eurocleft' ran and lying) or any act accompanying violence (such as between 1996 and 2000 and aimed to promote a broad cursing and yelling). The boys and girls were very uplift in the quality of care and research in the area of similar in their views except regarding the issue of cleft lip and palate. RESULTS: The results of the intimate-partner violence. The girls were almost 1996-2000 project include: a register of services in universally concerned about this issue, but the boys Europe, with details of professionals and teams seemed noticeably unaware that intimate-partner involved in cleft care, service organization, clinical violence was considered a form of violence. Most children felt safe at home, and almost no child felt safe 844
- 853. at school. Theylooked to trusted adults to keep them school adjustment, and problem behavior in chinese safe. CONCLUSIONS: Future investigators measuring adolescents with and without economic disadvantage. J the effect of violence-prevention activities on preteen Genet Psychol 2002; 163(4):497-502. children should be aware that their definition of Abstract: Using an indigenously developed measure of violence may differ from that of young children and family functioning, the author examined the association should be cognizant of potential sex differences, between family functioning and adolescent adjustment especially around the topic of intimate-partner in 1,519 Chinese adolescents. Results showed that violence. Those designing violence-prevention family functioning was significantly related to programs for children should consider engaging adult measures of adolescent psychological well-being family members as well because children usually turn (existential well-being, life satisfaction, self-esteem, to them for safety. sense of mastery, general psychiatric morbidity), school adjustment (perceived academic performance, Sheeshka J, Potter B, Norrie E, Valaitis R, Adams G, satisfaction with academic performance, and school Kuczynski L. Women's experiences breastfeeding in conduct), and problem behavior (delinquent and public places. J Hum Lact 2001; 17(1):31-8. substance abuse behavior). Family functioning was Abstract: This two-part field study compared generally more strongly related to measures of researchers' recorded observations to mothers' adolescent adjustment for adolescents with economic perceptions of attention they received while publicly disadvantage than for adolescents without economic breastfeeding. In part 1, four breastfeeding and four disadvantage. bottle-feeding mothers each made eight restaurant visits. On average, there were more neutral looks from Shek DT. Perceived parental control processes, parent-child customers (P = .01) during breastfeeding visits, but no relational qualities, and psychological well-being in differences in the amount of overtly negative or chinese adolescents with and without economic positive attention given during breastfeeding versus disadvantage. J Genet Psychol 2005; 166(2):171-88. bottle feeding. In part 2, four breastfeeding mothers Abstract: The author assessed the relationships made a total of 24 visits to shopping malls. There were between poverty and perceived parenting style, parent- more neutral looks given while mothers were child relationships, and adolescent psychological well- breastfeeding and more smiles and comments while being in Chinese secondary school students (N = they were not feeding, but no difference in total 3,017). Participants completed questionnaires designed amount of attention received. Breastfeeding mothers to assess (a) the degree to which their parents used acknowledged they had anticipated some undesirable monitoring, discipline, and other techniques to control attention but instead received little attention. their behavior; (b) the extent to which their parents Nevertheless, they felt "vulnerable" nursing in public. attempted to control them in a way that undermined Certain proactive behaviors and personal attributes as their psychological development; (c) the parent-child well as support from other women enabled them to relational qualities, such as the child's readiness to breastfeed successfully in public. communicate with the parents and perceived mutual trust; and (d) the child's psychological well-being. Shek DT. Beliefs about the causes of poverty in parents and Although adolescents with economic disadvantage did adolescents experiencing economic disadvantage in not differ from adolescents without economic Hong Kong. J Genet Psychol 2004; 165(3):272-91. disadvantage on the maternal variables (except on Abstract: Over 2 consecutive years, parents and their parental knowledge and parental monitoring), adolescent children from 199 poor families in Hong adolescents whose families were receiving public Kong responded to the Chinese Perceived Causes of assistance generally perceived paternal behavioral Poverty Scale, which assesses beliefs about the causes control and father-child relational qualities to be more of poverty. The author abstracted 4 factors from the negative than did adolescents who were not receiving scale. Analyses showed that these factors (personal public assistance. The author found psychological well- problems, exploitation, lack of opportunity, fate) were being (shown by hopelessness, mastery, life stable across time and across different samples. The satisfaction, self-esteem) of adolescents experiencing author also found related subscales to be internally economic disadvantage to be weaker than that of consistent. Regarding the effects of time, adolescents adolescents not experiencing economic disadvantage. had weaker endorsement of the belief that poverty is caused by the personal problems of poor people over Sheldon M. Male circumcision, religious preferences, and time. The author found parent-adolescent differences the question of harm. Am J Bioeth 2003; 3(2):61-2. (parents vs. adolescents) and parental differences Notes: GENERAL NOTE: KIE: 3 refs. (fathers vs. mothers) regarding beliefs about the causes GENERAL NOTE: KIE: KIE Bib: patient care/minors of poverty in terms of personal problems of poor people, exploitation, and fate. Sheldon S, Wilkinson S. 'On the sharpest horns of a dilemma': Re A (conjoined twins). Med Law Rev 2001; Shek DT. Family functioning and psychological well-being, 9(3):201-7. 845
- 854. Notes: GENERAL NOTE:KIE: Sheldon, Sally; significant reductions (P < .05) in hospitalizations, Wilkinson, Stephen hospitalization cost, ICU days, non-ICU days, length of GENERAL NOTE: KIE: 17 fn. stay, emergency department visits and cost, physician GENERAL NOTE: KIE: KIE Bib: patient care/minors office visits and cost, and school days missed. CONCLUSIONS: A pediatric in-home ADMP Sheldon S, Wilkinson S. Should selecting saviour siblings be provided by respiratory therapists can improve banned? J Med Ethics 2004; 30(6):533-7. outcomes and reduce cost in patients with moderate to Notes: GENERAL NOTE: KIE: 25 refs. severe asthma. GENERAL NOTE: KIE: KIE Bib: genetic screening; organ and tissue donation; prenatal diagnosis Sheller B. Challenges of managing child behavior in the 21st Abstract: By using tissue typing in conjunction with century dental setting. Pediatr Dent 2004; 26(2):111-3. preimplantation genetic diagnosis doctors are able to Abstract: This paper discussed factors influencing pick a human embryo for implantation which, if all behavior management of the child dental patient. goes well, will become a "saviour sibling", a brother or Pediatric dentists are affected by changes in: (1) sister capable of donating life-saving tissue to an society; (2) marketing and media; (3) communications existing child.This paper addresses the question of and technology; and (4) parenting practices. Behavior whether this form of selection should be banned and of pediatric patients reflects fewer boundaries, less concludes that it should not. Three main prohibitionist discipline and self-control, and lowered behavioral arguments are considered and found wanting: (a) the expectations by parents and contemporary culture. The claim that saviour siblings would be treated as insurance industry, regulatory bodies, legal system, commodities; (b) a slippery slope argument, which dental staff, and pediatric dentist education are other suggests that this practice will lead to the creation of influences on behavior management. Responses of the so-called "designer babies"; and (c) a child welfare American Academy of Pediatric Dentistry (AAPD), argument, according to which saviour siblings will be which could support the pediatric dentist in the physically and/or psychologically harmed. changing environment, include: (1) research; (2) continuing education for staff and dentists; (3) Sheldon T. Dutch doctors should tackle female genital development of Internet accessible materials for the mutilation. BMJ 2005; 330(7497):922. public; (4) legislative activity; (5) partnering with pediatric medicine to develop new behavior Sheldon T. Dutch government rejects tough measures on management strategies; (6) establishment of an AAPD genital mutilation. BMJ 2005; 331(7516):534. Council on Child Behavior; and (7) ongoing critical reassessment of behavior issues by the AAPD. Sheler J. Unholy crisis. US News World Rep 2002; 132(4):24-5. Sheridan C, Wolfe N. If only you hadn't, I would not have hit you: infant crying and abuse. Lancet 2004; Sheler JL. Confess and repent. US News World Rep 2002; 364(9442):1295-6. 132(22):28. Sherrard J, Ozanne-Smith J, Staines C. Prevention of Sheler JL. Will it rid the church of clergy sex abuse this unintentional injury to people with intellectual time? US News World Rep 2002; 133(20):44-5. disability: a review of the evidence. J Intellect Disabil Res 2004; 48(Pt 7):639-45. Shelledy DC, McCormick SR, LeGrand TS, Cardenas J, Abstract: BACKGROUND: Recent research evidence Peters JI. The effect of a pediatric asthma management shows that people with intellectual disability (ID) have program provided by respiratory therapists on patient double the unintentional injury risk of the general outcomes and cost. Heart Lung 2005; 34(6):423-8. population and the risk is further increased in the Abstract: OBJECTIVE: The objective was to presence of psychopathology and epilepsy. The pattern determine whether a pediatric asthma disease of injury and the circumstances surrounding an injury management program (ADMP) provided by respiratory event in those with ID have some similarity with that therapists can improve patient outcomes and reduce of young children in the general population. cost. DESIGN: This was a pre-and post-intervention Interventions to prevent injuries are an important health observational study. METHODS: Hospitalizations, priority in this vulnerable population. This paper non-intensive care unit (ICU) hospital days, ICU days, reviews evidence from injury prevention studies for emergency department visits, doctor's office visits, people with ID and also considers the relevance of school days missed, and associated costs were general population injury interventions for this collected on 18 children with moderate to severe population. METHOD: Information regarding injury asthma, ages 3 to 18 years, 12 months before and after prevention in both ID and general populations was implementation of the ADMP. The ADMP consisted of identified using online systems and consultation with eight home visits for assessment, environmental research and public health organizations. RESULTS: review, and patient education. RESULTS: There were Few published studies were identified addressing the 846
- 855. issue of injuryprevention for those with ID. Possible Abstract: This study examined whether maltreated injury prevention strategies appropriate for the major children were more likely than nonmaltreated children causes of injury in the ID population were identified to develop poor-quality representations of caregivers from the general population literature. While many and whether these representations predicted children's environmental injury prevention strategies for young rejection by peers. A narrative task assessing children in the general population are applicable to the representations of mothers and fathers was population with ID, some may require design administered to 76 maltreated and 45 nonmaltreated modification to ensure effectiveness. Other promising boys and girls (8-12 years old). Maltreated children's approaches include improved information for representations were more negative/constricted and less parents/carers, primary care physician counselling, and positive/coherent than those of nonmaltreated children. home visits by well-informed and motivated Maladaptive representations were associated with professionals. There may be injury prevention benefit emotion dysregulation, aggression, and peer rejection, from improved management of psychopathology and whereas positive/coherent representations were related epilepsy. CONCLUSIONS: The issue of injury to prosocial behavior and peer preference. prevention for those with ID has not been addressed to Representations mediated maltreatment's effects on the extent that the magnitude of the problem requires. peer rejection in part by undermining emotion Injury prevention programmes trialling a variety of regulation. Findings suggest that representations of evidence-based approaches and strategies are needed to caregivers serve an important regulatory function in the protect the quality of life for the ID population and peer relationships of at-risk children. their families. Shields J. The NAS EarlyBird Programme: partnership with Sherriff A, Ott J. Artificial neural networks as statistical parents in early intervention. The National Autistic tools in epidemiological studies: analysis of risk factors Society. Autism 2001; 5(1):49-56. for early infant wheeze. Paediatr Perinat Epidemiol Abstract: Early intervention bridges the gap between 2004; 18(6):456-63. early diagnosis and appropriate educational placement. Notes: CORPORATE NAME: ALSPAC Study Team The National Autistic Society has developed an autism- Abstract: Artificial neural networks (ANNs) are being specific three-month parent package, the NAS used increasingly for the prediction of clinical EarlyBird Programme, that emphasizes partnership outcomes and classification of disease phenotypes. A with parents. Six families participate in each three- lack of understanding of the statistical principles month programme, which combines weekly group underlying ANNs has led to widespread misuse of training sessions for parents with individualized home these tools in the biomedical arena. In this paper, the visits. During the programme parents learn to authors compare the performance of ANNs with that of understand autism, to build social communication, and conventional linear logistic regression models in an to analyse and use structure, so as to prevent epidemiological study of infant wheeze. Data on the inappropriate behaviours. The use of video and the putative risk factors for infant wheeze have been group dynamic amongst families are important obtained from a sample of 7318 infants taking part in components of the programme. An efficacy study the Avon Longitudinal Study of Parents and Children evaluated the pilot programme and further monitoring (ALSPAC). The data were analysed using logistic is in progress. Training courses in the licensed use of regression models and ANNs, and performance based the NAS EarlyBird Programme are now available for on misclassification rates of a validation data set were teams of professionals with prior experience of autism. compared. Misclassification rates in the training data Strengths and weaknesses of the programme are set decreased as the complexity of the ANN increased: discussed. This short-term, affordable package, with h = 0: 17.9%; h = 2: 16.2%; h = 5: 14.9%, and h = 10: supporting evidence of efficacy, offers a model of early 9.2%. However, the more complex models did not intervention that is very popular with parents. generalise well to new data sets drawn from the same population: validation data set misclassification rates: h Shifman P, Renaud T. Food-coping in post-emergency- = 0: 17.9%; h = 2: 19.6%; h = 5: 20.2% and h = 10: phase camps. Lancet 2003; 361(9366):1392-3; author 22.9%. There is no evidence from this study that ANNs reply 1393. outperform conventional methods of analysing epidemiological data. Increasing the complexity of the Shifren K. Early caregiving and adult depression: good news models serves only to overfit the model to the data. It is for young caregivers. Gerontologist 2001; 41(2):188- important that a validation or test data set is used to 90. assess the performance of highly complex ANNs to Abstract: PURPOSE: Limited information is available avoid overfitting. on the effects of caregiving experiences on the adult development of caregivers under 21 years old in the Shields A, Ryan RM, Cicchetti D. Narrative representations United States. The current study provided an of caregivers and emotion dysregulation as predictors examination of the effects of youthful caregiving on of maltreated children's rejection by peers. Dev the mental health of these persons when adults. Psychol 2001; 37(3):321-37. 847
- 856. DESIGN AND METHODS:Twelve individuals, 23 to children who had experienced neglect and a control 58 years old, were given brief phone interviews with group to determine the ways that neglect may interfere semistructured questions, and then they completed with children's emotional development. METHOD: questionnaires on their early caregiving experiences Participants included children 6--12 years of age and and current mental health. To be included, respondents their mothers (neglect group, N=24; control, N=24). must have provided primary caregiving assistance (i.e., Participants completed questionnaires and an interview bathing, dressing, feeding, etc.) for at least one parent that assessed children's emotional understanding and when the caregiver was under 21 years old. RESULTS: emotion regulation. RESULTS: Findings indicated that The findings showed that individuals were young neglected children, compared to their non-maltreated caregivers for parents with a number of problems, peers, demonstrated lower understanding of negative ranging from dementia to drug abuse. Individuals emotions (i.e., anger, sadness) and fewer adaptive reported more positive mental health than negative emotion regulation skills. Further, neglected children mental health, and only two individuals had scores expected less support and more conflict from mothers indicative of clinical depressive symptoms. in response to displays of negative emotion and IMPLICATIONS: It appears that early caregiving reported that they were more likely to attempt to inhibit experiences may not result in universally negative the expression of negative emotion. CONCLUSIONS: consequences in the adulthood of young caregivers. Findings suggest that neglect may interfere with the normal acquisition of emotional understanding and Shifrin T. Slow but sure. Health Serv J 2003; 113(5841):13- emotion regulation skills, highlighting the importance 4. of addressing these skills in the context of clinical intervention with neglected children. Shin DI, Huh SJ, Lee TS, Kim IY. Web-based remote monitoring of infant incubators in the ICU. Int J Med Shipman KL, Zeman J. Socialization of children's emotion Inform 2003; 71(2-3):151-6. regulation in mother-child dyads: a developmental Abstract: A web-based real-time operating, psychopathology perspective. Dev Psychopathol 2001; management, and monitoring system for checking 13(2):317-36. temperature and humidity within infant incubators Abstract: This study investigated the socialization of using the Intranet has been developed and installed in children's emotion regulation in 25 physically the infant Intensive Care Unit (ICU). We have created maltreating and 25 nonmaltreating mother-child dyads. a pilot system which has a temperature and humidity Maltreating mothers and their 6- to 12-year-old sensor and a measuring module in each incubator, children were recruited from two parenting programs which is connected to a web-server board via an RS485 affiliated with Children's Protective Services with a port. The system transmits signals using standard web- control group matched on race, SES, child gender, and based TCP/IP so that users can access the system from child age. Children and their mothers were interviewed any Internet-connected personal computer in the individually about their (a) management of emotional hospital. Using this method, the system gathers expression. (b) strategies for coping with emotional temperature and humidity data transmitted from the arousal, and (c) anticipated consequences following measuring modules via the RS485 port on the web- emotional displays. Compared to controls, maltreated server board and creates a web document containing children expected less maternal support in response to these data. The system manager can maintain their emotional displays, reported being less likely to centralized supervisory monitoring of the situations in display emotions to their mothers, and generated fewer all incubators while sitting within the infant ICU at a effective coping strategies for anger. Maltreating work space equipped with a personal computer. The mothers indicated less understanding of children's system can be set to monitor unusual circumstances emotional displays and fewer effective strategies for and to emit an alarm signal expressed as a sound or a helping children to cope with emotionally arousing light on a measuring module connected to the related situations than nonmaltreating mothers. Further, incubator. If the system is configured with a large findings indicated that maternal socialization practices number of incubators connected to a centralized (e.g., providing support in response to children's supervisory monitoring station, it will improve emotional display, generating effective coping convenience and assure meaningful improvement in strategies for their child) mediate the relation between response to incidents that require intervention. child maltreatment and children's regulation of emotional expression and emotional arousal. These Shipman K, Edwards A, Brown A, Swisher L, Jennings E. findings suggest that children's emotion regulation Managing emotion in a maltreating context: a pilot strategies are influenced by their relationship with their study examining child neglect. Child Abuse Negl 2005; social environment (e.g.. physically maltreating, 29(9):1015-29. nonmaltreating) and that the experience of a physically Abstract: OBJECTIVE: The primary goal of this pilot maltreating relationship may interfere with children's study was to examine emotion management skills (i.e., emotional development. emotional understanding, emotion regulation) in Shriberg LD. Diagnostic markers for child speech-sound 848
- 857. disorders: introductory comments.Clin Linguist Phon Shulman ST. Immunizations: the greatest good. 2003; 17(7):501-5. Pediatricians must advocate for children at the national, Abstract: The four papers in this issue report findings state, and local levels. Pediatr Ann 2004; 33(8):489. from a research programme on the etiological origins of child speech-sound disorders of currently unknown Shumba A. The nature, extent and effects of emotional abuse origin. Overviews elsewhere describe an evolving on primary school pupils by teachers in Zimbabwe. classificatory framework that posits six putative Child Abuse Negl 2002; 26(8):783-91. subtypes within this general domain of communicative Abstract: OBJECTIVE: The study seeks to determine disorders (cf. Shriberg, 2002). The following the nature, extent and effects of emotional abuse; and introductory comments provide brief historical and who the perpetrators are in Zimbabwean primary clinical perspectives on the primary objective of this schools. METHOD: Data collection was twofold research: the availability of a suite of computer-assisted because this involved reported cases of emotional diagnostic markers that clinicians and clinical abuse and the use of two questionnaires to collect data researchers can use to classify six etiological subtypes on the forms of emotional abuse perpetrated on pupils of child speech-sound disorders. by teachers. First, data of reported cases of emotional abuse were collected from six regional offices of the Shrimpton AE. Molecular diagnosis of cystic fibrosis. Ministry of Education, Sport and Culture in Zimbabwe. Expert Rev Mol Diagn 2002; 2(3):240-56. The rationale was to determine forms of emotional Abstract: A review of the current molecular diagnosis abuse perpetrated on pupils by teachers in Zimbabwean of cystic fibrosis including an introduction to cystic primary schools. Second, the Teacher Trainees fibrosis, the gene function, the phenotypic variation, Questionnaire and the Teacher Questionnaire were who should be screened for which mutation, newborn administered to randomly selected samples of 150 and couple screening, quality assurance, phenotype- primary school teacher trainees and 300 primary school genotype correlation, methods and method limitations, teachers. Random numbers were used in the selection options, statements, recommendations, useful Websites of the teachers and teacher trainees. The rationale for and treatments. using teachers and teacher trainees was to make an in- depth analysis of the forms of emotional abuse Shrimpton R. Evidence v. rights-based decision making for perpetrated on pupils by teachers and to determine who nutrition. Proc Nutr Soc 2003; 62(2):553-62. the perpetrators are in this form of child abuse. In this Abstract: The need for an evidence base for human study, emotional abuse shall refer to constant belittling nutrition action is analysed in the context of human of a pupil, the absence of a positive emotional rights. Over the last 50 years the twin tracks of atmosphere, verbal abuse, shouting, scolding, use of development, economical needs based and normative vulgar language, humiliation and negative labeling of rights based, have come progressively closer in terms pupils, and terrorizing of pupils by teachers in schools. of goals and objectives, even if they do maintain RESULTS: The study found that the majority of different orientations and origins. The international teacher trainees and teachers believe that shouting, human rights machinery is described, together with scolding, use of vulgar language, humiliation and those parts that are of relevance to the right to food and negatively labeling of pupils as stupid, ugly, foolish is nutrition. The role of the State in respecting, protecting mainly done by female teachers in schools. However, and facilitating these rights is further described. The 52.7% of the teacher trainees indicated that it is the evidence base for the benefit of nutrition interventions male teachers who "use vulgar language on pupils." during the fetal and infant period to the health and This study found some of the forms of emotional abuse well-being of populations throughout life's course is that are perpetrated on pupils by teachers in schools. briefly reviewed, and reasons why such a large body of The findings seem to be consistent with the literature evidence has not been acted upon are discussed. The available on the gender of perpetrators associated with power of nutrition is in prevention more than cure, and this form of child abuse. CONCLUSION: It is clear the prevention of nutritional deficiency is best suited to that emotional abuse exists in Zimbabwean primary radical population-wide strategies rather than high-risk schools and female teachers appear to be the main strategies targeted at individuals. The population-wide perpetrators of this form of child abuse. This form of distribution of benefits of nutrition is in congruence child abuse may involve one perpetrator and a series of with universality of human rights. In the UK much victims. remains to be done to ensure that food and nutrition rights are realised, especially during the critical period Siddiqi S, Haq IU, Ghaffar A, Akhtar T, Mahaini R. of fetal and infant growth. What role the Nutrition Pakistan's maternal and child health policy: analysis, Society might play in the realisation of these rights, lessons and the way forward. Health Policy 2004; including the creation of a robust evidence base for 69(1):117-30. nutrition action, is further discussed. Abstract: An estimated 400,000 infant and 16,500 maternal deaths occur annually in Pakistan. These Shulman ST. Child abuse. Pediatr Ann 2005; 34(5):338. translate into an infant mortality rate and maternal mortality ratio that should be unacceptable to any state. 849
- 858. Disease states includingcommunicable diseases and described DV at some point in their lives. Sixty-nine reproductive health (RH) problems, which are largely (16%) reported abuse longer than 2 years before the preventable account for over 50% of the disease screen and 26 (6%) reported more recent abuse. While burden. The analysis of Pakistan's maternal and child 11 of 117 women screened in the more affluent private health (MCH) and family planning (FP) policy covers practice reported a history of past abuse, no women in the period 1990-2002, and focuses on macroeconomic that group reported DV occurring within 24 months. influences, priority programs and gaps, adequacy of The proportion of women reporting violence did not resources, equity and organizational aspects, and the differ significantly by site, but the proportion of process of policy formulation. The overall MCH/FP patients reporting new violence was significantly lower policy is well directed. MCH/FP has been a priority in at the private practice site by Chi-square analysis. In all policies; resource allocation, although unacceptably conclusion, women screened in a variety of pediatric low, has substantially increased during the last decade; settings will disclose DV. Recent abuse is more likely and there is a progressive shift from MCH to the to be reported in settings with indigent patients. All reproductive health (RH) agenda. Areas in need of pediatricians should be screening for DV and have improvement include greater use of evidence as a basis protocols in place to offer women the services they for policy; increased priority to nutrition programs, need if DV is revealed. measures to reduce neonatal and perinatal mortality, provision of emergency obstetric care, availability of Sieminski AL, Hebbel RP, Gooch KJ. Improved skilled birth attendants, and a clear policy on integrated microvascular network in vitro by human blood management of childhood illnesses. Enhanced planning outgrowth endothelial cells relative to vessel-derived capacity, development of a balanced human resource, endothelial cells. Tissue Eng 2005; 11(9-10):1332-45. improved governance to reduce staff absenteeism and Abstract: Evidence suggests that bone marrow-derived frequent transfers, and a greater role of the private cells circulating in adult blood, sometimes called sector in the provision of services are some endothelial progenitor cells, contribute to organizational aspects that need the governments' neovascularization in vivo and give rise to cells consideration. There are several lessons to be learnt: (i) expressing endothelial markers in culture. To explore Ministries of Health need sustained stewardship and the utility of blood-derived cells expressing an well-documented evidence to protect cuts in resource endothelial phenotype for creating tissue-engineered allocation; (ii) frequent policy announcement sends microvascular networks, we employed a three- inappropriate signals to managers and weakens on- dimensional in vitro angiogenesis model to compare going implementation; (iii) MCH/FP policies unless microvascular network formation by human blood informed by evidence and participation of interest outgrowth endothelial cells (HBOECs) with three groups are unlikely to address gaps in programs; (iv) human vessel-derived endothelial cell (EC) types: distributional and equity objectives of MCH/FP be human umbilical vein ECs (HUVECs), and adult and addressed while setting overall national goals; (v) neonatal human microvascular ECs. Under every institutional capacity is a vital ingredient in translating condition investigated, HBOECs within collagen gels MCH/FP policies into effective services. The suggested elongated significantly more than any other cell type. strategic directions emphasize, among others, the need Under all conditions investigated, gel contraction and for a comprehensive MCH/FP framework; cell elongation were correlated, with HBOECs strengthened stewardship in ministry of health, cost- demonstrating the largest generation of force. HBOECs effective strategies to address the gaps identified and did not exhibit a survival advantage, nor did they doubling of the public sector resource allocation to enhance elongation of HUVECs when the two cell MCH/FP over the next 5 years. The ability to ensure types were cocultured. Network formation of both delivery of quality health services remains the biggest HBOECs and HUVECs was inhibited by blocking challenge in the Pakistani health sector. Unless sound antibodies to alpha2beta1, but not alpha(v)beta3, policies are backed by well-functioning programs they integrins. Taken together, these data suggest that are likely to become a victim of poor implementation. superior network exhibited by HBOECs relative to vessel-derived endothelial cells is not due to a survival Siegel RM, Joseph EC, Routh SA et al. Screening for advantage, use of different integrins, or secretion of an domestic violence in the pediatric office: a autocrine/paracrine factor, but may be related to multipractice experience. Clin Pediatr (Phila) 2003; increased force generation. 42(7):599-602. Abstract: The purpose of our study was to screen for Silk JS, Sessa FM, Morris AS, Steinberg L, Avenevoli S. domestic violence (DV) in 4 different pediatric practice Neighborhood cohesion as a buffer against hostile settings. Women who accompanied their children to maternal parenting. J Fam Psychol 2004; 18(1):135-46. well-child visits were eligible. The women were Abstract: This study explored the moderating effects of screened with a 6-question tool previously piloted by children's neighborhoods on the link between hostile our group, which included questions on partner abuse, parenting and externalizing behavior. Participants were child abuse, and pet abuse. Over a 1-year period, 435 1st- or 2nd-grade children in an urban northeastern women were screened. Of these women, 95 (22%) community. Children were administered the Parenting 850
- 859. and Neighborhood scalesof the Child Puppet insight into potential problems for other state Interview, and mothers completed questionnaires on vaccination programs. Professor Silverman concludes neighborhood quality and parenting practices. Census by advocating that states adopt an "informed refusal" tract measures of neighborhood quality and teachers' approach to vaccination exemption as a way of reports of children's externalizing behavior also were improving immunity protections, while respecting the obtained. Results indicated that children's and mothers' autonomy rights of those who wish to opt out of the perceptions of neighborhood involvement-cohesion program. buffered the link between hostile parenting and externalizing problems. Children's externalizing Silverman WA. 'Acceptable' and 'unacceptable' risks. behavior was unrelated to census tract variables. Paediatr Perinat Epidemiol 2002; 16(1):2-3. Findings highlight the protective effect of neighborhood social cohesion and the utility of Silverman WA. Mandatory rescue of fetal infants. Paediatr including young children's perspectives in research on Perinat Epidemiol 2005; 19(2):86-7. neighborhoods and families. Silverman WA. Russian roulette in the delivery room. Silverman K, Schonberg SK. Adolescent children of drug- Pediatrics 2005; 115(1):192-3. abusing parents. Adolesc Med 2001; 12(3):485-91. Abstract: The effects of a substance-abusing parent on Silverstein H. In the matter of anonymous, a minor: fetal a child are wide-spread, and unfortunately they follow representation in hearings to waive parental consent for that child well into adolescence and adulthood. abortion. Cornell J Law Public Policy 2001; 11(1):69- Cognitive difficulty, poor judgment, and conduct 111. problems are but a few of the sequelae, and similar results are seen whether the drug is alcohol or cocaine Simmons TM, Novins DK, Allen J. Words have power: (re)- or another illicit substance. In addition to affecting the defining serious emotional disturbance for American biology of the adolescent from the perinatal period, Indian and Alaska Native children and their families. parental substance abuse often causes a disrupted, Am Indian Alsk Native Ment Health Res 2004; chaotic home, financial insecurity, and exposure of the 11(2):59-64. teen to illegal substances and violence. The emotional Abstract: Circles of Care grantees were provided the toll on the adolescent is steep, and the overall cost to opportunity to develop a locally relevant definition of the health care system is enormous. Ultimately, many serious emotional disturbance that would be used to of these adolescents progress to substance abuse define what type of emotional, behavioral, and mental themselves. Health care providers need to be sensitive disability would be required to receive services. After to the possibility of substance abuse in the home, and conducting detailed assessments of the definition in the should aggressively pursue early treatment/therapy guidance for applicants GFA and the definitions used options for those teens at risk. by others in their respective states, seven of the nine grantees developed their own local, project-specific Silverman RA. Scald or pseudoscald? Arch Dermatol 2002; definitions through the participation of community 138(12):1615-6. focus groups and Advisory Councils. The six definitions for SED developed by rural grantees all Silverman RD. No more kidding around: restructuring non- included American Indian and Alaska Native concepts medical childhood immunization exemptions to ensure specific to each tribal community's culture; the urban public health protection. Ann Health Law 2003; grantee's definition was purposely focused for reaching 12(2):277-94, table of contents. out to non-professional members of the community. Notes: GENERAL NOTE: KIE: 112 fn. This opportunity for the communities to redefine SED GENERAL NOTE: KIE: KIE Bib: immunization not only provided each community with a definition Abstract: Professor Silverman's article examines the which would be more culturally specific, but also complex challenges faced by U.S. policymakers proved to be an extraordinarily exercise in attempting to balance the public health protections of empowerment and self-determination. mandatory childhood immunization programs with the legal, religious, philosophical, and practical concerns Simoens WA, Wuyts FL, De Beuckeleer LH, Vandevenne raised by permitting non-medical exemptions under the JE, Bloem JL, De Schepper AM. MR features of programs. The article begins with a discussion of the peripheral nerve sheath tumors: can a calculated index history of childhood immunization programs, and compete with radiologist's experience? Eur Radiol continues by describing the inconsistency of 2001; 11(2):250-7. enforcement of state immunization laws and Abstract: The aims of this study were, firstly, to exemptions. The author analyzes recent cases from provide a formula (neurogenic index) based on MR New York, Wyoming, and Arkansas, and discusses characteristics used in daily routine for predicting how these decisions both pose threats to these whether a soft tissue tumor is neurogenic or not, programs' public health protections, while also offering secondly, to test prospectively the performance of this 851
- 860. formula, and thirdly,to compare this performance with etiologies were thrombocytopenia, shaken baby that of radiologists experienced in MR imaging of soft syndrome, and birth trauma. In 9 cases (12 eyes), the tissue tumors. Retrospectively, MR images of 70 vitreous hemorrhage was idiopathic. Mean time neurogenic and 70 non-neurogenic soft tissue tumors between diagnosis and surgery was 1.4 months. were evaluated in random order by two teams of two Complications included strabismus, cataract, glaucoma, observers each. A neurogenic index (NI) was high myopia, and retinal detachment. Recognition calculated based on those MR parameters that showed visual acuities were available for 8 eyes: 20/25 (2 no or minor interobserver variability. Subsequently, eyes), 20/30, 20/40 (2 eyes), 20/60 (2 eyes), and three investigators in concert used the NI in a 20/100. One eye had no light perception. validation group of 15 neurogenic and 22 CONCLUSIONS: The etiologies encountered in our nonneurogenic soft tissue tumors. The same team, patients were similar to those reported previously. based on their own experience, tried to differentiate in Visual outcomes were much worse in cases with retinal the same validation group neurogenic from non- complications. Other patients had better visual neurogenic soft tissue tumors. This was expressed in a outcomes. Despite potential surgical and postoperative subjective score (SS). Sensitivity, specificity, and complications, this series demonstrates favorable visual predictive values were calculated. NI comprised spread outcomes can be achieved following early vitrectomy (intra- or extracompartmental), distribution, fluid-fluid in this setting. levels, homogeneity on T2-weighted images (WI), highest signal intensity (SI) on T1WI, lowest SI on Simonoff E. Gene-environment interplay in oppositional T2WI, and delineation on T2WI. In the validation defiant and conduct disorder. Child Adolesc Psychiatr group, NI had a sensitivity of 88.6%, a specificity of Clin N Am 2001; 10(2):351-74, x. 52.0%, a positive predictive value (PPV) of 54.1%, and Abstract: Oppositional defiant and conduct disorder is a negative predictive value (NPV) of 84.6% for a disturbance in behavior that is characterized by neurogenic tumors. The subjective score SS was aggressive and antisocial acts. At present, genetic superior and had a sensitivity of 93.3%, a specificity of research on conduct disorder has raised more questions 77.2%, a PPV of 73.7%, and a NPV of 94.4%. Our NI than it has answered, and basic questions such as the was less accurate than the SS; however, the low heritability of childhood antisocial behavior cannot yet number of false-negative diagnoses for neurogenic be answered with certainty. Current research, however, tumors warrants continued efforts in development of has consistently highlighted the importance of gene- neural networks. environment interplay in antisocial behavior. Simon D, Adams AM, Madhavan S. Women's social power, Simpson KR. Time out: it's time well spent. MCN Am J child nutrition and poverty in Mali. J Biosoc Sci 2002; Matern Child Nurs 2004; 29(4):272. 34(2):193-213. Abstract: While the macro-level association between Sinal SH, Woods CR. Human papillomavirus infections of poverty and child malnutrition is well-established, the the genital and respiratory tracts in young children. concept of 'poverty' and its operationalization in terms Semin Pediatr Infect Dis 2005; 16(4):306-16. of measures of socioeconomic status shed little or no Abstract: Human papillomavirus (HPV) causes light on the mechanisms through which malnutrition is papillomas (warts) on the skin and respiratory mucosal created and/or prevented. This paper investigates a surfaces (laryngeal and oral papillomas) in addition to woman's social power, one such mechanism that may condyloma acuminata (anogenital warts). HPV has mediate the impact of poverty on childhood nutrition. become one of the most common sexually transmitted This micro-level factor is examined using survey data diseases in adults. Vertical transmission from mother to on 402 children 5 years of age and younger and their infant during birth is well recognized. Laryngeal 261 Fulbe mothers in rural Mali. A conceptual model papillomas are the most common tumors of the larynx of social power is developed and used to test the in children worldwide, and recurrent lesions are hypothesis that a mother's social power can predict her common occurrences. Anogenital warts in children are child's nutritional status. problematic in that child sexual abuse is a potential means of acquisition, but many cases are acquired Simon J, Sood S, Yoon MK et al. Vitrectomy for dense perinatally. Postnatal acquisition by nonsexual means vitreous hemorrhage in infancy. J Pediatr Ophthalmol also can occur. The likelihood of sexual abuse as the Strabismus 2005; 42(1):18-22. mode of acquisition increases with increasing age in Abstract: PURPOSE: To report clinical data, including childhood. The virus infects primarily epithelial cells, etiology and visual outcome, in newborns requiring where it can exist as a long-term latent infection that vitrectomy for dense vitreous hemorrhage. can reactivate or persist actively (even subclinically), METHODS: In this retrospective case series, we with resultant accumulation of host chromosomal surveyed subscribers to the American Association for mutations. The latter accounts for the oncogenic Pediatric Ophthalmology and Strabismus ListServe potential of a number of HPV types, and childhood regarding patients under their care. RESULTS: A total infections may lead to neoplasia later in life. of 28 eyes of 21 patients were included. Most common 852
- 861. Regression of papillomasover the course of months to Developmental outcomes and environmental correlates years is the usual natural course. Numerous treatments of very low birthweight, cocaine-exposed infants. Early are available, but most do not prevent persistent Hum Dev 2001; 64(2):91-103. infection or problematic recurrences. Multivalent HPV Abstract: Fetal cocaine exposure may have vaccines have been developed, and early results of differentially adverse effects on developmental clinical trials appear to be very promising. outcomes of very low birthweight (VLBW) infants. As part of a longitudinal study, 31 cocaine-positive very Sinclair J, Green J. Understanding resolution of deliberate low birthweight infants, and age, race and self harm: qualitative interview study of patients' socioeconomic status matched VLBW controls experiences. BMJ 2005; 330(7500):1112. enrolled at birth were followed. Neonatal maternal- Abstract: OBJECTIVE: To explore the accounts of child interactions, concurrent maternal psychological those with a history of deliberate self harm but who no characteristics and environmental factors longer do so, to understand how they perceive this conceptualized as important for child outcome were resolution and to identify potential implications for assessed as well as standard developmental outcomes provision of health services. DESIGN: Qualitative in- at 3 years.In the neonatal period, cocaine-exposed depth interview study. SETTING: Interviews in a VLBW infants who remained in maternal custody community setting. PARTICIPANTS: 20 participants tended to be rated as less responsive and their mothers selected from a representative cohort identified in 1997 as less nurturing, less emotionally available and with a after an episode of deliberate self poisoning that tendency to use more maladaptive coping mechanisms resulted in hospital treatment. Participants were than nonexposed VLBW infants. At follow-up, included if they had no further episodes for at least two cocaine-exposed VLBW children were delayed in years before interview. RESULTS: We identified three cognitive, motor and language development compared recurrent themes: the resolution of adolescent distress; to controls. Almost half (45%) of the exposed children the recognition of the role of alcohol as a precipitating scored in the range of mental retardation compared to and maintaining factor in self harm; and the 16% of the comparison VLBW children.The persistent understanding of deliberate self harm as a symptom of cognitive, motor and language delays of the cocaine- untreated or unrecognised illness. CONCLUSION: exposed VLBW children, combined with the poorer Patients with a history of deliberate self harm who no behavioral interactions of cocaine-using women with longer harm themselves talk about their experiences in their infants in the neonatal period, indicate a need for terms of lack of control over their lives, either through increased developmental surveillance of cocaine- alcohol dependence, untreated depression, or, in exposed VLBW infants with a focus on maternal drug adolescents, uncertainty within their family treatment and parenting interventions. relationships. Hospital management of deliberate self harm has a role in the identification and treatment of Singh M. Ethical and social issues in the care of the depression and alcohol misuse, although in adolescents newborn. Indian J Pediatr 2003; 70(5):417-20. such interventions may be less appropriate. Abstract: Ethical and social issues are based upon a system of moral values that serve the best interests of Sindelar HA, Abrantes AM, Hart C, Lewander W, Spirito A. the society in a humane and compassionate manner. Motivational interviewing in pediatric practice. Curr The ethical decisions should be based upon the well- Probl Pediatr Adolesc Health Care 2004; 34(9):322-39. enunciated principles of beneficence, non-maleficence, parental autonomy, correct medical facts and justice. In Singer E, Doornenbal J, Okma K. Why do children resist or view of our economic constraints, we should follow the obey their foster parents? The inner logic of children's philosophy of utilatarian ethics based on the concept of behavior during discipline. Child Welfare 2004; "value for money" and focus our resources and efforts 83(6):581-610. for the care of salvageable babies. Nevertheless, we Abstract: This article discusses a study of children's should try to ensure equitable development of health perspectives on disciplinary conflicts with their foster care of neonates at all levels, and NICU facilities parents. Most children accept parental authority, but should be developed in the country in a phased manner. they also defend their personal autonomy and loyalties In order to ensure justice and cost-effectiveness, the to peers. In this study, only birthchildren told real-life narrow principles of "best interest" of the child should stories about fierce resistance to get their own way. be replaced by the concept of global beneficence to the Fierce resistance among foster children was motivated family, society and the state. Neonatologists are often by inner conflicts and confusion. Obedience among faced with a large number of ethical issues and foster children often derived from fear of punishment dilemmas in the care of critically sick newborn babies or a feeling of impotence. The authors discuss the and they should be resolved jointly by taking nurses, theoretical and pedagogical implications of these sub-speciality colleagues and family members into findings. confidence. The technology should not be allowed to further dehumanize medicine and we must establish Singer LT, Hawkins S, Huang J, Davillier M, Baley J. rapport and provide emotional support to the family members by showing our concern, sympathy and 853
- 862. compassion in thecare of their critically sick and train the ANN. Data from the prospective study was extremely preterm babies. It is desirable that all the used to validate the ANN, construct a logistic medical and nursing schools in the country should regression model, and compare physician prediction. initiate regular education programs in the field of RESULTS: Forty-five (12.9%) of 351 patients had behavioural sciences, communication techniques and abnormal CT scans. In predicting CT scan abnormality, medical ethics for the benefit of graduate and the ANN model was more sensitive (82.2%) compared postgraduate medical and nursing students. with physician prediction (62.2%). CONCLUSION: ANNs may serve as a useful aid for decision support Singhal N, Oberle K, Burgess E, Huber-Okrainec J. Parents' for emergency physicians in predicting intracranial perceptions of research with newborns. J Perinatol abnormalities in closed head injury. 2002; 22(1):57-63. Abstract: OBJECTIVE: To examine beliefs and Siqueira LM, Rolnitzky LM, Rickert VI. Smoking cessation attitudes of parents about research with babies. in adolescents: the role of nicotine dependence, stress, STUDY DESIGN: Survey of 72 parents of newborn and coping methods. Arch Pediatr Adolesc Med 2001; babies in the neonatal intensive care unit (NICU), and 155(4):489-95. 159 parents of normal newborns using instrument Abstract: OBJECTIVES: To compare perceived designed for the study. The instrument included reasons for continued smoking and withdrawal questions with graded responses and five research symptoms between current smokers and quitters in an scenarios with varied risks and benefits. Statistical inner-city adolescent population. To examine the analysis included chi(2) analysis and Fisher's exact test. relationship of nicotine dependence, stress, and coping RESULTS: Parents showed generally favorable methods between smokers and quitters and, using the attitudes toward research with babies. There were few Transtheoretical Model of Change, among adjacent differences between the two groups of parents, but smoking cessation stages. DESIGN: A cross-sectional there was a trend toward more trust in doctors by study using a self-administered questionnaire. "NICU parents." Couples with newborns in NICU were PARTICIPANTS: The study comprised 354 clinic significantly more likely to enroll their newborn in a patients between the ages of 12 and 21 years who study involving moderate risk and possible major direct reported past or present smoking. MAIN OUTCOME benefit. Almost a third of the sample in both groups MEASURES: Demographic characteristics, smoking was willing to enroll their newborn in a study with status, perceived reasons for continued smoking, moderate risk and no direct benefit. CONCLUSION: attempts to quit, and withdrawal symptoms, as well as Parents believe research is necessary and want to be standardized scales assessing nicotine dependence, asked for consent, but many feel they have limited stress, and coping methods. RESULTS: The overall knowledge and would depend on their physician's prevalence of smoking in this population was 26%. advice. The fact, that some might enroll their newborn Smokers were significantly more likely to report in a study involving a risky procedure that would not smoking more cigarettes per day as well as higher benefit the newborn, supports the notion of levels of physical addiction (P<.01), greater levels of vulnerability and emphasizes the fact that physicians perceived stress (P<.02), and less use of cognitive must be alert to the possibility of coercion and undue coping methods (P<.02) than quitters (P<.005). influence. However, comparison of consecutive stages revealed a significant difference only between precontemplation Sinha M, Kennedy CS, Ramundo ML. Artificial neural and contemplation in cognitive coping methods network predicts CT scan abnormalities in pediatric (P<.01). Three of 20 withdrawal symptoms (cravings, patients with closed head injury. J Trauma 2001; difficulty dealing with stress, and anger) were reported 50(2):308-12. more frequently among current smokers who had Abstract: BACKGROUND: Artificial neural networks attempted to quit in the last 6 months than among (ANNs) use nonlinear statistical modeling techniques former smokers (P<.01). CONCLUSION: to explore relationships in complex clinical situations. Interventions for inner-city adolescents who smoke This study compared predictive ability of a trained should be designed to target those with the highest ANN model to that of physician prediction of cranial levels of nicotine dependence, stress, and decreased use computed tomographic (CT) scan abnormalities in of cognitive coping methods because they are the least children with head injury. METHODS: A prospective likely to quit on their own, rather than developing cohort of 351 patients who presented with head trauma stage-specific models. and underwent CT scans were studied. All pertinent data on historical and demographic information, and Sirois S. Autoassociator networks: insights into infant clinical features were recorded. Emergency department cognition. Dev Sci 2004; 7(2):133-40. physicians used clinical judgment to record pretest Abstract: This paper presents autoassociator neural probability of abnormal CT scans for all patients networks. A first section reviews the architecture of prospectively. Similar data from a retrospective chart these models, common learning rules, and presents review of 382 patients with head injury in the sample simulations to illustrate their abilities. In a immediate preceding year were collected and used to second section, the ability of these models to account 854
- 863. for learning phenomenasuch as habituation is CONCLUSION: The findings highlight the importance reviewed. The contribution of these networks to of social factors in children's disclosure of sexual discussions about infant cognition is highlighted. A abuse. new, modular approach is presented in a third section. In the discussion, a role for these learning models in a Skene L. Ownership of human tissue and the law. Nat Rev broader developmental framework is proposed. Genet 2002; 3(2):145-8. Notes: GENERAL NOTE: KIE: 23 refs. Sirois S, Mareschal D. An interacting systems model of GENERAL NOTE: KIE: KIE Bib: biomedical infant habituation. J Cogn Neurosci 2004; 16(8):1352- research; informed consent; organ and tissue donation 62. Abstract: Genetic researchers and medical practitioners Abstract: Habituation and related procedures are the often need to obtain access to stored human tissue primary behavioral tools used to assess perceptual and without consent from the people concerned. But the cognitive competence in early infancy. This article laws that relate to the ownership of, and control over, introduces a neurally constrained computational model stored human tissue are at present unclear, especially in of infant habituation. The model combines the two the light of recent cases and inquiries. Here, I discuss leading process theories of infant habituation into a how the law might be clarified, and argue that the law single functional system that is grounded in functional should allow stored human tissue to be used without brain circuitry. The HAB model (for Habituation, consent, providing that this occurs with ethical Autoassociation, and Brain) proposes that habituation approval and that the confidentiality of the donor is behaviors emerge from the opponent, complementary protected. processes of hippocampal selective inhibition and cortical long-term potentiation. Simulations of a Skinner H, Biscope S, Poland B. Quality of internet access: seminal experiment by Fantz [Visual experience in barrier behind internet use statistics. Soc Sci Med infants: Decreased attention familiar patterns relative to 2003; 57(5):875-80. novel ones. Science, 146, 668-670, 1964] are reported. Abstract: The rapid growth of the Internet is The ability of the model to capture the fine detail of increasingly international with young people being the infant data (especially age-related changes in early adopters in most countries. However, the quality performance) underlines the useful contribution of of Internet access looms as a major barrier hidden neurocomputational models to our understanding of behind Internet use statistics. The goal of this study behavior in general, and of early cognition in was to provide an in-depth evaluation of young particular. people's perspectives on using the Internet to obtain health information and resources (e-health). Using an Sjoberg RL. [The Cleveland case as a lesson. Single cases inductive qualitative research design, 27 focus groups and case series can be simple to take in but they are not were conducted in Ontario, Canada. The 210 young suitable to secure the cause-effect relationship]. participants were selected to reflect diversity in age, Lakartidningen 2004; 101(41):3166-7. sex, geographic location, cultural identity and risk. A major finding was how the quality of Internet access Sjoberg RL. [Satanic ritualistic murders and child abuse-- influenced young people's ability to obtain health evidence-basing versus ideology]. Lakartidningen information and resources. Quality of Internet access 2005; 102(40):2824-5. was affected by four key factors: 1. Privacy, 2. Gate- keeping, 3. Timeliness and 4. Functionality. Privacy Sjoberg RL. [Sexual experiences in connection with sexual was particularly relevant to these young people in abuse can delay the disclosure]. Lakartidningen 2003; getting access to sensitive health information (e.g. 100(17):1549. sexual activities). Variations in access quality also impacted participation in mutual support, fostering Sjoberg RL, Lindblad F. Delayed disclosure and disrupted social networks and getting specific health questions communication during forensic investigation of child answered. These results serve as a warning about using sexual abuse: a study of 47 corroborated cases. Acta Internet penetration statistics alone as a measure of Paediatr 2002; 91(12):1391-6. access. Concerted attention is needed on improving the Abstract: AIM: To study factors of relevance for the quality of Internet access for achieving the potential of understanding of disclosure of child sexual abuse. e-health. This is imperative for addressing the digital METHODS: Cases from a Swedish district court divide affecting populations both within countries and involving 47 children in which allegations of child globally between countries. sexual abuse had been corroborated by a confession from the defendant were studied. RESULTS: Delayed Skopp NA, McDonald R, Manke B, Jouriles EN. Siblings in disclosure was related to a close relationship with the domestically violent families: experiences of perpetrator and young age at the first experience of interparent conflict and adjustment problems. J Fam abuse. Disrupted communication during the police Psychol 2005; 19(2):324-33. interview was related to less violent abuse. Abstract: This research examines whether siblings in 855
- 864. domestically violent familiesdiffer in experiences of among the youths. Implications for social workers interparent conflict and whether such differences are include advising high-risk clients and their families on associated with differences in children's adjustment. gun removal and safe storage practices. Participants included 112 sibling pairs and their mothers temporarily residing in domestic violence Slovak K, Singer M. Gun violence exposure and trauma shelters. Children completed measures of their among rural youth. Violence Vict 2001; 16(4):389-400. experiences of interparent conflict, and children and Abstract: This study compared rural youth exposed to mothers reported on children's adjustment problems. gun violence and rural youth not exposed to gun Cross-sibling correlations for experiences of violence on a number of variables: anger, anxiety, interparent conflict were low to moderate. Sibling dissociation, depression, posttraumatic stress, total differences in threat appraisals of interparent conflict trauma, violent behavior, parental monitoring, and were associated with sibling differences in levels of violence in the home, school, and community. internalizing problems. Differences in self-blame One-fourth (25%) of the rural youth in this study appraisals were associated with differences in reported having been exposed to gun violence at least internalizing and externalizing problems. The direction once. Youth exposed to gun violence reported of the relations indicated that the sibling who felt more significantly more anger, dissociation, posttraumatic threatened by or more at fault for interparent conflict stress, and total trauma. In addition, youth exposed to experienced more adjustment problems. These findings the violence of guns reported significantly higher levels suggest the potential utility of individually assessing of violent behaviors and exposure to violence in other sibling experiences of interparent conflict and tailoring settings and also reported lower levels of parental interventions individually. monitoring.The present study contributes to the growing body of literature addressing the stereotype Slote KY, Cuthbert C, Mesh CJ, Driggers MG, Bancroft L, that rural communities are not immune to the violence Silverman JG. Battered mothers speak out: of firearms. This stereotype acts as a barrier to mental participatory human rights documentation as a model health practice, research, and policy issues in rural for research and activism in the United States. Violence communities. Against Women 2005; 11(11):1367-95. Abstract: This article describes the work of the Slovis TL. Controversial aspects of child abuse. Pediatr Battered Mothers' Testimony Project, a multiyear effort Radiol 2001; 31(11):759. that documented human rights violations against battered women and their children in the Massachusetts Smallbone SW, Wortley RK. Onset, persistence, and family court system. This article (a) presents the versatility of offending among adult males convicted of Battered Mothers' Testimony Project's participatory sexual offenses against children. Sex Abuse 2004; human rights methodology as an alternative model for 16(4):285-98. research and activism on violence against women and Abstract: Official sexual and nonsexual offense children in the United States, (b) summarizes the histories and confidential self-report data on sexual authors' findings and human rights analysis of how the offending were obtained on 207 adult males serving Massachusetts family courts handled custody and sentences for sexual offenses against children (98 visitation in specified cases involving partner and child intrafamilial, 72 extrafamilial, and 37 mixed-type abuse, and (c) discusses U.S. obligations under offenders). The mean self-reported age when offenders international human rights law and the value of a first had sexual contact with a child was 32.2 years human rights approach to violence against women and (median = 31 years; range = 10-63 years). The mean children in the United States. age at first conviction for any offense was 30.5 years (median = 27 years, range = 12-66 years), and the Slovak K. Gun violence and children: factors related to mean age at first conviction for a sexual offense was exposure and trauma. Health Soc Work 2002; 37.3 years (median = 37 years; range = 15-76 years). 27(2):104-12. Sixty-nine percent (n = 143) of the combined sample Abstract: The study discussed in this article had at least one previous conviction, and 80% of these investigated the relationship between access to firearms (n = 114) had first been convicted for a nonsexual and parental monitoring on rural youths' exposure to offense. ANCOVA revealed a systematic pattern of gun violence and examined the effect of gun violence onset with first convictions for any offense preceding exposure on the mental health of these youths. A first sexual contact with a child. Taken together, results survey was administered to rural students who indicate that, in general, adult child molesters (a) begin participated in a student assistance program (n = 162) sexual offending in their 30s, (b) have already become that provided in-school support groups for students in involved in nonsexual crime by the time they first have grades 6 through 12. Results indicated that a substantial sexual contact with a child, (c) are criminally versatile, number of students were exposed to gun violence and and (d) vary considerably in their persistence with exposure was significantly related to firearm access respect to both sexual and nonsexual offending. and parental monitoring. Furthermore, gun violence exposure was significantly associated with trauma 856
- 865. Smetana JG, DaddisC. Domain-specific antecedents of (1microCi/well) incorporation after stimulation in parental psychological control and monitoring: the role primary culture with phytohaemagglutinin (PHA) (1 of parenting beliefs and practices. Child Dev 2002; microg/mL), house dust mite [HDM] extract (30 73(2):563-80. microg/mL), immunopurified Der p 1 (30 microg/mL), Abstract: This research examined the effects of Tetanus toxoid (TT) (aluma free, 30 Lf/mL) or vehicle. domain-differentiated beliefs about legitimate parental Blood was collected from 144 infants at the age of 1 authority and ratings of restrictive parental control on years and stimulated proliferative responses were adolescent- and mother-reported psychological and assessed using the same procedure. RESULTS: PHA- behavioral control. The influence of parenting beliefs stimulated lymphoproliferative response was and practices regarding socially regulated (moral and significantly lower in HR compared to LR neonates conventional) and ambiguously personal (multifaceted (mean difference 38%, 95% CI 15%-54%; P = 0.003); and personal) issues was examined in 93 middle-class significantly lower proportion of positive CBMC African American early adolescents (M = 13.11 years, responses to HDM occurred in LR than in HR neonates SD = 1.29) and their mothers, who were followed (30.4% vs. 46.6%; P = 0.034). There was no longitudinally for 2 years. Domain-specific parenting relationship between Der p 1 levels in maternal bed and beliefs and ratings predicted adolescent-reported CBMC immunoproliferative responses, despite the 21 maternal psychological control and parental 000-fold range of maternal Der p 1 exposure. No monitoring, but the nature and direction of the relations significant differences in magnitude, or in proportion differed. Adolescents who rated parents as more of positive responses to any stimulant were observed restrictive in their control of personal issues and who between the neonates at low, medium or high tertile of believed that parents should have less legitimate allergen exposure. Immunoproliferative responses at authority over these issues rated their mothers as higher birth were not predictive of 1-year PBMC responses. in psychological control. In contrast, more adolescent- There was no relationship between maternal allergen reported parental monitoring was associated with exposure in pregnancy and 1-year PBMC proliferative gender (being female) and adolescents' beliefs that responses. However, the proportion of positive parents have more legitimate authority to regulate proliferative responses at 1 years significantly personal issues. As expected, adolescent age and increased with increasing infant Der p 1 exposure at 1 gender influenced mother-reported monitoring and years. CONCLUSION: These results indicate that the psychological control; in addition, the effects of magnitude of immunoproliferative responses are mothers' ratings of restrictive control on both unrelated to maternal mite allergen exposure and psychological control and monitoring were moderated cannot be used as evidence for in utero sensitization to by gender. The results indicate that psychological inhalant allergens. The immunoproliferative responses control and monitoring can be understood in terms of at 1 year seem to shift away from the genetically the particular behaviors that are controlled, as well as influenced responses at birth towards responses to the style in which control is exercised. specific stimulants which correlate with environmental exposure to those specific stimulants. These data Smillie FI, Elderfield AJ, Patel F et al. Lymphoproliferative support the concept of sensitization to inhalant responses in cord blood and at one year: no evidence allergens occurring in early life, but not in utero. for the effect of in utero exposure to dust mite allergens. Clin Exp Allergy 2001; 31(8):1194-204. Smith A, Coveney J, Carter P, Jolley G, Laris P. The Eat Abstract: BACKGROUND: Maternal allergen Well SA project: an evaluation-based case study in exposure beyond the 22nd week of pregnancy may be building capacity for promoting healthy eating. Health important in foetal T cell priming. Allergen-specific Promot Int 2004; 19(3):327-34. cord blood mononuclear cell (CBMC) Abstract: The term 'capacity building' is used in the immunoproliferative responses without corresponding health promotion literature to mean investing in bacterial antigen responses (tetanus toxoid), have been communities, organizations and structures to enhance suggested as evidence of in utero sensitization. access to knowledge, skills and resources needed to OBJECTIVES: To investigate the relationship between conduct effective health programs. The Eat Well SA lymphoproliferative responses at birth and at 1 year project aimed to increase consumption of healthy food with maternal and 1-year infants house dust mite by children, young people and their families in South allergen exposure. METHODS: Home visits and dust Australia. The project evaluation demonstrated that sampling were performed by the 20th week of awareness about healthy eating among stakeholders pregnancy, immediately after birth, and then at 1 years across a range of sectors, coalitions and partnerships to of age. Der p 1 was assayed using a two-site promote healthy eating and sustainable programs had immunometric ELISA. CBMC immunoproliferative been developed. The project achievements were responses (AIM V serum-free medium; 1 x 105 analysed further using a capacity-building framework. cells/well) were measured for 225 neonates (171 had a This analysis showed that partnership development was high risk of atopy (HR)--both parents skin test positive; a key strategy for success, leading to increased 59 had a low risk of atopy (LR) - both parents skin test problem-solving capacity among key stakeholders and negative, no history of atopy) by 3H-Thymidine workers from education, child care, health, transport 857
- 866. and food industrysectors. It was also a strategy that ethnic attitudes and academic achievement among 98 required concerted effort and review. New and ongoing African American fourth-grade children. It has been programs were initiated and institutionalized within posited that young people who feel better about their other sectors, notably the child care, vocational racial-ethnic background have better behavioral and education and transport sectors. A model for planning academic outcomes, yet there is a need for more and evaluating nutrition health promotion work is empirical tests of this premise. Psychometric described. information is reported on measures of parent, teacher, and child racial-ethnic attitudes. Path analysis was used Smith C, Bell JE, Keeling JW, Risden RA. Dural to investigate ecological variables potentially related to haemorrhage in nontraumatic infant deaths: does it children's racial-ethnic attitudes and achievement. explain the bleeding in 'shaken baby syndrome'? Parental education and level of racial-ethnic pride were Geddes JE et al. A response. Neuropathol Appl correlated and both were related to children's Neurobiol 2003; 29(4):411-2; author reply 412-3. achievement though in the final path model, only the path from parental education level was statistically Smith CA, Ireland TO, Thornberry TP. Adolescent significant. Children whose teachers exhibited higher maltreatment and its impact on young adult antisocial levels of racial-ethnic trust and perceived fewer behavior. Child Abuse Negl 2005; 29(10):1099-119. barriers due to race and ethnicity evidenced more trust Abstract: STATEMENT OF PROBLEM: Childhood and optimism as well. Children living in communities maltreatment is known to be a risk factor for a range of with higher proportions of college-educated residents later problems, but much less is known about also exhibited more positive racial-ethnic attitudes. For adolescent maltreatment. The present study aims to children, higher racial-ethnic pride was related to investigate the impact of adolescent maltreatment on higher achievement measured by grades and antisocial behavior, while controlling for prior levels of standardized test scores, while racial distrust and problem behavior as well as sociodemographic perception of barriers due to race were related to characteristics. METHODS: Data are from the reduced performance. This study suggests that family, Rochester Youth Development Study, a cohort study of school, and community are all important factors related the development of problem behaviors in a sample of to children's racial-ethnic attitudes and also to their 1,000 urban youth followed from age 13 into academic achievement. adulthood. Subjects include 68% African American, 17% Hispanic, and 15% White youth. This analysis Smith EP, Gorman-Smith D, Quinn WH, Rabiner DL, Tolan includes a maximum of 884 subjects, of whom 9.3% PH, Winn DM. Community-Based multiple family had substantiated maltreatment reports in adolescence. groups to prevent and reduce violent and aggressive Among the maltreated adolescents, 14 experienced sex behavior: the GREAT Families Program. Am J Prev abuse, 36 experienced physical abuse, and 32 were Med 2004; 26(1 Suppl):39-47. neglected or emotionally abused. Outcomes explored in Notes: CORPORATE NAME: Multisite Violence late adolescence (ages 16-18) and young adulthood Prevention Project (ages 20-22) include arrest, self-reported general and Abstract: This paper describes the targeted intervention violent offending, and illicit drug use. Control variables component of GREAT Schools and Families. The include prior levels of these outcomes as well as intervention-GREAT Families-is composed of 15 sociodemographic characteristics like poverty, parent weekly multiple family group meetings (e.g., 4-6 education, and caregiver changes. RESULTS: Logistic families per group) and addresses parenting practices regression analysis determined that experiencing any (discipline, monitoring), family relationship substantiated maltreatment during adolescence characteristics (communication, support, cohesion), increases the odds of arrest, general and violent parental involvement and investment in their child's offending, and illicit drug use in young adulthood, even schooling, parent and school relationship building, and controlling for sociodemographic characteristics and planning for the future. High-risk youth and their prior levels of problem behavior. Different types of families-students identified by teachers as aggressive adolescent maltreatment, including neglect, appear to and socially influential among their peers-were produce similar adverse behavioral consequences. targeted for inclusion in the intervention. The paper CONCLUSIONS: Adolescent maltreatment describes the theoretical model and development of the necessitates increased attention in view of its enduring intervention. Approaches to recruitment, engagement, and potentially wide-ranging impact on the life span. staff training, and sociocultural sensitivity in work with families in predominantly poor and challenging Smith EP, Atkins J, Connell CM. Family, school, and settings are described. The data being collected community factors and relationships to racial-ethnic throughout the program will aid in examining the attitudes and academic achievement. Am J Community theoretical and program processes that can potentially Psychol 2003; 32(1-2):159-73. mediate and moderate effects on families. This work Abstract: This study examined family, school, and can inform us about necessary approaches and community factors and the relationships to racial- procedures to engage and support families in efforts to reduce individual and school grade-level violence and 858
- 867. aggression. encounter at traumatic crash scene. J Emerg Nurs 2005; 31(2):185-7. Smith F. Child protection: every nurse's responsibility. Paediatr Nurs 2003; 15(7):28. Smith PK, Ananiadou K, Cowie H. Interventions to reduce school bullying. Can J Psychiatry 2003; 48(9):591-9. Smith F. A new era for child protection. Paediatr Nurs 2003; Abstract: In the last 2 decades, school bullying has 15(8):3. become a topic of public concern and research around the world. This has led to action to reduce the problem. Smith F. Safeguarding the young. Paediatr Nurs 2003; We review interventions targeted at the school level 15(10):24-5. (for example, whole school policy, classroom climate, peer support, school tribunal, and playground Smith-Khuri E, Iachan R, Scheidt PC et al. A cross-national improvement), at the class level (for example, study of violence-related behaviors in adolescents. curriculum work), and at the individual level (for Arch Pediatr Adolesc Med 2004; 158(6):539-44. example, working with specific pupils). Effectiveness Abstract: BACKGROUND: Violent behavior among of interventions has been sporadically assessed. We adolescents is a significant problem worldwide, and a review several systematically evaluated, large-scale, cross-national comparison of adolescent violent school-based intervention programs. Their behaviors can provide information about the effectiveness has varied, and we consider reasons for development and pattern of physical violence in young this. We suggest ways to improve the evaluation and adolescents. OBJECTIVES: To determine and compare comparability of studies, as well as the effectiveness of frequencies of adolescent violence-related behaviors in future interventions. 5 countries and to examine associations between violence-related behaviors and potential explanatory Snodgrass SR, Vedanarayanan VV, Parker CC, Parks BR. characteristics.Design, Setting, and PARTICIPANTS: Pediatric patients with undetectable anticonvulsant Cross-sectional, school-based nationally representative blood levels: comparison with compliant patients. J survey at ages 11.5, 13.5, and 15.5 years in 5 countries Child Neurol 2001; 16(3):164-8. (Ireland, Israel, Portugal, Sweden, and the United Abstract: Undetectable anticonvulsant blood levels States). MAIN OUTCOME MEASURES: Frequency indicate sustained noncompliance (several consecutive of physical fighting, bullying, weapon carrying, and doses missed). We compared 91 consecutive fighting injuries in relation to other risk behaviors and outpatients with epilepsy and undetectable characteristics in home and school settings. RESULTS: anticonvulsant blood levels to 100 patients seen during Fighting frequency among US youth was similar to that the same time period, verified as compliant by of all 5 countries (nonfighters: US, 60.2%; mean acceptable serum levels. We hypothesized that pay frequency of 5 countries, 60.2%), as were the status, application for Supplemental Security Income, frequencies of weapon carrying (noncarriers: US, patient age, history of missed appointments, and 89.6%; mean frequency of 5 countries, 89.6%) and functional status would differ between compliant and fighting injury (noninjured: US, 84.5%; mean noncompliant patients. We were surprised to find large frequency of 5 countries, 84.6%). Bullying frequency differences between clinic and insurance patients and varied widely cross-nationally (nonbullies: from 57.0% between Caucasian and non-Caucasian patients. The for Israel to 85.2% for Sweden). Fighting was most 100 compliant patients included 44 Caucasian and 56 highly associated with smoking, drinking, feeling non-Caucasian patients, whereas only 9 of 91 irritable or bad tempered, and having been bullied. noncompliant patients were Caucasian, and only 9 had CONCLUSIONS: Adolescents in 5 countries behaved insurance, compared to 32 compliant patients. similarly in their expression of violence-related Applications for Supplemental Security Income and behaviors. Occasional fighting and bullying were history of missed appointments were significantly common, whereas frequent fighting, frequent bullying, associated with noncompliance, but patient age, seizure any weapon carrying, or any fighting injury were type, and seizure control were not. Uninsured infrequent behaviors. These findings were consistent Caucasians were more often compliant than non- across countries, with little cross-national variation Caucasians were. Many noncompliant patients had except for bullying rates. Traditional risk-taking mild epilepsy, which was reportedly doing well. Race behaviors (smoking and drinking) and being bullied and pay status were closely correlated. Several were highly associated with the expression of violence- noncompliant females became pregnant, whereas no related behavior. compliant patients did. Compliant patients were much more likely to be accompanied by a parent or caretaker Smith M. Child safety: homicide by child abuse: South on clinic visits than noncompliant patients. Carolina upholds conviction under "Crack Mom" law. J Noncompliant patients had at least one acceptable Law Med Ethics 2003; 31(3):457-8. subsequent serum level, although 2 patients with intractable epilepsy had undetectable serum levels on Smith P. Emergency nurse urges booster seat advocacy after three or more occasions. Noncompliance may respond to discussion and advice. We reviewed 124 episodes of 859
- 868. undetectable drug levelsin the 91 noncompliant the interaction of ineffective discipline and hostile patients. Eighteen of these resulted in hospitalization, attribution predicted growth in child conduct problems but in 25 cases, we were told that there had been no at home during kindergarten and first grade. Changes seizures since the preceding visit. Many noncompliant in teacher-reported and observed child conduct patients have infrequent seizures, even if they take little problems at school during kindergarten and first grade or no medication. Socioeconomic status influences were predicted by growth in conduct problems at home health, life expectancy, and educational success, but it and by the interaction of ineffective discipline and has been claimed to be irrelevant to compliance and hostile attribution. adherence issues in epilepsy. Our data and the experience of other centers with childhood diabetes Sobin C, Kiley-Brabeck K, Daniels S, Blundell M, Anyane- suggest that socioeconomic, racial, and family factors Yeboa K, Karayiorgou M. Networks of attention in influence compliance or adherence to treatment for children with the 22q11 deletion syndrome. Dev many chronic conditions. Educational efforts and Neuropsychol 2004; 26(2):611-26. support for parents at the start of anticonvulsant Abstract: The 22q11 chromosomal deletion syndrome treatment may improve compliance. Uninsured patients (22q11 DS) is associated with learning disabilities and missed more appointments and were much more likely a complex neuropsychological profile. Previous to be noncompliant than insured patients. Attention to findings have suggested that executive attention the special problems of Medicaid and minority children deficits might underlie other neurocognitive anomalies. is needed. We administered the child Attention Network Test (ANT) to 52 children ages 5.0 to 11.5, 32 22q11 DS Snyder A, Bossomaier T, Mitchell DJ. Concept formation: children (19 girls) and 20 controls (13 girls) and 'object' attributes dynamically inhibited from conscious assessed the efficiency of segregated executive, awareness. J Integr Neurosci 2004; 3(1):31-46. orienting, and alerting networks. We hypothesized that Abstract: We advance a dominant neural strategy for 22q11 DS children have impaired executive network facilitating conceptual thought. Concepts are groupings efficiency as compared to control siblings. The internal of "object" attributes. Once the brain learns such validity of the child ANT was confirmed for this critical groupings, the "object" attributes are inhibited population. Analysis of variance results showed from conscious awareness. We see the whole, not the significant main effects for flanker and cue types and parts. The details are inhibited when the concept no interaction effect in either 22q11 DS children or network is activated, ie. the inhibition is dynamic and control siblings. Compared to control siblings, 22q11 can be switched on and off. Autism is suggested to be DS children had significantly larger (less efficient) the state of retarded concept formation. Our model executive network scores, significantly increased errors predicts the possibility of accessing nonconscious on only incongruent trials, and a significant correlation information by artificially disinhibiting (turning off) between executive network scores and accuracy. The the inhibiting networks associated with concept implications of these findings for future neurocognitive formation, using transcranial magnetic brain studies of 22q11 DS children are considered. stimulation (TMS). For example, this opens the door for the restoration of perfect pitch, for recalling detail, Sobol Z. The Denplan child protection line. Dent Update for acquiring accent-free second languages beyond 2001; 28(9):475. puberty, and even for enhancing creativity. The model further shows how unusual autistic savant skills as well Soderberg S, Kullgren G, Salander Renberg E. Childhood as certain psychopathologies can be due respectively to sexual abuse predicts poor outcome seven years after privileged or inadvertent access to information that is parasuicide. Soc Psychiatry Psychiatr Epidemiol 2004; normally inhibited from conscious awareness. 39(11):916-20. Abstract: BACKGROUND: There is substantial Snyder J, Cramer A, Afrank J, Patterson GR. The empirical research linking borderline personality contributions of ineffective discipline and parental disorder with prolonged mental instability and hostile attributions of child misbehavior to the recurrent suicidality. At the same time, a growing body development of conduct problems at home and school. of observations links borderline personality disorder to Dev Psychol 2005; 41(1):30-41. sexual abuse and other forms of abuse and trauma in Abstract: Data were collected in a longitudinal study of childhood. The aim of this study was to investigate 134 boys and 132 girls and their families during among patients admitted for parasuicide the predictive kindergarten and first grade. Four hours of parent-child value for outcome 7 years after the parasuicide of a interaction were coded to ascertain parent discipline diagnosis of borderline personality disorder compared practices. A structured interview assessed maternal to the predictive value of a history of childhood sexual attributions about child behavior. Maternal ratings of abuse. METHODS: Semi-structured interviews were child conduct problems at kindergarten entry reliably conducted at the time of the index parasuicide, with predicted the mother's subsequent hostile attributions follow-up interviews 7 years later. In addition, concerning child misbehavior and use of ineffective information was collected from medical records at the discipline tactics. Ineffective maternal discipline and 860
- 869. psychiatric clinic. Alogistic regression analysis was to adulthood psychopathic traits and personality used to assess the specific influence of the covariates disorders. Compr Psychiatry 2005; 46(2):111-6. borderline personality disorder, gender and reported Abstract: Childhood conduct disorder (CD) and adult childhood sexual abuse on the outcome variables. psychopathic traits according to the Psychopathy RESULTS: Univariate regression analysis showed Checklist Revised (PCL-R) were the closest psychiatric higher odds ratios for borderline personality disorder, covariates to repeated violent crimes and aggression female gender and childhood sexual abuse regarding among offenders under forensic psychiatric prolonged psychiatric contact and repeated investigation in Sweden. As psychopathy is not parasuicides. A combined logistic regression model included in the present psychiatric diagnostic systems, found significantly higher odds ratios only for we compared total and factor PCL-R scores to Axis I childhood sexual abuse with regard to suicidal ideation, disorders, including childhood-onset neuropsychiatric repeated parasuicidal acts and more extensive disorders, and to Axis II personality disorders, to psychiatric support. CONCLUSION: The findings establish the convergence of psychopathic traits with support the growing body of evidence linking the other psychiatric diagnoses, and to identify possible characteristic symptoms of borderline personality unique features. Psychopathic traits were positively disorder to childhood sexual abuse, and identify sexual correlated with bipolar mood disorder and negatively abuse rather than a diagnosis of borderline personality with unipolar depression. The total PCL-R scores as disorder as a predictor for poor outcome after a well as the Factor 2 (unemotionality) and Factor 3 parasuicide. The findings are relevant to our (behavioral dyscontrol) scores were significantly understanding and treatment of parasuicide patients, correlated with attention-deficit/hyperactivity disorder, especially those who fulfil the present criteria for Asperger's syndrome/high-functioning autistic traits, borderline personality disorder. CD, substance abuse, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Cluster B Soderstrom H, Blennow K, Sjodin AK, Forsman A. New personality disorders. The interpersonal Factor 1 evidence for an association between the CSF HVA:5- showed none of these correlations and may capture HIAA ratio and psychopathic traits. J Neurol features that are specific to psychopathy, distinguishing Neurosurg Psychiatry 2003; 74(7):918-21. core psychopathy from other diagnostic definitions. Abstract: OBJECTIVES: To replicate the relation between the CSF HVA:5-HIAA ratio and psychopathic Soderstrom H, Sjodin AK, Carlstedt A, Forsman A. Adult traits previously reported in a pilot group of 22 psychopathic personality with childhood-onset perpetrators of violent crimes. METHODS: CSF hyperactivity and conduct disorder: a central problem monoamine metabolite concentrations in another 28 constellation in forensic psychiatry. Psychiatry Res violent and sexual offenders, aged 45 or below, 2004; 121(3):271-80. referred to pretrial forensic psychiatric investigation, Abstract: To describe lifetime mental disorders among were compared to features of psychopathy according to perpetrators of severe inter-personal crimes and to the Psychopathy Checklist-Revised (PCL-R). identify the problem domains most closely associated RESULTS: Our previous finding was repeated in the with aggression and a history of repeated violent new study group, where the HVA:5-HIAA ratio was criminality, we used structured interviews, clinical strongly associated with psychopathic traits (r = 0.50, p assessments, analyses of intellectual functioning, = 0.010), particularly its behavioural aspects (r = 0.523, medical and social files, and collateral interviews in p = 0.004). In subsamples of individuals from both 100 consecutive subjects of pretrial forensic psychiatric study groups who had no medication (n = 25) or no investigations. Childhood-onset neuropsychiatric current axis I disorder, including a history of mood disorders [attention-deficit/hyperactivity disorder disorder or substance dependence (n = 21), the HVA:5- (AD/HD), learning disability, tics and autism spectrum HIAA ratio remained strongly associated with all disorders] affected 55% of the subjects and formed psychopathy factors but most closely with the complex comorbidity patterns with adult personality behavioural features. Retrospective assessments of disorders [including psychopathic traits according to childhood disruptive symptomatology, such as the Psychopathy Checklist (PCL-R)], mood disorders attention deficit hyperactivity disorder or conduct and substance abuse. The closest psychiatric covariates disorder, analysed in relation to the monoamine to high Lifetime History of Aggression (LHA) scores metabolites, showed the same association with the and violent recidivism were the PCL-R scores and HVA:5-HIAA ratio. CONCLUSIONS: Violent and childhood conduct disorder (CD). Behavioral and aggressive behavioural traits with childhood onset and affective PCL-R factors were closely associated with adult expression as psychopathic features are childhood AD/HD, CD, and autistic traits. The results associated with changed activity in the brain support the notion that childhood-onset social and dopaminergic system, possibly as a result of behavioral problems form the most relevant psychiatric serotonergic dysregulation. symptom cluster in relation to pervasive adult violent behavior, while late-onset mental disorders are more Soderstrom H, Nilsson T, Sjodin AK, Carlstedt A, Forsman often associated with single acts of violent or sexual A. The childhood-onset neuropsychiatric background aggression. 861
- 870. Solagberu BA, AyorindeRO. Tuberculosis of the spine in [Use of psychotropics drugs among students: Ilorin, Nigeria. East Afr Med J 2001; 78(4):197-9. prevalence and associated social factors]. Rev Saude Abstract: BACKGROUND: Data on tuberculosis (TB) Publica 2004; 38(2):277-83. of the spine from Nigeria is scanty despite the Abstract: OBJECTIVE: To determine the prevalence of endemicity of the disease. OBJECTIVE: To highlight the heavy use of drugs among elementary and high hospital data on spinal tuberculosis. DESIGN: A ten- school students in a sample of public and private year retrospective study of records on spinal TB from schools, and to identify associated demographic, the medical records, orthopaedic and medical wards psychological, cultural and social factors. METHODS: was done. The clinical notes, radiographs and This report describes a cross-sectional study using an haematology results of the patients were analysed. intention-type sampling technique that compared SETTING: University of Ilorin Teaching Hospital, public schools in central and peripheral areas and Ilorin, Nigeria. SUBJECTS: All patients treated for private schools. An anonymous self-administered spinal TB in the hospital from January 1990 to questionnaire was applied. The sample consisted of December 1999 were studied. RESULTS: Fifty 2,287 elementary and high school students in the city patients were seen, 24 males and 26 females, age range of Campinas in 1998. Heavy use of drugs was defined 1.5-70 years (mean 27.1 +/- 22.8 years). Peak as the use of drugs on 20 or more days during the 30 prevalence (30%) was in the first decade. Twenty days preceding the survey (WHO, 1981). For the seven patients had complete clinical data in their case statistical analysis, polytomic logistic regression notes. Twelve patients had paraplegia and three had analysis (logit model) was utilized to identify factors concomitant pulmonary TB. The lumbar spine was the that influenced this manner of using drugs. RESULTS: commonest site of involvement. Two thirds (18 Heavy use of legal and illegal drugs was found as patients) had positive mantoux test. Twenty three follows: alcohol (11.9%), tobacco (11.7%), marijuana patients had chemotherapy but a third was lost to (4.4%), solvents (1.8%), cocaine (1.4%), medications follow up within two months. Twenty one patients (1.1%) and ecstasy (0.7%). The heavy use of drugs was (77.8%) had difficulty obtaining the prescribed drugs greatest among students at the city-center public school due to financial difficulties. No patient had surgical who had daytime jobs and studied in the evenings. intervention. CONCLUSION: Spinal TB is still a These students were in the A and B socioeconomic common disease in Nigeria with unacceptable laxity in classes and had had little religious education during control measures. There is need for patient health childhood. CONCLUSIONS: Greater availability of education, contact tracing, provision of free anti-TB cash and specific socialization patterns were identified drugs and a general improvement in the economy to as factors associated with the heavy use of drugs reduce the prevalence of spinal TB in the country. among students. Solbakk JH. Use and abuse of empirical knowledge in Solodiuk J, Curley MA. Pain assessment in nonverbal contemporary bioethics. Med Health Care Philos 2004; children with severe cognitive impairments: the 7(1):5-16. Individualized Numeric Rating Scale (INRS). J Pediatr Notes: GENERAL NOTE: KIE: KIE Bib: Nurs 2003; 18(4):295-9. AIDS/human experimentation; human Abstract: Children's Hospital Boston began a major experimentation/foreign countries; human pain assessment and management initiative 3 years experimentation/research design ago: Pain assessment and management are considered Abstract: In 1997 a debate broke out about the ethical one of the institution's primary standards of care. The acceptability of using placebo as a comparative initiative included State of the Science meetings with alternative to establish effective treatment in trials internationally renowned nursing pain researchers and conducted in developing countries for the purpose of clinicians. These meetings generated nursing staff preventing perinatal HIV-transmission. The debate has interest in specific applications of what is known about now been going on for more than five years. In spite of pain; how evidence-based knowledge can be used to extensive and numerous attempts at resolving the ask population-specific clinical questions; and how an controversy, the case seems far from being settled. The evidence-based approach can be applied to aim of this paper is to provide an updated account of systematically develop, implement, and assess the debate, by identifying empirical arguments interventions that suit a population's clinical needs. employed in the controversy and by critically assessing This article is an example of an evidence-based pain their use in the debate. A notion of resolution of moral assessment project at Children's Hospital Boston that conflicts will be introduced that makes it possible to focused on nonverbal children with cognitive give a more positive verdict on the moral results of this impairments. After developing a clinical question, the controversy. Finally, the procedural problem of authors did a literature review and a benchmarking safeguarding the selection of empirical arguments analysis of best practice. The pilot of an adapted, against undue forms of normative bias will be existing pain assessment tool is described in this addressed. article. Soldera M, Dalgalarrondo P, Correa Filho HR, Silva CA. Solum LL, Schaffer MA. Ethical problems experienced by 862
- 871. school nurses. JSch Nurs 2003; 19(6):330-7. Sood B, Delaney-Black V, Covington C et al. Prenatal Abstract: This study explored school nurses' experience alcohol exposure and childhood behavior at age 6 to 7 of ethical conflict in school nursing through interviews years: I. dose-response effect. Pediatrics 2001; with six school nurses. The study examined how school 108(2):E34. nurses resolved ethical problems and the rationale used Abstract: OBJECTIVE: Moderate to heavy levels of to resolve them. Emergent themes of ethical problems prenatal alcohol exposure have been associated with were professional relationship conflicts, delegation to alterations in child behavior, but limited data are and supervision of health assistants, child protection available on adverse effects after low levels of reporting, maintaining confidentiality, Do Not exposure. The objective of this study was to evaluate Resuscitate policy, and pressure to work outside of the dose-response effect of prenatal alcohol exposure nursing practice standards. School nurses did not use for adverse child behavior outcomes at 6 to 7 years of ethical decision-making models in resolving conflict age. METHODS: Beginning in 1986, women attending but demonstrated the use of professional standards, the urban university-based maternity clinic were ethical principles, and personal values as rationale to routinely screened at their first prenatal visit for resolve ethical problems. Results of this study alcohol and drug use by trained research assistants suggested that school nurses would benefit from from the Fetal Alcohol Research Center. All women additional knowledge about ethical decision-making reporting alcohol consumption at conception of at least models. School nurses would also profit from hearing 0.5 oz absolute alcohol/day and a 5% random sample each other's voices through dialogue about ethical of lower level drinkers and abstainers were invited to problems and decision making. participate to be able to identify the associations between alcohol intake and child development. Songok EM, Fujiyama Y, Tukei PM et al. The use of short- Maternal alcohol, cigarette, and illicit drug use were course zidovudine to prevent perinatal transmission of prospectively assessed during pregnancy and human immunodeficiency virus in rural Kenya. Am J postnatally. The independent variable in this study, Trop Med Hyg 2003; 69(1):8-13. prenatal alcohol exposure, was computed as the Abstract: To determine the feasibility of using short- average absolute alcohol intake (oz) per day across course zidovudine (ZDV) to prevent mother-to-child pregnancy. At each prenatal visit, mothers were transmission of human immunodeficiency virus (HIV) interviewed about alcohol use during the previous 2 in a breastfeeding population in a rural area in Kenya, weeks. Quantities and types of alcohol consumed were pregnant mothers attending clinics in seven health converted to fluid ounces of absolute alcohol and centers in western Kenya between 1996 and 1998 were averaged across visits to generate a summary measure requested to volunteer for participation in this study. of alcohol exposure throughout pregnancy. Alcohol The HIV-infected mothers were given a daily dose of was initially used as a dichotomous variable comparing 400 mg of ZDV starting at 36 weeks of gestation and children with no prenatal alcohol exposure to children another 300 mg every three hours intrapartum. After with any exposure. To evaluate the effects of different delivery, mothers and their children were followed-up levels of exposure, the average absolute alcohol intake and clinically monitored every 3-4 months for two was relatively arbitrarily categorized into no, low (>0 years, and child and mother mortality rates were but <0.3 fl oz of absolute alcohol/day), and analyzed. Of the 825 mothers who consented, 216 moderate/heavy (>/=0.3 fl oz of absolute alcohol/day) (26.2%) were infected with HIV. Of those infected, 51 for the purpose of this study. Six years later, 665 (23.6%) took the full prescribed dose, 69 (31.9%) took families were contacted. Ninety-four percent agreed to only the prenatal dose, and the remaining 96 (44.4%) testing. Exclusions included children who missed did not take any dose. Failure to take ZDV was multiple test appointments, had major congenital attributed mainly to delivery occurring earlier than malformations (other than fetal alcohol syndrome), expected, while non-compliance to the intrapartum possessed an IQ >2 standard deviations from the dose was due to mothers giving birth at home and fear sample mean, or had incomplete data. The Achenbach of traditional birth attendants. By the end of the second Child Behavior Checklist (CBCL) was used to assess year, 75 HIV-exposed children (34.7%) and 33 HIV- child behavior. The CBCL is a parent questionnaire infected mothers (15.3%) had died. The HIV-free applicable to children ages 4 to 16 years. It is widely survival of children at 24 months was significantly used in the clinical assessment of children's behavior associated with mother survival (P < 0.001) and problems and has been extensively used in research. prenatal ZDV compliance (P < 0.003). Our findings Eight syndrome scales are further grouped into suggest that implementation of programs for Externalizing or undercontrolled (Aggressive and prevention of mother-to-child transmission of HIV in Delinquent) behavior and Internalizing or rural areas of Africa need to consider the various overcontrolled (Anxious/Depressed, Somatic socioeconomic and cultural barriers that may prevent Complaints, and Withdrawn) behaviors. Three successful uptake of antiretroviral prophylaxes. syndromes (Social, Thought, and Attention Problems) Similarly, the rapid disease progression in mothers may fit neither group. Higher scores are associated with eliminate the increase in child survival due to ZDV more problem behaviors. Research assistants who were prophylaxis. trained and blinded to exposure status independently 863
- 872. interviewed the childand caretaker. Data were is the presentation of an overview regarding the collected on a broad range of control variables known radiology of the battered child. Typical examples will to influence childhood behavior and/or to be associated be shown. with prenatal alcohol exposure. These included perinatal factors of maternal age, education, cigarette, Sorensen J, Abbott E. The maternity and infancy revolution. cocaine, and other substances of abuse and the Matern Child Health J 2004; 8(3):107-10. gestational age of the baby. Postnatal factors studied included maternal psychopathology, continuing alcohol Soto Mas F, Villalbi JR, Balcazar H, Valderrama Alberola J. and drug use, family structure, socioeconomic status, [Smoking initiation: epidemiology, research, and children's whole blood lead level, and exposure to behavioral sciences]. An Esp Pediatr 2002; 57(4):327- violence. Data were collected only from black women 33. as there was inadequate representation of other racial Abstract: Becoming a regular smoker is a process that groups. STATISTICAL ANALYSES: Statistical begins even before the first cigarette, and ends in analyses were performed using the SPSS statistical lifelong physical and psychological dependence. package. Frequency distribution, cross-tabulation, odds Various psychological and behavioral factors ratio, and chi(2) tests were used for analyzing contribute to this process. This article discusses categorical data. Continuous data were analyzed using t smoking initiation from a comprehensive perspective, tests, analyses of variance (ANOVAs) with posthoc including the physiological and addictive effects of tests, and regression analysis. RESULTS: Testing was nicotine, and the personal and environmental factors available for 501 parent-children dyads. Almost one that lead to smoking. Because smoking usually begins fourth of the women denied alcohol use during in adolescence, special emphasis is placed on this pregnancy. Low levels of alcohol use were reported in developmental stage and on the situations that 63.8% and moderate/heavy use in 13% of pregnancies. encourage teenagers to smoke the first cigarette. Increasing prenatal alcohol exposure was associated Finally, this article analyzes the importance of the with lower birth weight and gestational age, higher lead initiation process in the epidemiology and prevention levels, higher maternal age, and lower education level, of smoking. This approach may prove to be particularly prenatal exposure to cocaine and smoking, custody useful to clinicians interested in interventions aimed to changes, lower socioeconomic status, and paternal curb smoking. drinking and drug use at the time of pregnancy. Children with any prenatal alcohol exposure were more Soulier J, Clappier E, Cayuela JM et al. HOXA genes are likely to have higher CBCL scores on Externalizing included in genetic and biologic networks defining (Aggressive and Delinquent) and Internalizing human acute T-cell leukemia (T-ALL). Blood 2005; (Anxious/Depressed and Withdrawn) syndrome scales 106(1):274-86. and the Total Problem Score. The odds ratio of scoring Abstract: Using a combination of molecular in the clinical range for Delinquent behavior was 3.2 cytogenetic and large-scale expression analysis in (1.3-7.6) in children with any prenatal exposure to human T-cell acute lymphoblastic leukemias (T- alcohol compared with nonexposed controls. The ALLs), we identified and characterized a new recurrent threshold dose was evaluated with the 3 prenatal chromosomal translocation, targeting the major alcohol exposure groups. One-way ANOVA revealed a homeobox gene cluster HOXA and the TCRB locus. significant between group difference for Externalizing Real-time quantitative polymerase chain reaction (RQ- (Aggressive and Delinquent) and the Total Problem PCR) analysis showed that the expression of the whole Score. (ABSTRACT TRUNCATED) HOXA gene cluster was dramatically dysregulated in the HOXA-rearranged cases, and also in MLL and Sorantin E, Lindbichler F. [Nontraumatic injury (battered CALM-AF10-related T-ALL cases, strongly child)]. Radiologe 2002; 42(3):210-6. suggesting that HOXA genes are oncogenic in these Abstract: The recognition of a battered child represents leukemias. Inclusion of HOXA-translocated cases in a a challenge for all groups of adults dealing with general molecular portrait of 92 T-ALLs based on children. Radiology plays a special role in this setting. large-scale expression analysis shows that this By detection typical injuries, imaging is able to rearrangement defines a new homogeneous subgroup, confirm the suspicion of a battered child. Recognition which shares common biologic networks with the of those injuries on films, taken for other reasons, gives TLX1- and TLX3-related cases. Because T-ALLs the caretaker an important hint, thus maybe preventing derive from T-cell progenitors, expression profiles of a fatal outcome for the child. One of the most the distinct T-ALL subgroups were analyzed with important injury types is represented by the so called respect to those of normal human thymic "shaken baby syndrome". The infant is held by the subpopulations. Inappropriate use or perturbation of thorax and shaken. Thus causing a repetitive specific molecular networks involved in thymic acceleration-deceleration trauma, which leads to the differentiation was detected. Moreover, we found a typical paravertebral rib fractures, intracranial bleeding significant association between T-ALL oncogenic and eye injuries. After shaking the child is thrown subgroups and ectopic expression of a limited set of away, with subsequent injuries. The aim of this article 864
- 873. genes, including severaldevelopmental genes, namely where the 2nd-order statistical information on the HOXA, TLX1, TLX3, NKX3-1, SIX6, and TFAP2C. background EEG and on the unknown EP, necessary These data strongly support the view that the abnormal for the optimal filtering of each sweep in a Bayesian expression of developmental genes, including the estimation framework, is, respectively, estimated from prototypical homeobox genes HOXA, is critical in T- pre-stimulus data and obtained through a multiple ALL oncogenesis. integration of a white noise process model. The latter model is flexible (i.e. it can be employed for a large Southam-Gerow MA, Weisz JR, Kendall PC. Youth with class of EP) and simple enough to be easily identifiable anxiety disorders in research and service clinics: from the post-stimulus data thanks to a smoothing examining client differences and similarities. J Clin criterion. The mean EP is determined as the weighted Child Adolesc Psychol 2003; 32(3):375-85. average of the filtered sweeps, where each weight is Abstract: Compared 2 groups of children with anxiety inversely proportional to the expected value of the disorders: those treated in a university-based research norm of the correspondent filter error, a quantity clinic (RC) and those treated in community-based determinable thanks to the employment of the Bayesian service clinics (SCs). A widely endorsed goal in approach. The performance of the new approach is intervention research is to disseminate evidence-based shown on both simulated and real auditory EP. A treatments from RCs to SCs. Attaining this goal signal-to-noise ratio enhancement is obtained that can requires an understanding of the similarities and allow the (possibly automatic) identification of peak differences between clients in these 2 settings. Youth latencies and amplitudes with less sweeps than those from SCs showed more comorbid externalizing required by CA. For cochlear EP, the method also diagnoses and externalizing problems and were more allows the audiology investigator to gather new and likely to come from low-income and single-parent clinically important information. The possibility of families. On measures of internalizing symptomatology handling single-sweep analysis with further and diagnoses, youth from RCs were very similar to development of the method is also addressed. SC youth. To facilitate development of treatments with real-world applicability, we describe a model involving Spencer TJ, Biederman J, Wozniak J, Faraone SV, Wilens the testing of treatments in real-world settings. We also TE, Mick E. Parsing pediatric bipolar disorder from its discuss limitations to this project. associated comorbidity with the disruptive behavior disorders. Biol Psychiatry 2001; 49(12):1062-70. Spak F, Allebeck P, Spak L, Thundal KL. [The Gothenburg Abstract: The unique pattern of comorbidity found in study of women and alcohol: problems during pediatric mania greatly complicates accurate diagnosis, childhood and adolescence important risk factors]. the course of the disorder, and its treatment. The Lakartidningen 2001; 98(10):1109-14. pattern of comorbidity is unique by adult standards, Abstract: This is a part of longitudinal study especially its overlap with attention- concerning women and alcohol in Gothenburg. The deficit/hyperactivity disorder (ADHD), aggression, and aim was to find out more about risk factors for alcohol conduct disorder. Clinically, symptoms of mania have dependence and abuse (ADA) among women in the been discounted as severe ADHD or ignored in the general population, as well as social conditions and life context of aggressive conduct disorder. This atypicality style among these women. Several indicators of may lead to neglect of the mood component. The dissatisfactory childhood conditions, and particularly addition of high rates of additional disorders sexual abuse before age 13, were related to ADA in contributes to the severe morbidity, dysfunction, and adulthood. Early substance abuse, such as having been incapacitation frequently observed in these children. A intoxicated before age 15 and having used narcotics comprehensive approach to diagnostic evaluation is the before 18, was strongly related to future ADA. Our keystone to establishing an effective treatment program findings point to the need of paying attention to mental because response to treatment differs with individual health problems in childhood and youth, and to prevent disorders. Recognition of the multiplicity of disorders early use of alcohol and drugs. guides therapeutic options in these often refractory conditions. What was previously considered refractory Sparacino G, Milani S, Arslan E, Cobelli C. A Bayesian ADHD, oppositionality, aggression, and conduct approach to estimate evoked potentials. Comput disorder may respond after mood stabilization. We Methods Programs Biomed 2002; 68(3):233-48. review these issues in this article. Abstract: Several approaches, based on different assumptions and with various degree of theoretical Spike J. The sound of chains: a tragedy. J Clin Ethics 2005; sophistication and implementation complexity, have 16(3):212-7. been developed for improving the measurement of Notes: GENERAL NOTE: KIE: 4 fn. evoked potentials (EP) performed by conventional GENERAL NOTE: KIE: KIE Bib: allowing to averaging (CA). In many of these methods, one of the die/infants; ethicists and ethics committees major challenges is the exploitation of a priori knowledge. In this paper, we present a new method Spittal PM, Schechter MT. Injection drug use and despair 865
- 874. through the lensof gender. CMAJ 2001; 164(6):802-3. reconsidering the conceptualisations of female perverse behavior, especially in connection with motherhood. Spivak H. Bullying: why all the fuss? Pediatrics 2003; 112(6 METHODS AND FINDINGS: Based on case material Pt 1):1421-2. obtained through psychoanalytic psychotherapy with female patients from a psychosomatic gynecological Spoth RL, Redmond C. Project Family prevention trials outpatient clinic, the characteristics of the psychic based in community-university partnerships: toward structure of these patients who presented symptoms of scaled-up preventive interventions. Prev Sci 2002; deliberate self harm and of misusing and mistreating 3(3):203-21. their children, are outlined. Another common trait is Abstract: Findings from Project Family are presented the embeddedness of their perverse behavior in a to illustrate how a partnership-based program of generational chain of transmission. Female patients research on universal family- and youth-focused who mistreat their children had been victims of interventions is addressing a public health challenge. traumatising experiences in their own biography, One aspect of this public health challenge is the high inflicted by their mothers and directed towards their prevalence of youth problem behaviors and a second bodies. DISCUSSION: Female perverse behavior, aspect concerns barriers to scaling-up empirically- therefore, is fundamentally different from male supported preventive interventions designed to perversion: the perverse act in women is aimed against ameliorate those problem behaviors. Illustrative themselves and/or their children. Currently used findings are presented within a conceptual framework diagnostic statistical manuals lack categories to for scaling-up preventive interventions to achieve describe this symptomatology adequately. Further greater public health impact. Three interrelated sets of research is requested to understand a mother's perverse research requirements and findings are addressed actions and thus develop treatment strategies, without within this framework: (a) rigorously demonstrating marginalizing these patients. intervention effectiveness; (b) attaining sufficient levels of intervention utilization in diverse general Spurrier NJ, Sawyer MG, Streiner D, Martin AJ, Kennedy populations, requiring study of recruitment/retention D. New measure of parental asthma management for strategies, cultural sensitivity, and economic viability; school-age children. Pediatr Pulmonol 2005; and (c) achieving implementation quality, involving 40(3):241-50. investigation of adherence and dosage effects, along Abstract: A new parent-completed questionnaire to with theory-driven, intervention quality improvement. measure parental asthma management was developed. The paper concludes with discussion of the need for The new questionnaire takes a parental perspective, careful investigation of community-university with content of items and scoring focusing on all partnership models as a key mechanism for large-scale behaviors considered important by parents and not just implementation. those considered appropriate by clinicians. Parents of 101 school-age children with a previous hospital Spriggs M. Defending de-identification of research samples admission with asthma completed the questionnaire on the grounds of public health benefit. J Paediatr during home visits. The questionnaire was based on Child Health 2004; 40(5-6):327-8; author reply 328. five asthma scenarios. Parents were asked to indicate on a 6-point Likert scale how likely they would be to Spriggs M, Savulescu J. The Perruche judgment and the carry out a series of behaviors if the situations "right not to be born". J Med Ethics 2002; 28(2):63-4. occurred. Two methods of scoring were used: scenario- Notes: GENERAL NOTE: KIE: 14 refs. based scoring, and factor-based scoring. Scenario- GENERAL NOTE: KIE: KIE Bib: wrongful life based subscale scores suggested that parent's level of Abstract: The French government has given in to activity was consistent across different situations. public pressure and overturned a controversial legal Factor analysis showed that the questionnaire had three ruling which recognised the right of a disabled child to dominant factors. The medical assessment subscale seek damages. Most notably, the ruling, widely describes parent's level of activity in terms of seeking described as establishing a child's right "not to be medical care, the external advice subscale describes born", had provoked "outrage" amongst groups parent's level of activity in terms of seeking assistance defending the rights of the disabled and led to a ban on from knowledgeable others, and the home management prenatal scans by French gynaecologists. Once again, subscale describes parents' approaches to monitoring only parents will be able to seek damages but some and treating children at home. Alpha coefficients for people think the ruling has been misinterpreted. scenario-based and factor-based subscales indicated good internal reliability (0.65-0.84 and 0.81-0.91, Springer-Kremser M, Leithner K, Fischer M, Loffler-Stastka respectively). Test-retest reliability, 4 weeks apart, was H. Gender and perversion--what constitutes a "bad also adequate (correlation coefficients of 0.75-0.87). mother". Arch Womens Ment Health 2003; 6(2):109- This exploratory study describes the development of a 14. new questionnaire, the Asthma Management Abstract: BACKGROUND: There is a need for Questionnaire (AMQ). The questionnaire has a unique parent focus, consistent with contemporary notions of 866
- 875. patient-centered chronic-disease management. sexual, and physical abuse of persons instructed to role-play either dissociative identity disorder (DID) (n Squier W. Addressing the fundamental methods. Arch = 33), major depression (n = 33), or a college student Pediatr Adolesc Med 2005; 159(2):195; author reply who experienced minor adjustment problems 195. ("normal") (n = 33) across a number of trials that included role-played hypnosis. As hypothesized, more Ssemakula JK. The impact of 9/11 on HIV/AIDS care in of the participants who were asked to role-play DID Africa and the Global Fund to Fight AIDS, reported at least one instance of satanic ritual abuse and Tuberculosis, and Malaria. J Assoc Nurses AIDS Care sexual abuse compared with those who role-played 2002; 13(5):45-56. depression or a college student with minor adjustment Abstract: The September 11, 2001 terrorist attacks in problems. DID role-players reported more incidents of the United States sent shock waves throughout the sexual abuse and more severe physical and sexual world. The World Bank said the events of 9/11 were abuse than did the major depression role-players. likely to have mid- to long-term negative effects in Further, the DID role-players differed from the normal some countries, and donor assistance to Africa could be role-players on all the measures of frequency and affected. The terrorist attacks also had the effect of severity of physical and sexual abuse. Participants in bringing up the issue of security and the potential threat all groups reported more frequent and severe incidents the HIV/AIDS epidemic poses to international security, of physical abuse after role-played hypnosis than they especially in Africa. This article examines some of the did prior to it. effects of the 9/11 attacks on the fight against HIV/AIDS in Africa, and their implications. Stahl C, Fritz N. Internet safety: adolescents' self-report. J Adolesc Health 2002; 31(1):7-10. St Germain DM. The way I see it. We have to stand up for Abstract: We examined the association between the children. Med Econ 2002; 79(14):50, 53. adolescents' unsafe experience online, types of Internet activity, and safety practices using a questionnaire Stadler C, Schmeck K, Nowraty I, Muller WE, Poustka F. returned by 213 private school students (seventh Platelet 5-HT uptake in boys with conduct disorder. through tenth grades) in spring 1999. One-fourth of Neuropsychobiology 2004; 50(3):244-51. respondents reported unsafe experiences. Types of Abstract: Dysregulation of serotonergic function has unsafe experience varied with gender, Internet activity, been found to be associated with aggression in animals, and identity sharing. human adults and adolescents. However, studies with children have shown conflicting results. The objective Stahlman MT. How does neonatology fit into maternal and of this study was to investigate whether the kinetic child health? J Perinatol 2005; 25(12):794-9. characteristics (Vmax and Km) of 5-HT uptake in platelets are different in children with the diagnosis of Stalker CA, Russell BD, Teram E, Schachter CL. Providing conduct disorder according to ICD-10 and healthy age- dental care to survivors of childhood sexual abuse: matched controls. In addition to the standardized treatment considerations for the practitioner. J Am assessment of general psychopathology, methods Dent Assoc 2005; 136(9):1277-81. assessing narrowband aggressive symptoms (Child Abstract: BACKGROUND: Adults who experienced Behavior Checklist) and emotional reactivity to an childhood sexual abuse frequently find dental treatment experimentally induced provocation (Taylor's difficult to tolerate. Increased understanding of competitive reaction time task) were used in both common long-term effects of this trauma may help groups. We found a trend for a lower mean Vmax of dental professionals to respond more sensitively to platelet 5-HT uptake in 14 conduct-disordered boys patients who have experienced it. METHODS: The compared with healthy controls (n=15). If, however, 2 authors recruited 58 men and 19 women with self- patients with a low degree of aggression and emotional reported histories of childhood sexual abuse from reactivity were excluded, the difference became social agencies serving this population and interviewed significant (mean=4.27, SD=3.49 in patients and the participants about their experiences with health care mean=8.45, SD=4.63 in controls). A significant professionals, including dentists. The authors analyzed negative correlation was found between parent-rated interview transcripts using the constant comparative aggression scores and Vmax (r=-0.41, p < 0.05, n=29). method to identify main themes and patterns. These data suggest that dysfunction of 5-HT transport RESULTS: Participants reported aspects of dental mechanisms might be associated with specific treatment that can be particularly difficult for them and behavioral symptoms in conduct-disordered children. offered ideas about how dental health professionals could make the experience more tolerable for them. Stafford J, Lynn SJ. Cultural scripts, memories of childhood The data analysis produced suggestions about how abuse, and multiple identities: a study of role-played dentists might respond sensitively to patients who enactments. Int J Clin Exp Hypn 2002; 50(1):67-85. frequently cancel appointments, are distressed by Abstract: This study compared the reports of satanic, certain body positions, need a sense of control and fear 867
- 876. judgment. The authorsalso report participants' thoughts likely to occur, and possibly assist us in predicting about questions from dental practitioners regarding a future outbreaks. The aim of this study is the history of childhood sexual abuse. CONCLUSIONS: investigation of the coverage achieved for compulsory Adults who report a history of childhood sexual abuse (diphtheria, tetanus, polio, hepatitis B,) and are more likely to experience dental treatment more recommended (pertussis, Haemophilus influenzae, positively when dental professionals have some measles-mumps-rubella) vaccinations between 1998 understanding of the long-term effects of such abuse, and 2002 in the municipality of Bologna and the including how it can affect dental treatment identification of the subjects not complying with interactions. Such knowledge enables dental compulsory and recommended vaccinations. professioinals to respond to their needs in a sensitive METHODS: The statistics regarding vaccinal coverage manner. were elaborated from the data supplied by the Bologna vaccinal registration system (1998-2000) and the IPV4 Staller KM, Nelson-Gardell D. "A burden in your heart": program (2001-2002). To calculate the coverage for lessons of disclosure from female preadolescent and compulsory vaccinations and cases of non-compliance adolescent survivors of sexual abuse. Child Abuse reference was made to the protocol drawn up by the Negl 2005; 29(12):1415-32. Emilia Romagna Regional Administration. The reasons Abstract: OBJECTIVES: To enhance understanding of for non-compliance were divided into various the sexual abuse disclosure process from the categories RESULTS: In Bologna the levels of perspective of preteen and teenage survivors. To immunization for the four compulsory vaccinations are reconsider prominent models of the disclosure process satisfactory: over 95% children completed the vaccinal in light of our findings. METHODS: We conducted a cycle, receiving the booster for anti-polio foreseen in secondary analysis of data from four focus groups in their 3rd year and for anti-diphtheria, tetanus, pertussis which 34 preadolescent and adolescent female at 6 years. The frequency of subjects with total non- survivors of sexual abuse had been asked about their compliance (i.e. those who have not begun any treatment experiences. Girls often recounted disclosing compulsory vaccinations by the age of one year) is their victimization to others. Using the disclosure generally higher in Bologna than in the region, with a segment as our unit of analysis, we isolated 106 for slight increase in 2002 (2.52% and 1.06% in the city study. During analysis, we wrote narrative summaries and the region respectively). The frequency of the anti- of each segment's significance, grouped these measles vaccination is higher than that of mumps and conceptually, and examined their interconnectedness. rubella, which means that the single vaccine, as When synthesized, individual experiences of disclosing opposed to the combined MMR (measles-mumps- contributed to understanding the overall disclosure rubella) was still being used in the period in question. process. RESULTS: Three phases were identified: Self, The most common reason for non compliance is where children come to understand victimization objection of parents and is probably due to reduction of internally; Confidant Selection-Reaction, where they certain diseases or anxiety about the possible risks. select a time, place, and person to tell and then weather CONCLUSION: In Bologna the frequency of children that person's reaction (supportive or hostile); and aged 12 and 24 months who have achieved compulsory Consequences (good and bad) that continued to inform vaccination varied, in 2002, between 95% and 98%. As their on-going strategies of telling. The actions and regards recommended vaccinations the percentage of reactions of adults were significant and informed the coverage against Haemophilus influenzae is 93.3%, girls' decisions. CONCLUSIONS: We advocate while the levels for measles, mumps and pertussis integrating existing theories and research into a model range from 84% to approx. 92%. Although these which views the disclosure process from the child's percentages are higher if compared to those obtained perspective and includes pre-disclosure and a post- by other Italian regions, every effort should be made to initial public disclosure stages. The model strengthen the aspects that lead to a successful vaccinal conceptualizes disclosure as an iterative process in strategy. which children interact with adults and incorporate responses into their on-going decisions about telling Stanger C, Dumenci L, Kamon J, Burstein M. Parenting and (recant, deny, affirm, etc.). The combined model children's externalizing problems in substance-abusing should recognize the concerns and position of adults as families. J Clin Child Adolesc Psychol 2004; well as the perspective and logic of youth. 33(3):590-600. Abstract: This study tested associations in path models Stampi S, Ricci R, Ruffilli I, Zanetti F. Compulsory and among positive and negative parenting and children's recommended vaccination in Italy: evaluation of rule-breaking behavior, aggressive and oppositional coverage and non-compliance between 1998-2002 in behavior, and attention problems for families with a Northern Italy. BMC Public Health 2005; 5(1):42. drug-dependent parent. A structural model tested Abstract: BACKGROUND: Since vaccinations are an relations between parenting and children's externalizing effective prevention tool for maintaining the health of problems for 251 families with 399 children between society, the monitoring of immunization coverage the ages of 6 and 18, controlling for nonindependence allows us to identify areas where disease outbreaks are of ratings at the family level. The model also tested 868
- 877. potential moderators, includingchild age, gender, and 2003, focusing on neonatal intensive care unit ethnicity (White vs. other), and caregiver gender admission rates. The return-on-investment evaluation (families with a female substance-abusing caregiver vs. reflected attributable incremental program costs and families with a male substance-abusing caregiver). resultant savings. METHODS: Interventions included Results indicated that caregiver ratings of monitoring enhanced identification and stratification of high-risk predicted rule-breaking behavior and use of women with the use of a health risk assessment form; inconsistent discipline predicted ratings of all 3 outreach through nursing care coordination offering externalizing syndromes, after controlling parenting home visits, transportation, support services, social and externalizing problems for the effects of the work services, and connection with other community- moderators and after controlling significant relations based organizations; and implementation of a strong among types of parenting and types of externalizing informatics structure. RESULTS: Neonatal intensive problems. care unit admission rates decreased from 107.6 per 1000 births in 1998 to 56.7 per 1000 births in 2003. Stanger C, Kamon J, Dumenci L et al. Predictors of The return on investment from the incremental internalizing and externalizing problems among program enhancements was just over dollars 2 per children of cocaine and opiate dependent parents. Drug dollars 1 expended. CONCLUSION: A program that Alcohol Depend 2002; 66(2):199-212. identifies its high-risk pregnant enrollees in a timely Abstract: We tested associations in structural models fashion, provides outreach using a strong nursing care among parent individual problems (severity of drug coordination and social work emphasis, and has an problems, medical problems, psychiatric symptoms), enhanced informatics structure can significantly affect family problems, and children's internalizing and birth outcomes for a Medicaid managed care externalizing problems. Results were compared for population. cocaine versus opiate dependent parents, mothers versus fathers, boys versus girls, and older versus Stanton B, Li X, Cottrell L, Kaljee L. Early initiation of sex, younger children. Cocaine and opiate dependent drug-related risk behaviors, and sensation-seeking parents in treatment (N=211) were interviewed about among urban, low-income African-American their substance use, psychiatric symptoms, and adolescents. J Natl Med Assoc 2001; 93(4):129-38. interpersonal problems and completed a measure of Abstract: The purpose of this study was to examine the family problems. Parents also rated children's relationship of early initiation of sex, drug-use, drug- internalizing and externalizing problems. In structural trafficking, and sensation-seeking among urban, models controlling for the significant correlations African-American adolescents. A longitudinal follow- between parent and family problems and between up of 383 youth ages 9 to 15 years at baseline over four children's internalizing and externalizing problems, years with serial risk-assessments was used. Sexual family problems but not individual parent problems experience and several drug-related risk behaviors predicted children's internalizing and externalizing increased significantly during the four-year study symptoms. Models were similar across all groups interval. Sensation-seeking scores were higher after the compared with the exception of parent gender, with baseline assessment among youth reporting tobacco, significant relations between parent and family alcohol, and marijuana use and were higher, both at problems for mothers but not for fathers. In addition, baseline and through several follow-up assessments, older girls were more deviant relative to their same-age among youth reporting drug-selling and sexual activity. and gender peers than the younger girls and boys. At baseline, the correlations among drug-related risk These results suggest that the personal problems of behaviors were all strong, except those between drug dependent mothers may influence children's initiation of sex and drug-related risk behaviors. problems indirectly by increasing family problems. For However, over time, early initiators of sex were drug dependent fathers, family problems were an significantly more likely to report involvement in independent predictor of children's problems. substance use and drug-delivery/sales than were late initiators. Youth reporting repeated involvement in Stankaitis JA, Brill HR, Walker DM. Reduction in neonatal drug-related activities were more likely to report intensive care unit admission rates in a Medicaid intensive sexual involvement than they were to report managed care program. Am J Manag Care 2005; experimental sex or no sex. Sensation-seeking scores 11(3):166-72. were lower among youth reporting no involvement in Abstract: BACKGROUND: Neonatal intensive care risk behaviors. However, scores did not differ between unit admission rates are an important birth outcome youth exhibiting experimental behavior compared to indicator for Medicaid managed care organizations. youth demonstrating repeated risk involvement. These OBJECTIVES: To reduce neonatal intensive care unit results support the need for alternative experiences for admission rates by at least 15% and to maintain that youth exhibiting high levels of sensation-seeking and reduction through implementation of a quality the need for early drug/sexual risk prevention improvement program. STUDY DESIGN: The programs. organization performed a longitudinal population- based review of its birth outcomes from 1997 through Starkey F, Moore L, Campbell R, Sidaway M, Bloor M. 869
- 878. Rationale, design andconduct of a comprehensive Children (HBSC). Using stratified random sampling, evaluation of a school-based peer-led anti-smoking the representative sample of 5645 schoolchildren aged intervention in the UK: the ASSIST cluster randomised 11, 13, and 15 years from 104 schools of Lithuania was trial. BMC Public Health 2005; 5(1):43. drawn and surveyed. Associations between potential Notes: CORPORATE NAME: ASSIST risk factors and injuries among schoolchildren were Abstract: BACKGROUND: To date, no school-based evaluated calculating odds ratio and its 95% confidence intervention has been proven to be effective in intervals. For the evaluation of the impact of preventing adolescent smoking, despite continuing explanatory variables on analyzed event, logistic concern about smoking levels amongst young people in regression analysis was performed. Behavioral, the United Kingdom. Although formal teacher-led psychological, and social integration factors were smoking prevention interventions are considered associated with the risk to sustain injuries among unlikely to be effective, peer-led approaches to school-aged children. The impact of these factors reducing smoking have been proposed as potentially varied within subgroups of schoolchildren by grade and valuable. METHODS/DESIGN: ASSIST (A Stop sex. The most significant factors were: risk-taking Smoking in Schools Trial) is a comprehensive, large- behavior (smoking, alcohol and drug consumption, scale evaluation to rigorously test whether peer premature sexual activity), frequent participation in supporters in Year 8 (age 11-12) can be recruited and sport activities, involvement in physical fight, longer trained to effect a reduction in smoking uptake among time spent away from home with friends, experienced their fellow students. The evaluation is employing a bullying, poor self-assessed health and academic cluster randomised controlled trial (RCT) design with achievement, unhappiness, feeling unsafe at school, secondary school as the unit of randomisation, and is and high suicidal risk. Analysis failed to identify an being undertaken in 59 schools in South East Wales expected association between lower socio-economic and the West of England. Embedded within the trial are status and risk for injury. Integrated approach to injury an economic evaluation of the intervention costs, a etiology is essential in planning injury prevention and process evaluation to provide detailed information on safety promotion activities among schoolchildren, how the intervention was delivered and received, and paying particular attention to lifestyle factors, which an analysis of social networks to consider whether such can have the potential influence on risk to sustain a peer group intervention could work amongst injuries. schoolchildren in this age group. Schools were randomised to either continue with normal smoking Stasevic I, Ropac D, Lucev O. Association of stress and education (n = 29 schools, 5562 students), or to do so delinquency in children and adolescents. Coll Antropol and additionally receive the ASSIST intervention (n = 2005; 29(1):27-32. 30 schools, 5481 students). No schools withdrew once Abstract: The aim of investigation was to assess the the trial had started, and the intervention was impact of subjective stress exposure on delinquent successfully implemented in all 30 schools, with behaviour in children and adolescents. The study excellent participation rates from the peer supporters. included 174 young male delinquents, selected by the The primary outcome is regular (weekly) smoking, method of stratified systematic (random) sample and validated by salivary cotinine, and this outcome has divided into three age groups of <14, 14-17, and 18-21 been obtained for 94.4%, 91.0% and 95.6% of eligible years. General data, data on the type of criminal students at baseline, immediate post-intervention, and offence, and data on the type of deviant behaviour were one-year follow-up respectively. DISCUSSION: collected. A standardised scale of subjective stress was Comprehensive evaluations of complex public health used to allow for comparison of the results obtained in interventions of this scale and nature are rare in the the study with those reported elsewhere. Analysis of United Kingdom. This paper demonstrates the variance, chi2-test and factor analysis were used on feasibility of conducting cluster RCTs of complex data processing. A majority of study subjects (55.2%) public health interventions in schools, and how the committed one criminal offence. The criminal offence rigour of such designs can be maximised both by structure was predominated by proprietary violation thorough implementation of the protocol and by (66.7%). Common forms of deviant behaviour included broadening the scope of questions addressed in the trial shirking school duties (55.2%), and aggressive by including additional evaluative components. behaviour at school (31.0%), in public (29.5%) and in the family (23.6). Parental distrust and punishment Starkuviene S, Zaborskis A. Links between accidents and (abuse) of the child were identified as the major lifestyle factors among Lithuanian schoolchildren. sources of subjective stress. Youngest subjects Medicina (Kaunas) 2005; 41(1):73-80. significantly differed from other age groups according Abstract: The aim of the study was to evaluate to their experience of subjective stress described as associations of some lifestyle factors with injuries punishment (abuse) (F = 22.1389, p < 0.001). They among schoolchildren. Analysis was performed using were considerably more vulnerable to this type of data from the survey conducted in 2002 according to stress than older age groups. These sources of stress the methods of World Health Organization Cross- were found to positively correlate with the number of National Study on Health Behavior in School-Aged criminal offences committed. Among the sources of 870
- 879. stress, parents' distrustof the child significantly educational efforts within the institution. All correlated with commitment of one criminal offence (F participants (except one) were African American and = 2.8618, p < 0.05), and child's punishment (abuse) reported low monthly family incomes (M = $869.45, with a higher number of criminal offences (F = 3.1539, SD = $832.63). Assessment instruments included p < 0.05). Criminal activity of children and adolescents measures of perceived vulnerability, caregiver-reported is significantly associated with their history of stress adherence and perceived barriers, and objective exposure over the last two years of life. The higher the measures of adherence (clinical pill count; electronic stress severity, the greater the rate of delinquency. measurement). The results failed to demonstrate a significant relationship between parental perceived Statman D. The right to parenthood: an argument for a vulnerability, perceived barriers and adherence to narrow interpretation. Ethical Perspect 2003; 10(3- antiretroviral medications. Methods of assessing 4):224-35. adherence provided significantly discrepant estimates Notes: GENERAL NOTE: KIE: 23 refs. 34 fn. of adherence. Results are discussed in terms of GENERAL NOTE: KIE: KIE Bib: reproduction; implications for patient care and for future research in reproductive technologies this area. The addition of behavioural and motivational Abstract: The paper argues for two kinds of limitations components to traditional educational approaches may on the right of parenthood. First, it claims that the right positively impact treatment results. to parenthood does not entail a right to have as many children as one desires. This conclusion follows from Steen K, Hunskaar S. Gender and physical violence. Soc Sci the standard justifications for the right to parenthood, Med 2004; 59(3):567-71. none of which establishes the need to grant special Abstract: This study examines incidents of physical protection to having as many children as one desires. violence in relation to the sex of both assault victim Second, with respect to the right to receive assistance and attacker. A survey of all assault victims attending from the state in IVF, it is suggested that the state an urban accident and emergency department (AED) in should also be allowed to take non-medical Norway during a 2-year period was carried out. All the considerations into account in determining whether or assault victims were interviewed using a structured not an applicant is entitled to this service, particularly questionnaire administered by the attending physician in cases where the applicant seems to lack mothering as part of the initial consultation at the AED. During ability. this interview, information about the victims, the attackers and the assaults was collected from the Steele H. Unrelenting catastrophic trauma within the family: victims. Information on the sex, age, alcohol state of when every secure base is abusive. Attach Hum Dev victims, and any referral to hospitals and specialists, 2003; 5(4):353-66; discussion 409-14. was collected from the victim's medical notes at the Abstract: This paper will present illustrations from AED. The severity of the victim's injuries was rated Adult Attachment Interviews conducted with adult retrospectively using Abbreviated Injury Scale (AIS) female survivors of chronic ritual abuse in their family and Shepherd's Injury Severity Scale for rating of of origin. A model of multiple personality disorder injuries of assault. A total of 1234 men (74%) were informed by the Adult Attachment Interview coding attacked by other men, 354 women (21%) were and classification system will be presented. A range of attacked by men, 33 men (2%) by women, and 59 victim, perpetrator and bystander personalities may be women (4%) by other women. The characteristics of identified in the same interview, indeed in the same the assaults carried out amongst female victim-female speaker. For the speaker who believes herself to be one attacker and male victim-male attacker groups had of a number of co-existing personalities, integration many similarities. The same was found for the female and coherence means death of a loved one, indeed victim-male attacker and male victim-female attacker death of the sense of self. Possibilities of re-birth into a groups. We conclude that changes in the traditional single integrated self are posited. behaviour associated with women and men in relation to physical violence may be taking place. Steele RG, Anderson B, Rindel B et al. Adherence to antiretroviral therapy among HIV-positive children: Steen K, Hunskaar S. Violence: a prospective study of police examination of the role of caregiver health beliefs. and health care registrations in an urban community in AIDS Care 2001; 13(5):617-29. Norway. Med Sci Law 2001; 41(4):337-41. Abstract: This study examined the association between two components of the Health Belief Model (perceived Steen K, Hunskaar S. Violence in an urban community from vulnerability and barriers) and adherence to the perspective of an accident and emergency antiretroviral therapy (ART) among children who are department: a two-year prospective study. Med Sci HIV-infected. The parents/caregivers of 30 children Monit 2004; 10(2):CR75-9. (mean age = 5.21, SD = 3.18) who were HIV-infected Abstract: BACKGROUND: Information about and who were on active ART were surveyed to assess violence in a given community is usually based on current methods of adherence assessment and crime statistics. The aim of this study was to explore 871
- 880. violence in anurban community from the perspective through later physical abuse and self- of an accident and emergency department. esteem.CONCLUSIONS: Although there was a strong MATERIAL/METHODS: All assault victims treated at relationship between childhood abuse and parent drug the Bergen Accident and Emergency Department use, childhood abuse was the more pervasive and (AED) during a two-year period (1994-1996) were devastating predictor of dysfunctional outcomes. prospectively registered, and data were collected about Childhood abuse predicted a wider range of problems the patients and the assault incidents. To assess the including lower self-esteem, more victimization, more proportion of unrecognized assault victims treated at depression, and chronic homelessness, and indirectly the AED, an anonymous questionnaire was sent to all predicted drug and alcohol problems. The mediating adult patients (first-time consultations) who visited the roles of recent physical abuse and self-esteem suggest AED during a ten-day period in 1997. RESULTS: 1803 salient leverage points for change through assault victims were registered, 433 of whom (24%) empowerment training and self-esteem enhancement in were females. Most of the victims were young men homeless women. assaulted at public locations, under the influence of alcohol, often by unknown attackers, and frequently Stein MT, Adams J, Wells RD. Erica: a question of sexual feeling that the attack was unprovoked (and thus abuse. J Dev Behav Pediatr 2001; 22(2 Suppl):S37-41. defined as street violence). Few victims of child abuse or elder abuse were identified. About 40% of the Stein MT, Pickering B, Tanner JL, Mazzella CB. Parental females were victims of domestic violence. Non- refusal to immunize a 2-month-old infant. J Dev Behav Norwegians, unemployed, and people living in Pediatr 2001; 22(2 Suppl):S87-91. economically deprived areas of the community were over represented. A minority of the assault victims Stein MT, Sandberg DE, Mazur T, Eugster E, Daaboul J. A wanted to press legal charges. From the postal survey newborn infant with a disorder of sexual (n=1264, response rate 43%) few unrecognized victims differentiation. J Dev Behav Pediatr 2004; 25(5 of violence could be identified among our patients. Suppl):S74-8. CONCLUSIONS: An accident and emergency department registration of violence victims will mostly Steinhausen HC, Willms J, Metzke CW, Spohr HL. identify male victims of street violence. Behavioural phenotype in foetal alcohol syndrome and foetal alcohol effects. Dev Med Child Neurol 2003; Stein JA, Leslie MB, Nyamathi A. Relative contributions of 45(3):179-82. parent substance use and childhood maltreatment to Abstract: A sample of 12 children (seven males, five chronic homelessness, depression, and substance abuse females; mean age 6 years 7 months, SD 2 years 6 problems among homeless women: mediating roles of months, range 2 years 4 months to 12 years 1 month) self-esteem and abuse in adulthood. Child Abuse Negl with moderate-to-severe foetal alcohol syndrome 2002; 26(10):1011-27. (FAS) and another sample of 26 children (12 males, 14 Abstract: OBJECTIVE: This study, using latent females; mean age of 6 years 2 months SD 2 years 10 variable methodology, explores simultaneously the months, range 2 years 6 months to 12 years 8 months) relative effects of childhood abuse and early parental with mild FAS or foetal alcohol effects (FAE) as well substance abuse on later chronic homelessness, as a sample of 15 age- and sex-matched control depression, and substance abuse problems in a sample children with unspecific intellectual disability were of homeless women. We also examine whether self- compared using the Developmental Behaviour esteem and recent violence can serve as mediators Checklist (DBC). There were significant differences between the childhood predictors and the dysfunctional (p=0.01) between the groups on five of six subscales of outcomes.METHOD: The sample consists of 581 the DBC with controls scoring lower on the disruptive, homeless women residing in shelters or sober living self-absorbed, anxiety, antisocial behaviour, and centers in Los Angeles (54% African-American, 23% communication disturbance scales. The DBC profiles Latina, 22% White, mean age=33.5 years). Multiple- of the two foetal alcohol exposed groups did not differ indicator latent variables served as predictors and from each other. It is concluded that quantitative outcomes in structural models. Childhood abuse was behaviour measurement provides insights into specific indicated by sexual, physical, and verbal behavioural phenotypes of FAS/FAE. abuse.RESULTS: Childhood abuse directly predicted later physical abuse, chronic homelessness, depression, Steliarova-Foucher E, Stiller C, Kaatsch P et al. and less self-esteem. Parent substance use directly Geographical patterns and time trends of cancer predicted later substance use problems among the incidence and survival among children and adolescents women. Recent physical abuse predicted chronic in Europe since the 1970s (the ACCISproject): an homelessness, depression, and substance use problems. epidemiological study. Lancet 2004; 364(9451):2097- Greater self-esteem predicted less depression and fewer 105. substance use problems. Childhood abuse also had Abstract: BACKGROUND: Cancer is rare before age significant indirect effects on depression, chronic 20 years. We aimed to use the European database of homelessness, and drug and alcohol problems mediated 872
- 881. childhood and adolescentcancer cases, within the Stephenson MT, Quick BL. Parent ads in the National Youth Automated Childhood Cancer Information System Anti-Drug Media Campaign. J Health Commun 2005; project, to estimate patterns and trends of incidence and 10(8):701-10. survival within Europe. METHODS: Comparable, Abstract: The National Youth Anti-Drug Media high-quality data from 63 European population-based Campaign aims not only to reduce drug use by teens cancer registries consisted of 113000 tumours in and preteens, but also to arm parents with knowledge children and 18243 in adolescents diagnosed in 1970- about specific parenting practices known to reduce the 99. Incidence rates and survival were compared by risk of teen drug use. Among the documented region (east vs west), period, and malignant disease. successes of the campaign to date was a small, but FINDINGS: In the 1990s, age-standardised incidence direct effect on some parenting practices, including rates were 140 per million for children (0-14 years) and parent-child discussions about drug use. To reach a 157 per million for ages 0-19 years. Over the three deeper understanding about the substance of the decades, overall incidence increased by 1.0% per year parental ads, we content analyzed the message (p<0.0001) in children (increases for most tumour strategies employed in the campaign's parent ads over types), and by 1.5% (p<0.0001) in adolescents (15-19 the inaugural 5 years of the campaign. Each ad was years; notable increases were recorded for carcinomas, coded for its major theme, minor subtheme, and lymphomas, and germ-cell tumours). Overall 5-year featured drug. Among seven possible major themes, the survival for children in the 1990s was 64% in the east parental anti-drug ads largely featured four: enhance and 75% in the west, with differences between regions the risk of their child's drug use, encourage monitoring for virtually all tumour groups; 5-year survival was practices, promote parent-child discussions about drug much the same in adolescents. Survival has improved use, or advocate positive involvement behaviors. dramatically since the 1970s in children and Moreover, most parental messages addressed adolescents, more so in the west than in the east. marijuana use or addressed drug use in general. INTERPRETATION: Our results are clear evidence of Marijuana and inhalant ads largely were risk based, an increase of cancer incidence in childhood and while general drug messages focused on monitoring, adolescence during the past decades, and of an parent-child discussions or positive involvement acceleration of this trend. Geographical and temporal practices. patterns suggest areas for further study into causes of these neoplasms, as well as providing an indicator of Stephenson MT, Quick BL, Atkinson J, Tschida DA. progress of public-health policy in Europe. Authoritative parenting and drug-prevention practices: implications for antidrug ads for parents. Health Sten E, Hansen TK, Stahl Skov P et al. Cross-reactivity to Commun 2005; 17(3):301-21. eel, eelpout and ocean pout in codfish-allergic patients. Abstract: This research employed the theory of Allergy 2004; 59(11):1173-80. reasoned action to investigate the role of authoritative Abstract: Fish allergy is one of the most common food parenting in 3 drug-prevention behaviors: (a) parental allergies in both children and adults and patients with monitoring, (b) parent-child discussions, and (c) allergic reactions to one fish species have in many awareness of the child's environment. A phone survey cases been given the advice to avoid all fish, without of 158 parents of adolescents in 7th, 9th, and 11th further evaluation. The possible common reactivity grades revealed that authoritative parenting was between different fish species is not well studied. correlated with parenting practices that reduce the Because of this and a possible exploitation of fish likelihood of adolescent drug use, including discussing species hitherto not much used in the Scandinavian diet family rules about drugs, discussing strategies to avoid ocean pout, eelpout and eel were evaluated. We drugs, discussing those in trouble with drugs, parental examined the serological and biological cross- monitoring, knowing the child's plans for the coming reactivity of these species in double-blind challenged- day, and personally knowing the child's friends well. confirmed codfish-allergic patients using CAP, Additionally, authoritative parenting moderated the Maxisorp-radio allergosorbent test (RAST) inhibition, attitude-behavioral intention relation for parental western blot, skin prick test (SPT) and histamine monitoring and awareness of the child's environment, release (HR). All 18 codfish allergic patients had with the weakest relation detected for low-authoritative specific IgE to ocean pout, eelpout and eel determined parents. The utility of these findings in helping design by Maxisorp-RAST. All four fish species could induce and target antidrug messages for parents more basophil HR using blood from 16 of 18 patients and all effectively is discussed. patients tested reacted in SPT. This study demonstrates that patients with a verified clinical allergy to codfish Sterk CE, Klein H, Elifson KW. Perceived condom use self- in a high frequency express biological cross-reactivity efficacy among at-risk women. AIDS Behav 2003; to other fish species. By RAST inhibition this common 7(2):175-82. reactivity was shown to be a true cross-reactivity. Abstract: The objectives of this study are to assess the confidence in their ability to use condoms among at- Stephenson JB. Shaken baby syndrome. J R Soc Med 2003; risk women and identify predictors for the women's 96(2):102-3; author reply 103. condom use self-efficacy. Structured interviews were 873
- 882. conducted with 250adult women in Atlanta, Georgia, and intraparietal sulcus bilaterally. There was a between August 1997 and August 2000. Overall, the significant group-by-condition interaction in the right women reported feeling moderately to moderately- dorsal anterior cingulate cortex that was due to a strongly confident in their ability to use condoms pronounced deactivation in the patient group during consistently. Multivariate analysis showed women with viewing of negative pictures. When correcting for higher condom use self-efficacy were significantly anxiety and depressive symptoms, we additionally younger, experienced childhood neglect, had higher found a reduced responsiveness of the left amygdala to self-esteem, communicated better with their sex negative pictures in patients compared with control partner, and had fewer drug problems. Findings suggest subjects. CONCLUSIONS: We suggest that these the importance of addressing condom use self-efficacy findings reflect an impairment of both the recognition in HIV risk reduction programs with a specific focus of emotional stimuli and the cognitive control of on women and the need to be attuned to tailored needs emotional behavior in patients with CD, resulting in a for specific subgroups such as older women or women propensity for aggressive behavior. who encountered childhood neglect. Stevens MC, Kaplan RF, Hesselbrock VM. Executive- Stern JM. Traumatic brain injury: an effect and cause of cognitive functioning in the development of antisocial domestic violence and child abuse. Curr Neurol personality disorder. Addict Behav 2003; 28(2):285- Neurosci Rep 2004; 4(3):179-81. 300. Abstract: The present study examined the association Sternberg KJ, Knutson JF, Lamb ME, Baradaran LP, Nolan of cognitive-executive abilities to two risk factors for CM, Flanzer S. The child maltreatment log: a alcoholism, i.e., antisocial behaviors and a family computer-based program for describing research history (FH+) of alcohol dependence. A sample of 91 samples. Child Maltreat 2004; 9(1):30-48. right-handed, non-substance-dependent, young male Abstract: The Child Maltreatment Log (CML) is a adults recruited from the community were classified computer-based program designed to record into three groups: (1) a control group of n=32 men with information about children's maltreatment experiences no history of DSM-III-R childhood conduct disorder and associated life events. Addressing concerns posed (CD) or antisocial personality disorder (ASPD); (2) by scientific panels and grant review panels, the CML n=25 men who met criteria for a DSM-III-R childhood was designed to improve upon existing instruments to CD diagnosis, but did not meet diagnostic criteria for facilitate collaboration among researchers interested in ASPD (i.e., CD/ASPD-); and (3) n=34 men who met maltreatment. The CML encourages researchers to DSM-III-R criteria for ASPD. They were further collect information from multiple sources and divided into those with and without a positive family informants concerning children's maltreatment history of alcoholism. A two-way (Antisocial Profile experiences. Rather than classifying types of (3)x Family History of Alcoholism (2)) ANOVA was maltreatment a priori, the CML allows researchers to used to compare several neuropsychological measures describe children's experiences using objective of executive-cognitive functioning (ECF) ability. descriptors pertaining to potential acts of abuse, Verbal abstraction ability was found to be significantly potential perpetrators, frequency, onset, consequential lower in ASPD subjects compared with controls and injuries, and treatment. The CML can be downloaded CD-only subjects, inversely related to antisocial by interested agencies and groups without charge. behavior severity (as measured by symptom count). CD-only and control subjects' abstraction ability were Sterzer P, Stadler C, Krebs A, Kleinschmidt A, Poustka F. statistically indistinguishable. FH+ was associated with Abnormal neural responses to emotional visual stimuli increased errors in planning performance on the in adolescents with conduct disorder. Biol Psychiatry Porteus Maze Test and diminished performance on 2005; 57(1):7-15. Luria's simple alternate-tapping motor tasks. The effect Abstract: BACKGROUND: It is widely held that was more pronounced when inhibition of prepotent aggression and antisocial behavior arise as a motor planning was required. Results are consistent consequence of a deficiency in responding to emotional with previous work examining ECF ability in antisocial cues in the social environment. We asked whether samples that find subtle differences in ECF ability neural responses evoked by affect-laden pictures would compared to controls. The findings suggest that normal be abnormal in adolescents with conduct disorder versus abnormal behavioral outcome for children with (CD). METHODS: Functional magnetic resonance conduct problems may be influenced by cognitive imaging during passive viewing of pictures with ability profile, perhaps because of varying maturational neutral or strong negative affective valence was processes. performed in 13 male adolescents with severe CD aged 9 to 15 years and in 14 healthy age-matched control Stevens TN, Ruggiero KJ, Kilpatrick DG, Resnick HS, subjects. RESULTS: Main effects for negative-neutral Saunders BE. Variables differentiating singly and affective valence included activations in the amygdala multiply victimized youth: results from the National and hippocampus, ventral extrastriate visual cortex, Survey of Adolescents and implications for secondary prevention. Child Maltreat 2005; 10(3):211-23. 874
- 883. Abstract: The authors examined variables has focused on the negative end of the continuum of differentiating singly and multiply victimized youth emotional and social health (eg, child abuse, conduct with a national household probability sample of 4,023 disorder, mental illness, drug and alcohol abuse) and adolescents. Youth endorsing one episode (i.e., one concentrated on the problems of the poor, not the rich. incident or series of repeat incidents) of sexual or The prevalence of emotional and social well-being has physical assault were classified as singly victimized (n not been well studied. At the other end of the spectrum, = 435). Multiply victimized youth were those who emotional and behavioral problems now are the most endorsed multiple discrete episodes of sexual or important cause of disability in childhood,(2) affecting physical assault and both sexual and physical assault (n between 10% and 20% of children.(3) In between these = 396). For boys, heightened risk of multiple 2 extremes, some children are socially competent, are victimization was associated with family alcohol liked by their peers, are resilient in the face of problems, Native American race, and earlier age at problems, know their own minds, are kind to others, assault onset. For girls, increased multiple and are able to handle conflict in a way that leads to victimization risk was associated with family alcohol resolution. Others are prone to aggression and deceit, problems, older current age, and several characteristics are ostracized by their peer group, and create conflict of the initial assault episode-earlier age at onset, and distress. These children may have very low self- acquaintance perpetrator, chronicity, perceived life esteem. They often are manifestly unhappy and threat, and injury. Findings imply that secondary anxious and certainly make others unhappy and prevention programs may be strengthened by anxious. This group may not meet the Diagnostic and broadening risk-reduction strategies to address a Statistical Manual of Mental Disorders-defined criteria greater range of victimization experiences. Additional for emotional and behavioral problems; teachers implications for secondary prevention are discussed. therefore may be more aware of them and their impact on others than physicians. As a result, teachers and Steves L, Blevins T. From tragedy to triumph: a segue to educational psychologists have been at the forefront of community building for children and families. Child developing interventions to help this group. Welfare 2005; 84(2):311-22. Abstract: In 2000, more than 60 nonprofit agencies, Stewart D, Sun J. How can we build resilience in primary health care providers, government officials, and school aged children? The importance of social support community advocates in Tarrant County, Texas, came from adults and peers in family, school and community together to work for systemic change in the mental settings. Asia Pac J Public Health 2004; 16 Suppl:S37- health care system. The coalition, known as the Mental 41. Health Connection, began working toward a "No Abstract: This study examines the association between Wrong Door" approach to mental health services, firstly, student resiliency and their perceptions of social which required aggressive coordination between support from parents/caregivers, teachers, and peers, federal, private, and nonprofit resources. The result is a and secondly, between student's perception of their five- to six-year plan for implementation of a new general health status and their social support. A cross- systems of care model for children with severe sectional research project was designed and conducted emotional disturbances and their families. The Mental in 2003 in an urban and remote area of Queensland, Health Connection also focuses on legislative advocacy Australia. The study population comprised of 2580 to bring about necessary policy changes at the local, students (Years three, five, and seven) across 20 state, and federal levels. Finally, the coalition focuses primary schools. The main outcome measures were on developing sustainable revenue streams that will self-reported health status and resiliency behaviours. allow the new systems to remain in place once the Independent variables included student perceptions of group accomplishes the initial mission of the Mental support from parents/caregivers, teachers, school peers, Health Connection. and prosocial groups. Students who perceived parents, teachers, and peers as supportive were more likely to Stewart-Brown S. Legislation on smacking. BMJ 2004; have higher resiliency behaviour in communication and 329(7476):1195-6. cooperation, self-esteem, empathy, help-seeking, goals and aspirations. Students who considered that their Stewart-Brown S. Research in relation to equity: extending parents, peers at school and prosocial groups were the agenda. Pediatrics 2003; 112(3 Part 2):763-5. supportive, were more likely to feel healthy. Findings Abstract: An appreciation of the role of social and suggest that providing adult and peer support to emotional well-being in determining health outcomes students at primary school age is a vital strategy in is important in advancing the equity agenda.(1) These promoting student resiliency and general health for aspects of health are adversely affected by inequity. children of primary school age. They also are important as potential causal factors. Low levels of emotional and social well-being among Stewart G, Ruggles R, Peacock J. The association of self- the rich may be important in perpetuating health and reported violence at home and health in primary school social inequity. In the past, most research on inequity pupils in West London. J Public Health (Oxf) 2004; 26(1):19-23. 875
- 884. Abstract: BACKGROUND: Theeffects of violence been framed within the discourse of juvenile upon young people are relatively poorly understood. In delinquency rather than family violence. Thus, unlike 2001 the London Borough of Ealing conducted a large- other forms of family violence, it has escaped close scale survey of primary school pupils, which included examination by health and welfare workers. A questions on levels of violence at home. The aim of literature review was conducted to examine current this study was to measure the association of violence at knowledge of child-to-mother violence. Study of the home with measures of health, health care use and literature reveals only partial understandings of this health-related behaviours in primary school pupils aged neglected aspect of family pathology. Directions for 9 and 11 in West London. METHODS: A total of 3007 research to address these gaps in knowledge are drawn pupils from 28 primary schools were given a self- from the findings of this literature review. complete health questionnaire; 2083 completed a question on violence at home. RESULTS: Pupils Stith R. Location and life: how Stenberg v. Carhart undercut reporting violence were more likely to have needed Roe v. Wade. William Mary J Women Law 2003; medical attention in the last year. Violence was also 9(2):255-78. associated with greater need of dental care, drinking Notes: GENERAL NOTE: KIE: 89 fn. and spending money on alcohol, spending money on GENERAL NOTE: KIE: KIE Bib: abortion/legal cigarettes, not eating or drinking before school, less aspects willingness to speak to parents and siblings about drugs, and less communication with teachers about Stoddard FJ, Saxe G. Ten-year research review of physical puberty and growing up. Violence was positively injuries. J Am Acad Child Adolesc Psychiatry 2001; associated with increased communication with relatives 40(10):1128-45. about puberty. CONCLUSION: Pupils who report Abstract: OBJECTIVE: To review the past 10 years of violence at home are more likely to have more injuries, research relevant to psychiatry on injuries in children riskier health behaviours and less social support than and adolescents. METHOD: A literature search of those reporting no violence at home. databases for "wounds and injuries, excluding head injuries," was done with Medline and PsycINFO, Stewart JL, Pyke-Grimm KA, Kelly KP. Parental treatment yielding 589 and 299 citations, respectively. Further decision making in pediatric oncology. Semin Oncol searching identified additional studies. RESULTS: Nurs 2005; 21(2):89-97; discussion 98-106. Progress is occurring in prevention, pain management, Abstract: OBJECTIVE: To review progress and future acute care, psychiatric treatment, and outcomes. The plans for a research program about parents' making emotional and behavioral effects of injuries contribute treatment decisions for their children with cancer. to morbidity and mortality. Psychiatric assessment, DATA SOURCES: Theoretical papers, review articles, crisis intervention, psychotherapy, and research reports. CONCLUSION: Three important psychopharmacological treatment, and interventions questions need to be addressed to achieve the goal of for families are now priorities. Research offers new supporting parents in treatment decision making: 1) interventions for pain, delirium, posttraumatic stress Whatfactors predict a parent's preferred role iln disorder, depression, prior maltreatment, substance decision making? 2) What are the critical outcomes abuse, disruptive behavior, and end-of-life care. High- from parental decision making that nurses could help to risk subgroups are infants, adolescents, maltreated improve? 3) Is it role choice, actual role assumed, or children, suicide attempters, and substance abusers. congruence between preferred and actual role in Staff training improves quality of care and reduces decision making that predicts decision outcomes for the staff stress. CONCLUSIONS: Despite the high priority parents? IMPLICATIONS FOR NURSING that injuries receive in pediatric research and treatment, PRACTICE: Research-based responses to the psychiatric aspects are neglected. There is a need for remaining questions about parent treatment decision assessment and for planning of psychotherapeutic, making will help nurses develop and test interventions psychopharmacological, and multimodal treatments, designed to support parents in their decision making based on severity of injury, comorbid experiences. psychopathology, bodily location(s), and prognosis. Psychiatric collaboration with emergency, trauma, and Stewart M, Jackson D, Mannix J, Wilkes L, Lines K. rehabilitation teams enhances medical care. Research Current state of knowledge on child-to-mother should focus on alleviating pain, early psychiatric case violence: a literature review. Contemp Nurse 2004- identification, and treatment of children, adolescents, 2005; 18(1-2):199-210. and their families, to prevent further injuries and Abstract: Child-to-mother violence is a common aspect reduce disability. of family violence, and presents nurses and health workers with continuing challenges. Though noted in Stoffels H, Ernst C. [Recall and pseudo-memory. On the the literature as early as the 1950's, this phenomenon yearning to be a trauma victim]. Nervenarzt 2002; remains poorly understood. A number of reasons for 73(5):445-51. the lack of research scrutiny are proposed, the most Abstract: Memories are not called up from "storage" compelling being that child-to-mother violence has 876
- 885. but instead areconstructed anew in each case. questionnaire indicate a marked difference between the Although many experiments have proven that reported satisfaction with and understanding of the memories are visual and inaccurate, many information provided on the one hand and the psychotherapists still assume that memories which significant lack of knowledge of some of the aims and surface during therapy are realistic representations of methods of the ABIS screening on the other, namely facts. They do not take into account that reminiscences concerning high-risk identification of involved (pseudomemories) of events can be planted in the children, potential prevention and future memory by the imagination or through behavioral questionnaires. Two questions evoked by our results pressure. In light of this, the question arises as to why are: (1) what information is required for participants in some patients during therapy tend to invent in longitudinal studies involving children? and (2) how do particular memories of traumatic early childhood we ensure and sustain understanding, and thus in a experiences. The authors assume that certain prolonging, informed consent in these studies? This suggestive elements come to bear with victimization. study underlines the importance of an increased The advantage gained is of great importance and has understanding of the ethical issues that longitudinal many facets. The case of Wilkomirski proves that research on children raise and the need to discuss how mystification of the ego via identification with victims information and informed consent strategies should be is not only provoked in psychotherapeutic treatment analysed and designed in longitudinal studies. but also is a means of gaining public attention and support. As concerns the therapeutic handling of actual Stone AL, Latimer WW. Adolescent substance use emotional traumatization (whose pathogenic assessment: concordance between tools using self- significance and long-term effects used to be administered and interview formats. Subst Use Misuse underestimated), suggestive and autosuggestive 2005; 40(12):1865-74. processes play a large role. In this respect, modern Abstract: The present study evaluates the agreement trauma research and psychotherapy are faced with between adolescent self-report of substance use special challenges. frequencies obtained from a self-administered questionnaire vs. face-to-face interview formats. Stokes E, Gilbert-Palmer D, Skorga P, Young C, Persell D. Participants were 108 adolescents (82 males, 26 Chemical agents of terrorism: preparing nurse females), aged 11 to 19 (M = 15.74, SD = 1.17), who practitioners. Nurse Pract 2004; 29(5):30-9; quiz 39- were referred for a chemical dependence assessment 41. between June of 1999 and June of 2000 in Minnesota. Abstract: Nurse practitioners must exercise vigilant The adolescent battery included the self-administered readiness to properly care for victims of chemical Personal Experience Inventory and the face-to-face injuries. In this article, appropriate clinical interviewer-administered Drug Use History Interview management of each category of chemicals is to assess substance use frequency. A urine sample was addressed, including supportive and pharmacologic also collected to validate self-report of recent substance care. Triage decisions are explained and use. Bivariate correlations between adolescent self- decontamination concerns are identified. Attention is report on the self-administered and interviewer- directed at special populations such as children and the administered formats were strong for alcohol (average r elderly. = 0.72) and marijuana (average r = 0.81) use frequencies during the 3 months and 12 months Stokowski LA. Make every mother and child count--World preceding the baseline assessment. However, Health Day. Adv Neonatal Care 2005; 5(3):124. adolescents were generally more likely to report greater frequencies of alcohol and marijuana use during the Stolt UG, Helgesson G, Liss PE, Svensson T, Ludvigsson J. interview-administered protocol when compared to the Information and informed consent in a longitudinal self-administered format. Study implications and screening involving children: a questionnaire survey. limitations are discussed. Eur J Hum Genet 2005; 13(3):376-83. Abstract: This empirical study explores participants' Stone NN. Hand-drumming to build community: the story of perceptions of information and understanding of their the Whittier Drum Project. New Dir Youth Dev 2005; children's and their own involvement in a longitudinal (106):73-83, 6. screening, the ABIS Study. ABIS (All Babies In Abstract: Over the years, the author participated in Southeast Sweden) is a multicentre, longitudinal drum circles and classes in Denver, Fort Collins, and research screening for Type 1 diabetes and Boulder, Colorado. He noticed that drumming made multifactorial diseases involving 17 005 children and him feel grounded and at peace. Drumming is very their families. For this study, a random selection of accessible, not like playing the piano or violin. Simple mothers was made, using perinatal questionnaire serial rhythms can be taught to people with no drumming numbers from the ABIS study. In total, 293 of these experience very quickly and an ensemble rhythm mothers completed an anonymous questionnaire created with a group in one sitting. Drumming turned (response rate 73.3%). Our findings from the out to be a highly effective way to engage with young people not only to address their individual spirits but to 877
- 886. join with othersto create a community. sibling deviance was significant. Implications for the development of substance use behavior in middle Stone RD. The cloudy crystal ball: genetics, child abuse, and childhood are discussed. the perils of predicting behavior. Vanderbilt Law Rev 2003; 56(5):1557-90. Storvoll EE, Wichstrom L. Do the risk factors associated Notes: GENERAL NOTE: KIE: 150 fn. with conduct problems in adolescents vary according to GENERAL NOTE: KIE: KIE Bib: behavioral genetics; gender? J Adolesc 2002; 25(2):183-202. genetic screening Abstract: The present paper examines whether there are gender differences in the associations between conduct Stoodley N. Neuroimaging in child abuse: reducing the risk. problems and risk factors such as family conditions, Clin Radiol 2004; 59(11):965-6. peer influence, leisure activities, school-related variables and pubertal timing. We analysed self- Stoolmiller M. Synergistic interaction of child manageability reported data collected as part of a large general problems and parent-discipline tactics in predicting population study of Norwegian adolescents (N=9342). future growth in externalizing behavior for boys. Dev On the basis of earlier studies, conduct problems were Psychol 2001; 37(6):814-25. decomposed into three dimensions, labelled theft and Abstract: Manageability problems during early vandalism, school opposition and covert behaviour. childhood for boys were hypothesized to disrupt The first dimension includes different kinds of theft parental discipline practices. In turn, disrupted parental and vandalism, whereas the second includes school- discipline practices were hypothesized to interact with related conduct problems of an overt aggressive kind. manageability problems during late childhood to The last dimension reflects avoidance of arenas under predict change in antisocial behavior during the adult control. Whether or not gender differences were transition from elementary to middle school. Results detected depended on the aspect of conduct problems indicated that maternal retrospective perceptions of considered. The associations between risk factors and unmanageability predicted observed maternal "theft and vandalism" and "school opposition" were discipline practices, even when maternal antisocial stronger for boys than for girls. No gender differences behavior and depressed mood and the disruptive and were detected in the associations between and risk antisocial behavior of the boy were statistically factors and "covert behaviour". Even though there were controlled. Graphical analyses and latent class growth gender differences in the strength of these associations, models indicated that level of temper tantrums the same risk factors seem to be relevant in explaining interacted with maternal discipline in predicting change conduct problems for both gender groups. in teacher ratings of antisocial behavior. The nature of the interaction indicated that maternal discipline was a Stover CS. Domestic violence research: what have we risk factor for growth in antisocial behavior only for learned and where do we go from here? J Interpers boys with high levels of tantrums. Violence 2005; 20(4):448-54. Abstract: Domestic violence has been an intense area Stormshak EA, Comeau CA, Shepard SA. The relative of study in recent decades. Early studies helped with contribution of sibling deviance and peer deviance in the understanding of the nature of perpetration, the the prediction of substance use across middle cycle of violence, and the effect of family violence on childhood. J Abnorm Child Psychol 2004; 32(6):635- children. More recently, studies have focused on 49. beginning to evaluate domestic violence interventions Abstract: This study investigated the quality of sibling and their effects on recidivism. This article relationships and sibling deviancy in a sample of acknowledges the importance of what we have learned children at-risk for substance use and antisocial about the prevalence and impact of domestic violence behavior. Based on a history of empirical and and explores the need for more focused effort to theoretical models suggesting strong associations pinpoint interventions that are effective with between children's development in the context of perpetrators and victims. Methodological issues relationships and the emergence of delinquency and relevant to past intervention studies are also discussed drug use, this research extends previous efforts by and future research directions are outlined. including sibling relationships in this developmental model, linking siblings with later substance use. Straetemans M, Schonbeck Y, Engel JA, Zielhuis GA. Sibling relationship quality as well as peer deviance Meconium-stained amniotic fluid is not a risk factor for were examined using a multirater, multimethod otitis media. Eur Arch Otorhinolaryngol 2003; assessment procedure. We tested 3 constructs 260(8):432-5. (deviancy, warmth, and conflict) related to sibling Abstract: It has recently been hypothesised that large behavior. Only sibling deviance and peer deviance amounts of amniotic fluid cellular content (AFCC) in directly predicted substance use. When both sibling the middle ear may lead to chronic inflammation and deviance and peer deviance were examined as predispose young children to recurrent middle ear predictors of changes in substance use over time, only infections. Because children born with meconium- 878
- 887. stained amniotic fluid(MSAF) have higher AFCC in fighting. When the victim had been knocked to the the middle ear, we performed a retrospective cohort ground, the offender started forceful kicking. Bleeding study to determine whether children born with MSAF to death and head injury were frequent causes of death. had a higher risk of OM during infancy. Children born More than 50% of all offences were committed by between May 1998 and April 2000 formed two groups single offenders. The diagnosis of kicking to death can based on the absence or presence of MSAF at birth as at best be derived from presence of boot traces leaving documented in the hospital birth records. In April shaped injuries. The trace-generating boot can be 2002, home visits were made to take tympanometric identified as offending tool by means of comparative measurements and administer a questionnaire on OM police investigation. In addition to evaluation of shoe history and possible confounders. Logistic regression sole profiles, there is other trace-relevant material that models were constructed to assess odds ratios (OR) as may be sampled from a suspected offender's footwear a measure of the effect of MSAF on OM and to adjust (skin cells, hair, blood, body tissue) and used to for potential confounders. There were no differences in identify findings by DNA analysis. There may be the point prevalence of a type-B tympanogram at the injuries with visible patterns supporting suspicion of home visit (OR 0.81; 95% confidence interval: 0.38- kicking and trampling, although conclusive 1.76). Also, no statistically significant association was confirmation can be obtained only by testimony by a found between the proportion of children with OM witness or confession by the offender. diagnosed in the 1st year of life (OR 0.86, 95% confidence interval: 0.27-2.73) and in the proportion of Strina A, Cairncross S, Barreto ML, Larrea C, Prado MS. children that had ever been diagnosed with OM (OR Childhood diarrhea and observed hygiene behavior in 0.91, 95% confidence interval: 0.40-2.91). It can be Salvador, Brazil. Am J Epidemiol 2003; 157(11):1032- concluded that children born with MSAF do not 8. constitute a high-risk group for OM in early childhood. Abstract: Brief biweekly home visits, made as part of a A long-term OM effect, especially in severe MSAF cohort study of diarrhea in young children under age 5 cases, cannot be excluded. years that was carried out in Salvador, Brazil, in 1998- 1999, were used as a low-cost way to collect structured Strasburger VC. Adolescents, sex, and the media: ooooo, observation data on domestic hygiene behavior. Field- baby, baby-a Q & A. Adolesc Med Clin 2005; workers were trained to check a list of 23 forms of 16(2):269-88, vii. hygienic or unhygienic behavior by the child or the Abstract: The media arguably have become the leading child's caretaker, if any behaviors were seen during the sex educator for American children and adolescents. visit. Children were grouped according to whether More than 80% of the top teen shows contain sexual mainly unhygienic behavior or mainly hygienic content, and the average teen views nearly 14,000 behavior had been recorded. This permitted study of sexual references on television alone. The gap between the determinants of hygiene behavior and of its role in suggestive and responsible content on primetime the transmission or prevention of diarrheal disease. television is narrowing, but only slowly. Parents and Observations were recorded on roughly one visit in 20. teachers need to recognize the power of the media to Households with adequate excreta disposal were educate and begin incorporating principles of media significantly more likely to be in the "mainly hygienic" literacy into existing sex education programs. group. The prevalence of diarrhea among children for whom mainly unhygienic behavior was recorded was Stratman E, Melski J. Scald abuse. Arch Dermatol 2002; 2.2 times that among children in the "mainly hygienic" 138(3):318-20. group. The relative risk for prevalence was 2.2 (95% confidence interval: 1.7, 2.8). The relative risk fell to Strauch H, Wirth I, Taymoorian U, Geserick G. Kicking to 1.9 (95% confidence interval: 1.5, 2.5) after data were death - forensic and criminological aspects. Forensic controlled for confounding, but the difference was still Sci Int 2001; 123(2-3):165-71. highly significant. Abstract: A total of 36,274 forensic autopsies was performed in Berlin, between 1980 and 1987, including Strina A, Cairncross S, Prado MS, Teles CA, Barreto ML. 152 cases (0.42%) in which death had been caused by Childhood diarrhoea symptoms, management and blunt violence due to kicking. Data were collected on duration: observations from a longitudinal community both victims and offenders, postmortem findings, study. Trans R Soc Trop Med Hyg 2005; 99(6):407-16. causes of death and the way violence had been Abstract: This study examined the evolution and perpetrated. The greater part of victims and offenders duration of diarrhoea episodes observed in a had been males originating from lower social strata. community setting, with regard to symptoms and Most of the victims and offenders had been in carers' responses. The study group comprised 1156 relationship with each other prior to the offence. children, aged 0-36 months, who were followed-up Typical course of events: Victims and offenders, under with twice-weekly home visits in 30 sampling areas in influence of alcohol, became involved in a brawl, the city of Salvador, northeast Brazil. A total of 2403 usually for trivial reasons, which soon led to physical diarrhoea episodes (mean duration: 2.9 days) were recorded. The number of soft/liquid motions per day 879
- 888. (3.6) did notvary significantly with duration, but other sensitive to individual variation in DSM-IV symptom symptoms were more commonly reported in the longer counts, suggesting the physiological components were episodes. However, when the data were analysed by not strongly related to the predominantly cognitive and day of the episode, rather than the episode's overall behavioral components of the DSM-IV nicotine duration, the reported frequency of fever and vomiting dependence syndrome. However, the mFTQ relative to declined significantly with time. During the course of the DSM-IV consistently showed stronger relationships an episode, rehydration, medication and care-seeking to the immediate consequences of nicotine deprivation also showed a decline in frequency after the first or (urge, craving), supporting the conceptualization of the second week. As episodes continue, less rehydration mFTQ as measuring nicotine exposure. These analyses and medical care are provided by carers, whereas they provide us with some preliminary understanding of the ought to be maintained because of the continued severity of particular symptoms and the order in which purging and cumulative effect of the symptoms. Since symptoms are likely to be expressed across levels of most cases of diarrhoea are managed at home, it is nicotine dependence. important to understand how to encourage better management of the longer episodes, which cause an Struffert T, Grunwald I, Reith W. [Craniocerebral trauma in increasing proportion of mortality in some countries. childhood]. Radiologe 2003; 43(11):967-76. Abstract: This article describes typical head injuries in Stritzke WG, Dandy J, Durkin K, Houghton S. Use of infants and children. In comparison with adults there interactive voice response (IVR) technology in health are distinct differences in the etiology of trauma and in research with children. Behav Res Methods 2005; the kind of reaction of the skull and brain. In infants 37(1):119-26. and children there are three different types of trauma: Abstract: This article reports on the feasibility of using birth trauma, accidental and non-accidental injury. The interactive voice response (IVR) technology to obtain typical injuries in these three groups are described. daily reports of attitudes toward alcohol and tobacco use among children 9-13 years of age. Two studies Stuhlmiller DF, Cudnik MT, Sundheim SM, Threlkeld MS, were conducted. The first was an investigation of the Collins TE Jr. Adequacy of online medical command use of IVR technology to obtain daily data from a communication and emergency medical services sample of primary school children over a period of 8 documentation of informed refusals. Acad Emerg Med weeks. The second was an extension of the research to 2005; 12(10):970-7. a large sample of primary and secondary school Abstract: BACKGROUND: In the out-of-hospital children in urban and rural areas who provided daily setting, when emergency medical services (EMS) data over a 4-week period. Retention and compliance providers respond to a 9-1-1 call and encounter a rates comparable to those obtained with adults were patient who wishes to refuse medical treatment and/or evident in both studies, supporting the feasibility of this transport to the hospital, the EMS providers must technology with children. The results are discussed in ensure the patient possesses medical decision-making relation to the benefits of this methodology for health capacity and obtain an informed refusal. In the city of research, particularly for studies of sensitive topics Cleveland, Ohio, Cleveland EMS completes a conducted with children and adolescents. nontransport worksheet that prompts the paramedics to evaluate specific patient characteristics that can Strong DR, Brown RA, Ramsey SE, Myers MG. Nicotine influence medical decision-making capacity and then dependence measures among adolescents with discuss the risks of refusing with the patient. Cleveland psychiatric disorders: evaluating symptom expression EMS then contacts an online medical command as a function of dependence severity. Nicotine Tob Res (OLMC) physician to authorize the refusal. OLMC 2003; 5(5):735-46. calls are recorded for review. OBJECTIVES: To assess Abstract: Using methods based in item response the ability of EMS to determine medical decision- theory, we examined a structured interview assessment making capacity and obtain an informed refusal of of Diagnostic and Statistical Manual of Mental transport. METHODS: This study was a retrospective Disorders, 4th edition (DSM-IV) nicotine dependence review of a cohort of recorded OLMC refusal calls and and the Modified Fagerstrom Tolerance Questionnaire of the accompanying written documentation by (mFTQ) symptoms to explore the expression of Cleveland EMS. The completeness of the verbal particular symptoms as a function of level of nicotine communication between the paramedic and OLMC involvement in a sample of 191 adolescents with physician and the written documentation on the psychiatric disorders. Despite our attempts to capture a nontransport worksheet were measured as surrogate broad range of smokers, 64% of teens were daily markers of the adequacy of determining medical smokers and 68% met DSM-IV criteria for nicotine decision-making capacity and obtaining an informed dependence. This paper describes the relative severity refusal. RESULTS: One hundred thirty-seven OLMC of DSM-IV and mFTQ items, as well as each item's calls for patient-initiated refusals were reviewed. Vital ability to discriminate among individuals at various signs and alertness/orientation were verbally levels of nicotine involvement. Comparisons across communicated more than 83% of the time. The measures revealed that the mFTQ was not particularly presence of head injury, presence of alcohol or drug 880
- 889. intoxication, and presenceof hypoglycemia were of psychosocial problems in both cases and controls. verbally communicated less than 31% of the time. The associations between health behaviour, Verbal communication stating that the risks of refusing psychosocial factors, and asthma death are varied and had been discussed with the patient occurred 44.5% of complex with a limited number of factors showing the time. The written documentation of the refusal positive relationships. encounter was more complete, exceeding 95% for vital signs and alertness/orientation, and exceeding 80% for Su B, Macer DR. Chinese people's attitudes towards genetic the remaining patient characteristics. The rate of diseases and children with handicaps. Law Hum written documentation that the risks of refusing had Genome Rev 2003; (18):191-210. been discussed with the patient was 48.7%. Notes: GENERAL NOTE: KIE: 53 refs. Discrepancies between the verbal and written GENERAL NOTE: KIE: KIE Bib: eugenics paramedic reports were clinically insignificant. CONCLUSIONS: Paramedic and OLMC physician Suarez-Orozco C, Todorova IL. The social worlds of communication for patients refusing out-of-hospital immigrant youth. New Dir Youth Dev 2003; (100):15- medical treatment and/or transport is inadequate in the 24. Cleveland EMS system. A written nontransport Abstract: This introductory chapter uses a detailed case worksheet improves documentation of the refusal study to illustrate the interconnection of multiple social encounter but does not ensure that every patient who influences on one particular youth's path of migration. refuses possesses medical decision-making capacity It further identifies some of the major influences on and the capacity to provide an informed refusal. immigrant youth development, including the stresses of migration, separations and reunifications, changing Sturdy PM, Victor CR, Anderson HR et al. Psychological, networks of relations, poverty and segregation, and social and health behaviour risk factors for deaths identity formation. certified as asthma: a national case-control study. Thorax 2002; 57(12):1034-9. Subkowski P. [Harry Potter--the trauma as a drive for Notes: CORPORATE NAME: Mortality and Severe psychic development]. Prax Kinderpsychol Morbidity Working Group of the National Asthma Kinderpsychiatr 2004; 53(10):738-53. Task Force Abstract: The Harry Potter books are centered around Abstract: BACKGROUND: Uncontrolled studies the psychic development of a traumatised young boy suggest that psychosocial factors and health behaviour starting from his internalised early experience of being may be important in asthma death. METHODS: A loved by his mother to the sudden loss of both of his community based case-control study of 533 cases, parents at the anal stage and the later cumulative comprising 78% of all asthma deaths under age 65 traumatisation by being negleced and mistreated by his years and 533 hospital controls individually matched relatives up to the present times. By identifying with for age, district and asthma admission date his father and other father replacements Harry Potter corresponding to date of death was undertaken in seven finally acquires self-assurance and wins new friends. regions of Britain (1994-98). Data were extracted blind Harry goes through different stages of initiation into from anonymised copies of primary care records for the adult world with all its conflicts and rivalries but the previous 5 years and non-blind for the earlier also friendships. He stands up to his fears and period. RESULTS: 60% of cases and 63% of controls symptoms resulting from his early childhood traumata were female. The median age in both groups was 53. and thereby helps to encourage readers of all ages to Cases had an earlier age of asthma onset, more chronic handle their own conflicts. On the oedipal level Harry obstructive lung disease, and were more obese. 48% of Potter finally has to deidealize his father and cases and 42% of controls had a health behaviour Dumbledore, but also their opponent the dark Lord problem; repeated non-attendance/poor inhaler Voldemort, who thereby becomes more human, technique was related to increased risk of death. understandable and in the long run probably defeatable. Overall, 85% and 86%, respectively, had a The reader can identify himself with Harry and/ or a psychosocial problem. Four psychosocial factors were wide range of other characters. He can recognize his associated with increased risk of death (psychosis, own experiences in life and conflicts in the story and alcohol/drug abuse, financial/employment problems, argue internally with the demonstrated conflict solving learning difficulties) and two with reduced risk patterns on different levels. It is the skillfully displayed (anxiety/prescription of antidepressant drugs and and logically constructed story of the psychic sexual problems). While alcohol/drug abuse lost development of a child that is traumatised at an early significance after adjustment for psychosis, other age and the possibilities the reader has to identify associations appeared independent of each other and of selectively with the different characters that constitutes indicators of severity and co-morbidity. None of the the attractiveness of the Harry Potter novels. remaining 13 factors including family problems, domestic abuse, bereavement, and social isolation were Suchman N, Mayes L, Conti J, Slade A, Rounsaville B. significantly related to risk of asthma death. Rethinking parenting interventions for drug-dependent CONCLUSION: There was an apparently high burden 881
- 890. mothers: from behaviormanagement to fostering experimental validation. J Clin Neurophysiol 2005; emotional bonds. J Subst Abuse Treat 2004; 27(3):179- 22(5):288-99. 85. Abstract: The essence of epilepsy is that a patient Abstract: Mothers who are physically and/or displays (long) periods of normal EEG activity (i.e., psychologically dependent upon alcohol and illicit nonepileptiform) intermingled occasionally with drugs are at risk for a wide range of parenting deficits epileptiform paroxysmal activity. The mechanisms of beginning when their children are infants and transition between these two types of activity are not continuing as their children move through school-age well understood. To provide more insight into the and adolescent years. Behavioral parent training dynamics of the neuronal networks leading to seizure programs for drug-dependent mothers have had limited generation, the authors developed a computational success in improving parent-child relationships or model of thalamocortical circuits based on relevant children's psychological adjustment. One reason patho(physiologic) data. The model exhibits bistability, behavioral parenting programs may have had limited i.e., it features two operational states, ictal and success is the lack of attention to the emotional quality interictal, that coexist. The transitions between these of the parent-child relationship. Research on two states occur according to a Poisson process. An attachment suggests that the emotional quality of alternative scenario for transitions can be a random mother-child relationships is an important predictor of walk of network parameters that ultimately leads to a children's psychological development through school- paroxysmal discharge. Predictions of bistable age and adolescent years. In this paper, we present a computational model with experimental results from rationale and approach for developing attachment- different types of epilepsy are compared. based parenting interventions for drug-dependent mothers and report preliminary data on the feasibility Suk WA, Ruchirawat KM, Balakrishnan K et al. of offering an attachment-based parenting intervention Environmental threats to children's health in Southeast in an outpatient drug treatment program for women. Asia and the Western Pacific. Environ Health Perspect 2003; 111(10):1340-7. Suchman NE, McMahon TJ, Luthar SS. Interpersonal Abstract: The Southeast Asia and Western Pacific maladjustment as predictor of mothers' response to a regions contain half of the world's children and are relational parenting intervention. J Subst Abuse Treat among the most rapidly industrializing regions of the 2004; 27(2):135-43. globe. Environmental threats to children's health are Abstract: In previous work, Luthar and Suchman widespread and are multiplying as nations in the area (2000, Development & Psychopathology, 12, 235) undergo industrial development and pass through the reported results of a randomized clinical trial testing epidemiologic transition. These environmental hazards the efficacy of the Relational Psychotherapy Mothers' range from traditional threats such as bacterial Group (RPMG) for methadone-maintained mothers. In contamination of drinking water and wood smoke in this extension, we examined maternal interpersonal poorly ventilated dwellings to more recently introduced maladjustment as a predictor of differential response to chemical threats such as asbestos construction RPMG versus standard drug counseling (DC). We materials; arsenic in groundwater; methyl isocyanate in predicted that RPMG mothers with high levels of Bhopal, India; untreated manufacturing wastes released interpersonal maladjustment would improve on parent- to landfills; chlorinated hydrocarbon and child relationship indices, whereas DC mothers with organophosphorous pesticides; and atmospheric lead high levels of interpersonal maladjustment would show emissions from the combustion of leaded gasoline. To no improvement. Fifty-two mothers enrolled in the address these problems, pediatricians, environmental study completed baseline, post-treatment and 6-month health scientists, and public health workers throughout followup assessments and a subset of 24 "target" Southeast Asia and the Western Pacific have begun to children between the ages of 7 and 16 completed build local and national research and prevention measures on mothers' parenting. As predicted, results programs in children's environmental health. Successes of hierarchical regression analyses indicated moderate have been achieved as a result of these efforts: A cost- interpersonal maladjustment x treatment interaction effective system for producing safe drinking water at effects for all parenting outcomes at post-treatment and the village level has been devised in India; many for a subset of outcomes at followup. Plotted nations have launched aggressive antismoking interactions confirmed predictions that, as maternal campaigns; and Thailand, the Philippines, India, and interpersonal maladjustment increased, parenting Pakistan have all begun to reduce their use of lead in problems improved for RPMG mothers and remained gasoline, with resultant declines in children's blood the same or worsened for DC mothers. Results indicate lead levels. The International Conference on the potential value of interpersonally oriented Environmental Threats to the Health of Children, held interventions for substance-abusing mothers and their in Bangkok, Thailand, in March 2002, brought together children. more than 300 representatives from 35 countries and organizations to increase awareness on environmental Suffczynski P, Lopes da Silva F, Parra J, Velis D, Kalitzin S. health hazards affecting children in these regions and Epileptic transitions: model predictions and throughout the world. The conference, a direct result of 882
- 891. the Environmental Threatsto the Health of Children visits between general practices than adjusting for age meeting held in Manila in April 2000, provided and sex alone. METHODS: The setting was 60 general participants with the latest scientific data on children's practices in England and Wales taking part in the 1 vulnerability to environmental hazards and models for year Fourth National Morbidity Survey. The future policy and public health discussions on ways to participants comprised 349 505 patients who were improve children's health. The Bangkok Statement, a registered with one of the participating general pledge resulting from the conference proceedings, is an practices for at least 180 days, and who had at least one important first step in creating a global alliance consultation during the period. The outcome measure is committed to developing active and innovative national whether or not a patient received a home visit in that and international networks to promote and protect year. A clinical case mix category (morbidity class) children's environmental health. based on 1 year's diagnostic information was assigned to each patient using the Johns Hopkins Adjusted Sullivan A. They know not what they do. Even in Rome, the Clinical Groups (ACG) Case Mix System. The social U.S. cardinals still forgot the children. Time 2002; class measure was derived from occupation and 159(18):31. employment status and is similar to that of the 1991 UK census. Variations in home visits between practices Sullivan A. Who says the church can't change? Time 2002; were examined using multilevel logistic regression 159(24):63-4. models. The variability between practices before and after adjusting for clinical case mix and social class Sullivan-Bolyai S, Grey M, Deatrick J, Gruppuso P, Giraitis was estimated using the intracluster correlation P, Tamborlane W. Helping other mothers effectively coefficient (ICC). RESULTS: The overall percentage work at raising young children with type 1 diabetes. of patients receiving a home visit over the 1 year study Diabetes Educ 2004; 30(3):476-84. period was 17%, and this varied from 7 to 31% across Abstract: PURPOSE: This study examined the the 60 practices. The percentage of the total variation feasibility of a postdiagnosis parent mentoring in home visits attributable to differences between intervention for mothers of young children (1-10 years practices was 2.5% [95% confidence interval (CI) 1.4- old) newly diagnosed with type 1 diabetes. 3.2%] after adjusting for age and sex. This reduced to METHODS: A mixed-method, prospective, 1.6% (95% CI 1.1-2.4%) after taking into account randomized, controlled clinical trial design was used. morbidity class. The results were similar when social Parent mentors (experienced mothers who have class was included instead of morbidity class. successfully raised young children with type 1 Morbidity and social class together reduced variation in diabetes) and mother participants with young children home visits between practices to 1.5% (95% CI 1.1- newly diagnosed with type 1 diabetes were recruited 2.2%). CONCLUSIONS: Age, sex, social class and from 2 regional pediatric diabetes centers. The mentors clinical case mix are strong determinants of home visits were trained to provide informational, affirmational, in the UK. Adjusting for morbidity and social class and emotional support using Ireys' modified parent results in a small improvement in explaining the mentor curriculum. During a 6-month trial, mentors variability in home visits between practices compared provided home visits and phone call support to the with adjusting for age and sex alone. There is far more mothers who were randomized to the experimental variation between patients within practices; however, it group. The control group had the option of receiving is not straightforward to examine the factors the intervention after the 6-month trial. RESULTS: influencing this variation. In addition to morbidity and Mothers in the experimental group had fewer concerns, social class, there could also be other unmeasured more confidence, identified more resources, and factors such as varying patient demand for home visits, perceived diabetes having less of a negative impact on disability or differences in GP home visiting practice their family compared with mothers in the control style that could influence the large within-practice group. Parent mentors provided important, practical variability observed in this study. day-to-day management information, reassurance, and emotional support during times of crises. Sumanen M, Koskenvuo M, Sillanmaki L, Mattila K. CONCLUSIONS: A postdiagnosis parent mentoring Childhood adversities experienced by working-aged intervention for mothers of children with diabetes coronary heart disease patients. J Psychosom Res 2005; appears to be feasible and potentially effective. 59(5):331-5. Abstract: OBJECTIVE: The aim of this study is to Sullivan CO, Omar RZ, Forrest CB, Majeed A. Adjusting investigate associations between childhood adversities for case mix and social class in examining variation in and coronary heart disease (CHD). METHODS: This home visits between practices. Fam Pract 2004; was a case-control study based on a postal 21(4):355-63. questionnaire addressed to randomly selected working- Abstract: OBJECTIVES: The purpose of this study was aged Finns, and response rate was 39% (N = 15,477). to investigate whether adjusting for clinical case mix The sample comprised 319 CHD patients. Four age- and social class explains more of the variation in home and gender-matched controls were selected for every patient. The participants were asked in six questions to 883
- 892. think about theirchildhood adversities. RESULTS: be a positive turning point for women with drug Fear of some family member and someone in the problems. family being seriously or chronically ill were more common during childhood among working-aged CHD Sutherland I, Sivarajasingam V, Shepherd JP. Recording of patients than among controls. Likewise, among female community violence by medical and police services. CHD patients, serious conflicts in the family and Inj Prev 2002; 8(3):246-7. someone in the family having had alcohol problems Abstract: OBJECTIVES: To determine the extent to and, among male CHD patients, long-lasting financial which community violence that results in injury treated problems were more common than among controls. in emergency departments appears in official police Odds ratios (OR) varied between 1.27 and 2.66. records and to identify age/gender groups at particular Adjustment for education had no influence among risk of under-recording by the police. METHODS: women, but it had an influence among men. Upon Non-confidential data for patients with assault related adjustment for conventional risk factors (smoking, injury treated in the emergency departments of two obesity, and hypertension), the association mostly hospitals in one South Wales city (Swansea) during a disappeared. A family member having been seriously six month period were compared with data relating to or chronically ill was statistically significant after full all recorded crimes in the category "Violence against adjustment among both genders. CONCLUSION: the person" in the police area where the hospitals were Working-aged CHD patients have experienced more located. RESULTS: Over the six month period a total dramatic events during their childhood than did the of 1513 assaults were recorded by Swansea emergency control population. This issue cannot be solved in departments and the police (1019, 67.3% injured males doctors' offices. Health-promoting social policies are of and 494, 32.7% injured females). The majority of these vital importance. assaults (993, 65.6%) were recorded exclusively by emergency departments; 357 (23.6%) were recorded Sundfaer A. [31 women with drug problems got children-- only by the police and 163 (10.8%) were recorded by what happened after that?]. Tidsskr Nor Laegeforen both emergency departments and the police. Equal 2001; 121(1):73-5. proportions of males (67.3%) and females (67.5%) Abstract: BACKGROUND: The intention of this study injured in assaults were recorded by both emergency was to increase the knowledge concerning the departments and the police, but men were more likely rehabilitation of women with drug problems after the to have their assault recorded exclusively in emergency birth of a child and to find out how the children departments (odds ratio (OR) 2.1, 95% confidence developed. MATERIAL AND METHODS: A follow- interval (CI) 1.7 to 2.7) while women were more likely up study of 31 women, former drug and alcohol to have their assault recorded exclusively by the police abusers and their children, 19 girls and 12 boys born in (OR 2.5, 95% CI 2.0 to 3.2). There were no significant 1982-1983. The first survey took place when the relationships between exclusive emergency department children were 2-3 years of age, then when they were 7- recording and increasing age (OR 1.0, 95% CI 0.9 to 9 and at last when they were 15-17. The biological 1.2), exclusive police recording and increasing age (OR mothers, foster or adoptive mothers, the children and 1.1, 95% CI 1.0 to 1.2), or between age and dual their teachers were interviewed. RESULTS: The recording (OR 0.9, 95% CI 0.8 to 1.0). women got more support and control during the CONCLUSIONS: Most assaults leading to emergency pregnancy than afterwards. Most of the mothers department treatment, particularly in which males were became single. Women with the shortest drug history, a injured, were not recorded by the police. Assaults on good social network and a stable partner without drug the youngest group (0-10, particularly boys) were those problems kept the care of their children. By the first least likely to be recorded by police and females over survey (1985), seven children had been placed in foster age 45, the most likely. Emergency department derived homes, in the second (1992) two further children had assault data provide unique perspectives of community been taken away from their mothers, and in the third violence and police detection. (1999) only one third of the children were living with their biological mothers. Most of the children did well Suzuki K, Morita S, Muraoka H, Niimi Y. [Fetal alcohol at school and in their families, had friends and leisure spectrum disorders (FASD) among Japanese children activities despite still living by their mothers or in of alcoholic mothers]. Nihon Arukoru Yakubutsu foster/adoption homes. None of the youngsters had Igakkai Zasshi 2005; 40(3):219-32. been in conflict with the law or were drug abusers, but Abstract: OBJECTIVE: This study was carried out to every second teenage girl needed psychological examine fetal alcohol spectrum disorders (FASD) support. Children who had been stable by their drug- among Japanese children of alcoholic mothers. This is free biological mothers functioned best. the first report concerning FASD in Japan. INTERPRETATION: Mothers with drug problems do METHODS: The subjects were 30 alcoholic women not get sufficient attention after the delivery and when who were inpatients in the Kurihama Alcoholism the children grow up. A supporting family should be Center and had given birth to children. They were brought in contact with mother and child after the subjected to a semi-structured interview by the author. delivery. Under special circumstances pregnancy can Sixty healthy women who had not drunk during 884
- 893. pregnancy were usedas a control group, and they also 99 incidents that occurred after September 11 involved underwent semi-structured interviews. The alcoholic at least 128 victims and 171 perpetrators. Most violent women were divided into two groups, 13 who drunk victimizations occurred within 10 days of the attacks, during pregnancies and 17 who did not drink. Twenty involved male perpetrators and male victims, and children experienced of prenatal alcohol exposure and occurred in convenience stores, on the streets, at gas 40 children did not. The three groups; i.e., 13 alcoholic stations, at schools/colleges, and at places of worship. mothers who had drunk during pregnancy and their 20 DISCUSSION: Most violent victimizations occurred in children (ALD group), 17 alcoholic mothers who had the 10 days immediately following the terrorist attacks not drunk during pregnancy and their 40 children indicating that interventions that promote tolerance and (ALND group) and 60 non-alcoholic control mothers understanding of diversity need to be implemented and their 80 children (Control group), were compared quickly in order to be effective. In addition, patrolling concerning the mothers' drinking problems and by police and Neighborhood Watch programs around abnormal deliveries, children's birth weights, convenience stores and gas stations may also be congenital abnormalities, abnormalities of the central effective strategies for reducing hate related violent nervous system and psychological problems. crimes. RESULTS: The mean age of onset of problem drinking of the mothers in the ALD group was significantly Swanson EF. Anchors of the community: community lower than that in the mothers of the ALND group, and schools in Chicago. New Dir Youth Dev 2005; some of the mothers in the ALD group showed alcohol (107):55-64, table of contents. dependence before their pregnancies. The mean birth Abstract: In partnership with Chicago's public and weights of the children of the ALD group, ALND private sectors, Chicago Public Schools (CPS) has group and Control group were 2816 g, 3128 g and 3142 successfully implemented a citywide education reform g, respectively and the differences were significant. effort, designed to transform Chicago's neighborhood The children of the ALD group had significantly more schools into vibrant centers of the community. Mayor abnormal birth episodes, developmental retardation and Richard M. Daley and Arne Duncan, CEO of CPS, psychiatric symptoms than those in the other two launched the Community Schools Initiative in January groups. Among 20 children in the ALD group, FASD 2002. What started as an idea that was developed by a was suspected in 6 children (10% of the children of local foundation has now grown into the largest-scale alcoholic mothers). Six children had low birth weights, community school effort in the nation, with sixty-seven abnormal birth episodes, mental retardation and schools in operation and a plan to move to one hundred psychiatric symptoms. CONCLUSION: One third of community schools by 2007. This initiative currently the Japanese children of alcoholic mothers had involves seventeen private funders, ten technical experiences of prenatal alcohol exposure and 10% of assistance providers, thirty-four community-based them had suspected FASD abnormalities. organizations that offer on-site services to children and families, and over three hundred additional community Svoboda JS. Circumcision--a Victorian relic lacking ethical, partnerships that provide one-day events such as health medical, or legal justification. Am J Bioeth 2003; fairs and violence prevention workshops. 3(2):52-4. Notes: GENERAL NOTE: KIE: 15 refs. Swanson T. Mighty like a rose. Pediatr Rehabil 2004; GENERAL NOTE: KIE: KIE Bib: patient care/minors 7(3):221-3. Swahn MH, Mahendra RR, Paulozzi LJ et al. Violent attacks Sweatt L, Harding CG, Knight-Lynn L, Rasheed S, Carter P. on Middle Easterners in the United States during the Talking about the silent fear: adolescents' experiences month following the September 11, 2001 terrorist of violence in an urban high-rise community. attacks. Inj Prev 2003; 9(2):187-9. Adolescence 2002; 37(145):109-20. Abstract: OBJECTIVES: To document and describe Abstract: The self-reported violent experiences of hate related violent attacks on Middle Easterners or adolescents living in a public-subsidized urban high- those perceived to be Middle Easterners during the rise building were examined. This effort was part of an month following the September 11, 2001 terrorist interdisciplinary, community-university collaboration attacks in New York City and Washington, DC. program called the HOME (High-rise On-site METHODS: The LexisNexis database of newspaper Multifamily Environments) Family Support Project. A reports were used to identify incidents of hate related survey of violent experiences and a one-on-one violent acts against Middle Easterners or those structured interview were conducted with 20 perceived to be Middle Easterners in the US between adolescent residents. Results of the quantitative and September 1 and October 11, 2001. A total of 100 qualitative analyses revealed high degrees of exposure incidents of hate related violence were identified in the to violence among these adolescents, concerns for their 2659 news articles that were reviewed. RESULTS: Of personal safety, as well as insights into what they the 100 incidents of violent victimization that took believe adults could and should be doing to address place during the period September 1 to October 11, increasing levels of community violence. The only one incident occurred before September 11. The 885
- 894. implications of theseresults for conducting components contribute to desired outcomes, and to ecologically valid research on sensitive issues with learn more about processes that underlie changes in adolescents and for family support program planning behaviour. are discussed. Sylvestre A, Payette H, Tribble DS. [The prevalence of Swick SD, Jellinek MS, Dechant E, Jellinek MS, Belluck J. communication problems in neglected children under Children of victims of September 11th: a perspective three years of age.]. Can J Public Health 2002; on the emotional and developmental challenges they 93(5):349-52. face and how to help meet them. J Dev Behav Pediatr Abstract: OBJECTIVE: Estimate the prevalence of 2002; 23(5):378-84. communication problems in children under three taken into care by Youth Centres in Quebec for negligence. Sword W, Niccols A, Fan A. "New Choices" for women Prevalence is calculated for the pragmatic aspect, with addictions: perceptions of program participants. receptive and expressive language, according to age BMC Public Health 2004; 4:10. and sex. METHOD: This is a cross-sectional study. A Abstract: BACKGROUND: Substance use in representative sample of 84 children was drawn pregnancy is a major public health problem. It can have consecutively from the lists of new children registered profound effects on pregnancy outcomes, and at the Youth Centres. RESULTS: 46.4% of the children childhood health and development. Additionally, present a problem in at least one area of women who use substances have their own health- communication. The prevalence and seriousness of the related issues. Although intervention is important, problems increase significantly with age. Boys are these women often have difficulty using traditional significantly more affected than girls. CONCLUSION: systems of care. The New Choices program is a Negligence constitutes a threat to the development of centralized, multi-sector approach to service delivery communication. According to the data reported in this that has attempted to overcome barriers to care by study, there is substantial justification for early offering one-stop shopping in a supportive intervention, promotion and prevention programs with environment. As part of an evaluation of this program regard to communication problems among neglected designed for women who are pregnant and/or parenting children. young children, interviews were conducted with participants to gain insight into their experiences in Szilagyi PG, Schaffer S, Shone L et al. Reducing New Choices and perceptions of any changes attributed geographic, racial, and ethnic disparities in childhood to program involvement. METHODS: A qualitative, immunization rates by using reminder/recall exploratory design was used to guide data collection interventions in urban primary care practices. and analysis. Four women participated in a focus group Pediatrics 2002; 110(5):e58. interview and seven women agreed to individual Abstract: CONTEXT: An overarching national health interviews over the course of the program evaluation goal of Healthy People 2010 is to eliminate disparities (N = 11). A semi-structured interview guide was used in leading health care indicators including to explore women's experiences in New Choices and immunizations. Disparities in US childhood their perceptions of the program and its impact. The immunization rates persist, with inner-city, black, and interview data were analyzed using NVivo software Hispanic children having lower rates. Although and an inductive approach to data analysis. RESULTS: practice or clinic-based interventions, such as patient The emergent themes captured women's motivations reminder/recall systems, have been found to improve for attending New Choices, benefits of participation, immunization rates in specific settings, there is little and overall quality of the program. Children were the evidence that those site-based interventions can reduce primary motivating factor for program enrollment. disparities in immunization rates at the community Perceived benefits included decreased substance use, level. OBJECTIVE: To assess the effect of a improved maternal health, enhanced opportunity for community-wide reminder, recall, and outreach (RRO) employment, increased access to other resources, system for childhood immunizations on known enhanced parenting skills, and improved child disparities in immunization rates between inner-city behaviour and development. Women highly valued the versus suburban populations and among white, black, comprehensive and centralized approach to service and Hispanic children within an entire county. delivery that provided a range of informal and formal SETTING: Monroe County, New York (birth cohort: supports. CONCLUSIONS: Interview findings endorse 10 000, total population: 750 000), which includes the the appropriateness and potential efficacy of a city of Rochester. Three geographic regions within the collaborative, centralized approach to service provision county were compared: the inner city of Rochester, for women with substance use issues. Although the which contains the greatest concentration of poverty findings provide insight into an alternative model of (among 2-year-old children, 64% have Medicaid); the service delivery for women with addictions, future rest of the city of Rochester (38% have Medicaid); and research is needed to evaluate the effectiveness of the the suburbs of the county (8% have Medicaid). intervention. Research also is needed to determine INTERVENTIONS: An RRO system was implemented which program components or constellation of in 8 city practices in 1995 (covering 64% of inner-city 886
- 895. children) and wasexpanded to 10 city practices by between rates for white and black children and a 15% 1999 (covering 74% of inner-city children, 61% of difference between white and Hispanic children. In rest-of-city children, and 9% of suburban children). 1999, rates were similar across the groups: white The RRO intervention involved lay community-based (88%), black (81%), and Hispanic (87%), with a 7% outreach workers who were assigned to city practices difference between rates for white and black children, to track immunization rates of all 0- to 2-year-olds, and and a 1% difference between white and Hispanic to provide a staged intervention with increasing children. CONCLUSIONS: A community-wide intensity depending on the degree to which children intervention of patient RRO raised childhood were behind in immunizations (tracking for all immunization rates in the inner city of Rochester and children, mail, or telephone reminders for most was associated with marked reductions in disparities in children, assistance with transportation or scheduling immunization rates between inner-city and suburban for some children, and home visits for 5% of children children and among racial and ethnic minority who were most behind in immunizations and who populations. By targeting a relatively manageable faced complex barriers). STUDY PARTICIPANTS: number of primary care practices that serve city Three separate cohorts of 0- to 2-year-old children children and using an effective strategy to increase were assessed-those residing in the county in 1993, immunization rates in each practice, it is possible to 1996, and 1999. STUDY DESIGN: Immunization rates eliminate disparities in immunizations for vulnerable were measured for each geographic region in Monroe children. County at 3 time periods: before the implementation of a systematic RRO system (1993), during early phases Sznajder M, Leduc S, Janvrin MP et al. Home delivery of an of implementation of the RRO system (1996), and after injury prevention kit for children in four French cities: implementation of the RRO system in 10 city practices a controlled randomized trial. Inj Prev 2003; 9(3):261- (1999). Immunization rates were compared for children 5; discussion 265. living in the 3 geographic regions, and for white, black, Abstract: OBJECTIVES: Home delivery of counselling and Hispanic children. Immunization rates were and safety devices to prevent child injuries could help measured by the same methodology in each of the 3 parents to adopt safe behaviour. The aim of this study time periods. A denominator of children was obtained was to test a safety kit designed and used in Quebec by merging patient lists from the practice files of most (Canada). DESIGN AND SUBJECTS: One hundred pediatric and family medicine practices in the county families from four towns in the Paris suburbs were (covering 85% to 89% of county children). A random visited at home by nurses or doctors when their child sample of children (>500 from the suburbs and >1200 reached 6-9 months. Selection criteria were: primipara, from the city for each sampling period) was then medical problem, psychological, and/or socioeconomic selected for medical chart review at practices to difficulties. INTERVENTIONS: During the first visit, determine demographic characteristics (including race 50 families (group 1) received counselling and a kit and ethnicity) and immunization rates. City children including preventive devices and pamphlets about were oversampled to allow detection of effects by indoor injuries and ways to avoid them. The other 50 geographic region and race. Rates for the 3 geographic families (group 2) received counselling but not the kit. regions and for the entire county were determined A second home visit was made 6-8 weeks later. MAIN using Stata to adjust for the clustered sampling. MAIN OUTCOME MEASURES: The number of safety OUTCOME MEASURES: Immunization rates at 12 improvements was calculated 6-8 weeks after a first and 24 months for recommended vaccines (4 home visit. Perceived usefulness of the kit was diphtheria-tetanus-pertussis:3 polio:1 measles-mumps- collected from families and from interviewers. rubella: > or =1 Haemophilus influenzae type b on or RESULTS: Between the first and the second visits, after 12 months of age). RESULTS: DISPARITIES safety improvement was significantly higher in the BY GEOGRAPHIC REGION: Baseline immunization group with the kit. This was mainly related to the risk rates (1993) for 24-month-olds were as follows: inner of fall (p<0.02), fire and burns (p<0.001), poisoning city (55%), rest of city (64%), and suburbs (73%), with (p<0.01), and suffocation (p<0.001). For improvement an 18% difference in rates between the inner city and related to devices provided in the kit, the difference suburbs. By 1996, immunization rates rose faster in the between the groups was significant: 64.4% inner city (+21% points) than in the suburbs (+14% improvement in group 1 versus 41.2% in group 2 points) so that the difference in rates between the inner (p<0.01). The relative risk (RR) of safety improvement city and suburbs had narrowed to 11%. In 1999, rates between groups was 1.56 (95% confidence interval were similar across geographic regions: inner city (CI) 1.35 to 1.80). Even for improvements not related (84%), rest of city (81%), and suburbs (88%), with a to the kit the difference remained significant: 31.2% in 4% difference between the inner city and suburbs. group 1 versus 20.2% in group 2 (p<0.05); RR = 1.54 DISPARITIES BY RACE AND ETHNICITY: (95% CI 1.22 to 1.93). CONCLUSION: Routine home Immunization rates were available in 1996 and 1999 by visits by social services offer a good opportunity to race and ethnicity. Twenty-four-month immunization tackle child injury prevention. Free delivery of rates in 1996 showed disparities: white (89%), black prevention kits and counselling allow families to (76%), and Hispanic (74%), with a 13% difference modify their behaviour and homes so as to reduce 887
- 896. risks. Subfactors of DSM-IV conduct disorder: evidence and connections with syndromes from the Child Behavior Szpurek D, Moszynski R, Smolen A, Sajdak S. Artificial Checklist. J Abnorm Child Psychol 2003; 31(6):647- neural network computer prediction of ovarian 54. malignancy in women with adnexal masses. Int J Abstract: Is conduct disorder (CD) as defined in the Gynaecol Obstet 2005; 89(2):108-13. Diagnostic and Statistical Manual of Mental Disorders Abstract: OBJECTIVE: Assessment of the usefulness (DSM-IV; American Psychiatric Association, 1994) a of a neural model to predict which ovarian tumors are unitary entity, or do variants of CD exist? We malignant. METHOD: Age, menopausal status, body addressed this question, using data collected from the mass index, grayscale and Doppler ultrasonographic parents of 1,669 Australian boys, aged 6-17. Parents features, as well as levels of specific markers (CA 125, were interviewed to assess DSM-IV Conduct Disorder tissue polypeptide specific antigen) were examined in (DSM-IV CD) criteria. Results revealed 2 subfactors of 686 women with adnexal masses. The probability of DSM-IV CD symptoms, made up of overt behaviors malignancy was calculated using an artificial neural (e.g., initiating physical fights) and covert behaviors network software and the diagnostic efficiency of the (e.g., stealing without confrontation). Ordinary least received model was estimated using a receiver- squares regressions showed the 2 CD subfactors to be operating characteristics (ROC) curve. RESULT: Of significantly and uniquely predicted by Child Behavior the 686 women, 431 (62.8%) had a benign and 255 Checklist (CBCL; T. M. Achenbach, 1991a, 1991b) (37.2%) had a malignant ovarian tumor. The significant syndromes labeled Aggressive Behavior and malignancy predictors are age, menopausal status, Delinquent Behavior, respectively. The results are maximum tumor diameter, internal wall structure of discussed in terms of the utility of differentiating these tumor, presence of septa and/or solid elements, tumor 2 variants of CD in future editions of the DSM. location, location of vessels, and blood flow indexes. The best network provided 96.0% sensitivity and Taft A, Broom DH, Legge D. General practitioner 97.7% specificity. The area under the curve for the management of intimate partner abuse and the whole received model was 0.9716. CONCLUSIONS: An family: qualitative study. BMJ 2004; 328(7440):618. artificial neural network model based on clinical and Abstract: OBJECTIVE: To explore management by ultrasonographic data allows to calculate the general practitioners of victimised female patients, probability of tumor malignancy. male partners who abuse, and children in the family. DESIGN: Triangulated qualitative study comparing Szwarcwald CL, Bastos FI, Andrade CL. [Health inequality doctors' reported management with current indicators: a discussion of some methodological recommendations in the literature. PARTICIPANTS: approaches as applied to neonatal mortality in the 28 general practitioners attending continuing medical Municipality of Rio de Janeiro, 2000]. Cad Saude education about management of domestic violence. Publica 2002; 18(4):959-70. RESULTS: Doctors perceived partner abuse in diverse Abstract: Epidemiology has investigated the ways. Their gender, perceptions, and attitudes could all relationship between health status and different social affect identification and management of this difficult and economic factors ever since the field emerged. problem. A few doctors practised in recommended Studies have consistently shown that the population's ways, but many showed stress and aversion, difficulties health status bears a strong social gradient, invariably in resolving the tensions involved in managing all unfavorable to the less privileged groups. Increasing family members, and neglect of the risks to children. interest in understanding and characterizing health Some doctors used contraindicated practices, such as inequalities has broadened the discussion in the recent breaking confidentiality and undertaking or referring literature on appropriate concepts and methodological for couple counselling. Doctors who were not familiar procedures for measuring differences in health status with community based agencies were reluctant to use according to socioeconomic level. This study presents them. A lack of expertise and support could have a a critical assessment of health inequality indicators, negative impact on doctors themselves. focusing on the following: the redistribution principle CONCLUSIONS: General practitioners managing and its application to health status; the influence of partner abuse need to be more familiar with and apply income inequality; epidemiological and statistical the central principles of confidentiality and safety of approaches to the problem; and evaluation of health women and children. Recommended guidelines for system performance in reducing health inequalities. As managing the whole family should be developed. an example, inequalities in the neonatal mortality rate Doctors should consider referring one partner are analyzed in the city of Rio de Janeiro, Brazil, 2000, elsewhere and avoid couple counselling; always ask according to the mother's level of schooling, reviewing about and act on the children's welfare; refer to the minimum requisites for defining an adequate health specialist family violence agencies; and seek training, inequality indicator. supervision, and support for the inherent stress. Medical education and administration should ensure Tackett JL, Krueger RF, Sawyer MG, Graetz BW. comprehensive training and support for doctors undertaking this difficult work. 888
- 897. Tagge ME. Wetnursing 2001: old practice, new dilemmas? cells were related to the presence of extrinsic neurons J Hum Lact 2001; 17(2):140-1. in aganglionic segment. Based on these findings, aperistalsis is considered not to relate with c-kit Tagle R. Full-service community schools: cause and positive cells, and c-kit positive cells are not supposed outcome of public engagement. New Dir Youth Dev to have a neurogenic origin and can develop without 2005; (107):45-54, table of contents. neurons, however the lack of enteric neurons may Abstract: Public Education Network (PEN)-a national influence the full differentiation of ICCs. organization of local education funds (LEFs)-along with individuals working to improve public schools Tai MC. The death of a little girl exposes an ethical hole. and build citizen support for quality public education, Formos J Med Humanit 2005; 6(1-2):1-2. embarked on an initiative to address the academic, Notes: GENERAL NOTE: KIE: KIE Bib: health enrichment, and social support needs of young people care/foreign countries; medical ethics to ensure their success in and out of school. PEN's Schools and Community Initiative called for the active Takeshita K, Nagamine T, Thuy DH et al. Maturational participation of broad constituencies-policymakers, change of parallel auditory processing in school-aged stakeholders, and the public-at-large-to create and children revealed by simultaneous recording of implement their common vision for full-service magnetic and electric cortical responses. Clin community schools. By engaging broad constituencies Neurophysiol 2002; 113(9):1470-84. across communities, LEFs have been able to build Abstract: OBJECTIVES: To elucidate the maturational strong relationships between and among community change of cortical auditory processing, we analyzed institutions under a common vision. simultaneously recorded auditory evoked potentials (AEPs) and magnetic fields (AEFs) in school-aged Taguchi T, Suita S, Masumoto K, Nada O. Universal children. METHODS: Simultaneous recording of AEP distribution of c-kit-positive cells in different types of and AEF were performed in 32 healthy children of age Hirschsprung's disease. Pediatr Surg Int 2003; ranging from 6 to 14 years and 10 adults. Tone bursts 19(4):273-9. of 1 kHz were presented to the left and right ears Abstract: Interstitial cells of Cajal (ICCs) have been alternately with 3 different within-ear stimulus onset reported to play the role of a pacemaker in regulating asynchronies (SOAs) (1.6, 3.0 and 5.0 s for each ear) bowel motility. The relationship between neurons and under attention-distracted condition. RESULTS: All ICCs, however, remains unclear. Hirschsprung's subjects showed clear N100 and N100m peaks under disease (HD) is an ideal model for investigating this the longest SOA condition (5.0 s). Under the shortest relationship. The operated specimens obtained from 6 SOA condition (1.6 s), 4 out of 19 subjects under 12 short and 3 long segment aganglionosis patients and 3 years (21%) failed to show the N100m component. By controls were used as the subject materials in this contrast, N250 and N250m were observed in the study. ICCs were immunohistochemically identified majority of children (29/32: 91%) while those were using a specific antiserum c-kit, a tyrosine kinase detected in only 4 out of 10 adults (40%). The spatial receptor expressing ICCs. Nitrergic nerves were distribution of N100 in children under 9 years differed demonstrated by NADPH-diaphorase (NADPH-d) from that in older subjects, whereas the dipole histochemistry. C-kit immunohistochemistry was also orientation of N100m was constant among age groups, combined with protein gene product 9.5 (PGP 9.5; as a suggesting that radially oriented sources might make general neuronal marker). In the normoganglionic additional contribution to the generation of N100 in segment of HD, numerous c-kit-positive cells and early childhood. N250 was significantly larger in NADPH-d positive neurons were found in the proper children than in adults. The strength of N250 was muscle layer, including Auerbach's plexus. In the suppressed with longer SOAs, whereas that of N100 oligoganglionic segment, the number of c-kit-positive was enhanced. The dipole of N250m was located cells and NADPH-d neurons slightly decreased. In the around Heschl's gyrus on the superior temporal plane inner border of the circular muscle layer (IBCM), the which was significantly medial, anterior and inferior to c-kit-positive cell networks and NADPH-d activities that of N100m. CONCLUSIONS: Dissociation of remained in short segment cases, while both of them maturational change between the tangential and radial were absent in the long segment cases. In the components of N100 suggests that auditory processing aganglionic segment, c-kit positive cells were present at around 100 ms consists of multiple parallel pathways universally but the number of them was slightly which mature independently. Furthermore, a negative decreased in the proper muscle layer. The c-kit-positive peak at around 250 ms specifically seen in children has cell networks of IBCM were seen where extrinsic different generators from N100 and might represent a neurons were present, while they were almost special auditory processing which takes an active part completely absent where extrinsic neurons were absent until acquisition of the efficient cortical networks of in the proximal zone of the long segment cases. C-kit the adult brain. positive cells were present universally in the oligoganglionic as well as aganglionic segments of Taket A, Nurse J, Smith K et al. Routinely asking women HD. The distribution and properties of c-kit positive 889
- 898. about domestic violencein health settings. BMJ 2003; mmHg recorded. (3) Bordetella pertussis bacteria 327(7416):673-6. attach to cilia in the airways, but do not invade the underlying tissue. The irritation causes the powerful Takeuchi H, Inoue M, Watanabe N et al. Parental coughing paroxysms of whooping cough. Brain enforcement of bedtime during childhood modulates haemorrhages and retinal detachment have been preference of Japanese junior high school students for observed to result from the high intravascular pressures eveningness chronotype. Chronobiol Int 2001; produced. The data suggest that any source of intense 18(5):823-9. airway irritation not easily removed (laryngeal Abstract: We examined the effect of home bedtime infection, inhalation of regurgitated feed, fluff, smoke discipline during childhood on morningness and etc.) could induce similar bleeding, a paroxysmal eveningness (M-E) preference by Japanese junior high cough injury (PCI). Additional objective evidence of school students. M-E was assessed by the M-E inflicted trauma is necessary to distinguish between Questionnaire (MEQ) of Torsvall and Akerstedt (the 'shaken baby syndrome' and PCI. higher the score, the greater the preference for morningness), and parental determination of bedtime Tam CM, Leung CC, Noertjojo K, Chan SL, Chan-Yeung during childhood was ascertained using an original M. Tuberculosis in Hong Kong-patient characteristics questionnaire. The average M-E score of adolescents and treatment outcome. Hong Kong Med J 2003; living in urban Kochi City (mean +/- SD; 15.10 +/- 9(2):83-90. 3.42) was significantly lower (P < .01) than the score Abstract: OBJECTIVES: To identify the general of those in suburban districts (16.14 +/- 3.44). Overall, characteristics of patients with tuberculosis, and to 43.1% of the junior high school students in Kochi City evaluate their treatment outcomes. DESIGN: compared to 53.0% of the students living in suburban Retrospective study. SETTING: Tuberculosis and districts had their bedtime decided during childhood by Chest Service, Department of Health, Hong Kong. parents (P < .01). In Kochi City, the M-E score for SUBJECTS AND METHODS: All patients with boys (14.62 +/- 3.51) was lower (P < .01) than girls tuberculosis registered for treatment from 1 January (15.53 +/- 3.28). During childhood, parents decided the 1996 to 31 December 1996 were included in the study. bedtime for 49% of the girls compared to 36.6% of the Information was extracted from their medical records boys (P < .01). Boys whose bedtime was not decided at treatment commencement and at 12 and 24 months by parents during childhood had a somewhat stronger after treatment was instigated. Data gathered included preference for eveningness (14.20 +/- 3.53) (P < .05) demographic data, past treatment, site of disease, case compared to those whose bedtime was decided by category, treatment regimen, bacteriological status, and parents (15.12 +/- 3.36). The results suggest bedtime treatment outcome. RESULTS: There were 5757 discipline at home during childhood has an effect on patients for analysis. Approximately one third of adolescent chronotype, modulating the extent of shift patients were aged 60 years or older, and 69.1% were to evening ness in Japanese junior high school boys in male. Pulmonary disease alone occurred in 77.7% of particular. patients, while both pulmonary and extrapulmonary diseases occurred in 8.6%. New patients comprised Talbert DG. Paroxysmal cough injury, vascular rupture and 84.6% of cases, and 16.3% had concomitant illnesses. 'shaken baby syndrome'. Med Hypotheses 2005; There was excess risk of disease among patients who 64(1):8-13. were male, elderly, or who had silicosis. Only 0.1% of Abstract: It is widely assumed that subdural and retinal patients were co-infected with human haemorrhage in infants can only result from traumatic immunodeficiency virus infection. Among the 5757 rupture of vulnerable blood vessels. An alternative cases evaluated, 1324 (23.0%) were new patients with aetiology, that of vascular rupture resulting from a positive sputum smear, 299 (5.2%) were patients who excessive intraluminal pressure, is presented in three were retreated with a positive sputum smear, and 4134 disease conditions. (1) Perlman et al., studying (71.8%) were new or retreatment patients with a premature neonates requiring mechanical ventilation negative sputum smear. The overall treatment for respiratory distress syndrome, observed "cough- completion rates at 12 and 24 months were 80.4% and like" fluctuations in oesophageal pressure greater than 84.8%, respectively. Males and patients aged 60 years 18 cms H2O, whose timing matched fluctuations in or older had lower treatment completion rates. Non- anterior cerebral artery flow. When 14 out of 24 adherence, transfer to other services, and mortality neonates were paralysed (to prevent abdominal muscle among the elderly were key factors influencing activity) intraventricular haemorrhage developed in all treatment outcomes. Co-morbidity was associated with 10 controls but in only one of the paralysed group better case-holding, and this more than compensated during paralysis. (2) New analysis of pressure data for its effect on prolongation of treatment and extracted from a previous study of prolonged mortality. CONCLUSIONS: There was an excess risk expiratory apnoea showed alveolar collapse induced of tuberculosis among male and elderly patients, who 100 mmHg intrathoracic cough pressure surges. also had a less favourable outcome. Active screening of Superior vena cava pressures up to 50 mmHg were clearly identified risk groups may be appropriate but implied, and radial artery systolic pressures over 180 requires the completion of more in-depth studies and 890
- 899. careful cost-effectiveness analyses.Further efforts with control. RESULTS: Parenting dimensions were related respect to case-holding are indicated to address to problem behavior for same- and mixed-gender treatment defaulting and transfer rates. sibling pairs, with coercive control as the strongest predictor. No direct association was found between Tamburlini G, Ronfani L, Buzzetti R. Development of a differential parental treatment and child outcomes child health indicator system in Italy. Eur J Public above the absolute levels of parenting in same-gender Health 2001; 11(1):11-7. sibling pairs. However, differential maternal and Abstract: BACKGROUND: The need for a uniform, paternal control was related to internalizing behavior of comprehensive and action-oriented child health girls and differential paternal warmth was linked to indicator system is widely recognised. As part of a externalizing behavior of the older siblings in mixed- Ministry of Health project, a working group was gender sibling pairs. CONCLUSION: Differential established in Italy in order to develop a proposal for a parental treatment is uniquely associated with child minimum set of health indicators to be adopted at the problem behavior above the absolute level of parenting regional and local health authority levels, where the for girls and early-born children in mixed-gender planning process takes place. METHODS: The sibling pairs. Any examination of the effects of indicators proposed cover 17 areas of perinatal, child differential treatment should not be undertaken without and adolescent health. The informing principles for the considering the gender and birth rank of the sibling choice were relevance to the main health problems, pairs. availability of a reliable data collection system, feasibility of the collection and analysis process at the Tan KC, Yu Q, Heng CM, Lee TH. Evolutionary computing two health system levels proposed and extent to which for knowledge discovery in medical diagnosis. Artif the information provides clues for policy options. Intell Med 2003; 27(2):129-54. RESULTS: The main difficulties arise from a lack of Abstract: One of the major challenges in medical uniform systems of classification and data collection domain is the extraction of comprehensible knowledge for disabilities, as well as adequate tools for assessing from medical diagnosis data. In this paper, a two-phase quality of care and quality of life. A basic framework hybrid evolutionary classification technique is for analysis is suggested, including further breakdown proposed to extract classification rules that can be used of the indicators proposed, such as analysis by in clinical practice for better understanding and birthweight and by cause of neonatal death and by prevention of unwanted medical events. In the first mother's education and father's employment. The phase, a hybrid evolutionary algorithm (EA) is utilized information provided by the health indicators put to confine the search space by evolving a pool of good forward needs to be evaluated within the broader candidate rules, e.g. genetic programming (GP) is scenario of the child's situation so that associated applied to evolve nominal attributes for free structured factors may be identified and clues found for rules and genetic algorithm (GA) is used to optimize intersectoral policies. Two research projects were the numeric attributes for concise classification rules started to evaluate the feasibility and reliability of data without the need of discretization. These candidate collection and the impact on the planning process at rules are then used in the second phase to optimize the both the regional and local health authority levels. order and number of rules in the evolution for forming CONCLUSION: A European-wide initiative is accurate and comprehensible rule sets. The proposed proposed to tackle existing methodological problems evolutionary classifier (EvoC) is validated upon effectively and develop a common child health hepatitis and breast cancer datasets obtained from the indicator system. UCI machine-learning repository. Simulation results show that the evolutionary classifier produces Tamrouti-Makkink ID, Dubas JS, Gerris JR, van Aken MA. comprehensible rules and good classification accuracy The relation between the absolute level of parenting for the medical datasets. Results obtained from t-tests and differential parental treatment with adolescent further justify its robustness and invariance to random siblings' adjustment. J Child Psychol Psychiatry 2004; partition of datasets. 45(8):1397-406. Abstract: BACKGROUND: The present study extends Taras H, Wright S, Brennan J, Campana J, Lofgren R. existing studies on the role of differential parental Impact of school nurse case management on students treatment in explaining individual differences in with asthma. J Sch Health 2004; 74(6):213-9. adolescent problem behaviors above the absolute level Abstract: This project determined asthma prevalence in of parenting and clarifies the function of gender of the a large school district, absentee rates, and potential child, birth rank and gender constellation of the sibling effects of school nurse case management for student dyads. METHOD: The absolute level of parenting asthma over three years. Data were derived from an practices and differential treatment were examined in a asthma tracking tool used by nurses in one school sample of 288 Dutch families consisting of two parents district for every student reported as having asthma by and two adolescents. Parents reported on adolescent their parent. School nurses began collecting data in internalizing and externalizing problem behavior and their schools in 1999-2000 when an asthma- adolescents reported on parental warmth and coercive management protocol was first developed. Nurses 891
- 900. documented perceived asthmaseverity for each Abstract: OBJECTIVE: This longitudinal study had student, presence of medication and peak flow meters three aims: 1) determine the extent to which boys at in school, and case management activities provided. high average risk and low average risk for substance This data base was cross matched with percentage of use disorder differ on a construct of neurobehavioral days students were absent for any illness. Prevalence of disinhibition, 2) evaluate the capacity of asthma, based on school nurse records of parent report, neurobehavioral disinhibition to predict substance use was between 5.1% to 6.2% during the three years. frequency at age 16, and 3) demonstrate the utility of Between 13.5% and 15% were moderate or severe. neurobehavioral disinhibition in predicting substance Students with asthma were absent between one-half to use disorder. METHOD: The authors derived an index one and one-quarter days more often than those of neurobehavioral disinhibition from measures of without asthma. In year three, 39% of students with affect, behavior, and cognition. The neurobehavioral asthma had medication at school, and 12% had a peak disinhibition score was used to discriminate youth at flow meter. Contacting a parent was the nurse case high and low average risk for substance use disorder management activity provided for the largest number and to predict substance use frequency after 4-6 years of students (27% of students with asthma), followed by and substance use disorder after 7-9 years. RESULTS: asthma education (16.5%), contact with physician The neurobehavioral disorder score significantly (6%), and home visits (1%). Students who received at discriminated boys at high average risk from those at least one school nurse case management intervention low average risk at ages 10-12. Neurobehavioral were more likely the next year to have an asthma disinhibition at age 16, in conjunction with substance medication at school, to use a peak flow meter at use frequency and risk status group, predicted school, and to have a change in asthma severity. School substance use disorder at age 19 with 85% accuracy nurse case management activity had no association and accounted for 50% of the variance in Drug Use with student absences. Availability of medication and Screening Inventory overall problem density score. peak flow meters at school was low, suggesting Neurobehavioral disinhibition was a stronger predictor standards of care for asthma were not followed. School of substance use disorder (odds ratio=6.83) than nurse case management, when performed outside a substance consumption frequency (odds ratio=3.19). project or intervention, offers a promising strategy to CONCLUSIONS: Cross-sectional and longitudinal improve asthma management. analyses indicated that neurobehavioral disinhibition is a component of the liability to early age at onset of Tarnow-Mordi WO. "Right to die": ...but context of limited substance use disorder. resources can be encountered in developed countries too. BMJ 2005; 330(7504):1389; discussion 1389. Tarter RE, Kirisci L, Reynolds M, Mezzich A. Notes: GENERAL NOTE: KIE: 2 refs. Neurobehavior disinhibition in childhood predicts GENERAL NOTE: KIE: KIE Bib: allowing to suicide potential and substance use disorder by young die/infants adulthood. Drug Alcohol Depend 2004; 76 Suppl:S45- 52. Tarter RE. Etiology of adolescent substance abuse: a Abstract: The objectives of this study were to (a) developmental perspective. Am J Addict 2002; determine whether two factors that are established 11(3):171-91. components of the risk for substance use disorder Abstract: Approximately 5% of adolescents in the U.S. (SUD) also impact on the risk for suicide; and (2) qualify for a diagnosis of substance use disorder evaluate whether SUD manifest by early adulthood (SUD). Low affect and behavior self-regulation during predicts suicide propensity. Neurobehavior child development interacting with family, peer and disinhibition assessed in 227 boys at ages 10-12 and 16 other ecological factors predisposes to substance use in and parental history of SUD were prospectively adolescence. Maturational processes during evaluated to determine their association with the risk adolescence, particularly involving the brain and for SUD and suicide propensity between ages 16 and reproductive system, exacerbate the low psychological 19. The results indicated that neurobehavior self-regulation evidenced during childhood to promote disinhibition at age 16 predicts suicide propensity initiation of alcohol, tobacco, and other drug (ATOD) between ages 16 and 19 (p = .04). A trend was consumption. This discussion examines the etiology of observed (p = .08) for SUD manifest between ages 16 ATOD abuse and SUD from a developmental and 19 to predict suicide propensity during the same perspective. The ramifications of a developmental period. Maternal SUD is directly associated with son's perspective for clinical practice and social policy are SUD risk but not suicide propensity. Paternal SUD also considered. predicts son's neurobehavior disinhibition that, in turn, predisposes to SUD. A direct relation between paternal Tarter RE, Kirisci L, Mezzich A et al. Neurobehavioral SUD and son's suicide propensity was not observed. disinhibition in childhood predicts early age at onset of These findings suggest that neurobehavior substance use disorder. Am J Psychiatry 2003; disinhibition, a component of the liability of SUD, is 160(6):1078-85. also associated with suicide risk. These results are discussed within a neurobehavioral framework in 892
- 901. which prefrontal cortexdysfunction is hypothesized to Taylor D. Unnatural eye injuries. Trans Med Soc Lond underlie the risk for these two outcomes. 2001-2002; 118:43-53. Taveras EM, Capra AM, Braveman PA, Jensvold NG, Taylor JS. The story catches you and you fall down: tragedy, Escobar GJ, Lieu TA. Clinician support and ethnography, and "cultural competence". Med psychosocial risk factors associated with breastfeeding Anthropol Q 2003; 17(2):159-81. discontinuation. Pediatrics 2003; 112(1 Pt 1):108-15. Abstract: Anne Fadiman's The Spirit Catches You and Abstract: OBJECTIVE: Breastfeeding rates fall short You Fall Down: A Hmong Child, Her American of goals set in Healthy People 2010 and other national Doctors, and the Collision of Two Cultures (Noonday recommendations. The current, national breastfeeding Press, 1997) is widely used in "cultural competence" continuation rate of 29% at 6 months lags behind the efforts within U.S. medical school curricula. This Healthy People 2010 goal of 50%. The objective of this article addresses the relationship between theory, study was to evaluate associations between narrative form, and teaching through a close critical breastfeeding discontinuation at 2 and 12 weeks reading of that book that is informed by theories of postpartum and clinician support, maternal physical tragedy and ethnographies of medicine. I argue that and mental health status, workplace issues, and other The Spirit Catches You is so influential as ethnography factors amenable to intervention. METHODS: A because it is so moving as a story; it is so moving as a prospective cohort study was conducted of low-risk story because it works so well as tragedy; and it works mothers and infants who were in a health maintenance so well as tragedy precisely because of the static, organization and enrolled in a randomized, controlled reified, essentialist understanding of "culture" from trial of home visits. Mothers were interviewed in which it proceeds. If professional anthropologists wish person at 1 to 2 days postpartum and by telephone at 2 our own best work to speak to "apparitions of culture" and 12 weeks. Logistic regression modeling was within medicine and other "cultures of no culture," I performed to assess the independent effects of the suggest that we must find compelling new narrative predictors of interest, adjusting for sociodemographic forms in which to convey more complex and other confounding variables. RESULTS: Of the understandings of "culture." 1163 mother-newborn pairs in the cohort, 1007 (87%) initiated breastfeeding, 872 (75%) were breastfeeding Taylor KI. Understanding communities today: using at the 2-week interview, and 646 (55%) were matching needs and services to assess community breastfeeding at the 12-week interview. In the final needs and design community-based services. Child multivariate models, breastfeeding discontinuation at 2 Welfare 2005; 84(2):251-64. weeks was associated with lack of confidence in ability Abstract: Matching Needs and Services (MNS) is a to breastfeed at the 1- to 2-day interview (odds ratio practice tool intended to help people who work with [OR]: 2.8; 95% confidence interval [CI]: 1.02-7.6), vulnerable children use rigorously assembled early breastfeeding problems (OR: 1.5; 95% CI: 1.1- information on needs as a guide to design, implement, 1.97), Asian race/ethnicity (OR: 2.6; 95% CI: 1.1-5.7), and evaluate more-effective services. To do this, MNS and lower maternal education (OR: 1.5; 95% CI: 1.2- focuses on needs but links them to outcomes and 1.9). Mothers were much less likely to discontinue thresholds before dealing with the services to achieve breastfeeding at 12 weeks postpartum if they reported those outcomes. (during the 12-week interview) having received encouragement from their clinician to breastfeed (OR: Taylor SG. Orem's general theory of nursing and families. 0.6; 95% CI: 0.4-0.8). Breastfeeding discontinuation at Nurs Sci Q 2001; 14(1):7-9. 12 weeks was also associated with demographic factors and maternal depressive symptoms (OR: 1.18; 95% CI: Tcheremissine OV, Lane SD, Lieving LM, Rhoades HM, 1.01-1.37) and returning to work or school by 12 weeks Nouvion S, Cherek DR. Individual differences in postpartum (OR: 2.4; 95% CI: 1.8-3.3). aggressive responding to intravenous flumazenil CONCLUSIONS: Our results indicate that support administration in adult male parolees. J from clinicians and maternal depressive symptoms are Psychopharmacol 2005; 19(6):640-6. associated with breastfeeding duration. Attention to Abstract: Nonhuman and human studies have shown these issues may help to promote breastfeeding that benzodiazepine (BZD) receptor agonists can continuation among mothers who initiate. Policies to modify aggressive behaviour. However, it is unknown enhance scheduling flexibility and privacy for whether flumazenil, a BZD receptor antagonist, breastfeeding mothers at work or school may also be enhances or inhibits aggressive behaviour.The present important, given the elevated risk of discontinuation study was designed to investigate the effects of acute associated with return to work or school. administrations of flumazenil on aggressive responding in adult humans.Six adult males with histories of Tay ET, Levin TL. Suspected abuse. Clin Pediatr (Phila) childhood conduct disorder (DSM IV R) participated in 2004; 43(6):583-5. experimental sessions. Aggression was measured using the Point Subtraction Aggression Paradigm (PSAP; 893
- 902. Cherek 1992), whichprovided subjects with aggressive over-representation of stepchildren as victims. For very and monetary-reinforced response options.Acute doses young stepchildren there was a tendency for over- of flumazenil (2 and 3mg) did not produce statistically representation. In families with both stepchildren and significant changes in either monetary-reinforced children genetically related to the offender, genetic responding or aggressive responding. The analysis of children tended to be more likely to be victims. individual subjects data revealed that aggressive responses varied across subjects.The results are Tenenbaum T, Hasan C, Kramm CM et al. Oncological discussed in terms of individual differences based on management of pediatric cancer patients belonging to the previous history of BZD abuse. Additional Jehovah's Witnesses: a two-institutional experience laboratory research is needed to better clarify the report. Onkologie 2004; 27(2):131-7. behavioural mechanisms by which BZD receptor Abstract: OBJECTIVES: Aim of this study was to antagonists modify human aggressive responding. analyze the feasibility of oncological treatment in pediatric patients belonging to Jehovah's Witnesses and Tein JY, Sandler IN, MacKinnon DP, Wolchik SA. How did to describe the changing policy in performing it work? Who did it work for? Mediation in the context transfusions and supportive care measures at two of a moderated prevention effect for children of German pediatric cancer institutions. PATIENTS AND divorce. J Consult Clin Psychol 2004; 72(4):617-24. METHODS: Over a period of 16 years 21 treatments Abstract: This study presents a reanalysis of data from according to the current cooperative protocols were an effective preventive intervention for children from performed in 14 children of Jehovah's Witnesses. divorced families to test mediation of program effects. Various hematological supportive care measures such The study involved 157 children, age 9-12 years, who as supplementation with iron, human erythropoietin, were randomly assigned to a parenting program or a interleukin 11, granulocyte colony-stimulating factor literature control condition. Program effects to reduce and autologous or allogeneic stem cell rescue had been posttest internalizing problems were mediated through applied. For comparison matched pairs treated in our improvement in mother-child relationship quality. hospitals not belonging to Jehovah's Witnesses and 50 Program effects to reduce externalizing problems at pediatric and adult oncological patients belonging to posttest and 6 months were mediated through Jehovah's Witnesses reviewed from the international improvement in posttest parental methods of discipline literature were analyzed with respect to transfusions and mother-child relationship quality. The study also and outcome. RESULTS: So far, 9 of 14 children are describes a new methodology to test mediation of surviving 16-195 months (median 26 months). During Program x Baseline Status interactions. Analyses the primary therapy they received markedly less demonstrate mediation effects primarily for children transfusions than the control cohort (-39,1% red blood who began the program with poorer scores on cell transfusions and -37,5% platelet transfusions). The discipline, mother-child relationship quality, and review of 50 reported cases showed that oncological externalizing problems. therapy can also be successfully performed with a restricted transfusion regimen in children and Teklehaimanot K. United Kingdom: denying children's milk particularly in adults. CONCLUSION: Pediatric cancer allowance to HIV-positive mother seeking asylum is patients belonging to Jehovah's Witnesses can be discriminatory. Can HIV AIDS Policy Law Rev 2003; treated similarly to other patients. A restrictive 8(1):73-4. transfusion policy and the broad application of Abstract: In July 2002, the High Court of Justice found hematopoietic supportive care measures may reduce that, in denying the milk allowance, the Home Office transfusions. This treatment policy and a continuous had failed to realize the real risk that the mother might collaboration with the Hospital Liaison Committee for breastfeed her daughter and that the daughter might be Jehovah's Witnesses appears to create an oncological infected with HIV. The Court also ruled that the Home treatment situation with a high compliance of patients Office's action was discriminatory under Article 14 of and parents where court orders may not be necessary. the European Convention on Human Rights and Fundamental Freedoms. Teplin LA, McClelland GM, Abram KM, Mileusnic D. Early violent death among delinquent youth: a Temrin H, Nordlund J, Sterner H. Are stepchildren over- prospective longitudinal study. Pediatrics 2005; represented as victims of lethal parental violence in 115(6):1586-93. Sweden? Proc Biol Sci 2004; 271 Suppl 3:S124-6. Abstract: OBJECTIVE: Youth processed in the Abstract: Evolutionary psychologists have suggested juvenile justice system are at great risk for early violent that stepchildren should be over-represented as victims death. Groups at greatest risk, ie, racial/ethnic of lethal parental violence compared with children minorities, male youth, and urban youth, are living with their two genetic parents, because of overrepresented in the juvenile justice system. We relatively more lapses in parental solicitude among compared mortality rates for delinquent youth with stepparents. In our study, using data over a period of 35 those for the general population, controlling for years in Sweden (1965-1999), there was no overall differences in gender, race/ethnicity, and age. METHODS: This prospective longitudinal study 894
- 903. examined mortality ratesamong 1829 youth (1172 empowering clients to inform professional practice. male and 657 female) enrolled in the Northwestern Qual Health Res 2005; 15(8):1129-40. Juvenile Project, a study of health needs and outcomes Abstract: Grounded theory and participatory action of delinquent youth. Participants, 10 to 18 years of age, research methods are distinct approaches to qualitative were sampled randomly from intake at the Cook inquiry. Although grounded theory has been County Juvenile Temporary Detention Center in conceptualized in constructivist terms, it has elements Chicago, Illinois, between 1995 and 1998. The sample of positivist thinking with an image of neutral search was stratified according to gender, race/ethnicity for objective truth through rigorous data collection and (African American, non-Hispanic white, Hispanic, or analysis. Participatory action research is based on a other), age (10-13 or > or =14 years), and legal status critique of this image and calls for more inclusive (processed as a juvenile or as an adult), to obtain research processes. It questions the possibility of enough participants for examination of key subgroups. objective social sciences and aspires to engage people The sample included 1005 African American (54.9%), actively in all stages of generating knowledge. The 296 non-Hispanic white (16.2%), 524 Hispanic authors applied both approaches in a project designed (28.17%), and 4 other-race/ethnicity (0.2%) subjects. to explore the experiences of female survivors of The mean age at enrollment was 14.9 years (median childhood sexual abuse with physical therapy and age: 15 years). The refusal rate was 4.2%. As of March subsequently develop a handbook on sensitive practice 31, 2004, we had monitored participants for 0.5 to 8.4 for clinicians that takes into consideration the needs years (mean: 7.1 years; median: 7.2 years; interquartile and perspectives of these clients. Building on this range: 6.5-7.8 years); the aggregate exposure for all experience, they argue that the integration of grounded participants was 12944 person-years. Data on deaths theory and participatory action research can empower and causes of death were obtained from family reports clients to inform professional practice. or records and were then verified by the local medical examiner or the National Death Index. For Tessa C, Mascalchi M, Matteucci L, Gavazzi C, Domenici comparisons of mortality rates for delinquents and the R. Permanent brain damage following acute clonidine general population, all data were weighted according to poisoning in Munchausen by proxy. Neuropediatrics the racial/ethnic, gender, and age characteristics of the 2001; 32(2):90-2. detention center; these weighted standardized Abstract: A child presented with recurrent episodes of populations were used to calculate reported lethargia for which he underwent several hospital percentages and mortality ratios. We calculated admissions and investigations. A further episode mortality ratios by comparing our sample's mortality culminated in respiratory arrest and hypoxic ischemic rates with those for the general population of Cook encephalopathy with permanent mental regression. County, controlling for differences in gender, Eighteen months later the mother was discovered while race/ethnicity, and age. RESULTS: Sixty-five youth providing clonidine pills to the child; the mother died during the follow-up period. All deaths were from appears to feature a Munchausen syndrome by proxy. external causes. As determined by using the weighted percentages to estimate causes of death, 95.5% of Teusch R. Substance abuse as a symptom of childhood deaths were homicides or legal interventions (90.1% sexual abuse. Psychiatr Serv 2001; 52(11):1530-2. homicides and 5.4% legal interventions), 1.1% of all Abstract: The recovery process of a 37-year-old deaths were suicides, 1.3% were from motor vehicle woman with adult onset posttraumatic stress disorder accidents, 0.5% were from other accidents, and 1.6% (PTSD) is presented. The patient had suffered were from other external causes. Among homicides, childhood sexual abuse and had self-medicated for 93.0% were from gunshot wounds. The overall many years with drugs and alcohol to maintain the mortality rate was >4 times the general-population rate. dissociation of memories of abuse and to facilitate The mortality rate among female youth was nearly 8 interpersonal functioning. Upon onset of PTSD, the times the general-population rate. African American patient's substance abuse became a full-blown male youth had the highest mortality rate (887 deaths addiction that was highly resistant to treatment. It per 100000 person-years). CONCLUSIONS: Early became evident that her substance abuse symbolically violent death among delinquent and general-population repeated her traumatization. In reexperiencing the youth affects racial/ethnic minorities disproportionately affects associated with her earlier trauma (despair, and should be addressed as are other health disparities. denial, shame, and helplessness) as part of her Future studies should identify the most promising substance abuse and in the transference, the patient was modifiable risk factors and preventive interventions, able to gain mastery over these affects and, explore the causes of death among delinquent female subsequently, was able to achieve a stable recovery youth, and examine whether minority youth express from both illnesses. suicidal intent by putting themselves at risk for homicide. Thabet AA, Abed Y, Vostanis P. Comorbidity of PTSD and depression among refugee children during war conflict. Teram E, Schachter CL, Stalker CA. The case for integrating J Child Psychol Psychiatry 2004; 45(3):533-42. grounded theory and participatory action research: 895
- 904. Abstract: BACKGROUND: Weexamined the strongest socioeconomic predictor of post-traumatic prevalence and nature of comorbid post-traumatic stress reactions (odds ratio 0.25 [95% CI 0.12-0.53], stress reactions and depressive symptoms, and the p=0.0008). By contrast, children exposed to other impact of exposure to traumatic events on both types of events, mainly through the media and adults, reported psychopathology, among Palestinian children during more anticipatory anxiety and cognitive expressions of war conflict in the region. METHODS: The 403 distress (p=0.001) than children who were directly children aged 9-15 years, who lived in four refugee exposed. INTERPRETATION: Children living in war camps, were assessed by completing the Gaza zones can express acute distress from various traumatic Traumatic Events Checklist, the Child Post Traumatic events through emotional problems that are not usually Stress Reaction Index (CPTSD-RI), and the Short recognised. Health professionals and other agencies Mood and Feelings Questionnaire (MFQ). RESULTS: coming in contact with children who have been Children reported experiencing a wide range of affected by war and political violence need to be traumatic events, both direct experience of violence trained in detection and treatment of such and through the media. CPTSD-RI and MFQ scores presentations. were significantly correlated. Both CPTSD-RI and MFQ scores were independently predicted by the Thadani PV. The intersection of stress, drug abuse and number of experienced traumatic events, and this development. Psychoneuroendocrinology 2002; 27(1- association remained after adjusting for socioeconomic 2):221-30. variables. Exposure to traumatic events strongly Abstract: Use or abuse of licit and illicit substances is predicted MFQ scores while controlling for CPTSD-RI often associated with environmental stress. Current scores. In contrast, the association between traumatic clinical evidence clearly demonstrates neurobehavioral, events and CPTSD-RI scores, while controlling for somatic growth and developmental deficits in children MFQ scores, was weak. The CPTSD-RI items whose born to drug-using mothers. However, the effects of frequency was significantly associated with total MFQ environmental stress and its interaction with prenatal scores were: sleep disturbance, somatic complaints, drug exposure on a child's development is unknown. constricted affect, impulse control, and difficulties in Studies in pregnant animals under controlled concentration. However, not all remaining CPTSD-RI conditions show drug-induced long-term alterations in items were significantly associated with exposure to brain structures and functions of the offspring. These traumatic events, thus raising the possibility that the cytoarchitecture alterations in the brain are often association between depression and PTSD was due in associated with perturbations in neurotransmitter part to symptom overlap. CONCLUSIONS: Children systems that are intimately involved in the regulation living in war zones are at high risk of suffering from of the stress responses. Similar abnormalities have PTSD and depressive disorders. Exposure to trauma been observed in the brains of animals exposed to other was not found to have a unique association with PTSD. adverse exogenous (e.g., environmental stress) and/or The relationship between PTSD and depressive endogenous (e.g., glucocorticoids) experiences during symptomatology requires further investigation. early life. The goal of this article is to: (1) provide evidence and a perspective that common neural Thabet AA, Abed Y, Vostanis P. Emotional problems in systems are influenced during development both by Palestinian children living in a war zone: a cross- perinatal drug exposure and early stress exposure; and sectional study. Lancet 2002; 359(9320):1801-4. (2) identify gaps and encourage new research Abstract: BACKGROUND: Children living in war examining the effects of early stress and perinatal drug zones are at high risk of developing post-traumatic exposure, in animal models, that would elucidate how stress and other emotional disorders, but little is known stress- and drug-induced perturbations in neural about the effect of traumatic events during war. We systems influence later vulnerability to abused drugs in aimed to assess the nature and severity of emotional adult offspring. problems in Palestinian children whose homes had been bombarded and demolished during the crisis in Therrell BL Jr. U.S. newborn screening policy dilemmas for Palestine, compared with children living in other parts the twenty-first century. Mol Genet Metab 2001; 74(1- of the Gaza strip. METHODS: 91 children exposed to 2):64-74. home bombardment and demolition during Al Aqsa Abstract: Newborn screening has traditionally referred Intifada and 89 controls who had been exposed to other to biochemical testing for inherited disorders, generally types of traumatic events related to political violence metabolic in origin, that are usually correctable by completed self-report measures of post-traumatic dietary or drug interventions. As new tests have been stress, anxiety, and fears. FINDINGS: Significantly developed, state public health newborn screening more children exposed to bombardment and home systems have slowly evolved without the benefit of demolition reported symptoms of post-traumatic stress national policies. Thus, newborn screening program (p=0.0008) and fear (p=0.002) than controls. 54 (59%) changes, when viewed nationally, have been of 91 exposed children and 22 (25%) of 89 controls uncoordinated. The net result has been unequally reported post-traumatic stress reactions of clinical applied mandated screening and, consequently, unequal importance. Exposure to bombardment was the availability of related public health disease prevention 896
- 905. services. Technological advancesin laboratory testing present changes in the Health (National Cervical over the past 10 years have resulted in limited program Screening Programme) Amendment Bill and the Code changes in some state newborn screening systems, and of Health and Disability Services Consumers' Rights of even greater program disparities. A recent Newborn 1996 are sufficient to resolve the issues. The paper Screening Task Force identified numerous issues of expresses concern about the delegation of decision- concern and proposed elements for a plan of action making in this area to ethics committees. involving public health programs, healthcare providers, and consumers. This minireview details past policy Thomas KA. Safety: when infants and parents are research history in newborn screening and identifies some of the subjects. J Perinat Neonatal Nurs 2005; 19(1):52-8. current issues confronting programs as they seek to Abstract: Patient safety is a central concern in nursing. move ahead with the technologies and medical Unlike other areas of patient safety, safety in research treatments for the twenty-first century. is particularly important because research is not part of standard care and participation is voluntary. Issues Therrien M. Did the principle of double effect justify the related to safety in research are especially pertinent to separation? Natl Cathol Bioeth Q 2001; 1(3):417-27. high-risk infants, because of the nature of parental (or Notes: GENERAL NOTE: KIE: Therrien, Michel legal guardian) consent and because children are GENERAL NOTE: KIE: 14 fn. considered a vulnerable group requiring special GENERAL NOTE: KIE: KIE Bib: patient care/minors protection from research risks. Nurses must be aware of safety in research whether independently conducting Thibault KL. Some pitfalls of computer modeling. Arch research, employed by a research project, or caring for Pediatr Adolesc Med 2002; 156(3):296-7. patients who are research subjects. This article reviews safety issues and policies, processes, and ethical Tholcken M, Lehna C. Advanced practice nurses as faculty. guidelines designed to protect infants and children who MCN Am J Matern Child Nurs 2001; 26(6):323-7. are research subjects. Abstract: This article details a program through which two child health faculty members who are advanced Thomas M, Karmiloff-Smith A. Are developmental practice nurses (APNs) combined practice with disorders like cases of adult brain damage? teaching undergraduate students in a community-based Implications from connectionist modelling. Behav clinical experience on nursing case management. A Brain Sci 2002; 25(6):727-50; discussion 750-87. collaborative agreement between a university-based Abstract: It is often assumed that similar domain- Children's Special Services Team (CSST) and school specific behavioural impairments found in cases of of nursing faculty was developed to extend services adult brain damage and developmental disorders into the home communities of children with special correspond to similar underlying causes, and can serve healthcare needs. Senior students made visits to the as convergent evidence for the modular structure of the homes of the team's clients, conducted assessments, normal adult cognitive system. We argue that this interacted with families, and provided additional care. correspondence is contingent on an unsupported The team, which included physicians, nurses, a social assumption that atypical development can produce worker, and therapists (occupational and physical) selective deficits while the rest of the system develops identified children and families who would benefit normally (Residual Normality), and that this from home visits by students nurses who were directed assumption tends to bias data collection in the field. by APNs. Both service and educational goals were Based on a review of connectionist models of acquired accomplished by this community-based case- and developmental disorders in the domains of reading management experience. The children and their and past tense, as well as on new simulations, we families received additional care from multiple explore the computational viability of Residual healthcare providers. Students practiced components of Normality and the potential role of development in community-based case management, and the CSST producing behavioural deficits. Simulations obtained vital information about their clients' living demonstrate that damage to a developmental model can environments. produce very different effects depending on whether it occurs prior to or following the training process. Thomas C. Guthrie test samples: is the problem solved? N Z Because developmental disorders typically involve Bioeth J 2004; 5(2):25-33. damage prior to learning, we conclude that the Notes: GENERAL NOTE: KIE: 24 refs. developmental process is a key component of the GENERAL NOTE: KIE: KIE Bib: genetic research; explanation of endstate impairments in such disorders. genetic screening; mass screening Further simulations demonstrate that in simple Abstract: Most babies born in New Zealand have a connectionist learning systems, the assumption of blood sample taken shortly after birth for the purposes Residual Normality is undermined by processes of of certain screening tests. The samples are retained compensation or alteration elsewhere in the system. indefinitely. This paper considers whether such We outline the precise computational conditions samples are the property of the child and whether the required for Residual Normality to hold in development, and suggest that in many cases it is an 897
- 906. unlikely hypothesis. Weconclude that in study design. MAIN RESULTS: Of the 76 randomised developmental disorders, inferences from behavioural controlled trials identified, we classified 16 as category deficits to underlying structure crucially depend on one (most valid). There were no category one studies developmental conditions, and that the process of of information giving alone. There were fifteen ontogenetic development cannot be ignored in category one studies of social influences interventions. constructing models of developmental disorders. Of these, eight showed some positive effect of intervention on smoking prevalence, and seven failed Thomas R. School-based programmes for preventing to detect an effect on smoking prevalence. The largest smoking. Cochrane Database Syst Rev 2002; and most rigorous study, the Hutchinson Smoking (4):CD001293. Prevention Project, found no long-term effect of an Abstract: BACKGROUND: Smoking rates in intensive 8-year programme on smoking behaviour. adolescents are rising. Helping young people to avoid There was a lack of high quality evidence about the starting smoking is a widely endorsed goal of public effectiveness of combinations of social influences and health, but there is uncertainty about how to do this. social competence approaches. There was limited Schools provide a route for communicating with a evidence about the effectiveness of multi-modal large proportion of young people, and school-based approaches including community initiatives. programmes for smoking prevention have been widely REVIEWER'S CONCLUSIONS: There is no rigorous developed and evaluated. OBJECTIVES: To review all test of the effects of information giving about smoking. randomised controlled trials of behavioural There are well-conducted randomised controlled trials interventions in schools to prevent children (aged 5 to test the effects of social influences interventions: in to12) and adolescents (aged 13 to18) starting smoking. half of the group of best quality studies those in the SEARCH STRATEGY: We searched The Cochrane intervention group smoke less than those in the control, Controlled Trials and Tobacco Review group registers, but many studies showed no effect of the intervention. MEDLINE, EMBASE, Psyclnfo, ERIC, CINAHL, There is a lack of high-quality evidence about the Health Star, Dissertation Abstracts and studies effectiveness of combinations of social influences and identified in the bibliographies of articles. Individual social competence interventions, and of multi-modal MEDLINE searches were made for 133 authors who programmes that include community interventions. had undertaken randomised controlled trials in this area. SELECTION CRITERIA: Types of studies: those Thomas T. Covert video surveillance: an appraisal of the in which individual students, classes, schools, or school UKCC Position Statement. Paediatr Nurs 2001; districts were randomised to the intervention or control 13(4):15-7. groups and followed for at least six months. Types of participants: Children (aged 5 to12) or adolescents Thompson A, Hollis C, Dagger DR. Authoritarian parenting (aged 13 to18) in school settings. Types of attitudes as a risk for conduct problems Results from a interventions: Classroom programmes or curricula, British national cohort study. Eur Child Adolesc including those with associated family and community Psychiatry 2003; 12(2):84-91. interventions, intended to deter use of tobacco. We Abstract: This study examines the associations, and included programmes or curricula that provided possible causal relationship, between mothers' information, those that used social influences authoritarian attitudes to discipline and child behaviour approaches, those that taught generic social using cross-sectional and prospective data from a large competence, and those that included interventions population sample surveyed in the 1970 British Cohort beyond the school into the community. We included Study. Results show a clear linear relationship between programmes with a drug or alcohol focus if outcomes the degree of maternal approval of authoritarian child- for tobacco use were reported. Types of outcome rearing attitudes and the rates of conduct problems at measures: Prevalence of non-smoking at follow-up age 5 and age 10. This association is independent of the among those not smoking at baseline. We did not confounding effects of socio-economic status and require biochemical validation of self-reported tobacco maternal psychological distress. Maternal authoritarian use for study inclusion. DATA COLLECTION AND attitudes independently predicted the development of ANALYSIS: We assessed whether identified citations conduct problems 5 years later at age 10. The results of were randomised controlled trials. We assessed the this longitudinal study suggest that authoritarian quality of design and execution, and abstracted parenting attitudes expressed by mothers may be of outcome data. Because of the marked heterogeneity of significance in the development of conduct problems. design and outcomes, we did not perform a meta- analysis. We synthesised the data using narrative Thompson DG. Safe sleep practices for hospitalized infants. systematic review. We grouped studies by intervention Pediatr Nurs 2005; 31(5):400-3, 409. method (information; social competence; social Abstract: Guidelines were established over 10 years influences; combined social influences/social ago by professional and government agencies that have competence and multi-modal programmes). Within dramatically changed the practice of infant sleep each category, we placed them into three groups positioning. Although these guidelines mainly focus according to validity using quality criteria for reported 898
- 907. care on thenewborn and infant in their home by a available for rent or sale in the United States by April parent, guardian or caregiver, hospital staff need to 1, 2001, to identify the distribution of games by genre examine their compliance with these guidelines.The and to characterize the distribution of content most controversial aspect of the "Back to Sleep" descriptors associated with these games. We played guidelines for the hospital setting is the parent and and assessed the content of a convenience sample of 55 infant sharing a bed. Although parents may choose to E-rated video games released for major home video sleep with their infant at home, the need for game consoles between 1985 and 2000. MAIN monitoring, ongoing assessment and care as well as the OUTCOME MEASURES: Game genre; duration of risk of entrapment or injury should be a priority in the violence; number of fatalities; types of weapons used; delivery of optimal patient care in the hospital setting. whether injuring characters or destroying objects is The need for a policy was identified and developed by rewarded or is required to advance in the game; a multidisciplinary task force focusing on the depiction of alcohol, tobacco and other substances; and physiological, behavioral and cultural aspects of sexual content. RESULTS: Based on analysis of the cosleeping. 672 current E-rated video games played on home consoles, 77% were in sports, racing, or action genres Thompson JB. International policies for achieving safe and 57% did not receive any content descriptors. We motherhood: women's lives in the balance. Health Care found that 35 of the 55 games we played (64%) Women Int 2005; 26(6):472-83. involved intentional violence for an average of 30.7% Abstract: Every minute of every day somewhere in the of game play (range, 1.5%-91.2%), and we noted world one woman dies during pregnancy or childbirth significant differences in the amount of violence and eight newborns die, which is a great loss to among game genres. Injuring characters was rewarded families and to societies. Nearly two decades of global or required for advancement in 33 games (60%). The efforts to promote safe motherhood and newborn health presence of any content descriptor for violence (n = 23 have led to several conclusions as to why these games) was significantly correlated with the presence unnecessary deaths of women and newborns continue, of intentional violence in the game (at a 5% especially in the developing world. Healthy women are significance level based on a 2-sided Wilcoxon rank- needed for healthy newborns and families, yet attention sum test, t(53) = 2.59). Notably, 14 of 32 games (44%) to the health of women, especially during childbearing, that did not receive a content descriptor for violence has received minimal or no attention at country and lo contained acts of violence. Action and shooting games cal levels where policies seem to ignore the value of led to the largest numbers of deaths from violent acts, the girl-child, women and newborns. One of the most and we found a significant correlation between the important interventions proven to promote safe or proportion of violent game play and the number of healthy pregnancy for women and their newborns is the deaths per minute of play. We noted potentially availability of skilled care--the combination of an objectionable sexual content in 2 games and the accredited health professional with midwifery skills presence of alcohol in 1 game. CONCLUSIONS: working in an well-equipped environment at the Content analysis suggests a significant amount of community level, supported by the political will violence in some E-rated video games. The content needed to save the lives of mothers and babies. Yet descriptors provide some information to parents and skilled care is missing from nearly half of the world's should be used along with the rating, but the game's women. This article describes the reasons for the genre also appears to play a role in the amount of continuing high rates of maternal and newborn deaths, violent play. Physicians and parents should understand key lessons learned about how to prevent such deaths that popular E-rated video games may be a source of based on the best available evidence, and the need for exposure to violence and other unexpected content for evidence-based policies directed at achieving safe children and that games may reward the players for motherhood for each woman who becomes pregnant violent actions. and for her newborn. Thompson RS, Lawrence DM, Huebner CE, Johnston BD. Thompson KM, Haninger K. Violence in E-rated video Expanding developmental and behavioral services for games. JAMA 2001; 286(5):591-8. newborns in primary care: implications of the findings. Abstract: CONTEXT: Children's exposure to violence, Am J Prev Med 2004; 26(4):367-71. alcohol, tobacco and other substances, and sexual Abstract: BACKGROUND: In two other papers in this messages in the media are a source of public health issue, the rationale, development, implementation, concern; however, content in video games commonly experimental design, approach to evaluation, and early played by children has not been quantified. results of a program to deliver developmental and OBJECTIVES: To quantify and characterize the behavioral services to all infants in primary care depiction of violence, alcohol, tobacco and other practice were described. Positive effects were seen for substances, and sex in video games rated E (for parental satisfaction, including decreased "Everyone"), analogous to the G rating of films, which disenrollment, provider satisfaction, parenting suggests suitability for all audiences. DESIGN: We practices, and health outcomes. METHODS: In the created a database of all existing E-rated video games present article, the results are reviewed and 899
- 908. implications of ourfindings for the delivery of care, with ACD to formaldehyde, formaldehyde-releasing families, healthcare systems, and further research are agents, and potassium dichromate in Kansas City were discussed. RESULTS: Findings that have broad likely caused by the referral of greater numbers of implications are as follows: (1) developmental and work-related cases. However, occupationally acquired behavioral services can be delivered successfully in ACD to MCI/MI and glutaraldehyde were not more practice using dedicated professionals to deliver and frequent in Kansas City than nationally, suggesting that integrate services; (2) the "planned care model" was other factors might be operative. Although awareness useful in program implementation for making "the right of national trends is important, dermatologists must be thing to do, the easy thing to do"; (3) the added focus cognizant of regional variations in allergen sources on satisfaction and cost helps to develop the "business within their communities and referral networks. case" for broad scale implementation; (4) bonding of parents to organizations has marketing implications; Thomson CC, Roberts K, Curran A, Ryan L, Wright RJ. (5) the program provides positive effects for all Caretaker-child concordance for child's exposure to parents, not just high-risk parents; and (6) several violence in a preadolescent inner-city population. Arch research questions emerge, including persistence of Pediatr Adolesc Med 2002; 156(8):818-23. effects on health outcomes, costs, and utilization. Abstract: BACKGROUND: Effective screening for CONCLUSIONS: The authors conclude that study exposure to violence (ETV) in the pediatric setting results have implications for preventive services, depends on informant reliability and recognition of families, child healthcare in office practice, healthcare patients at increased risk. Pediatricians screening for systems, and healthcare policy. In this ongoing study, children's ETV often rely on parent reporting. examination of intervention effects at 30 months of age HYPOTHESIS: That there would be poor caretaker- shoud be informative. Further research is warranted as child concordance given that children would report it remains to be seen whether or not these interventions events occurring outside the home not witnessed by the can become viable ongoing programs. caretaker and that ETV would be higher among immigrant families. OBJECTIVES: To examine Thompson TR, Belsito DV. Regional variation in prevalence concordance between caretaker and child self-report of and etiology of allergic contact dermatitis. Am J the child's ETV in a preadolescent population and to Contact Dermat 2002; 13(4):177-82. explore factors related to increased risk. DESIGN: Abstract: BACKGROUND: The 1994-1996 North Community-based survey. SETTING: Urban American Contact Dermatitis Group (NACDG) patch community health center. PARTICIPANTS: One test results were the first, since the inception of the hundred sixty-five caretaker-child pairs. METHODS: NACDG in 1970, to include results from a medium- The ETV was assessed by means of a standardized sized metropolitan city in the Midwest. OBJECTIVE: interview questionnaire on location and frequency of The aim of this study was to determine whether the ETV. A Rasch model was used to develop summary causative allergens of allergic contact dermatitis scores of ETV (frequency and severity). RESULTS: (ACD) in the Midwest differ from those in other Caretaker-child concordance on reports of child's ETV regions of the United States and, if so, whether was poor. The kappa statistics ranged from -0.04 for occupational or other factors account for the observed seeing someone knifed to 0.39 for witnessing a differences. METHODS: Retrospective analyses of shooting. Children reported ETV more often in their patch test data collected at the University of Kansas neighborhood or at school, whereas caretakers reported Medical Center (Kansas City, KS) were compared with more events near or at home. Univariate predictors of the data collected by the other NACDG centers. child's self-reported ETV were female sex (beta +/- SE, RESULTS: Patients in Kansas City were statistically -10.1 +/- 4.6; P =.03) and caretaker being divorced more likely to react to potassium dichromate, (beta +/- SE, 12.6 +/- 6.0; P =.04). In multivariate formaldehyde and its releasers, analyses, country of origin predicted child's ETV, methylchloroisothiazolinone/methylisothiazolinone adjusting for child's age and sex, and caretaker (MCI/MI), and glutaraldehyde. Occupational exposures educational status and marital status. CONCLUSIONS: to chromium and formaldehyde were increased Caretakers and their children have poor agreement on significantly among patients from Kansas City, reports of the child's ETV. Intervention strategies although the percentages of the local population around ETV should include assessment of the child engaged in these occupations did not differ from those independent of caretaker report for preadolescents. in other NACDG cities. Equal percentages of workers Screening may be more effective if pediatricians are in Kansas City and nationally had occupationally aware of factors related to increased risk, including related allergy to glutaraldehyde, although the overall immigration status and caretaker marital status. rate of glutaraldehyde was higher among patients from Kansas City. Most cases of relevant allergy to MCI/MI Thun-Hohenstein L. [The work of child protection groups in were cosmetically induced both in Kansas City and Austria]. Wien Med Wochenschr 2005; 155(15- nationally. CONCLUSIONS: The current findings 16):365-70. show significant regional differences in causal Abstract: AIM: To document the number of child allergens. The increased percentages of patients seen protection groups (CPG) in children's hospitals and 900
- 909. paediatric surgeries inAustria. Further, to document ratio 16.2, 95% CI 2.3 to 112). CONCLUSIONS: detection frequency of abuse syndromes per inpatients Adolescents who choose movie stars who use tobacco per year and structural differences between on-screen are significantly more likely to have an departments with and without CPGs. METHODS: Self- advanced smoking status and more favourable attitudes compiled questionnaire was distributed to all pediatric toward smoking than adolescents who choose non- (43) and all pediatric surgery units (7). RESULTS: smoking stars. This finding supports the proposition 68% of children's hospitals and 100% of paediatric that the portrayal of tobacco use in contemporary surgical units had a CPG. Average detection frequency motion pictures, particularly by stars who are admired was reported to be 0.8 +/- 0.67% (range, 0-3.5). by adolescents, contributes to adolescent smoking. Distribution of CPG diagnoses is comparable, only sexual abuse was reported more frequently than Tiedje LB, Darling-Fisher C. Promoting father-friendly reported internationally. Departments with CPG have healthcare. MCN Am J Matern Child Nurs 2003; more beds, more personnel, especially more 28(6):350-7; quiz 358-9. psychosocial workers, and higher detection frequency. Abstract: Fathers are taking a more active role in their CONCLUSIONS: Frequency of CPGs is comparable to children's lives and healthcare; consequently, U.S. and Swiss data. Detection rates are low normal, healthcare providers need to be more aware of and but in departments without CPG, far below attentive to fathers in clinical encounters. The literature international standards. on healthcare provider inclusion of fathers is sparse. The focus has been mainly on exhortations to include Tickle JJ, Sargent JD, Dalton MA, Beach ML, Heatherton fathers, or has documented treatment of fathers as TF. Favourite movie stars, their tobacco use in invisible in healthcare settings. While not overtly contemporary movies, and its association with hostile to fathers, healthcare providers occasionally adolescent smoking. Tob Control 2001; 10(1):16-22. marginalize or ignore them. The purpose of this article Abstract: OBJECTIVE: To assess the relation between is to help healthcare providers: (1) become aware of adolescents' favourite movie stars, the portrayal of and assess their interactions with fathers and (2) be tobacco use by those stars in contemporary motion more intentional in their interactions with them. To that pictures, and adolescent smoking. DESIGN AND end, this article includes a self-assessment of one's SETTING: 632 students (sixth to 12th grade, ages 10- practice, including the following components: 19 years) from five rural New England public schools introductions, body language, eye contact, completed a voluntary, self administered survey in obtaining/giving information, and beliefs about the role October 1996. The survey assessed tobacco use, other of fathers. Intentional interactions for developing more variables associated with adolescent smoking, and father-friendly healthcare are discussed including both favourite movie star. In addition, tobacco use by 43 small and large changes, guided by the PLISSIT selected movie stars was measured in films between model. Finally, best practices, challenges, issues, and 1994 and 1996. OUTCOME MEASURES: Students resources related to father inclusion in healthcare are were categorised into an ordinal five point index described. The major issue for providers is to no longer (tobacco status) based on their smoking behaviour and question whether to include fathers, but how. their smoking susceptibility: non-susceptible never smokers, susceptible never smokers, non-current Tien I, Bauchner H, Reece RM. What is the system of care experimenters, current experimenters, and smokers. for abused and neglected children in children's We determined the adjusted cumulative odds of having institutions? Pediatrics 2002; 110(6):1226-31. advanced smoking status based on the amount of on- Abstract: OBJECTIVES: The objectives of this study screen tobacco use by their favourite film star. were to describe the number of children with suspected RESULTS: Of the 43 stars, 65% used tobacco at least abuse or neglect (CAN) cared for in selected children's once, and 42% portrayed smoking as an essential hospitals, to determine how they are tracked and character trait in one or more films. Stars who smoked followed, and to better describe the composition, more than twice in a film were considered smokers. function, and financial support of child protection For adolescents whose favourite stars smoked in only teams (CPTs). METHODS: A self-administered survey one film, the odds of being higher on the smoking was mailed to child abuse contact leaders at institutions index was 0.78 (95% confidence interval (CI) 0.53 to that were members of the National Association of 1.15). For adolescents whose favourite stars smoked in Children's Hospitals and Related Institutions in 2001. two films, the odds of being higher on the smoking Responses from rehabilitation hospitals and those that index was 1.5 (95% CI 1.01 to 2.32). For adolescents did not indicate whether a CPT was present were whose favourite stars smoked in three or more films excluded. RESULTS: One hundred thirty-four of 157 (Leonardo DiCaprio, Sharon Stone, John Travolta), the leaders responded. One hundred twenty-two (91%) met odds of being higher on the smoking index was 3.1 study criteria. Eighty-eight hospitals (72%) had a CPT- (95% CI 1.34 to 7.12). Among never smokers (n = 54% were pediatric facilities, 59% had >100 beds, and 281), those who chose stars who were smokers in three 89% had a pediatric residency. Compared with or more films were much more likely to have institutions without a CPT, institutions with a CPT favourable attitudes toward smoking (adjusted odds were less likely to be located in the South (28% vs 901
- 910. 70%) and morelikely to have >200 beds (26% vs 1%), clinicians should be vigilant for the presence of a medical school affiliation (92% vs 74%), and a domestic violence with all clients, it is important to pediatric residency (98% vs 68%). Sixty-one percent of know when a woman experiences increased risk for institutions cared for <300 suspected CAN cases, and violence. The findings indicate a need for education for 66% had 5 or fewer CAN-associated deaths the communities, those who provide care for women and previous year. Institutions with a CPT used more children, and people in whom victims may confide. comprehensive documentation for CAN, including special CAN forms (55% vs 21%) and photographs Timmermans JP, Hens J, Adriaensen D. Outer submucous (77% vs 53%). They also more commonly referred plexus: an intrinsic nerve network involved in both CAN cases to law enforcement (58% vs 35%) or a secretory and motility processes in the intestine of CAN clinic for follow-up (52% vs 26%). Fifty-two large mammals and humans. Anat Rec 2001; percent of CPTs had an annual budget of $500 000 or 262(1):71-8. less. The most common primary source of financial Abstract: The architecture of the enteric nerve support for CPTs was the hospital (51%), although networks in the gastrointestinal tract appears to be funding was usually composed of a combination of more complex in large mammals, including humans, funds from the hospital, patient fees, and state than in small laboratory animals. At least two distinct government. Functions performed by CPTs included ganglionic nerve plexuses could be identified in the consulting on cases of CAN (89%), functioning as a submucous layer in the digestive tract of large liaison with child protective services (85%), tracking mammals. While functionally and morphologically cases of abuse or neglect (70%), providing quality similar neuron populations are found in the intestinal assurance on CAN cases (63%), and filing reports with wall of both small and large mammals, significant child protective services (61%). Twenty-four hour differences in their topographical organization and consultative coverage was provided by most CPTs neurochemical features may be present. This short (79%), for which 94% provided phone consultation and review clearly illustrates that the close and exclusive 81% provided in-person consultation when necessary. association, which has been assumed so far between CONCLUSIONS: The institutions surveyed cared for the efferent pathways of the submucous plexus and many children suspected of abuse and neglect. Thirty- regulation of intestinal secretion/absorption on the one eight percent did >300 evaluations per year. In general, hand and between the myenteric plexus and regulation institutions with CPTs provided more comprehensive of intestinal motility on the other hand, cannot be documentation and follow-up of children suspected of interpreted that strictly. An attempt has been made to having been abused or neglected than institutions give a briefoverview of the current status of the without CPTs. Whether this is associated with better identification of distinct functional enteric neuronal outcomes for children suspected of abuse or neglect is classes in the gastrointestinal tract of large mammals unknown. using the pig and human intestine as references, and to compare these data with the more extensive Tierney H. Conjoined twins: the conflict between parents information gathered from the guinea-pig intestine. and the courts over the medical treatment of children. Denver J Int Law Policy 2002; 30(4):458-75. Tirosh E, Cohen A, Stein M, Jaffe M. Factors affecting Notes: GENERAL NOTE: KIE: 199 fn. participation in a child development programme. Int J GENERAL NOTE: KIE: KIE Bib: allowing to Rehabil Res 2001; 24(4):321-4. die/legal aspects; patient care/minors; treatment refusal/minors Tirosh E, Offer Shechter S, Cohen A, Jaffe M. Attitudes towards corporal punishment and reporting of abuse. Tilley DS, Brackley M. Violent lives of women: critical Child Abuse Negl 2003; 27(8):929-37. points for intervention--phase I focus groups. Perspect Abstract: OBJECTIVES: To assess physicians' Psychiatr Care 2004; 40(4):157-66, 170. attitudes towards corporal punishment in childhood and Abstract: PROBLEM: To identify critical their subsequent actions regarding the reporting of developmental periods, experiences, and events in child abuse. PARTICIPANTS: 107 physicians (95 women's lives associated with violence to guide a pediatricians and 12 family practitioners) who work in larger study. METHODS: Two focus groups of 10 hospitals and community clinics in northern Israel were women each (N = 20) were conducted to determine the interviewed. Of the participants, 16% were new critical times when girls and women might be exposed immigrants. PROCEDURE: A structured interview to violence. FINDINGS: Broad themes in the data were was conducted by one of two pediatric residents. developmental periods, abusers, staying in the RESULTS: Attitudes towards corporal punishment relationship, leaving the relationship, parenting, and were not influenced by the physicians' sex or specialty. living with violence. The women in these focus groups Corporal punishment was approved by 58% of the clearly identified times of increased risk for violence in physicians. A significant difference in attitudes towards their lives: establishing intimate relationships, corporal punishment between immigrants and Israeli pregnancy, childrearing years, and times when born physicians was found (p=.004). Family substance abuse is occurring. CONCLUSIONS: While 902
- 911. practitioners and especiallysenior ones were found Toker A, Urkin J, Bloch Y. Role of a medical students' significantly less tolerant towards corporal punishment association in improving the curriculum at a faculty of than pediatricians (p=.04). While reporting behavior health sciences. Med Teach 2002; 24(6):634-6. was not found to be associated with parental status and Abstract: The Joyce and Irving Goldman School of the past experience of the physicians with child abuse, Medicine, Faculty of Health Sciences at the Ben a significant effect of attitudes towards corporal Gurion University of the Negev encourages students to punishment on reporting behavior was found (p=.01). take part in the development and evaluation of the CONCLUSIONS: (1) Corporal punishment is still teaching experience. These special relations between perceived as an acceptable disciplinary act by a the school and the students contribute not only to significant proportion of physicians responsible for the changes in the curriculum but also to increased health care of children in our area. (2) Attitudes involvement of faculty and students in the community. towards corporal punishment are different between This article reviews the special relationship between immigrants and native born Israeli trained doctors and, the Faculty of Health Sciences and its medical students unexpectedly, pediatricians were more tolerant of through the Medical Students Association (ASRN). corporal punishment than family practitioners. During the last decade, BGU medical students have initiated innovative programmes some of which have Titus JC, Dennis ML, White WL, Scott CK, Funk RR. recently become integrated into the curriculum. These Gender differences in victimization severity and include: prevention of sexual violence among youth, outcomes among adolescents treated for substance decreasing white-coat fear in small children ('Teddy abuse. Child Maltreat 2003; 8(1):19-35. Bear hospital') and participation in home-hospice Abstract: This article uses data from the Global activities. By encouraging students to become equal Appraisal of Individual Needs (GAIN) on 214 partners in faculty development and rejecting the adolescents entering substance abuse treatment. The traditional paternalistic mode of teacher-student goals of the article are to validate the General relationships, the faculty has created an improved Victimization Index (GVI), examine its relationship to learning experience, and increased student motivation gender and co-occurring problems, and determine its and levels of communication between the teachers and relationship to outcomes. The GVI includes 15 items the future clinicians. on lifetime traumatic events, traumagenic factors, and current worries of victimization. The items fall along a Tomasso JB. Separation of the conjoined twins: a severity dimension (alpha = .88), and evidence was comparative analysis of the rights to privacy and generated to support the construct validity of cutoff religious freedom in Great Britain and the United scores for interpretation. Girls were significantly more States. Rutgers Law Rev 2002; 54(3):771-801. likely than boys to have experienced a variety of Notes: GENERAL NOTE: KIE: 292 fn. victimization incidents. When used as grouping GENERAL NOTE: KIE: KIE Bib: patient care/minors; variables, gender and severity of victimization treatment refusal significantly interacted with measures of intake status and were significant predictors of 3-month Tomatis S, Bono A, Bartoli C et al. Automated melanoma postdischarge treatment outcomes. detection: multispectral imaging and neural network approach for classification. Med Phys 2003; 30(2):212- Tkeshelashvili-Kessler A, del Rio C, Nelson K, Tsertsvadze 21. T. The emerging HIV/AIDS epidemic in Georgia. Int J Abstract: Our aim in the present research is to STD AIDS 2005; 16(1):61-7. investigate the diagnostic performance of artificial Abstract: The first case of HIV in Georgia was neural networks (ANNs) applied to multispectral diagnosed in 1989. Through December 2002, a total of images of cutaneous pigmented skin lesions as well as 375 cases of HIV infection were reported. However, to compare this approach to a standard traditional the World Health Organization estimates that the true linear classification method, such as discriminant number of infections may be closer to 1700. In all, function analysis. This study involves a series of 534 70% of reported cases are among injection drug users. patients with 573 cutaneous pigmented lesions (132 Based on the UNAIDS classification, Georgia is a 'low- melanomas and 441 nonmelanoma lesions). Each level HIV country' with an HIV prevalence of less than lesion was analyzed by a telespectrophotometric 1% in all groups, including drug users. However, there system (TS) in vivo, before surgery. The system is able is a high prevalence of hepatitis B and C, suggesting a to acquire a set of 17 images at selected wavelengths significant risk for the spread of HIV. Georgia, a newly from 400 to 1040 nm. For each wavelength, five lesion independent republic, is experiencing an increase in descriptors were extracted, related to the criteria of the injection drug use, a rise in sexually transmitted ABCD (for asymmetry, border, color, and dimension) infections and commercial sex trade that create a fertile clinical guide for melanoma diagnosis. These variables soil for the potential rapid spread of HIV. However, it were first reduced in dimension by the use of factor is also a country with a unique window of opportunity analysis techniques and then used as input data in an for limiting the spread of HIV. ANN. Multivariate discriminant analysis (MDA) was also performed on the same dataset. The whole dataset 903
- 912. was split intotwo independent groups: i.e., train (the show that performance of an automated system is first 400 cases, 95 melanomas) and verification set (last greatly population dependent, suggesting caution in the 173 cases, 37 melanomas). Factor analysis was able to comparison with results reported in the literature. In summarize the data structure into ten variables, our opinion, scientific reports should provide, at least, accounting for at least 90% of the original parameters the median values of thickness and dimension of variance. After proper training, the ANN was able to melanomas, as well as the number of small (6 mm) classify the population with 80% sensitivity, 72% melanomas. specificity, and 78% sensitivity, 76% specificity for the train and validation set, respectively. Following ROC Tomeo ME, Templer DI, Anderson S, Kotler D. Sensitivity analysis, area under curve (AUC) was 0.852 (train) and but not censorship. Arch Sex Behav 2002; 31(2):157-8. 0.847 (verify). Sensitivity and specificity values obtained by the standard discriminant analysis Tomita Y, Tomida S, Hasegawa Y et al. Artificial neural classifier resulted in a figure of 80% sensitivity, 60% network approach for selection of susceptible single specificity and 76% sensitivity, 57% specificity for the nucleotide polymorphisms and construction of train and validation set, respectively. AUC for MDA prediction model on childhood allergic asthma. BMC was 0.810 and 0.764 for the train and verify set, Bioinformatics 2004; 5:120. respectively. Classification results were significantly Abstract: BACKGROUND: Screening of various gene different between the two methods both for diagnostic markers such as single nucleotide polymorphism (SNP) scores and model stability, which was worse for MDA. and correlation between these markers and development of multifactorial disease have previously Tomatis S, Carrara M, Bono A et al. Automated melanoma been studied. Here, we propose a susceptible marker- detection with a novel multispectral imaging system: selectable artificial neural network (ANN) for results of a prospective study. Phys Med Biol 2005; predicting development of allergic disease. RESULTS: 50(8):1675-87. To predict development of childhood allergic asthma Abstract: The aim of this research was to evaluate the (CAA) and select susceptible SNPs, we used an ANN performance of a new spectroscopic system in the with a parameter decreasing method (PDM) to analyze diagnosis of melanoma. This study involves a 25 SNPs of 17 genes in 344 Japanese people, and select consecutive series of 1278 patients with 1391 10 susceptible SNPs of CAA. The accuracy of the cutaneous pigmented lesions including 184 ANN model with 10 SNPs was 97.7% for learning data melanomas. In an attempt to approach the 'real world' and 74.4% for evaluation data. Important combinations of lesion population, a further set of 1022 not excised were determined by effective combination value (ECV) clinically reassuring lesions was also considered for defined in the present paper. Effective 2-SNP or 3-SNP analysis. Each lesion was imaged in vivo by a combinations were found to be concentrated among the multispectral imaging system. The system operates at 10 selected SNPs. CONCLUSION: ANN can reliably wavelengths between 483 and 950 nm by acquiring 15 select SNP combinations that are associated with CAA. images at equally spaced wavelength intervals. From Thus, the ANN can be used to characterize the images, different lesion descriptors were extracted development of complex diseases caused by multiple related to the colour distribution and morphology of the factors. This is the first report of automatic selection of lesions. Data reduction techniques were applied before SNPs related to development of multifactorial disease setting up a neural network classifier designed to from SNP data of more than 300 patients. perform automated diagnosis. The data set was randomly divided into three sets: train (696 lesions, Tomlin P, Clarke M, Robinson G, Roach J. Rehabilitation in including 90 melanomas) and verify (348 lesions, severe head injury in children: outcome and provision including 53 melanomas) for the instruction of a proper of care. Dev Med Child Neurol 2002; 44(12):828-37. neural network, and an independent test set (347 Abstract: Functional outcome and provision of care to lesions, including 41 melanomas). The neural network 82 children (males:females 2.7:1; age range 0 to 16 was able to discriminate between melanomas and non- years) with severe head injury were investigated. The melanoma lesions with a sensitivity of 80.4% and a children were admitted to the intensive care units of the specificity of 75.6% in the 1391 histologized cases data Regional Neuroscience Units of the Greater set. No major variations were found in classification Manchester and Lancashire districts of the North West scores when train, verify and test subsets were Region of the UK between 1994 and 1996. A separately evaluated. Following receiver operating questionnaire was devised based on 12 areas of characteristic (ROC) analysis, the resulting area under recovery and data were collected at discharge and 6 the curve was 0.85. No significant differences were weeks, 6 months and 12 months from discharge. Data found among areas under train, verify and test set were collected during home visits and at joint curves, supporting the good network ability to assessment at 12 months with the district consultant generalize for new cases. In addition, specificity and community paediatrician (CCP). Early involvement of area under ROC curve increased up to 90% and 0.90, the CCP enhanced the provision of needs at discharge respectively, when the additional set of 1022 lesions and 6 weeks after discharge, as did a period of stay in without histology was added to the test set. Our data 904
- 913. district-level care beforedischarge home. CCPs Abstract: Studies on health effects of air pollutants received formal notification of the injured child in only ideally define exposure through the collection of air 32% of cases by discharge, and 54% of cases by 6 samples in the participants' homes. Concentrations months. Sixty-five per cent of children required early derived from these samples are then considered as an educational support but structured help reached only estimate for the average concentration of air pollutants 55% of these children by the end of the study. in the homes. Conclusions drawn from such studies Integrated planning between health and education was therefore depend very much on the validity of the achieved in about half of the study population. Good measured air pollution concentrations. In this paper we physical recovery was achieved by the majority of analysed repeated BTEX and NO(2) measurements children but parents said they did not feel prepared for with a time period of several months lying between the the degree of help which their child still required 12 two conducted home visits. We investigated the months after discharge. Children who required variability of their concentrations over time by anticonvulsants at 12 months' follow-up scored determining correlation coefficients and calculating significantly lower on cognitive potential. Psychosocial within- and between-home variances. Our population family functioning deteriorated in a substantial number consisted of 631 homes of participants from two cohort of families according to parental perception. studies within the framework of the German study on Prevalence of this perception did not diminish over the Indoor Factors and Genetics in Asthma. Air pollutants study period. Aspects of caregivers' understanding and were measured using passive samplers both indoors the child's language deficits, self-care skills, fine and and outdoors. The measured BTEX concentrations gross motor performance, as well as family, social, and were poorly correlated, with Pearson's correlation financial consequences were assessed. A dedicated and coefficient r ranging from -0.19 to 0.27. Additionally, a integrated approach to assessment and provision of considerable seasonal effect could be observed. A care across the domains of hospital, education, and higher correlation was found for the NO(2) community is discussed. concentrations with r ranging between 0.24 and 0.55. For the BTEX, the between-home variance was bigger Tong Y, Frize M, Walker R. Extending ventilation duration than the within-home variance, for NO(2) both estimations approach from adult to neonatal intensive variances were of about the same order. Our results care patients using artificial neural networks. IEEE indicate that in a setting of moderate climate like in Trans Inf Technol Biomed 2002; 6(2):188-91. Germany, the variability of BTEX and NO(2) Abstract: In earlier work, the research group concentrations over time is high and a single successfully used artificial neural networks (ANNs) to measurement is a poor surrogate for the long-term estimate ventilation duration for adult intensive care concentrations of these air pollutants. unit (ICU) patients. The ANNs performed well in terms of correct classification rate (CCR) and average Tornqvist K, Kallen B. Risk factors in term children for squared error (ASE) classifying the outcome into two visual impairment without a known prenatal or classes: whether patients were ventilated for less postnatal cause. Paediatr Perinat Epidemiol 2004; than/equal to or for more than 8 h (< or >). The 18(6):425-30. objective of new work was to apply this adult model to Abstract: Risk factors were studied for visual the estimation of ventilation with neonatal ICU (NICU) impairment in children without known pre- or postnatal patient records. The performance obtained with the cause, for a decrease of visual acuity. Children born at neonatal patients was comparable to that previously term 1979-98 and with a visual impairment were found with the adult database, again as measured in identified from the Swedish Register of Visually terms of a maximum CCR and a minimum ASE. The Impaired Children and data were linked with the effectiveness of using the weight-elimination technique Swedish Medical Birth Registry. Maternal in controlling overfitting was again validated for the characteristics such as maternal age, parity, maternal neonatal patients as it had been for our adult patients. It smoking habits in early pregnancy, maternal education, was concluded that the approach developed for ICU nationality, and subfertility were studied as well as adult patients was also successfully applied to a maternal diagnoses such as pre-eclampsia, prolonged different medical environment: neonatal ICU patients. second stage of labour, abruptio placentae, and placenta praevia. Mode of delivery was analysed as Topley J, Thomas A, Hobbs C, Wynne J. Detection of child well as birthweight, and birthweight in relation to sexual abuse. Am J Obstet Gynecol 2001; 184(5):1043- gestational age. Abruptio placentae turned out to be the 5. strongest risk factor (OR = 8.24 [95% CI 5.01, 13.51]). Smoking did not give a statistically significant Topp R, Cyrys J, Gebefugi I et al. Indoor and outdoor air increased risk. There is an increased risk with breech concentrations of BTEX and NO2: correlation of delivery (OR = 2.01 [95% CI 1.28, 3.17]). Pre- repeated measurements. J Environ Monit 2004; eclampsia was associated with an increased risk (OR = 6(10):807-12. 2.22 [95% CI 1.46, 3.38]). There is also an increase in Notes: CORPORATE NAME: INGA Study Group risk at low birthweight and small-for-gestational-age as well as birthweight > 4 kg and large-for-gestational- 905
- 914. age. In thisstudy we found that risk factors particularly research: the National Implementing Evidence-Based worth noticing in term children with a presumed Practice Project. Child Adolesc Psychiatr Clin N Am perinatal cause of visual impairment are abruptio 2005; 14(2):297-306, ix. placentae, pre-eclampsia, excessively low as well as Abstract: The National Implementing Evidence-Based excessively high birthweight, and breech delivery, a Practice Project is an ongoing effort to promote the fact worth noticing in current discussion on risks, implementation of effective practices for adults who advantages or excessive exploitation of caesarean have severe mental illnesses. The project members section. designed and developed integrated packages of materials and services to help practice sites implement Torres C, Mujica OJ. [Health, equity, and the Millennium evidence-based practices and is field-testing the Development Goals]. Rev Panam Salud Publica 2004; approach in eight states. These implementations are 15(6):430-9. being evaluated carefully to learn how to make the Abstract: In September 2000 representatives of 189 technology transfer process more efficient in the future. countries met for the Millennium Summit, which the This article describes the project and provides some United Nations convened in New York City, and early reflections on the implementation experience. adopted the declaration that provided the basis for formulating the Millennium Development Goals Totet A, Latouche S, Lacube P et al. Pneumocystis jirovecii (MDGs). The eight goals are part of a long series of dihydropteroate synthase genotypes in initiatives that governments, the United Nations immunocompetent infants and immunosuppressed system, and international financial institutions have adults, Amiens, France. Emerg Infect Dis 2004; undertaken to reduce world poverty. Three of the eight 10(4):667-73. goals deal with health, so the health sector will be Abstract: To date, investigations of Pneumocystis responsible for implementing, monitoring, and jirovecii circulation in the human reservoir through the evaluating measures proposed to meet targets that have dihydropteroate synthase (DHPS) locus analysis have been formulated: to reduce by two-thirds the mortality only been conducted by examining P. jirovecii isolates rate in children under 5 years of age between 1990 and from immunosuppressed patients with Pneumocystis 2015; to reduce by three-quarters the maternal pneumonia (PCP). Our study identifies P. jirovecii mortality rate between 1990 and 2015; and to halt and genotypes at this locus in 33 immunocompetent infants begin to reverse the spread of HIV/AIDS by the year colonized with P. jirovecii contemporaneously with a 2015, as well as to halt and begin to reverse the bronchiolitis episode and in 13 adults with PCP; both incidence of malaria, tuberculosis, and other major groups of patients were monitored in Amiens, France. diseases. The health sector must also work with other The results have pointed out identical features of P. parties to achieve targets connected with two other of jirovecii DHPS genotypes in the two groups, the goals: to improve access to affordable essential suggesting that in these groups, transmission cycles of drugs, and to reduce the proportion of persons who do P. jirovecii infections are linked. If these two groups not have safe drinking water. Adopting a strategy represent sentinel populations for P. jirovecii focused on the most vulnerable groups-ones infections, our results suggest that all persons concentrated in locations and populations with the parasitized by P. jirovecii, whatever their risk factor for greatest social exclusion-would make possible the infection and the form of parasitism they have, act as largest total reduction in deaths among children, thus interwoven circulation networks of P. jirovecii. reaching the proposed target as well as producing greater equity. In the Region of the Americas the Towner E, Dowswell T. Community-based childhood injury principal challenges in meeting the MDGs are: prevention interventions: what works? Health Promot improving and harmonizing health information Int 2002; 17(3):273-84. systems; designing health programs related to the Abstract: Unintentional injury, with its broad range of MDGs that bring together the set of services and injury types, possible countermeasures, and great interventions that have the greatest impact, according number of agencies involved in its prevention, lends to the special characteristics of the populations who are itself to community-based approaches. In this paper we intended to be the beneficiaries; strengthening the examine 10 community-based injury prevention political will to support the MDGs; and guaranteeing programmes that have targeted childhood injury funding for the measures undertaken to attain the prevention and have been evaluated using some MDGs. measure of outcome. We investigate the nature of the intervention, targeting, the length of programmes and Torrey EF. Early physical and sexual abuse associated with multi-agency involvement. We also consider how the an adverse course of bipolar illness. Biol Psychiatry programmes have been evaluated, and what outcome, 2002; 52(8):843; author reply 843-5. impact and process measures have been used. The information on the intervention and how it was Torrey WC, Lynde DW, Gorman P. Promoting the evaluated, how effective the programme was, and the implementation of practices that are supported by strength of the evidence, is summarized in tabular form. There is increasing evidence emerging about the 906
- 915. effectiveness of community-basedapproaches in injury test the factor structure of the scales and to examine the prevention. Important elements of such approaches are inter-relationships among the proposed psychosocial long-term strategy, effective focused leadership, multi- factors. Sunscreen-use and sun-avoidance behavioral agency collaboration, tailoring to the needs of the local models were tested in a sample of 384 parents. The community, the use of local injury surveillance, and results provided a basis for the reliable and valid time to coordinate existing and develop new local measurement of psychosocial factors related to parental networks. We recommend that there is a need to sun-protection practices. These scales may be useful in develop indicators to assess and monitor a culture of more fully understanding the determinants of sun- safety, programme sustainability and long-term protection behaviors and in evaluating intervention community involvement. programs designed to improve such behaviors. Traeen B, Spitznogle K, Beverfjord A. Attitudes and use of Tritten J. How do you feel about giving up your freedom? pornography in the Norwegian population 2002. J Sex Midwifery Today Int Midwife 2002; (61):47. Res 2004; 41(2):193-200. Abstract: The purpose of this study was to describe and Trostle LC. Overrating pornography as a source of sex analyze use of pornographic material in a information for university students: additional representative sample of adult Norwegians. The data consistent findings. Psychol Rep 2003; 92(1):143-50. collection was carried out by means of a standardized Abstract: This study is an empirical investigation of questionnaire administered via personal telephone how 175 university students obtained their knowledge interviews. Among the 90% of participants who of sexual matters and whether pornography functioned reported ever having examined pornography, 76% as an important source. Analysis indicated that reported examining a pornographic magazine, 67% had pornography does not play an important role in the watched a pornographic film, and 24% had examined dissemination of sexual information; peers appear to be pornography on the Internet. Significant gender the primary source. There are, however, certain differences emerged in the reporting. The percentage of statistically significant differences between the sexes in men and women who reported frequent use of reports of the extent of specific sexual information pornography was small. We identified three from pornography on matters such as oral and anal dimensions of attitudes toward pornography: intercourse. The findings extend research on pornography as a means of sexual enhancement, pornography as a source of sex information and are pornography as a moral issue, and social climate. contrasted with previous studies. These attitude dimensions were included in path models as intermediating variables between Troxel WM, Matthews KA. What are the costs of marital demographic variables (age, gender, and level of conflict and dissolution to children's physical health? education) and frequency of reading or watching Clin Child Fam Psychol Rev 2004; 7(1):29-57. pornographic materials. These models explained 36% Abstract: Do parental marital conflict and dissolution of the variance in frequency of watching pornographic influence the risk trajectory of children's physical films, 35% of the variance in frequency of reading health risk? This paper reviews evidence addressing pornographic magazines, and 21% of the variance in this question in the context of understanding how early frequency of watching pornography on the Internet. environmental adversities may trigger a succession of risks that lead to poor health in childhood and greater Trenchs V, Curcoy AI, Pou J, Morales M, Serra A. Retinal risk for chronic health problems in adulthood. We first haemorrhages as proof of abusive head injury. J Pediatr review existing evidence linking marital conflict and 2005; 146(3):437-8; author reply 438. dissolution to offspring's physical health outcomes. Next, we provide evidence supporting biopsychosocial Tripp MK, Carvajal SC, McCormick LK et al. Validity and pathways that may link marital conflict and dissolution reliability of the parental sun protection scales. Health with accelerated health risk trajectories across the Educ Res 2003; 18(1):58-73. lifespan. Specifically, we posit that consequential to the Abstract: Skin cancer is the most common cancer stresses associated with marital conflict and disruption, diagnosed in the US and its incidence continues to rise. parenting practices are compromised, leading to Epidemiological studies have shown that excessive sun offspring deficits in affective, behavioral, and cognitive exposure received during childhood may increase the domains. These deficits, in turn, are hypothesized to risk of developing skin cancer later in life. Yet, there increase health risk through poor health behaviors and are few published reports on the development of by altering physiological stress-response systems, reliable and valid theory-based scales that assess the including neuroendocrine, cardiovascular, and factors associated with parental sun-protection neurotransmitter functioning. On the basis of the practices to reduce sun exposure in preschool children. available direct evidence and theoretically plausible To fill this gap, the Parental Sun Protection Scales pathways, it appears that there is a cost of marital were developed and validated. Two series of conflict and disruption to children's health; however, confirmatory factor analytic models were employed to more comprehensive investigations are needed to 907
- 916. further elucidate thisrelationship. In the final section, Med 2005; 33(1):61-88. we address limitations in the current literature and Abstract: OBJECTIVE: Acute lymphoblastic leukemia identify research that is needed to better evaluate the (ALL) is the most common malignancy of childhood, association between marital conflict and dissolution representing nearly one third of all pediatric cancers. and children's physical health. Currently, the treatment of pediatric ALL is centered on tailoring the intensity of the therapy applied to a Tsao JC, Glover DA, Bursch B, Ifekwunigwe M, Zeltzer patient's risk of relapse, which is linked to the type of LK. Laboratory pain reactivity and gender: relationship leukemia the patient has. Hence, accurate and correct to school nurse visits and school absences. J Dev diagnosis of the various leukemia subtypes becomes an Behav Pediatr 2002; 23(4):217-24. important first step in the treatment process. Recently, Abstract: Currently, there are no clear methods for gene expression profiling using DNA microarrays has identifying children vulnerable to frequent school been shown to be a viable and accurate diagnostic tool absences. Our study examined relationships between to identify the known prognostically important ALL gender and laboratory pain reactivity to the cold- subtypes. Thus, there is currently a huge interest in pressor task (CPT), and parent-involved school developing autonomous classification systems for absences and self-initiated school nurse visits in 57 cancer diagnosis using gene expression data. This is to children (36 female; ages 8-10 years). Using multiple achieve an unbiased analysis of the data and also partly regression analyses, CPT pain ratings, tolerance, and to handle the large amount of genetic information gender were analyzed in relation to nurse visits and extracted from the DNA microarrays. absences collected prospectively across 2 years. We METHODOLOGY: Generally, existing medical found that higher pain ratings and female gender decision support systems (DSS) for cancer predicted more absences; female gender also predicted classification and diagnosis are based on traditional increased nurse visits for acute complaints with statistical methods such as Bayesian decision theory documented physical findings. Our results suggest that and machine learning models such as neural networks laboratory pain reactivity is a potentially useful (NN) and support vector machine (SVM). Though high indicator of vulnerability to parent-involved functional accuracies have been reported for these systems, they impairment, as indexed by school absences, and that fall short on certain critical areas. These included (a) girls are more likely than boys to miss school and visit being able to present the extracted knowledge and the nurse for acute illnesses. Limitations and pathways explain the computed solutions to the users; (b) having for further study are discussed. a logical deduction process that is similar and intuitive to the human reasoning process; and (c) flexible Tulananda O, Roopnarine JL. Mothers' and fathers' enough to incorporate new knowledge without running interactions with preschoolers in the home in northern the risk of eroding old but valid information. On the Thailand: relationships to teachers' assessments of other hand, a neural fuzzy system, which is synthesized children's social skills. J Fam Psychol 2001; 15(4):676- to emulate the human ability to learn and reason in the 87. presence of imprecise and incomplete information, has Abstract: Using ecocultural theory as a guide, the the ability to overcome the above-mentioned authors observed some everyday activities of mothers shortcomings. However, existing neural fuzzy systems and fathers with children for 2 hr in the home in 53 have their own limitations when used in the design and families residing in Chaing Mai Province in northern implementation of DSS. Hence, this paper proposed the Thailand. Teachers provided assessments of children's use of a novel neural fuzzy system: the generic self- general social skills in preschool using the Preschool organising fuzzy neural network (GenSoFNN) with Kindergarten Behavior Scale (K. W. Merrell, 1994). truth-value restriction (TVR) fuzzy inference, as a Mothers were significantly more likely to engage in fuzzy DSS (denoted as GenSo-FDSS) for the basic care, general conversations, and educational classification of ALL subtypes using gene expression activities; to praise; and to use commands and data. RESULTS AND CONCLUSION: The reasoning as forms of discipline with children than performance of the GenSo-FDSS system is fathers. Mothers and fathers did not significantly differ encouraging when benchmarked against those of NN, in the display of affection, teasing or joking, and modes SVM and the K-nearest neighbor (K-NN) classifier. On of play interactions with children. Parents generally average, a classification rate of above 90% has been treated boys and girls similarly. Few associations achieved using the GenSo-FDSS system. between parent-child involvement and children's social skills in preschool were significant. Data are discussed Tuohy PG. In that case: a Lead Maternity Carer (LMC) is with respect to changes in culturally driven parent- discussing newborn health checks with a pregnant child practices. woman and her partner. Response. N Z Bioeth J 2003; 4(1):40-1. Tung WL, Quek C. GenSo-FDSS: a neural-fuzzy decision Notes: GENERAL NOTE: KIE: 1 ref. support system for pediatric ALL cancer subtype GENERAL NOTE: KIE: KIE Bib: informed identification using gene expression data. Artif Intell consent/minors; mass screening 908
- 917. Tupola S, Kivitie-KallioS, Viheriala L, Kallio P. [What explosiveness, cognitive and learning problems, and should a doctor do when suspecting child abuse?]. poor social skills. The rate of comorbidity is high, with Duodecim 2005; 121(20):2215-20. attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) being the most Turgay A. Aggression and disruptive behavior disorders in common; comorbid anxiety and depressive disorders children and adolescents. Expert Rev Neurother 2004; are also seen, especially in adolescents. The diagnostic 4(4):623-32. process should include the use of structured interviews, Abstract: Aggression is a common symptom of many and scores from reliable and valid rating scales that psychiatric disorders including attention deficit cover all psychiatric disorders must be considered in hyperactivity disorder, oppositional defiant disorder, the differential diagnosis, because CD alone is an conduct disorder, Tourette's disorder, mood disorders extreme rarity and multiple disorders are almost always (including bipolar disorder), substance-related the rule rather than exception. Treatment should disorders, alcohol-related disorders, mental retardation, include parenting skills training combined with training pervasive developmental disorders, intermittent of the child to improve his or her relationships with explosive disorder and personality disorders peers, academic performance, and compliance with (particularly antisocial personality disorder). Many legitimate demands of authority figures. The forms of organic brain disorders may present with appropriate use of medications and integration of aggressive behavior. Aggression is common in some patient/parent education and support, as well as epileptic patients and some endocrinological diseases individual, group, family, residential, and inpatient (e.g., diabetes and hyperthyroidism) may be associated treatment may be beneficial for patients with CD and with aggressive behavior. Physicians need to rule out ADHD. The article describes a number of many medical and psychiatric disorders before psychopharmacological agents that are used in patients diagnosing aggressive behavior. A thorough diagnostic with CD with ADHD and other comorbid disorders. work up is the most important step in determining the Drugs that may be useful include psychostimulants; nature of comorbid disorders associated with the atomoxetine (Strattera); antidepressants (imipramine behavioral problem. Structured interviews and rating [Tofranil], desipramine [Norpramin]); Selective scales completed by patients, parents, teachers and Serotonin Reuptake Inhibitors (SSRIs); atypical clinicians may aid the diagnosis and provide antipsychotics such as risperidone (Risperdal); or mood quantification for the change process related to regulators including lithium (Eskalith). treatment. The integration of medication, individual and family counseling, educational and psychosocial Turner M, McCrory P. Child protection in sport. Br J Sports interventions including the school and community, may Med 2004; 38(2):106-7. increase the effectiveness of interventions. Due to the common association of aggression and disruptive Tursz A, Crost M, Gerbouin-Rerolle P. [Child abuse in behaviors with attention deficit hyperactivity disorder, France: how much, how reliable are the numbers?]. psychostimulants including new generation long-acting Rev Epidemiol Sante Publique 2003; 51(4):439-44. medications and other nonstimulant medications are considered the drug of choice for managing aggressive Tursz A, Gerbouin-Rerolle P, Crost M. ["Suspicious deaths" behavior and disruptive behavior disorders. Severe in infants: national study]. Rev Infirm 2003; (93):27-9. aggressive behavior not responding to these medications may require the single or combined use of Twemlow SW, Fonagy P, Sacco FC. A developmental mood regulators including lithium and/or antispychotic approach to mentalizing communities: I. A model for medications. Drugs such as risperidone (Risperdal, social change. Bull Menninger Clin 2005; 69(4):265- Janssen-Cilag) have documented effectiveness and 81. safety in children and adolescents, and can be used in Abstract: A developmental model is proposed applying treatment. attachment theory to complex social systems to promote social change. The idea of mentalizing Turgay A. Treatment of comorbidity in conduct disorder communities is outlined with a proposal for three with attention-deficit hyperactivity disorder (ADHD). projects testing the model: ways to reduce bullying and Essent Psychopharmacol 2005; 6(5):277-90. create a peaceful climate in schools, projects to Abstract: Conduct disorder (CD) is one of the most promote compassion in cities by a focus of end-of-life common psychiatric disorders in childhood and care, and a mentalization-based intervention into adolescence. It is characterized by a variety of chronic parenting style of borderline and substance abusing antisocial behaviors, a repetitive and persistent pattern parents. of behavior that violates the basic rights of others, major age-appropriate societal norms, or both. Twetman S, Petersson L, Axelsson S et al. Caries-preventive Aggressive behavior, lying, stealing, fire-setting, and effect of sodium fluoride mouthrinses: a systematic running away from home and school are the most review of controlled clinical trials. Acta Odontol Scand frequent manifestations of CD and are often 2004; 62(4):223-30. accompanied by hyperactivity, impulsive behavior, 909
- 918. Abstract: The SwedishCouncil on Technology affecting incest disclosure. Participants described Assessment in Health Care launched a project group in cognitive reframing, determination and separation from 1999 to systematically review and evaluate the existing the perpetrator as ways of coping with incest. literature on different caries-preventive methods. The aim of this article was to report the findings concerning Tyden T, Rogala C. Sexual behaviour among young men in the caries-preventive effect of fluoride mouthrinses Sweden and the impact of pornography. Int J STD (FMRs) in various age groups, with special reference to AIDS 2004; 15(9):590-3. background fluorides. A systematic search in electronic Abstract: The purpose was to investigate the sexual databases for literature published between 1966 and behaviour among young men (n = 300), visiting a August 2003 was conducted with the inclusion criteria genitourinary clinic in Sweden, focusing on the impact of a randomized or controlled clinical trial, at least 2 of pornography. Almost all, 98% (n = 292) claimed to years' follow-up, and caries increment in the permanent be heterosexual. The mean age at first intercourse was dentition (DeltaDMFS/T) as endpoint. Out of 174 16 years and on that occasion 64% (n = 187) used some articles originally identified, 62 met the inclusion kind of contraceptive, mainly condom. All, 99% (n = criteria. These studies were assessed independently by 296) had consumed pornography and 53% (n = 157) at least two reviewers and scored A-C according to felt that pornography impacted their sexual behaviour; predetermined criteria for methodology and they got inspired. About half (n = 161) had had anal performance. The measure of effect was the prevented intercourse. Of these, 70% (n = 113) had had it more fraction (PF) expressed as percent. The level of than once and 84% (n = 133) could imagine doing it evidence was based on 25 articles. The results revealed again. Only 17% (n = 28) always used a condom in this limited evidence (evidence level 3) for the caries- situation. One out of four (n = 70) had had at least one preventive effect (PF 29%) of daily or weekly sodium sexually transmitted disease. The low use of condoms fluoride rinses compared with placebo in permanent when heterosexual men have anal sex might have teeth of schoolchildren and adolescents with no serious consequences for a spread of sexually additional fluoride exposure and for a caries-preventive transmitted diseases. effect on root caries in older adults. Inconclusive evidence (evidence level 4) was found regarding the Tyre P, Scelfo J. A Fed for the church. Newsweek 2002; effect of FMRs in schoolchildren and adolescents 140(21):66. exposed to additional fluoride sources such as daily use of fluoride toothpaste. No firm support for the use of Tzoumakis S, Dube M, Marleau JD, Leveillee S. Sex of the FMRs was disclosed in a small number of studies offender, sex of the victim, and motivation in filicidal designed for patients at caries risk. Furthermore, no situations in Quebec. Can J Psychiatry 2005; association between the frequency of the rinses and 50(2):126. prevented fraction or saved surfaces per year was found. In conclusion, this systematic review suggests Ulinski T, Lhopital C, Cloppet H et al. Munchausen that sodium fluoride mouthrinses may have an anti- syndrome by proxy with massive proteinuria and caries effect in children with limited background of gastrointestinal hemorrhage. Pediatr Nephrol 2004; fluoride exposure, while its additional effect in children 19(7):798-800. with daily use of fluoride toothpaste could be Abstract: A 5-year-old boy presented with acute questioned. The need for further clinical trials to abdominal pain. Massive proteinuria of 10 g/1.73 m(2) elucidate the effect of FMRs in risk patients and older per day was detected on standard urinalysis. There was adults is emphasized. no peripheral edema. Serum concentrations of total proteins, lipids, and creatinine and immunological Twombly R. For gene therapy, now-quantified risks are investigations were normal. Two kidney biopsies deemed troubling. J Natl Cancer Inst 2003; revealed no abnormalities. Several weeks later he was 95(14):1032-3. admitted for intestinal hemorrhage with significant anemia. Endoscopy of the esophagus, stomach, colon, Tyagi SV. Incest and women of color: a study of experiences and small bowel (via laparotomy) were normal. and disclosure. J Child Sex Abus 2001; 10(2):17-39. Electrophoresis of urine proteins revealed the unusual Abstract: Clinical literature on incest trauma assumes a finding of an albumin fraction of 99.4%. During a homogeneity of experience of all incest survivors routine check-up in the outpatient clinic fresh urine including women of color. Experiences relating to samples were obtained while the boy's mother was community, culture, and family need to be absent. These were all negative for protein. The acknowledged as salient aspects of the experiences of mother, who was a nurse, finally confessed to adding women of color who are also incest survivors. Twelve human albumin to the urine samples. participants were interviewed regarding their experiences related to disclosure and coping. Ullman SE, Filipas HH. Ethnicity and child sexual abuse Participants described value systems, community experiences of female college students. J Child Sex mindedness, social attitudes, negative consequences Abus 2005; 14(3):67-89. amongst other social and cultural issues as factors 910
- 919. Abstract: This researchexamines the understudied MMR vaccines. J R Soc Health 2005; 125(4):155; issue of race/ethnicity in relation to child sexual abuse author reply 155. experiences (CSA) in a cross-sectional convenience sample of 461 female college students completing a Untalan F, Woodruff K, Hardy C, Liao M, Krupitsky D. survey. Comparisons of students' abuse experiences Disparities in outcomes for pediatric cancer patients revealed ethnic differences in sexual abuse prevalence, treated in Hawai'i: comparing Hawai'i residents to severity of abuse, the victim- offender relationship and children referred from the Pacific Islands. Pac Health post-abuse coping. Black students reported more sexual Dialog 2004; 11(2):114-9. abuse than other ethnic groups, followed by Hispanics, Abstract: This article examines whether pediatric Whites, and Asians. Although timing and extent of cancer patients referred to Hawai'i from the Pacific disclosure of sexual abuse did not vary by ethnicity, Islands had poorer outcomes than Hawai'i residents negative social reactions to disclosure were more treated at the same hospital. For children admitted from common for certain ethnic groups than others. No 1981 to 2002, we obtained data on patient ethnic differences emerged for depressive or PTSD demographics and outcomes from a review of medical symptoms. Implications are drawn for future research charts and physician case reviews. We found that on the issue of ethnic differences in the aftermath of pediatric cancer patients referred from the Pacific CSA experiences. Islands for treatment in Hawai'i had a higher relative risk of death, of not receiving treatment in a timely Umar US, Adekunle AO, Bakare RA. Pattern of condom use manner, of not completing treatment, and of being lost among commercial sex workers in Ibadan, Nigeria. Afr to follow-up than pediatric cancer patients that were J Med Med Sci 2001; 30(4):285-90. residents of Hawai'i. The higher risk of poor outcomes Abstract: Regular condom use has been proven to for pediatric cancer patients referred from the Pacific remarkably reduce the transmission of sexually Islands can be addressed by improving the health care transmitted diseases (STDs) and its regular use for systems in both the Pacific Islands and in Hawai'i. casual and commercial sex is important for the success of any STD/AIDS control programme. We studied the Upadhyay K, Thomson A, Luckas MJ. Congenital myotonic pattern of condom use among commercial sex workers dystrophy. Fetal Diagn Ther 2005; 20(6):512-4. in Ibadan, Nigeria in an attempt to identify the factors Abstract: We describe a case of severe congenital associated with it. Two hundred and ninety-five myotonic dystrophy (CDM). A 38-year-old commercial sex workers in 21 brothels were randomly primigravida, who was known to suffer from mild selected, using a multi-stage sampling technique, from myotonic dystrophy (DM), conceived spontaneously a total of 31 identified in the 5 local government areas and booked for confinement at 11 weeks in our unit. that make up Ibadan municipality. They were The couple had been fully counseled about the risks of administered a pre-tested, semi-structured transmission of this condition to their offspring before questionnaire by trained research assistants. Results embarking on this pregnancy. Despite being fully showed that over half (53.2%) of the respondents were aware of the risks, they declined prenatal diagnosis. in the 20-29 year age group and most (71.5%) had been The pregnancy was monitored by serial ultrasound in the profession for less than a year. Sixty-five scans. The diagnosis of CDM was suspected by (22.0%) had no formal education, 29.8 % had some ultrasound markers of borderline ventriculomegaly, secondary education whilst 22.4 % had completed polyhydramnios, and reduced fetal movements. The secondary school. Their overall knowledge of sexually pregnancy ended prematurely at 33 weeks in an transmitted diseases (STDs) was rated as poor (20.7%), emergency caesarean section because of severe fetal moderate (64.1%) and good (15.2%). Their perceived compromise. The neonate died almost immediately risk of contracting HIV/AIDS was low (21.7%) after birth. The genetic analysis of cord blood although 87.8% regard it as a health problem in confirmed severe DM. This case highlights the Nigeria. Eighty-three percent of the respondents always importance of ultrasound markers for the diagnosis of insisted that their clients used condoms, 13.2% did so CDM in the absence of definitive prenatal diagnosis. frequently whilst 1.4% only occasionally. Of those who asked clients to use condoms, 69.5% of the women Uppard S. Child soldiers and children associated with the would refuse sex without condoms, 49 (16.6%) would fighting forces. Med Confl Surviv 2003; 19(2):121-7. do nothing and have sex without condoms, but 4.4% Abstract: Experience has shown that the breakdown of would charge extra money. No factor was found to protective structures such as families and communities, have a significant association with the practice of particularly in times of conflict, leaves children asking clients to use condoms or of refusing sex vulnerable to recruitment into armed groups. These without condoms. We concluded that consistent children are subject to gross violations of their human condom use was high among sex workers in brothels in rights, such as the right to protection from harm, Ibadan and was independent of the sex workers violence and abuse. At least 300,000 children are knowledge and perception of STDs. currently being used to fight in armed conflicts in over 30 countries across the world. Girls and boys are Unstead-Joss L. Relative merits of the single and triple 911
- 920. abducted, coerced orpersuaded to join armed forces, population may have had little contact with HIV core often in brutal circumstances. These children are groups in Central America and in the Soconusco and usually involved in internal conflicts, where poverty no history of blood transfusion or intravenous drug use. and exclusion leave very few other viable options-- becoming soldiers may appear to be their only means Uscinski RH, Thibault LE, Ommaya AK. Rotational injury. of survival. Many, however, sustain physical injuries J Neurosurg 2004; 100(3):574-5; author reply 575. and permanent disabilities as a result of combat and it is impossible to know how many are killed. A large V Essen H, Schlickewei W, Dietz HG. [Child abuse]. number encounter health problems such as sexually Unfallchirurg 2005; 108(2):92-101. transmitted diseases, including HIV/AIDS. Lack of Abstract: Child abuse is most often diagnosed by an data on the health of child soldiers means that emergency doctor on call who sometimes "feels" more appropriate medical care and treatment may be than knows what he is confronted with. He should inadequate or inaccessible, even during a planned nevertheless always take a medical history and make a demobilization. There is an urgent need for systematic physical and radiological examination. X-ray imaging research and data collection in order to better and an ophthalmologic retinal examination are the most understand and provide for the healthcare of all important diagnostic steps. Typical findings are children leaving armed groups. multiple and/or dorsal rib fractures, complex skull fractures, physeal fractures, all fractures within the first Uribe-Salas F, Conde-Glez CJ, Juarez-Figueroa L, 12 months, multiple fractures in different localisations Hernandez-Castellanos A. Sociodemographic and stages of healing, all injuries with uncommon dynamics and sexually transmitted infections in female distributions, all patterned bruises, immersion burns, sex workers at the Mexican-Guatemalan border. Sex intramural hematoma and every unexplained loss of Transm Dis 2003; 30(3):266-71. consciousness. The first step towards victim protection Abstract: BACKGROUND: If the predominant means is always the removal of the abused child from its of HIV transmission is heterosexual in the Soconusco caregivers by admitting it to hospital, as 95% of all region of Mexico, then the female sex workers (FSWs) cases of reported child abuse take place within the from Central America who work in this region may be child's family. playing a significant role in the heterosexual transmission of HIV. GOAL: The goal was to estimate Vain N, Prudent L, Szyld E, Wiswell T. A difficult ethics the prevalence of several sexually transmitted issue. Lancet 2004; 364(9447):1751; author reply infections (STIs), including HIV infection, and to 1752. evaluate the population mobility of Mexican and Notes: GENERAL NOTE: KIE: 5 refs. Central American FSWs in the Soconusco region in GENERAL NOTE: KIE: KIE Bib: human Chiapas State, Mexico. METHODS: A cross-sectional experimentation/informed consent study was conducted upon the construction of a sampling frame of sex work-related bars in the Valdizan JR, Abril-Villalba B, Mendez-Garcia M et al. municipalities of the Soconusco region. Consenting [Cognitive evoked potentials in autistic children]. Rev participants answered a questionnaire that recorded Neurol 2003; 36(5):425-8. sociodemographic characteristics, previous and current Abstract: AIMS: The aim of this study was to examine experience in commercial sex, and risk indicators for the latency, amplitude and distribution of N400 STI. Women also provided blood and endocervical potential in order to evaluate the semantic processing swab specimens to be analyzed. RESULTS: A sample capacity in autistic children and in children suffering of 484 women were enrolled, who were characterized from Asperger s syndrome (AS), and to compare them as follows: the average age was 25.6 years, and a high with a control group. PATIENTS AND METHODS: proportion had children, were single, had started sexual 24 autistic children, six boys with AS and 25 controls, activity at an early age, and had a low level of aged between 6 and 14 years old. The cases were education and low earnings. The global prevalences of examined using the DSM IV diagnostic criteria. infections with Treponema pallidum, HSV-2, HIV, Auditory stimulation was performed with pairs of Neisseria gonorrhoeae, and Chlamydia trachomatis congruent and incongruent words: two lists of 20 pairs were 9.4%, 85.7%, 0.6%, 11.6%, and 14.4%, of semantically related words (congruent) and 20 pairs respectively. Frequencies of HBcAb and HBsAg of words with no semantic relationship whatsoever hepatitis B markers were 17.7% and 1.3%. The (incongruent). RESULTS: The most striking parameter cumulative prevalence of treatable gonorrhea, is the increase in latency in N400 for the group of chlamydia, and syphilis was 27.4%. CONCLUSION: autistic children, which did not occur in the group of The data on women's mobility illustrate that the children with AS. Maximum N400 negativity for the Soconusco region attracts Central American women to children with autism was found in the left frontocentral enter the commercial sex trade. The women's region. No significant differences were observed for sociodemographic characteristics were consistent with the amplitude of N400 between the three groups that high prevalences of STI, except HIV infection. The were studied. CONCLUSION: Neurophysiologically, low frequency of HIV infection suggests that this 912
- 921. the autistic childrenand those affected by AS perhaps experimental use, and (5) failure to discontinue regular use different neuronal networks in semantic processing. use. Data were analyzed using logistic regression The N400 wave can be a valid test for monitoring analysis. PARTICIPANTS: Middle school and high verbal processing in these children. school students (N = 13 718, aged 11-21 years) participating in the National Longitudinal Study of Valentin SR. Commentary: Sleep in German infants--the Adolescent Health (Add Health). RESULTS: Three "cult" of independence. Pediatrics 2005; 115(1 risk factors (own and peer involvement with Suppl):269-71. substances, delinquency, and school problems) were Abstract: OBJECTIVES: Significant cultural variations the strongest predictors of all stages. Their combined exist in sleep practices for young children, including presence greatly increased risk of initiation of bedtime rituals and routines, soothing techniques, and experimental (odds ratio, 20) and regular (odds ratio, cosleeping. This study examined parenting styles at 87) marijuana use over the next year. Personality, bedtime and sleep behavior in a group of German family, religious, and pastime factors exerted stage- infants. The results are compared with sleep practices specific, sex-specific, and age-specific influences. of other western European countries. CONCLUSIONS: Assessment of substance, school, PARTICIPANTS: German parents of 50 boys and 50 and delinquency factors is important in identifying girls 6 to 30 months old. METHOD: Parents were individuals at high risk for continued involvement with asked to fill out a questionnaire about the sleep marijuana. Prevention and/or intervention efforts behavior of their child. Personal interviews with the should focus on these areas of risk. parents were conducted to augment the survey results; in selected cases, bedtime routines were filmed. van der AA F, Roskams T, Blyweert W, Ost D, Bogaert G, RESULTS: The infants in this sample largely slept in De Ridder D. Identification of kit positive cells in the their own bed in a separate room. Bedtime rituals were human urinary tract. J Urol 2004; 171(6 Pt 1):2492-6. common and in general characterized by parents Abstract: PURPOSE: Analogous to interstitial cells of maintaining behavioral distance from the infants during Cajal in the bowel, functional important networks of the bedtime routine. However, parenting style was interstitial cells could have a role in the complex likely to become more "proximal" (close) in response mechanism of central and peripheral control of urinary to bedtime refusal and nocturnal infant crying. A tract function. Recently various reports mentioned the majority of parents (79%) used lullabies as part of the presence of interstitial cells in different parts of the bedtime ritual, and the use of a sleep aid was very urinary tract and in different species. Since important common (80%). CONCLUSION: As is the case with differences among species exist, we performed most cultures, German bedtime parenting practices immunohistochemistry on fresh frozen human tissue to tend to reflect parenting values and beliefs associated study the presence of interstitial cells in the human with their specific culture. The parenting style at urinary tract. MATERIALS AND METHODS: A total bedtime in this group of infants in general seemed less of 65 tissue pieces from all levels of the urinary tract rigid and less distancing than bedtime rituals typically were obtained from 44 patients treated at our described in other northern European countries and institution. Tissue was processed for may represent more of a synthesis of parenting styles immunohistochemistry immediately after removal. We across various Western cultures. performed immunohistochemistry for kit, connexin 43 and VRL1/TRPV2. RESULTS: Interstitial cells Van Biema D. Rebels in the pews. Time 2002; 159(24):54-8. immunopositive for all 3 antibodies were seen beneath the urothelium and between smooth muscle cells in all van den Bree MB, Pickworth WB. Risk factors predicting tissue pieces with slight topographical differences. changes in marijuana involvement in teenagers. Arch CONCLUSIONS: Together with morphological and Gen Psychiatry 2005; 62(3):311-9. functional data from other experiments these Abstract: BACKGROUND: Marijuana use during morphological data suggest that, as in the bowel, adolescence has various adverse psychological and networks of interstitial cells might have an important health outcomes. It is poorly understood whether the role in the physiology and pathology of the urinary same risk factors influence different stages in the tract. They could be involved in pacemaking or have an development of marijuana involvement. OBJECTIVE: integrating role through the modulation of To establish which risk factors best explain different neurotransmission and conduction of electrical stages of marijuana involvement. DESIGN: Data were impulses. Functional experiments are the next step to collected at 2 points using computer-assisted personal study these hypotheses. interview (wave 1 and wave 2 were separated by 1 year). Twenty-one well-established risk factors of van der Heide A, Deliens L, Faisst K et al. End-of-life adolescent substance use/abuse were used to predict 5 decision-making in six European countries: descriptive stages of marijuana involvement: (1) initiation of study. Lancet 2003; 362(9381):345-50. experimental use, (2) initiation of regular use, (3) Notes: CORPORATE NAME: EURELD consortium progression to regular use, (4) failure to discontinue GENERAL NOTE: KIE: 25 refs. GENERAL NOTE: KIE: KIE Bib: allowing to die; 913
- 922. euthanasia; suicide; terminal care Abstract: In a 4-months-old male infant who had been Abstract: BACKGROUND: Empirical data about end- discovered in his bed pale, apnoeic and cold, of-life decision-making practices are scarce. We aimed fundoscopy revealed multiple retinal haemorrhages due to investigate frequency and characteristics of end-of- to shaken baby syndrome. life decision-making practices in six European countries: Belgium, Denmark, Italy, the Netherlands, van der Velden VH, Hochhaus A, Cazzaniga G, Szczepanski Sweden, and Switzerland. METHODS: In all T, Gabert J, van Dongen JJ. Detection of minimal participating countries, deaths reported to death residual disease in hematologic malignancies by real- registries were stratified for cause (apart from in time quantitative PCR: principles, approaches, and Switzerland), and samples were drawn from every laboratory aspects. Leukemia 2003; 17(6):1013-34. stratum. Reporting doctors received a mailed Abstract: Detection of minimal residual disease (MRD) questionnaire about the medical decision-making that has prognostic value in many hematologic had preceded the death of the patient. The data- malignancies, including acute lymphoblastic leukemia, collection procedure precluded identification of any of acute myeloid leukemia, chronic myeloid leukemia, the doctors or patients. All deaths arose between June, non-Hodgkin's lymphoma, and multiple myeloma. 2001, and February, 2002. We weighted data to correct Quantitative MRD data can be obtained with real-time for stratification and to make results representative for quantitative PCR (RQ-PCR) analysis of all deaths: results were presented as weighted immunoglobulin and T-cell receptor gene percentages. FINDINGS: The questionnaire response rearrangements, breakpoint fusion regions of rate was 75% for the Netherlands, 67% for chromosome aberrations, fusion-gene transcripts, Switzerland, 62% for Denmark, 61% for Sweden, 59% aberrant genes, or aberrantly expressed genes, their for Belgium, and 44% for Italy. Total number of deaths application being dependent on the type of disease. studied was 20480. Death happened suddenly and RQ-PCR analysis can be performed with SYBR Green unexpectedly in about a third of cases in all countries. I, hydrolysis (TaqMan) probes, or hybridization The proportion of deaths that were preceded by any (LightCycler) probes, as detection system in several end-of-life decision ranged between 23% (Italy) and RQ-PCR instruments. Dependent on the type of MRD- 51% (Switzerland). Administration of drugs with the PCR target, different types of oligonucleotides can be explicit intention of hastening death varied between used for specific detection, such as an allele-specific countries: about 1% or less in Denmark, Italy, Sweden, oligonucleotide (ASO) probe, an ASO forward primer, and Switzerland, 1.82% in Belgium, and 3.40% in the an ASO reverse primer, or germline probe and primers. Netherlands. Large variations were recorded in the To assess the quantity and quality of the RNA/DNA, extent to which decisions were discussed with patients, one or more control genes must be included. Finally, relatives, and other caregivers. INTERPRETATION: the interpretation of RQ-PCR MRD data needs Medical end-of-life decisions frequently precede dying standardized criteria and reporting of MRD data needs in all participating countries. Patients and relatives are international uniformity. Several European networks generally involved in decision-making in countries in have now been established and common guidelines for which the frequency of making these decisions is high. data analysis and for reporting of MRD data are being developed. These networks also include van der Kolk BA. The neurobiology of childhood trauma standardization of technology as well as regular quality and abuse. Child Adolesc Psychiatr Clin N Am 2003; control rounds, both being essential for the introduction 12(2):293-317, ix. of RQ-PCR-based MRD detection in multicenter Abstract: During the past decade there has been rapid clinical treatment protocols. progress in the understanding of the effects of exposure to traumatic life experiences on subsequent van der Walt JH, Sainsbury DA, Pettifer R. Anaesthesia psychopathology in children. Trauma exposure affects alert: an integrated, networked, register of paediatric what children anticipate and focus on and how they anaesthetic problems. Anaesth Intensive Care 2001; organize the way they appraise and process 29(2):113-6. information. Trauma-induced alterations in threat Abstract: The Paediatric Register of Anaesthetic perception are expressed in how they think, feel, Problems (PaedRAP) is a network-based anaesthesia behave, and regulate their biologic systems. The task of hazard alert system. It is integrated with pre- therapy is to help these children develop a sense of anaesthesia consultations and patient questionnaires. physical mastery and awareness of who they are and All files, both electronic and on paper, are available 24 what has happened to them to learn to observe what is hours a day close to the operating theatres. This happening in present time and physically respond to ensures that pertinent information is readily available current demands instead of recreating the traumatic when and where it is most needed. The PaedRAP is past behaviorally, emotionally, and biologically. also linked to the automated theatre booking system to print warnings on the theatre lists. This minimizes the van der Maesen K, Moll AC, Imhof SM. [Diagnostic image chance that important information goes unnoticed. (177). A lifeless infant. Shaken baby syndrome]. Ned Documentation of the progression of the various Tijdschr Geneeskd 2004; 148(8):377. categories of patient problems and evolving 914
- 923. management strategies hasbeen useful both for low levels of aggression. Children following the early- individuals and groups. onset/increasers trajectory showed physical forms of aggression at baseline. Male gender and comorbid Van Dorn RA, Mustillo S, Elbogen EB, Dorsey S, Swanson attention deficit/hyperactivity problems, oppositional JW, Swartz MS. The effects of early sexual abuse on defiant problems and poor prosocial behavior plus adult risky sexual behaviors among persons with severe negative life events predicted which children would mental illness. Child Abuse Negl 2005; 29(11):1265- follow the early-onset/increasers trajectory of 79. aggression. The outcomes associated with the early- Abstract: OBJECTIVE: There were two aims: first, to onset/increaser children suggest high risk for examine the relationship between prior sexual abuse chronically high levels of aggressive behavior. and three types of adult risky sexual behaviors [(1) ever traded sex for drugs or money, (2) had unprotected sex van Loveren C, Ketley CE, Cochran JA, Duckworth RM, in the past 6 months, and (3) frequency of unprotected O'Mullane DM. Fluoride ingestion from toothpaste: sex in the past 6 months] among persons with severe fluoride recovered from the toothbrush, the expectorate mental illness (SMI), and second, to examine the and the after-brush rinses. Community Dent Oral potential mediating effects of adult rape, substance use, Epidemiol 2004; 32 Suppl 1:54-61. and PTSD. METHOD: Using a pooled sample of Abstract: OBJECTIVES: The aim of this study was to individuals with SMI (N=609), logistic and negative determine the effects of rinsing and spitting on fluoride binomial regression analyses were used to investigate ingestion from toothpaste during normal oral-hygiene the impact of prior sexual abuse on these adult risky procedures of younger children, and hence to make sexual behaviors. RESULTS: Childhood sexual abuse recommendations on rinsing during toothbrushing. was associated with having ever traded sex for money METHODS: The brushing habits of 166 Dutch and 185 and having engaged in unprotected sex in the past 6 Irish children between 1.5 and 3.5 years were observed months. However, childhood sexual abuse was during home visits. The weight of the toothpaste tube inversely associated with the number of times males was determined before and after use. After brushing, had unprotected sex in the past 6 months. Results the toothbrush and any associated expectorate and differed between males and females and the impact of rinses, combined with any toothpaste spilled during the potential mediators also varied by gender and type of brushing procedures, were collected. The amounts of outcome studied. CONCLUSION: These findings fluoride retained on the toothbrush and in the suggest a complex link between childhood sexual associated expectorate and rinses were measured. abuse and adult risky sexual behaviors in persons with RESULTS: Over 90% of the Dutch children used a SMI. Clinical assessments of child abuse sequelae special toddlers' toothpaste with < or =500 ppm F. should include a variety of indicators and parameters of Eleven per cent of the younger (<2.5 years) Dutch adult risky sexual behavior, as persons with SMI are at children and 22% of the older children rinsed after an increased risk of engaging in high-risk sexual brushing. Of the Irish children approximately 52% behaviors and tend to have a higher exposure to used a children's toothpaste containing around 500 ppm childhood sexual abuse than does the general F. Of the younger Irish children 31% spat without population. rinsing, while another 31% rinsed during or after brushing. For the older Irish children, these percentages Van Houdenhove B, Egle UT. Comment on Raphael, K.G., were 14 and 70%, respectively. On average, 22% of the Widom, C.S., Lange, G., Childhood victimization and fluoride dispensed on the toothbrush was retained on pain in adulthood: a prospective investigation, PAIN the brush after brushing irrespective of the rinsing and 92 (2001) 283-293. Pain 2002; 96(1-2):215-6; author spitting behaviour of the children. The maximum reply 216-7. ingestible amount of fluoride from toothpaste assuming no rinsing or spitting was calculated. CONCLUSIONS: van Lier PA, Crijnen AA. Trajectories of peer-nominated Fluoride ingestion from toothpaste is significantly aggression: risk status, predictors and outcomes. J reduced by rinsing and/or spitting during Abnorm Child Psychol 2005; 33(1):99-112. toothbrushing. Recommendations that younger children Abstract: Developmental trajectories of peer- use small amounts of toothpaste (< 0.5 g) and that nominated aggression, risk factors at baseline, and children using toothpaste with > or = 1000 ppm F rinse outcomes were studied. Peer nominations of aggression their mouths after brushing continue to be valid. were obtained annually from grades 1 to 3. Three developmental trajectories were identified: an early- van Manen TG, Prins PJ, Emmelkamp PM. Reducing onset/increasers trajectory with high levels of peer- aggressive behavior in boys with a social cognitive nominated aggression at elementary school entry and group treatment: results of a randomized, controlled increasing levels throughout follow-up; a moderate- trial. J Am Acad Child Adolesc Psychiatry 2004; persistent trajectory of aggression in which children 43(12):1478-87. were characterized by moderate levels of physical Abstract: OBJECTIVE: To evaluate the effectiveness aggression at baseline; and a third trajectory with stable of a social cognitive intervention program for Dutch aggressive boys and to compare it with a social skills 915
- 924. training and awaitlist control group. METHOD: A activity of system opetators for indications of visual randomized, controlled treatment outcome study with workload and scanning efficiency. 97 aggressive boys (aged 9-13 years) was presented. An 11-session group treatment, a social cognitive Van Reempts PJ, Van Acker KJ. Ethical aspects of intervention program (n = 42) based on Dodge's social cardiopulmonary resuscitation in premature neonates: information-processing theory, was compared with where do we stand? Resuscitation 2001; 51(3):225-32. social skills training (n = 40) and waitlist control group Notes: GENERAL NOTE: KIE: KIE Bib: allowing to (n = 15). Measures of aggressive behavior, self-control, die/infants; patient care/minors social cognitive skills, and appropriate social behavior Abstract: Advances in diagnosis, techniques, were completed before and after the group treatment therapeutic interventions, organisation of perinatal and at 1-year follow-up. RESULTS: The outcome of care, and socio-economic factors have all contributed both treatment conditions indicated (1) a significant to the survival after resuscitation and intensive care of increase in appropriate social behavior, social cognitive neonates with extremely low birth weight and skills, and self-control and (2) a significant decrease in gestational age. While morbidity during the first years aggressive behavior. There was a significant difference of life in those infants does not increase, at school age between treatment and no treatment and between the multiple dysfunctions may become apparent. What are social cognitive intervention program and social skills the limits of intensive care for the newborn? Is it right training on various child, parent, and teacher measures. to use extreme technical and economic measures for CONCLUSIONS: The expectation that focusing on the neonates with a borderline chance of survival? What is deficits and distortions in social cognitive processes justifiable for the neonate, the family, the society and (social cognitive intervention program) instead of how does legislation interfere in a decision process merely focusing on social skills (social skills training) which involves starting, stopping or continuing would enhance the effectiveness was supported on intensive care? A short historical overview for the care child, parent, and teacher measures. At 1-year follow- of the newborn is given, followed by the outcome after up, the mean effect sizes of the social cognitive resuscitation and treatment of the very low birth weight intervention program and social skills training were infant. Published management strategies and 0.76 and 0.56, respectively. recommendations are discussed. Van Orden KF, Limbert W, Makeig S, Jung TP. Eye activity van Rossum AM, Oudesluys-Murphy AM. [Diagnostic correlates of workload during a visuospatial memory image (177). A lifeless infant. Shaken baby syndrome]. task. Hum Factors 2001; 43(1):111-21. Ned Tijdschr Geneeskd 2004; 148(23):1169; author Abstract: Changes in six measures of eye activity were reply 1169. assessed as a function of task workload in a target identification memory task. Eleven participants van Uden CJ, Zwietering PJ, Hobma SO et al. Follow-up completed four 2-hr blocks of a mock anti-air-warfare care by patient's own general practitioner after contact task, in which they were required to examine and with out-of-hours care. A descriptive study. BMC Fam remember target classifications (friend/enemy) for Pract 2005; 6(1):23. subsequent prosecution (fire upon/allow to pass), while Abstract: BACKGROUND: Little is known about the targets moved steadily toward two centrally located care process after patients have contacted a GP ship icons. Target density served as the task workload cooperative for out-of-hours care. The objective of this variable; between one and nine targets were study was to determine the proportion of patients who simultaneously present on the display. For each seek follow-up care after contact with a GP cooperative participant, moving estimates of blink frequency and for out-of-hours care, and to gain insight into factors duration, fixation frequency and dwell time, saccadic that are related to this follow-up care. METHODS: A extent, and mean pupil diameter, integrated over total of 2805 patients who contacted a GP cooperative periods of 10 to 20 s, demonstrated systematic changes for out-of-hours care were sent a questionnaire. They as a function of target density. Nonlinear regression were asked whether they had attended their own GP analyses found blink frequency, fixation frequency, within a week after their contact with the cooperative, and pupil diameter to be the most predictive variables and for what reason. To investigate whether other relating eye activity to target density. Participant- variables are related to follow-up care, a logistic specific artificial neural network models, developed regression analysis was applied. Variables that entered through training on two or three sessions and in this analysis were patient characteristics (age, subsequently tested on a different session from the gender, etc.) and patient opinion on correctness of same participant, correlated well with actual target diagnosis, urgency and severity of the medical density levels (mean R = 0.66). Results indicate that complaint. RESULTS: The response rate was 42%. In moving mean estimation and artificial neural network total, 48% of the patients received follow-up care from techniques enable information from multiple eye their own GP. Only 20% were referred or advised to measures to be combined to produce reliable near-real- attend their own GP. Others attended because their time indicators of workload in some visuospatial tasks. medical condition worsened or because they were Potential applications include the monitoring of visual 916
- 925. concerned about theircomplaint. Variables that past infestation was 40.7%. A home visit was made to predicted follow-up care were the patient's opinion on 58% of the positive children. 85% of the positive the correctness of the diagnosis, patient's health children were screened again on day 14. Wet combing insurance, and severity of the medical problem. was the most widely used treatment, followed by CONCLUSION: Almost half of all patients in this chemical treatment and a combination of the two. In study who contacted the GP cooperative for out-of- school 1 and 3 51% were cured, and in school 2 24% hours care attended their own GP during office hours became nit-free. A wet combing screening campaign within a week, for the same medical complaint. The and a community-oriented approach to head-louse most important factor that predicted follow-up care control is feasible though resource-intensive. The from the patient's own GP after an out-of-hours contact prevalence of head lice was high and the cure rate was was the patient's degree of confidence in the diagnosis low, with either topical treatments or wet combing. established at the GP cooperative. Despite the limited generalisability, this study is a first step in providing Vandermeeren Y, Sebire G, Grandin CB, Thonnard JL, insight into the dimension of follow-up care after a Schlogel X, De Volder AG. Functional reorganization patient has contacted the GP cooperative for out-of- of brain in children affected with congenital hours primary care. hemiplegia: fMRI study. Neuroimage 2003; 20(1):289- 301. Van Zyl L. Intentional parenthood: responsibilities in Abstract: Using functional magnetic resonance surrogate motherhood. Health Care Anal 2002; imaging, the brain activation related to unilateral 10(2):165-75. sequential finger-to-thumb opposition was studied in Notes: GENERAL NOTE: KIE: 9 refs. six children with a right congenital hemiplegia of GENERAL NOTE: KIE: KIE Bib: surrogate mothers cortical origin. They were compared to six age- Abstract: In recent years, a number of writers dealing matched controls. In the control group, movements with questions over parenthood that arise in the context with either hand asymmetrically activated the of reproductive technologies and surrogate sensorimotor cortex and premotor areas in both motherhood, have appealed to the notion of cerebral hemispheres with a typical contralateral "intentional parenthood". Basing their argument on predominance. By contrast, paretic finger movements liberal values such as individual autonomy, the activated both hemispheres in the hemiplegic patients, freedom to enter contracts, the right to privacy, and with a strong ipsilateral predominance favoring the individual self-fulfilment, they argue that contractually undamaged hemisphere. The activation induced by stated intentions, rather than genetic or gestational nonparetic finger movements was restricted to the relationships, should form the basis of parental rights. contralateral undamaged hemisphere. Furthermore, the Against this I argue that parental rights do not derive level of activation in the undamaged cortex was partly from contractual agreements, but are based in their related to residual finger dexterity, according to obligations towards the child. I then examine the nature covariance analysis. These activation patterns indicate of the obligations that the various parties have towards an adaptive reorganization of the cortical motor the child both pre- and postnatally. networks in this group of patients, with a prominent involvement of the undamaged hemisphere in the Vander Stichele RH, Gyssels L, Bracke C et al. Wet control of finger movements with either hand. combing for head lice: feasibility in mass screening, treatment preference and outcome. J R Soc Med 2002; VanderVoort DJ. Hawaii's public mental health system. 95(7):348-52. Hawaii Med J 2005; 64(3):62-4, 66-7, 81. Abstract: There is no scientific consensus on the best Abstract: The following article addresses the nature of way to control head louse infestation in schoolchildren. and problems with the public mental health system in A study was conducted to test the feasibility and Hawaii. It includes a brief history of Hawaii's public acceptability of a screening campaign by wet combing mental health system, a description and analysis of this and a community approach to head-louse control with system, economic factors affecting mental health, as home visits, and to explore parents' treatment well as a needs assessment of the elderly, individuals preferences and treatment outcomes. A non-controlled with severe mental illness, children and adolescents, intervention (advice on treatment options offered to all and ethnically diverse individuals. In addition to positive children) was nested within an having the potential to increase suicide rates and epidemiological prevalence study. All children in three unnecessarily prolong personal suffering, problems in primary schools in Ghent, Belgium, were invited to the public mental health system such as inadequate take part in screening by wet combing (n=677, 3-11 services contribute to an increase in social problems years). Positive children were offered structural including, but not limited to, an increase in crime rates treatment advice, a home visit on day 7, and a check by (e.g., domestic violence, child abuse), divorce rates, wet combing on day 14. 83% of the children were school failure, and behavioral problems in children. screened. The prevalence of active infestation (living The population in need of mental health services in moving lice) was 13.0% in school 1 and 19.5% in Hawaii is under served, with this inadequacy of school 3. In school 2, prevalence of signs of active and services due to economic limitations and a variety of 917
- 926. other factors. study examined parenting practices in 2-parent families of Mexican, MD, and Caucasian-non-Hispanic (CNH) Vane DW, Sartorelli KH, Reese J. Emotional considerations parents. Parents in all groups reported using and attending involvement ameliorates organ donation authoritative practices more often than authoritarian in brain dead pediatric trauma victims. J Trauma 2001; strategies. MD parents reported greater use of 51(2):329-31. authoritarian practices than Mexican and CNH parents. Abstract: PURPOSE: The purpose of this study was to Results suggest that previously found cultural ascertain a strategy for maximizing parental consent for variations in parenting between MD parents and CNH organ donation in traumatically injured children parents may be more related to the ecological context suffering from brain death. Our hypothesis was that of MD families than to an affiliation with Mexican appropriate attending surgeon involvement and delay culture. Clinicians should explore the positive qualities in evaluating children for brain death leads to an of authoritative parenting in MD families along with increased percentage of organ donors. METHODS: the potential motivations for using authoritarian From January 1993 to August 1999, the records of all strategies. children who died in a Level I trauma center were evaluated. Those children suffering brain death that Varns JL, Mulik JD, Sather ME, Glen G, Smith L, Stallings were suitable for organ donation were entered into the C. Passive ozone network of Dallas: a modeling study. Cases were reviewed for patient demographics, opportunity with community involvement. 1. Environ time to entry into brain death protocol (measured from Sci Technol 2001; 35(5):845-55. time of admission), time to parent notification about Abstract: Despite tremendous efforts toward regulating brain death (measured from time of admission), and controlling tropospheric ozone (O3) formation, a specific attending involved in the case (with level of large portion of the U.S. population presently lives in involvement), and success of organ donation request. environments where air quality exceeds both 1- and 8-h In all, 43 charts were reviewed. RESULTS: Of 43 National Ambient Air Quality Standards (NAAQS) set deaths, 33 were deemed suitable for donation. Age of for O3. High O3 concentrations annually cost the suitable donors ranged from 1 month to 18 years. In all, United States billions of dollars in excessive human 11 attending physicians were involved in the care of health costs, reduced crop yields, and ecological these children. Overall, 20 of 33 were organ donors damage. This paper describes a regional networking of (60%). When the attending surgeon was involved, O3 monitoring sites, operated by the public, that used donation success for organ retrieval was 86%, whereas simplified passive sampling devices (PSDs). In if the attending was not involved personally, the collaboration with EPA Region 6, a lay network (i.e., success rate dropped to 23% (p < 0.04). One senior Passive Ozone Network of Dallas, acronym POND), pediatric surgeon obtained a success rate of 12 of 12 consisting of 30 PSD sites in the Dallas-Fort Worth children. It was this surgeon's policy to not initiate (DFW) Metroplex, a region representing 16 counties, brain death protocols in children immediately on entry successfully measured daily ozone during 8 weeks of into the emergency room, but rather to delay initiation the 1998 high ozone season. It was demonstrated that until family could be gathered and spend time with the the concerned public, when properly trained, could affected child in order that the family could recover successfully operate a large PSD network that requires from the initial shock of trauma (always at least daily sample handling and weekly mailing procedures, overnight). When time to initiation of brain death even from remote sites. Data treatment of the 2880 protocol was examined, success was obtained when a POND measurements included (i) high correlations delay of 15.5 hours was respected, versus 7.0 hours with collocated continuous monitoring data [r range = when donation was requested but denied (p < 0.03). 0.95-0.97], (ii) daily O3 contour mapping of the 24,000 CONCLUSION: These data indicate that attending km2 area, and (iii) a ranking of O3 severity in 12 peri- involvement is important when parents of brain dead urban counties for guidance in sitting additional children are asked about organ retrieval (p < 0.04). monitors. With a new 8-h NAAQS standard now in Delay in initiating brain death protocols in order for place, a cost-effective network such as POND could family members to deal with the shock of the initial aid regional airshed models in generating meaningful trauma appears to increase willingness to participate in guidance for O3 state implementation plans (SIPs) by organ donation. providing input that is representative of both rural and urban sites. Varela RE, Vernberg EM, Sanchez-Sosa JJ, Riveros A, Mitchell M, Mashunkashey J. Parenting style of Vassal G, Mery-Mignard D, Caulin C. Clinical trials in Mexican, Mexican American, and Caucasian-non- paediatric oncology. Recommendations for the Hispanic families: social context and cultural development of new anticancer agents. Therapie 2003; influences. J Fam Psychol 2004; 18(4):651-7. 58(3):229-46. Abstract: To begin accounting for cultural and Abstract: Childhood and adolescent cancers are rare contextual factors related to child rearing in Mexican- diseases. Despite the progress in treatment (more than descent (MD; Mexican American and Mexican two-thirds of all cases are cured), cancer remains the immigrant) families in the United States, the current leading cause of death by disease in children older than 918
- 927. 1 year. Accessto new drugs that are more efficacious orthopaedics (40%), rheumatology (8%), nephrology or better tolerated is therefore an important public (4%) and paediatrics (4%). Initial email replies were health priority. The objective of our round table was received at the CRP within a day of referral in 70% of thus to take inventory of the situation and to propose cases and within thee days in 100%, which shows that recommendations aimed at facilitating coordinated, store-and-forward telemedicine can be both fast and rational and more rapid access to new treatments. The reliable. Telemedicine consultation was complete active participation of paediatric oncologists, parents, within three days in 14 cases (52%) and within three pharmaceutical companies and regulatory authorities weeks in 24 cases (89%). Referral was judged to be proved not only necessary but very constructive. beneficial in 24 cases (89%), the benefits including Pharmaceutical companies have developed very few establishment of the diagnosis, the provision of new anticancer agents for children during the past 10 reassurance to the patient and referring doctor, and a years. The round table identified current trends that change of management. Four patients (15% of the appear propitious: the mobilisation of parents and total) and their families were spared the considerable patients' associations; European initiatives to encourage expense and unnecessary stress of travelling abroad for companies to assess drugs in children; regulatory a second opinion, and the savings from this alone initiatives to guide drug development; and the outweighed the set-up and running costs in existence of structured clinical research networks in Bangladesh. The latter are limited to an email account paediatric oncology, including for the development of with an Internet service provider and the local-rate early treatment. The round table recommends the telephone call charges from the CRP. This successful following measures to improve access to new telemedicine system is a model for further telemedicine treatments for children and adolescents with cancer: 1. projects in the developing world. Conduct preclinical paediatric evaluation of all anticancer agents that begin the development process Vaughn BE. Discovering pattern in developing lives: for adults (research and validation of treatment targets; reflections on the Minnesota study of risk and pharmacological evaluation in relevant experimental adaptation from birth to adulthood. Attach Hum Dev models) to help choose the agents to study in children. 2005; 7(4):369-80. 2. Initiate paediatric clinical development before the Abstract: The Minnesota Study of Risk and Adaptation first application for authorization for adults is filed, was initiated in the mid-1970s as a short-term when sufficient safety and tolerability data are longitudinal study of infants at elevated risk for abuse available, that is, after the phase I trials in adults and and neglect. At the outset, the project leaders intended optimally during the phase II trials. 3. Optimise to characterize the infant, the caregiving environment, paediatric clinical evaluation by defining development and the larger social milieu of the family in as plans early and by reducing the duration of studies comprehensive a manner as possible so as to test (enlargement of the early treatment research network to explicitly posed hypotheses about pathways leading ensure adequate recruitment; new evaluation methods; from the child, the caregiving environment, and the better extrapolation of pharmacological data from social milieu to abuse or neglect. Paradoxically, only a adults to children for dose-finding). 4. Improve minority of infants recruited to the study were information to and participation of parents and patients ultimately abused or neglected over the 36-month in clinical research for new treatments. The period for which funding had been provided, but it prerequisite for the success of this project became proved possible to identify several antecedent rapidly clear to all the round-table participants: indicators that predicted their outcome. It was also cooperation and partnership between specialists and evident from the data that developmental casualty was other scientists from academia, parent associations, elevated in this sample and the frequencies of pharmaceutical companies and regulatory authorities. suboptimal outcomes in social, emotional, and Only with such cooperation can progress in treatment behavioral domains were greater than expected for less occur and new hopes for recovery be fulfilled. stressed samples. The study had yielded a wealth of information about infants and families from this at-risk Vassallo DJ, Hoque F, Roberts MF, Patterson V, Swinfen P, sample and it was clear that the sample must be Swinfen R. An evaluation of the first year's experience followed into childhood so as to describe the with a low-cost telemedicine link in Bangladesh. J trajectories of developmental successes and casualties Telemed Telecare 2001; 7(3):125-38. that were already apparent in the first 24 months of Abstract: In July 1999, the Swinfen Charitable Trust in data. Alan Sroufe joined the project leaders in this the UK established a telemedicine link in Bangladesh, endeavor and the childhood data supported the study of between the Centre for the Rehabilitation of the the sample into adolescence and now into adulthood. Paralysed (CRP) in Dhaka and medical consultants At this point, children of the original sample of infants abroad. This low-cost telemedicine system used a are now being assessed using many of the protocols digital camera to capture still images, which were then and procedures used with their parents. The study has transmitted by email. During the first 12 months, 27 produced hundreds of published reports about risk and telemedicine referrals were made. The following its consequences, as well as about positive adjustment specialties were consulted: neurology (44%), to life in a socio-cultural milieu that frequently can be 919
- 928. non-supportive or evendangerous. This essay is a significantly related to the crude mortality rate but reflection on some accomplishments of the Minnesota were not significantly related to the age-standardized study as these have helped shape how developmental mortality rate. Two of the inequality measures were scientists think about social and emotional related to mortality rates for males aged 0-44 and for development and more generally about how theory has males aged 45-64 before but not after controlling for guided the conceptual, empirical, and measurement mean household income. DISCUSSION: Health plans for the study from its beginning. researchers have yet to report a meaningful relationship between income inequality and population health Vaught W, Fleetwood J. Covert video surveillance in within Canada. At the risk of committing the ecological pediatric care. Hastings Cent Rep 2002; 32(6):10-1; fallacy, these findings provisionally support a psycho- discussion 11-2. social interpretation of the individual-level relationship Notes: GENERAL NOTE: KIE: KIE Bib: patient between income and health wherein members of these care/minors communities compare themselves to an encompassing community, e.g., all Canadians. Veenema TG, Schroeder-Bruce K. The aftermath of violence: children, disaster, and posttraumatic stress Vega J, Bedregal P, Jadue L, Delgado I. [Gender inequity in disorder. J Pediatr Health Care 2002; 16(5):235-44. the access to health care in Chile]. Rev Med Chil 2003; Abstract: Terrorist attacks, situations of armed conflict, 131(6):669-78. and all forms of catastrophe tax our abilities to cope, Abstract: BACKGROUND: In the last two decades, understand, and respond. Because of their Chile has experienced advances in economical developmental status, children are even more development and global health indicators. However, emotionally vulnerable to the devastating effects of a gender inequities persist in particular related to access disaster. When tragedy strikes a family, community, or to health services and financing of health insurance. the nation, helping children cope and regain a sense of AIM: To examine gender inequities in the access to safety is critical. A child with posttraumatic stress health care in Chile. MATERIAL AND METHODS: disorder (PTSD) develops symptoms such as intense An analysis of data obtained from a serial national fear, disorganized and agitated behavior, emotional survey applied to assess social policies (CASEN) numbness, anxiety, or depression after being directly carried out by the Ministry of Planning. During the exposed to or witnessing an extreme traumatic situation survey 45,379 and 48,107 dwellings were interviewed involving threatened death or serious injury. Victims of in 1994 and in 1998, respectively. RESULTS: Women repeated abuse or children who live in violent use health services 1.5 times more often, their salaries neighborhoods or war zones, or who have witnessed are 30% lower in all socioeconomic strata. Besides, in extensive media coverage of violent events, may the private health sector, women pay higher insurance experience PTSD. premiums than men. Men of less than two years of age have 2.5 times more preventive consultations than Veenstra G. Income inequality and health. Coastal girls. This difference, although of lesser magnitude, is communities in British Columbia, Canada. Can J also observed in people over 60 years. Women of high Public Health 2002; 93(5):374-9. income quintiles and users of private health insurance Abstract: OBJECTIVE: An imbalance in the have a better access to preventive consultations but not distribution of economic resources, i.e., income to specialized care. CONCLUSIONS: An improvement inequality, is a characteristic of a community that may in equitable access of women to health care and influence the aggregate health of the population. In financing is recommended. Also, monitoring systems North America, income inequality seems to be strongly to survey these indicators for women should improve related to mortality rates among American their efficiency. communities such as states and metropolitan areas but largely irrelevant for health at similar levels of Vehmas S. Just ignore it? Parents and genetic information. geopolitical aggregation in Canada. This article Theor Med Bioeth 2001; 22(5):473-84. summarizes relevant international and North American Notes: GENERAL NOTE: KIE: Vehmas, Simo evidence and then explores relationships between GENERAL NOTE: KIE: KIE Bib: genetic counseling; income inequality and mortality rates among coastal genetic screening communities in the province of British Columbia, Abstract: This paper discusses whether prospective Canada. METHODS: Cross-sectional analysis was parents ought to find out about their genetic conducted among twenty-four coastal communities in constitution for reproductive reasons. It is argued that British Columbia, utilizing four measures based on the ignoring genetic information can be in line with 1996 Census to measure income inequality and crude, responsible parenthood or perhaps even age-standardized and age- and gender-specific recommendable. This is because parenthood is mortality rates averaged over the five-year period essentially an unconditional project in which parents 1994-98 to measure health. RESULTS: The three valid ought to commit themselves to nurturing any kind of measures of income inequality were positively and child. Besides, the traditional reasons offered for the unfortunateness of impairments and the tragic fate of 920
- 929. families with disabledchildren are not convincing. stress-strain-coping-support model). It will outline Other morally problematic outcomes of genetics, such some of the key findings of this programme, and as discrimination against individuals with impairments, address some of the key universals that we have and limiting free parental decision making, are also observed across various cultures. It will end by considered. describing current research, including the testing of brief interventions being delivered through primary Vehmas S. Response to "abortion and assent" by Rosamond care to family members to enable them to cope better Rhodes (CQ Vol 8, No 4) and "abortion, disability, with the problems which family substance misuse assent, and consent" by Matti Hayry (CQ Vol 10, No causes. 1). Assent and selective abortion: a response to Rhodes and Hayry. Camb Q Healthc Ethics 2001; 10(4):433- Vellutino FR, Fletcher JM, Snowling MJ, Scanlon DM. 40. Specific reading disability (dyslexia): what have we Notes: GENERAL NOTE: KIE: 26 fn. learned in the past four decades? J Child Psychol GENERAL NOTE: KIE: KIE Bib: abortion Psychiatry 2004; 45(1):2-40. Abstract: We summarize some of the most important Velez ML, Jansson LM, Montoya ID, Schweitzer W, Golden findings from research evaluating the hypothesized A, Svikis D. Parenting knowledge among substance causes of specific reading disability ('dyslexia') over abusing women in treatment. J Subst Abuse Treat the past four decades. After outlining components of 2004; 27(3):215-22. reading ability, we discuss manifest causes of reading Abstract: The purpose of this study was to assess difficulties, in terms of deficiencies in component parenting knowledge and beliefs among drug abusing reading skills that might lead to such difficulties. The pregnant and recently postpartum women engaged in a evidence suggests that inadequate facility in word comprehensive substance abuse treatment program. identification due, in most cases, to more basic deficits The effects of a parenting skills training program for in alphabetic coding is the basic cause of difficulties in this population were evaluated. A Parenting Skills learning to read. We next discuss hypothesized Questionnaire was developed and administered to a deficiencies in reading-related cognitive abilities as sample of 73 pregnant and drug-dependent women underlying causes of deficiencies in component reading during their first week of substance abuse treatment skills. The evidence in these areas suggests that, in and again approximately 7 weeks later, following most cases, phonological skills deficiencies associated parenting skills training. The questionnaire was with phonological coding deficits are the probable designed to assess whether group and individual causes of the disorder rather than visual, semantic, or parenting sessions changed the subjects' knowledge syntactic deficits, although reading difficulties in some and beliefs in four parenting domains: newborn care, children may be associated with general language feeding practices, child development and drug abuse deficits. Hypothesized deficits in general learning during pregnancy. Pre-intervention scores for all abilities (e.g., attention, association learning, cross- parenting domains were low. Post- vs. pre-intervention modal transfer etc.) and low-level sensory deficits have comparisons showed significant increases in all domain weak validity as causal factors in specific reading scores after individual and group parenting skills disability. These inferences are, by and large, training. Preliminary results obtained from this clinic- supported by research evaluating the biological based sample suggest that these substance abusing foundations of dyslexia. Finally, evidence is presented mothers lacked important parenting knowledge and in support of the idea that many poor readers are that this knowledge improved after comprehensive impaired because of inadequate instruction or other substance abuse treatment that included parenting experiential factors. This does not mean that biological training. factors are not relevant, because the brain and environment interact to produce the neural networks Velleman R, Templeton L. Alcohol, drugs and the family: that support reading acquisition. We conclude with a results from a long-running research programme within discussion of the clinical implications of the research the UK. Eur Addict Res 2003; 9(3):103-12. findings, focusing on the need for enhanced instruction. Notes: CORPORATE NAME: UK Alcohol, Drugs and the Family Research Group Vemulapalli C, Grady K, Kemp JS. Use of safe cribs and Abstract: This article will outline the main strands of bedroom size among African American infants with a the UK-based Alcohol, Drugs and the Family (ADF) high rate of bed sharing. Arch Pediatr Adolesc Med research programme. This programme has examined 2004; 158(3):286-9. the impact of substance misuse problems on children, Abstract: BACKGROUND: Impoverishment and spouses, and families, both in the UK and elsewhere, crowding are associated with an increased risk of especially in urban Mexico City and in Australia sudden unexpected death among infants. Bed sharing amongst both urban and rural Aborigine populations. likely increases this risk, particularly among African This article will outline the main theoretical American infants. OBJECTIVES: To compare the perspective that we have developed from this work (the sleep environment of African American infants who bed share with that of infants who do not share sleep 921
- 930. surfaces and tocompare access to a safe crib, and the expression of FasL in Hodgkin lymphoma (HL) on space available for it, in the sleeping rooms of both protein and RNA level, while considering the Epstein- groups of infants. METHODS: Home visits were made Barr virus status of the Hodgkin and Reed-Sternberg at approximately age 2 weeks to the homes of serially (HRS) cells. Tumor tissue from 47 patients with classic enrolled African American infants born between July HL (32 nodular sclerosis [NS], 11 mixed cellularity 15, 2001, and November 1, 2001. Questionnaires were [MC], and 4 lymphocyte-rich [LR]) was analyzed by used to survey sleep practices, especially sleep surface immunohistochemistry for FasL, Fas, CD21, and CD23 used. The area of the floor space of rooms used for and by Western blotting for FasL. FasL mRNA was sleeping was calculated. A portable crib was provided detected by an exon 4-specific oligonucleotide and for infants lacking access to safe sleep surfaces. Epstein-Barr virus infection by in situ hybridization for RESULTS: Of these infants, 42 (41%) usually bed Epstein-Barr virus early RNAs (EBER). Western shared and 60 (59%) slept alone. The areas of the floor blotting showed soluble and membrane-bound forms of spaces were similar (mean +/- SD, 13.8 +/- 3.3 m(2) for FasL. Immunohistochemistry showed FasL expression bed sharers vs 12.7 +/- 3.7 m(2) for those who slept in virtually all HRS of 94% of NS cases and 82% of alone; 95% CI for difference, -0.34 to 2.51 m(2)). MC cases. FasL expression did not correlate with the Infants sleeping alone were much more likely to have Epstein-Barr virus status of the HRS. Low FasL protein access to a safe crib (51 of 60 vs 13 of 42; P<.001), and expression was found in some HRS of LR cases. FasL 53 cribs were provided. Follow-up telephone calls mRNA was detected in 39% of NS, 46% of MC, and made at approximately age 7 months to 43.4% of 33% of LR cases. Seventy percent to 90% of the HRS recipients suggested that the cribs were used on most cells expressed Fas. CD21 immunohistochemistry nights, were durable, and were enthusiastically showed disrupted FDC networks in the tumor tissue received. CONCLUSIONS: Crowding is not a strong with reduced and virtually absent expression of CD23 explanation for bed sharing among impoverished and FasL. These observations suggest that FasL African American infants in St Louis, Mo, who often expression in HRS cells and the absence of FasL in the bed share because there is not a safe crib available. FDC cluster represent a disturbed microenvironment Providing safe cribs may reduce the prevalence of bed that may be involved in the pathogenesis of HL. sharing. Verburg G, Borthwick B, Bennett B, Rumney P. Online Ventura DE, Herbella FA, Schettini ST, Delmonte C. support to facilitate the reintegration of students with Rapunzel syndrome with a fatal outcome in a neglected brain injury: trials and errors. NeuroRehabilitation child. J Pediatr Surg 2005; 40(10):1665-7. 2003; 18(2):113-23. Abstract: The "Rapunzel" syndrome (a trichobezoar Abstract: The reintegration of students after with a long tail extending from the stomach to the acquired/traumatic brain injury (ABI/TBI) continues to small bowel) is an uncommon disease. It is related to be fraught with difficulties. Presented are (1) case severe complications but rarely associates to a fatal studies exploring the potential of online support for outcome. We report a case of a 5-year-old girl admitted teachers of students with ABI after returning from a at the emergency department in cardiorespiratory arrest paediatric rehabilitation centre; (2) results of Internet- whose autopsy disclosed an ileal perforation that is based courses about reintegrating students with ABI; caused by a long bezoar extending from the stomach to (3) outcomes of videoconferencing-based and Internet the small bowel. The authors discuss a possible link email-based support; (4) development of an online between Rapunzel syndrome and child neglect. support process that uses Questions and Answers as a quick and immediate resource for teachers. The authors Ventura-Junca P. A commentary on the Consensus recommend that a collaborative process be instituted, Statement of the Working Group on Roman Catholic in order to generate a relatively small number of high Approaches to Determining Appropriate Critical Care. quality online resources about re-integrating students Christ Bioeth 2001; 7(2):271-89. into their school and community. A second Notes: GENERAL NOTE: KIE: Ventura-Junca, recommendation focuses on the development of online Patricio support network which may be text or email based or GENERAL NOTE: KIE: 28 refs. which may use videoconferencing over the Internet. GENERAL NOTE: KIE: KIE Bib: patient care; Such networks allow students with ABI to maintain resource allocation/biomedical technologies contact with their family and friends in the home community and facilitate their reintegration. An Verbeke CS, Wenthe U, Grobholz R, Zentgraf H. Fas ligand Internet-based support structure also allows expression in Hodgkin lymphoma. Am J Surg Pathol professionals to provide consultation, collaboration and 2001; 25(3):388-94. continuing input. Abstract: Because previous investigations suggested involvement of the Fas ligand (FasL) in the selection Vereecken CA, Keukelier E, Maes L. Influence of mother's process in the follicular dendritic cell (FDC)-associated educational level on food parenting practices and food cell cluster of the germinal center, we investigated the habits of young children. Appetite 2004; 43(1):93-103. Abstract: The main purpose of the present study is to 922
- 931. examine whether differencesin mothers' food the characteristics of recently discovered number- parenting practices by educational level could explain selective neurons. In a second study, we simulate differences in food consumption in Flemish preschool symbol learning by presenting symbolic and children. Three hundred and sixteen mothers of nonsymbolic input simultaneously. The same number- children aged 2.5-7 years, completed a self- selective neurons learn to represent the numerical administered questionnaire. Differences by educational meaning of symbols. In doing so, they show properties level were found in children's and mothers' reminiscent of the originally available number- consumption frequencies of fruit, vegetables and soft selective neurons, but at the same time, the drinks, and in the use of restrictions, verbal praise, representational efficiency of the neurons is increased negotiation, discouragement of sweets and restraining when presented with symbolic input. This finding from negative modelling behaviour. Multiple logistic presents a concrete proposal on the linkage between regression analyses revealed that mothers' consumption higher order numerical cognition and more primitive was an independent predictor for all four outcome numerical abilities and generates specific predictions variables; verbal praise was a significant predictor for on the neural substrate of number processing. children's vegetable consumption, permissiveness for regular consumption of soft drinks and sweets, and, Verhoek-Oftedahl W, Devine A. The gray zone between using food as a reward for regular sweet consumption. children witnessing domestic violence and child Differences in children's food consumption by mothers' maltreatment: a call to establish a threshold for educational level were completely explained by intervention. Med Health R I 2003; 86(12):379-82. mother's consumption and other food parenting practices for fruit and vegetables but not for soft Verma SK, Srivastava DK. A study on mass hysteria drinks. (monkey men?) victims in East Delhi. Indian J Med Sci 2003; 57(8):355-60. Vereecken CA, Van Damme W, Maes L. Measuring Abstract: During the summer month of May 2001 East attitudes, self-efficacy, and social and environmental Delhi came in grip of an outbreak of mass hysteria. influences on fruit and vegetable consumption of 11- Initial reports alleged that some monkey like creature and 12-year-old children: reliability and validity. J Am attacked and caused injuries among number of persons. Diet Assoc 2005; 105(2):257-61. A medical board was set up to examine and find out the Abstract: This article examines the reliability and cause of injuries in the victims of the outbreak as a part construct validity of questions assessing mediating exercise to apprehend the culprit. The study describes factors of fruit and vegetable consumption among 11- the sociodemographic pattern and injuries observed in and 12-year-old children (N=207). Internal these cases. Majority of victims were adult males, consistencies were good for most scales, ranging from belonging to low socioeconomic strata and having low 0.56 to 0.94. Intraclass correlation coefficients between educational level. The incidents occurred mainly test and retest were acceptable, ranging from 0.39 to during night at the time of power failure. The type, 0.90. Concerning predictive validity, preferences and distribution and characteristic of the injuries suggested perceived parental and peer behavior were significantly of their accidental nature. The paper also discusses the associated with fruit and vegetable consumption. Self- role of forensic experts and press in such outbreak. efficacy in difficult situations and a variety of available fruit were significantly correlated with fruit Verona E, Hicks BM, Patrick CJ. Psychopathy and consumption, while permissive eating practices and suicidality in female offenders: mediating influences of obligation rules were significantly correlated with personality and abuse. J Consult Clin Psychol 2005; vegetable consumption. General attitudes, outcome 73(6):1065-73. expectations, selection efficacy, and encouraging Abstract: The influence of personality and childhood practices were not associated with fruit or vegetable abuse on suicidal behaviors and psychopathy was consumption. examined among female prisoners. Scores on the affective/interpersonal component (Factor 1; F1) and Verguts T, Fias W. Representation of number in animals and the antisocial deviance (Factor 2; F2) component of humans: a neural model. J Cogn Neurosci 2004; psychopathy were obtained from the Psychopathy 16(9):1493-504. Checklist--Revised (R. D. Hare, 1991). Suicide attempt Abstract: This article addresses the representation of and childhood physical and sexual abuse history were numerical information conveyed by nonsymbolic and coded from interviews and prison files, and personality symbolic stimuli. In a first simulation study, we show was assessed using the Multidimensional Personality how number-selective neurons develop when an Questionnaire (A. Tellegen, in press). Suicide attempts initially uncommitted neural network is given were positively associated with F2 and negatively nonsymbolic stimuli as input (e.g., collections of dots) associated with F1, and each factor accounted for under unsupervised learning. The resultant network is unique variance in suicidality. Path analyses able to account for the distance and size effects, two demonstrated that personality mediated the effects of ubiquitous effects in numerical cognition. Furthermore, physical abuse on F2, but sexual abuse accounted for the properties of the network units conform in detail to 923
- 932. unique variance inboth suicide attempts and F2. Abuse Neonatal Survival Series (2005). Both series drew and personality accounted for minimal variance in F1. attention to the nearly 11 million annual deaths of These results are discussed in relation to the children under the age of five years, and to the fact that identification of individuals at risk for both self- and almost 4 million of these deaths occur in the first other-harm behaviors. month of life. We show that two thirds of these deaths could be prevented through universal coverage with Verona E, Sachs-Ericsson N. The intergenerational existing, low-cost interventions that are failing to reach transmission of externalizing behaviors in adult most children in the world. The series also highlighted participants: the mediating role of childhood abuse. J the importance of reducing inequities both between and Consult Clin Psychol 2005; 73(6):1135-45. within countries. The relevance of these series to Latin Abstract: Childhood abuse was investigated as a America and the Caribbean is examined. Although potential mediator of the intergenerational transmission substantial progress has been made in reducing of externalizing behaviors (EXT) in adulthood among a mortality and improving coverage, two major large general population sample drawn from the challenges remain: how to improve the quality of National Comorbidity Survey. Community participants health interventions, and how to reach the most (N = 5,424) underwent diagnostic and psychosocial disadvantaged children in the Latin American and interviews and reported on their own adult symptoms Caribbean Region. of antisocial behavior and substance dependence, parental symptoms, and childhood abuse history. Viens AM. Value judgment, harm, and religious liberty. J Multiple group structural equation modeling revealed Med Ethics 2004; 30(3):241-7. that (a) EXT in parents was associated with childhood Notes: GENERAL NOTE: KIE: 35 refs. abuse in offspring, particularly among mother- GENERAL NOTE: KIE: KIE Bib: patient care/minors daughter dyads, (b) abuse had a unique influence on adult EXT in offspring above parental EXT, and (c) Vigliani M. Caring for survivors of childhood sexual abuse abuse accounted for the relationship between parental in medical practice. Med Health R I 2004; 87(6):191-2. EXT and offspring EXT in female but not male participants. This article emphasizes the importance of Viljoen DL, Gossage JP, Brooke L et al. Fetal alcohol examining different environmental processes which syndrome epidemiology in a South African may explain familial transmission of destructive community: a second study of a very high prevalence behaviors in men and women and highlights the area. J Stud Alcohol 2005; 66(5):593-604. importance of family interventions that target parental Abstract: OBJECTIVE: The aim of the study was to symptoms to ameliorate risk to offspring. determine the prevalence and characteristics of fetal alcohol syndrome (FAS) in a second primary school Vessey JA, Ben-Or K, Mebane DJ et al. Evaluating the cohort in a community in South Africa. METHOD: value of screening for hypertension: an evidence-based Active case ascertainment, two-tier screening, and approach. J Sch Nurs 2001; 17(1):44-9. Institute of Medicine assessment methodology were Abstract: No recommendations regarding in-school employed among 857 first grade pupils, most born in blood pressure (BP) screening currently exist. The 1993. Characteristics of children with FAS were purpose of this project was to use an evidence-based contrasted with characteristics of a randomly selected approach to determine whether BP screening should be control group from the same classrooms. Physical initiated as part of one school district's standard growth and development, dysmorphology and screening protocols. Pediatric BP measurement, risk psychological characteristics of the children and factors for hypertension, issues for determining youth measures of maternal alcohol use and smoking were at risk for hypertension, and eligibility criteria for analyzed. RESULTS: The rate of FAS found in this determining conditions appropriate for screening are study is the highest yet reported in any overall discussed. BPs of 1st, 6th, and 11th graders were community in the world, 65.2-74.2 per 1,000 children evaluated according to standardized criteria. The in the first grade population. These rates are 33-148 evidence indicated that BP screening in school appears times greater than U.S. estimates and higher than in a warranted, although a formalized study is needed previous cohort study in this same community (40.5- before a definitive decision can be made regarding the 46.4 per 1,000). Detailed documentation of physical incorporation of BP screening into school health features indicates that FAS children in South Africa services. have characteristics similar to those elsewhere: poor growth and development, facial and limb Victora CG, Barros FC. Global child survival initiatives and dysmorphology, and lower intellectual functioning. their relevance to the Latin American and Caribbean Frequent, severe episodic drinking of beer and wine is Region. Rev Panam Salud Publica 2005; 18(3):197- common among mothers and fathers of FAS children. 205. Their lives are characterized by serious familial, social Abstract: We review two series of papers published by and economic challenges, compared with controls. The Lancet: the Child Survival Series (2003) and the Heavy episodic maternal drinking is significantly 924
- 933. associated with negativeoutcomes of children in the adolescence and young adult life, that have been shown area of nonverbal intelligence but even more so in to be effective in improving many outcomes in verbal intelligence, behavior and overall development, health and well-being. Much remains to dysmorphology (physical anomalies). Significantly be done to enable the promise of effective universal more FAS exists among children of women who were and targeted early intervention to be translated into rural residents (odds ratio: 7.36, 95% confidence policies, programs and practices that could be life- interval: 3.31-16.52), usually among workers on local changing for citizens bogged in the mire of substance farms. CONCLUSION: A high rate of FAS was misuse and their children. Realistic, timely investment, documented in this community. Given social and influenced by the best scientific evidence indicating economic similarities and racial admixture, we suspect what works, for whom, under what circumstances, an that other communities in the Western Cape have rates increased degree of collaboration within and between that also are quite high. governments and their agencies to enable "whole of government" responses in partnership with community- Villarreal LR. California's Healthy Start: A solid platform based initiatives are essential along with investments in for promoting youth development. New Dir Youth Dev multidisciplinary program evaluation research that will 2005; (107):89-97, table of contents. enable evidence-informed policy decisions to be Abstract: A school in Los Angeles County reports tailored to the needs of individual countries. absences down by 30 percent and disciplinary actions down by 10 percent. A town near Fresno reports Vinchon M, Defoort-Dhellemmes S, Noule N, Duhem R, having 99 percent of their new kindergartners ready to Dhellemmes P. [Accidental or non-accidental brain start school on the first day of class because their injury in infants. Prospective study of 88 cases]. Presse immunization and school readiness outreach was so Med 2004; 33(17):1174-9. thorough. A school in San Diego reports youth tobacco Abstract: OBJECTIVE: To study the epidemiology of use down from 15 percent to 3 percent, absences down head injury (HI) in infants, the factors favouring the by 10 percent, and detentions down by over 50 percent. occurrence of a subdural haematoma (SDH), the Schools in Humboldt report a 30 percent improvement prevalence of retinal haemorrhages (RH) and the in math scores and a 40 percent improvement in prognostic factors, by comparing the non-accidental reading scores. Young adults report that the assistance (NAHI) and accidental (AHI) head injuries. RH, in they received as teens through their school's Healthy particular, are of fundamental value in the diagnosis of Start program saved their lives and enabled them to be NAHI but, in the absence of systematic studies, their successful parents today. These are results from one of sensitivity and specificity for the diagnosis of the California's most successful education mandates- NAHI have rarely been assessed. METHOD: We SB620 1991-California's Healthy Start. prospectively collected the clinical, ophthalmologic and radiological data of HI occurring in children under Vimpani G. Getting the mix right: family, community and 24 months old, notably by distinguishing essential social policy interventions to improve outcomes for macrocrania and symptomatic macrocrania of an SDH, young people at risk of substance misuse. Drug by classifying the HI according to its severity. Alcohol Rev 2005; 24(2):111-25. RESULTS: We observed 88 cases over a period of 22 Abstract: Societal responses to the existence of months. It 28 cases it was NAHI and in the 60 others, substance misuse fluctuate between harm minimisation AHI. The SDH was often correlated with the presence and prohibition. Both approaches are predominantly of retinal haemorrhages and the absence of signs of downstream reactions to substance misuse that focus cranial impact, but not with child abuse or with on the supply of harmful substances and the essential macrocrania. The RH were of great containment of misuse through treatment, rehabilitation importance in the diagnosis of NAHI; however, non- or punishment. Until recently, little attention has been severe RH was noted in 4 cases of AHI. The paid to the upstream individual, family, relationship, neurological prognosis was essentially correlated with community or societal antecedents of substance misuse the initial clinical severity. CONCLUSION: Although (which often overlap with those for other adverse life only representing 33% of cases, child abuse was outcomes, such as unemployment, antisocial responsible for 2/3 of the deaths and for the totality of personality disorder and mental health problems) that the severe morbidity in our series. The infants have operated during earlier life. A growing body of exhibiting perinatal problems represented an important evidence highlights the overlapping biological and group at risk of abuse, which justified their regular experiential antecedents for substance abuse and other medical-social follow-up. poor outcomes as well as the trajectory-changing protective factors that can prevent risks being Vinter A, Perruchet P. Implicit motor learning through translated into destiny. Risk minimisation and observational training in adults and children. Mem protection enhancement embedded in family and social Cognit 2002; 30(2):256-61. systems are the essential building blocks of a set of Abstract: Although evidence of implicit motor learning early intervention strategies that begin antenatally and on the basis of observation alone has been reported, continue through the developing years of childhood, there is some data to suggest that the phenomenon 925
- 934. could be contaminatedby the intentional exploitation Vizard E, French L, Hickey N, Bladon E. Severe personality of explicit knowledge. In the present experiment, a disorder emerging in childhood: a proposal for a new special procedure was adapted to study observational developmental disorder. Crim Behav Ment Health learning in a situation involving the acquisition of a 2004; 14(1):17-28. new drawing behavior. The participants consisted of Abstract: BACKGROUND: The concept of 'severe adults and children 6-10 years of age. The results personality disorder' is currently applied to adults with provide support for the view that overt motor practice a history of serious antisocial and offending behaviour. is not strictly necessary for implicit motor learning. There is, however, no similar classification that can be They demonstrate that children display capacities applied to the sub-group of children and adolescents similar to those of adults in this form of learning. Some who display persistent and serious offending from an suggestions are made to account for the contradictory early age. This omission from diagnostic nomenclature results present in this area of research. prevents the appropriate early identification, assessment and management of these young people. Visitsunthorn N, Durongpisitkul W, Uoonpan S, METHOD: This paper therefore proposes a new Jirapongsananuruk O, Vichyanond P. Medical charge developmental disorder: 'severe personality disorder of asthma care in admitted Thai children. J Med Assoc emerging in childhood'. The existing evidence base Thai 2005; 88 Suppl 8:S16-20. strongly supports the presence of a developmental Abstract: BACKGROUND: Asthma is one of the most trajectory from childhood to adult life for the small common chronic diseases in children. Due to high number of children who show early signs of severe admission rate for acute asthmatic attack, children personality disorder (SPD). Based on a review of the often miss their schools and parents have to stop literature and the experience of working in a specialist, working to take care of them. These affect both mental forensic Child and Adolescent Mental Health Service and physical health as well as socioeconomic status of (CAMHS), a multi-factorial model is proposed that the family and the country. OBJECTIVES: To evaluate outlines the developmental trajectory of SPD. This medical charge of asthma care in children admitted to model includes neurobiological, psychosocial, the Department of Pediatrics, Faculty of Medicine environmental and systemic factors, within a Siriraj Hospital, Mahidol University. MATERIAL developmental framework, and contributes to a more AND METHOD: The study was a retrospective and developmentally appropriate understanding of the descriptive study. Data were collected from children genesis of severe personality disorder. with asthmatic attack admitted to the Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Voges MA, Romney DM. Risk and resiliency factors in Mahidol University, Bangkok, Thailand from January posttraumatic stress disorder. Ann Gen Hosp 1st, 2000 to June 30th, 2003. Cost of room, food, Psychiatry 2003; 2(1):4. drugs, devices, laboratory study and service charge Abstract: BACKGROUND: Not everyone who were recorded. Total medical charges per year, per experiences a trauma develops posttraumatic stress patient per admission and per patient per day were disorder (PTSD). The aim of this study was to calculated. Data were analyzed with Chi square test, determine the risk and resiliency factors for this ANOVA and Post Hoc test. A p value of < 0.05 was disorder in a sample of people exposed to trauma. considered statistical significant. RESULTS: Numbers METHOD: Twenty-five people who had developed of children with asthmatic attack admitted to the PTSD following a trauma and 27 people who had not Department of Pediatrics, Siriraj Hospital increased were asked to complete the Posttraumatic Stress between 2000-2002 (113,147 and 176 in 2000, 2001, Diagnostic Scale, the Coping Inventory for Stressful and 2002). Seventy two percent of the patients were < Situations, and the State-Trait Anxiety Inventory. In or = 5 years of age. Most were mild intermittent addition, they completed a questionnaire to provide asthma. The average duration of hospitalization was 4 information autobiographic and other information. days (95% CI, 3.6-4.3). Average medical charge per ANALYSIS: Five variables that discriminated patient per admission and per day was 3236.20 and significantly between the two groups using chi-square 998.60 Bahts respectively. There was no significant analysis or t-tests were entered into a logistic difference in the medical charge per patient among the regression equation as predictors, namely, being admitted years. Medical charge of admission was female, perceiving a threat to one's life, having a significantly associated with the asthma severity. (p < history of sexual abuse, talking to someone about the or = 0.05) CONCLUSION: The rate of admission from event, and the "intentionality" of the trauma. asthmatic attack in children at Siriraj Hospital and the RESULTS: Only being female and perceiving a threat total medical charge per year increased between 2000- to one's life were significant predictors of PTSD. 2002. Nevertheless, medical charge of asthma Taking base rates into account, 96.0% of participants admission per person was unchanged. Main expense in with PTSD were correctly classified as having the medical charge of asthma admission was the cost of disorder and 37.0% of participants without PTSD were medication and room. Severity of asthma was related correctly classified as not having the disorder, for an directly to medical charge. overall success rate of 65.4% CONCLUSIONS: Because women are more likely than men to develop 926
- 935. PTSD, more preventivemeasures should be directed smaller sample size, user-friendliness, robustness, and towards them. The same is true for trauma victims (of speed. Expert knowledge for spectral interpretation is both sexes) who feel that their life was in danger minimized by the combination of a library search and ANN prediction, but visual inspection remains Vogler SD, Davidson AJ, Crane LA, Steiner JF, Brown JM. necessary. Can paraprofessional home visitation enhance early intervention service delivery? J Dev Behav Pediatr von Salis T. ["Violence and psychotherapy": what transfers? 2002; 23(4):208-16. Some experiences in private practice]. Rev Med Suisse Abstract: A 1-year randomized trial compared Romande 2001; 121(7):517-20. intensive case management (ICM) versus basic case management (BCM) in facilitating early intervention Vora A, Makris M. Personal practice: An approach to (EI) service use among children in an urban health investigation of easy bruising. Arch Dis Child 2001; system. Of 159 participating families with delayed or 84(6):488-91. at-risk preschool-aged children, 88 received ICM from paraprofessionals versus 71 families who received less Vostanis P. Patients as parents and young people comprehensive BCM from a nurse. In the ICM versus approaching adulthood: how should we manage the BCM group, a shorter interval to assessment (98 vs 140 interface between mental health services for young d, p =.05) but similar assessment rate (86% vs 80%, p people and adults? Curr Opin Psychiatry 2005; =.29) was observed. The ICM group had more services 18(4):449-54. recommended per child (1.64 vs 1.16, p < .004) and Abstract: PURPOSE OF REVIEW: The present review initiated (1.20 vs 0.85, p < .04). There was no discusses critically recent research findings (published difference in median time to EI program initiation for during the period 2003-2004) on the mental health ICM versus BCM (228 vs 200 d, p = .88) or initiation needs of young people in transition (old adolescents and visit compliance rate for EI services. Specific and young adults), including those of young parents. efforts to improve outcomes (e.g., decrease initiation Also, the evidence on effective interventions and time and increase use of EI services) are still needed. service models is considered. RECENT FINDINGS: Emerging evidence indicates that young people have Volmer M, de Vries JC, Goldschmidt HM. Infrared analysis high rates of mental health needs (in addition to high of urinary calculi by a single reflection accessory and a prevalence of psychiatric disorders) that may be related neural network interpretation algorithm. Clin Chem to life transitions. These needs often fall between the 2001; 47(7):1287-96. remit of adolescent/adult and mental health/social care Abstract: BACKGROUND: Preparation of KBr tablets, services, and therefore are not adequately met. With used for Fourier transform infrared (FT-IR) analysis of the exception of mental health interventions for early urinary calculus composition, is time-consuming and psychosis and psychosocial programmes for teenage often hampered by pellet breakage. We developed a parents, there is very limited knowledge on how best to new FT-IR method for urinary calculus analysis. This meet the mental health needs of young people in method makes use of a Golden Gate Single Reflection transition. SUMMARY: It is widely recognized that Diamond Attenuated Total Reflection sample holder, a young people in transition require services and computer library, and an artificial neural network interventions tailored to their characteristics, rather (ANN) for spectral interpretation. METHODS: The than a mere extension to either child/adolescent or library was prepared from 25 pure components and 236 adult services. Recent policies and research findings binary and ternary mixtures of the 8 most commonly have led to the development of early psychosis occurring components. The ANN was trained and interventions, with initial encouraging messages. validated with 248 similar mixtures and tested with 92 Similar initiatives are required for young people with patient samples, respectively. RESULTS: The optimum nonpsychotic disorders. ANN model yielded root mean square errors of 1.5% and 2.3% for the training and validation sets, Votruba-Drzal E, Coley RL, Chase-Lansdale PL. Child care respectively. Fourteen simple expert rules were added and low-income children's development: direct and to correct systematic network inaccuracies. Results of moderated effects. Child Dev 2004; 75(1):296-312. 92 consecutive patient samples were compared with Abstract: A large literature has documented the those of a FT-IR method with KBr tablets, based on an influence of child care on young children's initial computerized library search followed by visual development, but few studies have examined low- inspection. The bias was significantly different from income children in community care arrangements. zero for brushite (-0.8%) and the concomitantly Using data from Welfare, Children, and Families: A occurring whewellite (-2.8%) and weddellite (3.8%), Three-City Study (N = 204), this study examined the but not for ammonium hydrogen urate (-0.1%), influence of child care quality and the extent of care on carbonate apatite (0.5%), cystine (0.0%), struvite low-income children's (ages 2-4 years) cognitive and (0.4%), and uric acid (-0.1%). The 95% level of socioemotional development over time. Higher levels agreement of all results was 9%. CONCLUSIONS: of child care quality were modestly associated with The new Golden Gate method is superior because of its 927
- 936. improvements in children's socioemotional data from 2003 female twins from a population-based development, and extensive hours in child care were twin registry and 1472 of their parents, we examined linked to increases in children's quantitative skills and retrospective reports of parental discipline from three decreases in behavior problems. Analyses suggest that perspectives. First, father and mother reporting child care quality may be particularly salient for separately on the type of discipline they provided for subgroups of children from low-income families. their offspring; second, each twin reporting on the type of discipline they received from their parents; and Vythilingam M, Heim C, Newport J et al. Childhood trauma third, each parent reporting on the discipline provided associated with smaller hippocampal volume in women by their spouse. Using a mixed model regression, we with major depression. Am J Psychiatry 2002; examined the impact on parental discipline of 25 159(12):2072-80. potential predictor variables, as reported by parents, Abstract: OBJECTIVE: Smaller hippocampal volume from three domains: social context, parental factors, has been reported only in some but not all studies of and childhood vulnerability factors. RESULTS: There unipolar major depressive disorder. Severe stress early was a great deal of overlap between the independent in life has also been associated with smaller variables for the two types of discipline in the areas of hippocampal volume and with persistent changes in the child vulnerability factors and family relationships, hypothalamic-pituitary-adrenal axis. However, prior with similar effect sizes for child disobedience, teenage hippocampal morphometric studies in depressed rebelliousness, and family discord. However, the patients have neither reported nor controlled for a profiles of parental characteristics associated with each history of early childhood trauma. In this study, the type of discipline were quite different. Greater use of volumes of the hippocampus and of control brain physical discipline was associated with less parental regions were measured in depressed women with and warmth, a higher incidence of parental lifetime without childhood abuse and in healthy nonabused generalised anxiety disorder, and more frequent comparison subjects. METHOD: Study participants religious attendance. Greater use of limit setting was were 32 women with current unipolar major depressive associated with more years of parental education, disorder-21 with a history of prepubertal physical younger age, and greater parental extroversion and and/or sexual abuse and 11 without a history of authoritarianism. CONCLUSIONS: Parental prepubertal abuse-and 14 healthy nonabused female characteristics, child temperament, and social context volunteers. The volumes of the whole hippocampus, may all contribute to the frequency of discipline used temporal lobe, and whole brain were measured on in families, but parental characteristics may be most coronal MRI scans by a single rater who was blind to influential in determining the type of discipline used. the subjects' diagnoses. RESULTS: The depressed subjects with childhood abuse had an 18% smaller Wadonda-Kabondo N, Sterne JA, Golding J, Kennedy CT, mean left hippocampal volume than the nonabused Archer CB, Dunnill MG. A prospective study of the depressed subjects and a 15% smaller mean left prevalence and incidence of atopic dermatitis in hippocampal volume than the healthy subjects. Right children aged 0-42 months. Br J Dermatol 2003; hippocampal volume was similar across the three 149(5):1023-8. groups. The right and left hippocampal volumes in the Notes: CORPORATE NAME: ALSPAC Study Team depressed women without abuse were similar to those Abstract: BACKGROUND: There is strong evidence in the healthy subjects. CONCLUSIONS: A smaller that the incidence and prevalence of atopic diseases is hippocampal volume in adult women with major increasing. However, estimates of the prevalence of depressive disorder was observed exclusively in those atopic dermatitis (AD) have varied greatly in the U.K. who had a history of severe and prolonged physical and most parts of the developed world. OBJECTIVES: and/or sexual abuse in childhood. An unreported The aim of the study was to estimate the prevalence history of childhood abuse in depressed subjects could and incidence of AD between the ages of 0 and 42 in part explain the inconsistencies in hippocampal months in children born in the 1990s in a defined volume findings in prior studies in major depressive population in the U.K. DESIGN: We used data from disorder. the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC), a large population-based study Wade TD, Kendler KS. Parent, child, and social correlates of in the U.K. that enrolled all pregnant mothers who parental discipline style: a retrospective, multi- were resident in Avon and had their delivery date informant investigation with female twins. Soc falling between 1 April 1991 and 31 December 1992. Psychiatry Psychiatr Epidemiol 2001; 36(4):177-85. Since then ALSPAC has collected a wide range of data Abstract: BACKGROUND: The type of parental from the newborns and their parents. Data reported discipline used in families appears to be related to here were collected at 6, 18, 30 and 42 months using parental characteristics, child temperament, and aspects parental reports in a postal questionnaire. Of the 14 009 of the social context. Within these three areas, we children originally enrolled 8530 provided information examine specific correlates of parental discipline on AD in each of the four follow-up questionnaires. (namely, limit setting and physical discipline) using a We defined AD as a report of rash in at least two of the multiple informant model. METHOD: Using interview four questionnaires. Incidence risk was defined as the 928
- 937. percentage of newcases of AD between follow-up 21.76)) vaccination. Furthermore, each 1-year increase questionnaires, out of the total number of children in age increased the chance of receiving influenza or whose parents had not reported that they had AD by pneumococcal vaccination by 22% (OR = 1.22 (1.09- the time of the previous follow-up. RESULTS: Period 1.67) and 29% (OR = 1.29 (1.07-1.72)), respectively. prevalence of 21.0%, 25.6%, 23.2% and 19.9% were CONCLUSIONS: Vaccination rates in these diabetic observed at ages 0-6, 6-18, 18-30 and 30-42 months, patients are unsatisfactory. Secondary care health respectively. The corresponding incidence risks were professionals might increase rates by raising the topic 21.0%, 11.2% and 3.8%, at 0-6, 6-18 and 18-30 in consultations. Diabet. Med. 18, 599-603 (2001) months, respectively. There were no gender differences in either the incidence or prevalence of the disease. Wainryb C, Brehl BA, Matwin S. Being hurt and hurting CONCLUSIONS: Results from this large, prospective others: children's narrative accounts and moral study are consistent with recent reports of increased judgments of their own interpersonal conflicts. Monogr incidence and prevalence of AD. Health planners can Soc Res Child Dev 2005; 70(3):1-114. use our estimates of incidence and prevalence to Abstract: Children's narrative accounts and moral project the number of children likely to suffer from AD evaluations of their own interpersonal conflicts with during infancy and early childhood, and thus to peers were examined. Girls and boys (N = 112) in determine the human and financial resources required. preschool (M= 4.8 years), first grade (M = 6.9 years), fifth grade (M = 10.9 years), and tenth grade (M = 16.2 Wagner M. Midwifery and international maternity care. years) provided one narrative of a time when they had Midwifery Today Int Midwife 2005; (75):12-3. been hurt by a peer ("victim"), and one of a time when they had hurt a peer ("perpetrator"). Victim and Wagner RS. Inflicted childhood neurotrauma: new name and perpetrator narratives were equally long and detailed new information. J Pediatr Ophthalmol Strabismus and depicted similar types of harmful behaviors, but 2004; 41(2):79. differed significantly in terms of various measures of content and coherence. Narratives given from the Wahid ST, Nag S, Bilous RW, Marshall SM, Robinson AC. victim's perspective featured a self-referential focus Audit of influenza and pneumococcal vaccination and a fairly coherent structure. When the same children uptake in diabetic patients attending secondary care in gave accounts of situations in which they had been the the Northern Region. Diabet Med 2001; 18(7):599-603. perpetrators, their construals were less coherent and Abstract: AIMS: To document uptake of influenza and included multiple shifts between references to their pneumococcal vaccination in diabetic patients own experience and the experience of the other. attending secondary care in the Northern Region, and Children's moral judgments also varied by perspective, to explore influencing factors. METHODS: Diabetic with the majority of victims making negative patients attending out-patients in Middlesbrough, judgments and nearly half the perpetrators making Gateshead and Newcastle were questioned from positive or mixed judgments. These differences in October 1999 to March 2000. Physicians inquired moral judgments were related to the distinct ways in about influenza and pneumococcal vaccination status which victims and perpetrators construed conflict using a standardized questionnaire. Data collected situations. Age differences were also found in both included age, year of diagnosis, duration of diabetes, narrative construals and moral evaluations, but type of diabetes, and the presence of other recognized regardless of their age children construed conflict indications for vaccination. RESULTS: Two hundred situations differently from the victim's and the and sixty-eight diabetic patients, 42% (113/268) with perpetrator's perspectives. By integrating, within the Type 1 diabetes, 34% (91/268) with ischaemic heart study of moral development, children's interpretations disease, 10% (26/268) with chronic pulmonary disease of the social interactions that are at the basis of moral (CPD) and 10% (27/268) with chronic renal disease, thinking, this approach brings us a step closer to were questioned. Thirty-five percent (93/268) of conceptualizing the study of children's moral behavior. patients received both influenza and pneumococcal vaccines, 24% (64/268) received only influenza Waisman Y, Aharonson-Daniel L, Mor M, Amir L, Peleg K. vaccine, and none received pneumococcus vaccine The impact of terrorism on children: a two-year alone. Most vaccinees received advice about influenza experience. Prehospital Disaster Med 2003; 18(3):242- and pneumococcal vaccination from their general 8. practitioner (90% (142/157) and 87% (81/93), Abstract: OBJECTIVES: To review and analyze the respectively). A large number of non-vaccinees were cumulative two-year, Israeli experience with medical unaware of the need for influenza and pneumococcal care for children victims of terrorism during the vaccination (69% (76/111) and 91% (159/175), prehospital and hospital phases. METHODS: Data respectively). Using multiple logistic regression co- were collected from the: (1) Magen David Adom existing CPD increased the odds of receiving influenza National Emergency Medical System Registry (odds ratio (OR) (95% confidence interval (CI)) = 1.99 (prehospital phase); (2) medical records from the (1.07-14.12)) or pneumococcal (OR = 3.77 (1.69- authors' institutions (pediatric triage); and (3) Israel Trauma Registry (injury characteristics and utilization 929
- 938. of in-hospital resources).Statistical analyses were article describes the model and a culturally competent performed as appropriate.INTRODUCTION: During method for assessing and adapting the model for the the recent wave of violence in Israel and the African American, Cherokee, and Latino/Hispanic surrounding region, hundreds of children have been communities in North Carolina. exposed to and injured by terrorist attacks. There is a paucity of data on the epidemiology and management Waldman HB. Millennium children. ASDC J Dent Child of terror-related trauma in the pediatric population and 2002; 69(3):332-5, 236. its effects on the healthcare system. This study focuses Abstract: A federal agency's extensive report on the on four aspects of terrorism-related injuries: (1) tending well-being of our children at the beginning of the new to victims in the prehospital phase; (2) triage, with a millennium provides an opportunity to review the description of a modified, pediatric triage algorithm; many achievements and remaining concerns about the (3) characteristics of trauma-related injuries in health and social environment of the children in our children; and (4) utilization of in-hospital resources. communities and in many of our dental practices. RESULTS: During the study period, 41 mass-casualty events (MCEs) were managed by Magen David Adom. Walker CR, Frize M. Are artificial neural networks "ready to Each event involved on average, 32 regular and nine use" for decision making in the neonatal intensive care mobile intensive care unit ambulances with 93 medics, unit? Commentary on the article by Mueller et al. and 19 paramedics, and four physicians. Evacuation time page 11. Pediatr Res 2004; 56(1):6-8. was 5-10 minutes in urban areas and 15-20 minutes in rural areas. In most cases, victims were evacuated to Walker SP, Chang SM, Powell CA, Grantham-McGregor multiple facilities. To improve efficiency and speed, SM. Psychosocial intervention improves the the Magen David Adom introduced the use of well- development of term low-birth-weight infants. J Nutr trained "first-responders" and volunteer, off-duty 2004; 134(6):1417-23. professionals, in addition to "scoop and run" on-the- Abstract: It is estimated that 11% of births in scene management. Because of differences in developing counties are term low-birth-weight (LBW); physiology and response between children and adults, a however, there is limited information on the pediatric triage algorithm was developed using four development of these infants. Our objectives were to categories instead of the usual three. Analysis of the determine the effect of psychosocial intervention on the injuries sustained by the 160 children hospitalized after development of LBW infants and to compare term these events indicates that most were caused by blasts LBW and normal-birth-weight (NBW) infants. Term and penetration by foreign objects. Sixty-five percent LBW (n = 140) and NBW infants (n = 94) were of the children had multiple injuries, and the proportion enrolled from the main maternity hospital in Kingston, of critical to fatal injuries was high (18%). Compared Jamaica. The LBW infants were randomly assigned to to children with non-terrorism-related injuries, the control or intervention comprising weekly home visits terrorism-related group had a higher rate of surgical from birth to 8 wk and from 7 to 24 mo of age. interventions, longer hospital stays, and greater needs Development was assessed at 15 and 24 mo with the for rehabilitation services. CONCLUSION: Terrorism- Griffiths Scales. The intervention benefited the infants' related injuries in children are severe and increase the developmental quotient (DQ, P < 0.05) and demand for acute care. The modifications in the performance subscale at 15 mo (P < 0.02), the hand management of pediatric casualties from terrorism in and eye (P < 0.05) and performance subscales (P < Israel may contribute to the level of preparedness of 0.02) at 24 mo, and home environment at 12 mo. The medical and paramedical personnel to cope with future effect of the intervention on development was mediated events. Further studies of other aspects of traumatic in part by the improvement in the home environment. injuries, such as its short- and long-term psychological The control LBW infants had significantly lower scores consequences, will provide a more comprehensive than the NBW in DQ and several subscales, whereas picture of the damage inflicted on children by acts of there were no significant differences between the NBW terrorism. and the LBW infants after intervention. In conclusion, term LBW was associated with developmental delays, Waites C, Macgowan MJ, Pennell J, Carlton-LaNey I, Weil which were reduced with psychosocial intervention. M. Increasing the cultural responsiveness of family group conferencing. Soc Work 2004; 49(2):291-300. Wall A, Scowen P. After Victoria: the outcome of the Abstract: Child welfare struggles to manage child Victoria Climbie inquiry. J Fam Health Care 2003; abuse and neglect and to seek permanency for children, 13(3):61-2. while being culturally responsive to the communities it serves. Family group conferencing, piloted in New Wall R, Cunningham P, Walsh P, Byrne S. Explaining the Zealand and now used in the United States and other output of ensembles in medical decision support on a countries, is a strengths-based model that brings case by case basis. Artif Intell Med 2003; 28(2):191- together families and their support systems to develop 206. and carry out a plan that protects, nurtures, and Abstract: The use of ensembles in machine learning safeguards children and other family members. This 930
- 939. (ML) has hada considerable impact in increasing the hand and digit movements, precedes targeted reaching. accuracy and stability of predictors. This increase in Neuropsychologia 2003; 41(14):1912-8. accuracy has come at the cost of comprehensibility as, Abstract: Previous work has described human reflexive by definition, an ensemble model is considerably more grasp patterns in early infancy and visually guided complex than its component models. This is of reaching and grasping in late infancy. There has been significance for decision support systems in medicine no examination of hand movements in the intervening because of the reluctance to use models that are period. This was the purpose of the present study. We essentially black boxes. Work on making ensembles video recorded the spontaneous hand and digit comprehensible has so far focused on global models movements made by alert infants over their first 5 that mirror the behaviour of the ensemble as closely as months of age. Over this period, spontaneous hand and possible. With such global models there is a clear digit movements developed from fists to almost tradeoff between comprehensibility and fidelity. In this continuous, vacuous movements and then to self- paper, we pursue another tack, looking at local directed grasping movements. Amongst the many hand comprehensibility where the output of the ensemble is and digit movements observed, four grasping patterns explained on a case-by-case basis. We argue that this emerged during this period: fists, pre-precision grips meets the requirements of medical decision support associated with numerous digit postures, precision systems. The approach presented here identifies the grips including the pincer grasp, and self-directed ensemble members that best fit the case in question and grasps. The finding that a wide range of independent presents the behaviour of these in explanation. digit movements and grasp patterns are displayed spontaneously by infants within their first 5 months of Wall TC, Brumfield CG, Cliver SP, Hou J, Ashworth CS, age is discussed in relation to the development of the Norris MJ. Does early discharge with nurse home visits motor system, including the suggestion that direct affect adequacy of newborn metabolic screening? J connections of the pyramidal tract are functional Pediatr 2003; 143(2):213-8. relatively early in infancy. It is also suggested that Abstract: OBJECTIVE: To examine the impact of early hand babbling, consisting of first vacuous and then discharge on newborn metabolic screening. STUDY self-directed movements, is preparatory to targeted DESIGN: Metabolic screening results were obtained reaching. from the Alabama State Lab for all infants born at our hospital between 8/1/97, and 1/31/99, and were Wallace RH, Marini C, Petrou S et al. Mutant GABA(A) matched with an existing database of early discharge receptor gamma2-subunit in childhood absence infants. An early newborn discharge was defined as a epilepsy and febrile seizures. Nat Genet 2001; discharge between 24 and 47 hours of age. Metabolic 28(1):49-52. screening tests included phenylketonuria (PKU), Abstract: Epilepsies affect at least 2% of the population hypothyroidism, and congenital adrenal hyperplasia at some time in life, and many forms have genetic (CAH). Early discharge and traditional stay infants determinants. We have found a mutation in a gene were compared to determine the percentage of encoding a GABA(A) receptor subunit in a large newborns screened and the timing of the first adequate family with epilepsy. The two main phenotypes were specimen. RESULTS: The state laboratory received childhood absence epilepsy (CAE) and febrile seizures specimens from 3860 infants; 1324 were on early (FS). There is a recognized genetic relationship discharge newborns and 2536 infants in the traditional between FS and CAE, yet the two syndromes have stay group. At least one filter paper test (PKU, different ages of onset, and the physiology of absences hypothyroidism, and CAH) was collected on 99.2% of and convulsions is distinct. This suggests the mutation early discharge infants and 96.0% of traditional stay has age-dependent effects on different neuronal infants (P<.0001). Early discharge infants had a higher networks that influence the expression of these rate of initial filter paper specimens being inadequate clinically distinct, but genetically related, epilepsy (22.9%) compared with traditional stay infants (14.3%, phenotypes. We found that the mutation in GABRG2 P<.0001) but had a higher rate of repeat specimens (encoding the gamma2-subunit) abolished in vitro when the initial specimen was inadequate (85.0% early sensitivity to diazepam, raising the possibility that discharge vs 75.3% traditional stay, P=.002). The early endozepines do in fact exist and have a physiological discharge group was more likely to have an adequate role in preventing seizures. specimen within the first 9 days of life (1001, 98.8% early discharge vs 2016, 96.7% traditional stay, Wallace SV, Semeraro D, Darne FJ. Consent for fetal P=.0005). CONCLUSIONS: In this well established necropsy. Lancet 2001; 357(9271):1884. early discharge program with nurse home visits, Notes: GENERAL NOTE: KIE: Wallace, Susan V F; newborn metabolic screening is not compromised by Semeraro, David early discharge. GENERAL NOTE: KIE: 1 ref. GENERAL NOTE: KIE: KIE Bib: informed consent; Wallace PS, Whishaw IQ. Independent digit movements and organ and tissue donation precision grip patterns in 1-5-month-old human infants: hand-babbling, including vacuous then self-directed 931
- 940. Walline JJ, HoldenBA, Bullimore MA et al. The current interviews and referring agencies. Chi-square and state of corneal reshaping. Eye Contact Lens 2005; univariate analyses of variance were used for between- 31(5):209-14. group comparisons. RESULTS: Twenty-one percent of Abstract: PURPOSE: The application of contact lenses the sample had a history of attempted suicide. Previous to alter the shape of the cornea and temporarily reduce and repeat attempters were more likely to have a or eliminate myopia is known as orthokeratology, history of family violence and substance abuse. Repeat corneal refractive therapy, or corneal reshaping. It was attempters were most likely to have depression, while first introduced in the 1960s, but high oxygen never and previous (but not recent) attempters were permeable materials and more sophisticated designs more likely to have conduct disorder. Other clinical allow patients to wear contact lenses only during sleep, differences were also found. CONCLUSIONS: Among while dramatically improving the predictability and children receiving mental health services, those who rate of myopia reduction. Many studies have shown attempt suicide experience more and different types of that most corneal reshaping patients achieve distress, depending on the recency and frequency of uncorrected visual acuity of 20/25 or better that lasts all attempts. Clinicians should be aware that depression is day long in one to two weeks of nighttime wear. not a necessary factor in predicting suicide attempts Treatment is primarily effective through central and that suicide risk is also associated with violent and epithelial thinning and midperipheral epithelial and aggressive behaviors. stromal thickening. Much remains to be learned about corneal reshaping contact lenses and their effects on Walsh C, Ross LF. Are minority children under- or the cornea. METHODS: The authors reviewed existing overrepresented in pediatric research? Pediatrics 2003; knowledge and determined what needs to be learned in 112(4):890-5. order to provide patients with appropriate informed Abstract: OBJECTIVES: There is extensive consent prior to corneal reshaping contact lens wear. documentation that minority adults are RESULTS: While corneal reshaping contact lenses are underrepresented in medical research, but there are effective at temporarily reducing or eliminating scant data regarding minority children and their myopia, claims about the progress of myopia being parents. METHODS: All full-length articles published controlled with corneal reshaping contact lenses should in the paper edition of 3 general pediatric journals not be made until further studies are published in peer- between July 1999 and June 2000 were collected and reviewed literature. The incidence and prevalence of reviewed. Articles were excluded when they did not microbial keratitis related to corneal reshaping contact include at least 1 US researcher, all subjects at US lens wear is not known. Any overnight wear of contact institutions, parents or children as subjects, some lenses increases the risk of infection, but it is not prospective data collection, or between 8 and 10 000 known whether the risks of microbial keratitis are subjects. We recorded the number and race/ethnicity greater for corneal reshaping overnight contact lens (R/E) of all subjects, the type of research, and the type wearers than other form of overnight contact lens wear. of data collected. Corresponding authors were surveyed It is also not known whether the risk of microbial to clarify R/E data. RESULTS: A total of 192 studies keratitis is greater for children than adults, but we must qualified. R/E data were reported in 114 (59%) studies, determine if children are at greater risk than adults and survey data provided additional or new information because many children are wearing corneal reshaping in 25 studies resulting in R/E data in 128 (67%) articles contact lenses. CONCLUSIONS: Finally, it is accounting for 75% of the subjects. R/E was described recommended that ongoing education be provided to by >10 different labels. There was an practitioners and staff regarding safety, informed overrepresentation of black subjects and an consent, and prevention of potential problems, with underrepresentation of white and Hispanic subjects special emphasis on the critical need to properly and compared with the census data. When compared with thoroughly disinfect lenses that will be worn overnight. research participation of child subjects, generally, black children were overrepresented and Hispanic Walrath CM, Mandell DS, Liao Q et al. Suicide attempts in children were underrepresented in clinical trials, and the "comprehensive community mental health services both were underrepresented in therapeutic research. for children and their families" program. J Am Acad Black and Hispanic children were overrepresented in Child Adolesc Psychiatry 2001; 40(10):1197-205. potentially stigmatizing research. CONCLUSIONS: Abstract: OBJECTIVE: To compare clinical Overall, we found an overrepresentation of black characteristics of youths who had attempted suicide subjects and an underrepresentation of white and recently, previously but not recently, repeatedly, or Hispanic subjects with significant variations depending never. METHOD: The sample comprised 4,677 youths on the type of research. receiving services between 1993 to 1998 in 22 communities and participating in the national Walsh P, Cunningham P, Rothenberg SJ, O'Doherty S, Hoey evaluation of the Comprehensive Community Mental H, Healy R. An artificial neural network ensemble to Health Services for Children and Their Families predict disposition and length of stay in children Program. Data on suicide attempts, demographics, and presenting with bronchiolitis. Eur J Emerg Med 2004; clinical characteristics were obtained from intake 11(5):259-64. 932
- 941. Abstract: BACKGROUND: Artificialneural networks negative health consequences. It is identified as one of apply complex non-linear functions to pattern the objectives in Healthy People 2010. Women are recognition problems. An ensemble is a 'committee' of more likely to be assaulted by a current or former neural networks that usually outperforms single neural intimate partner than an acquaintance, family member, networks. Bronchiolitis is a common manifestation of friend, or stranger. Universal screening is advocated as viral lower respiratory tract infection in infants and an effective approach in identifying affected women. toddlers. OBJECTIVE: To train artificial neural There exists a few states mandating report of women network ensembles to predict the disposition and length with injuries resulting from IPV but it is only clearly of stay in children presenting to the Emergency mandated in California. Interventions to address the Department with bronchiolitis. METHODS: A problem include those focused on increasing specifically constructed database of 119 episodes of identification and screening, and treatment of intimate bronchiolitis was used to train, validate, and test a partner violence. This paper reviews the epidemiology, neural network ensemble. We used EasyNN 7.0 on a identification and screening, and interventions for IPV. 200 Mhz pentium PC with a maths co-processor. The The role for nursing is discussed concluding with ensemble of neural networks constructed was subjected directions for further investigation. to fivefold validation. Comparison with actual and predicted dispositions was measured using the kappa Wandersman A, Florin P. Community interventions and statistic for disposition and the Kaplan-Meier effective prevention. Am Psychol 2003; 58(6-7):441-8. estimations and log rank test for predictions of length Abstract: The prevalence of pregnancy, substance of stay. RESULTS: The neural network ensembles abuse, violence, and delinquency among young people correctly predicted disposition in 81% (range 75-90%) is unacceptably high. Interventions for preventing of test cases. When compared with actual disposition problems in large numbers of youth require more than the neural network performed similarly to a logistic individual psychological interventions. Successful regression model and significantly better than various interventions include the involvement of prevention 'dumb machine' strategies with which we compared it. practitioners and community residents in community- The prediction of length of stay was poorer, 65% level interventions. The potential of community-level (range 60-80%), but the difference between observed interventions is illustrated by a number of successful and predicted lengths of stay were not significantly studies. However, more inclusive reviews and multisite different. CONCLUSION: Artificial neural network comparisons show that although there have been ensembles can predict disposition for infants and successes, many interventions did not demonstrate toddlers with bronchiolitis; however, the prediction of results. The road to greater success includes prevention length of hospital stay is not as good. science and newer community-centered models of accountability and technical assistance systems for Walter AJ. Misdiagnosis of abuse. CMAJ 2003; 169(7):651- prevention. 2; author reply 652. Wang AT, Dapretto M, Hariri AR, Sigman M, Bookheimer Walton MK. Advocacy and leadership when parental rights SY. Neural correlates of facial affect processing in and child welfare collide: the role of the advanced children and adolescents with autism spectrum practice nurse. J Pediatr Nurs 2002; 17(1):49-58. disorder. J Am Acad Child Adolesc Psychiatry 2004; Abstract: This article describes the experience of an 43(4):481-90. advanced practice nurse in a challenging clinical Abstract: OBJECTIVE: To examine the neural basis of situation. A mother with mental illness and mental impairments in interpreting facial emotions in children retardation seeks to retain parental rights and care for and adolescents with autism spectrum disorders (ASD). her newborn with cystic fibrosis. The nurse provides METHOD: Twelve children and adolescents with ASD leadership to the hospital team and serves as an and 12 typically developing (TD) controls matched advocate throughout legal proceedings. A systematic, faces by emotion and assigned a label to facial nonjudgmental, and empathic approach to gathering expressions while undergoing functional magnetic information, working with the family, welfare, and resonance imaging. RESULTS: Both groups engaged legal representatives is described. Enacting a complex similar neural networks during facial emotion and court-mandated homecare education regimen to the processing, including activity in the fusiform gyrus disabled mother is discussed. Preparation to testify in a (FG) and prefrontal cortex. However, between-group termination of parental rights proceeding is outlined analyses in regions of interest revealed that when and a summary description of the testimony provided. matching facial expressions, the ASD group showed significantly less activity than the TD group in the FG, Walton-Moss BJ, Campbell JC. Intimate partner violence: but reliably greater activity in the precuneus. During implications for nursing. Online J Issues Nurs 2002; the labeling of facial emotions, no between-group 7(1):6. differences were observed at the behavioral or neural Abstract: Intimate partner violence is responsible for level. Furthermore, activity in the amygdala was 30% of female homicides in the U. S. and has multiple moderated by task demands in the TD group but not in the ASD group. CONCLUSIONS: These findings 933
- 942. suggest that childrenand adolescents with ASD in part Wang CC, Wang Y, Zhang K et al. Reproductive health recruit different neural networks and rely on different indicators for China's rural areas. Soc Sci Med 2003; strategies when processing facial emotions. High- 57(2):217-25. functioning individuals with ASD may be relatively Abstract: We report community-based development of unimpaired in the cognitive assessment of basic reproductive health indicators for China's rural areas. emotions, yet still show differences in the automatic To generate these indicators, we sequenced two processing of facial expressions. participatory techniques known as nominal group process and Delphi survey methodology. Nominal Wang CC, Pies CA. Family, maternal, and child health group process entailed grassroots reproductive health through photovoice. Matern Child Health J 2004; workers' generating indicators, followed by refinement 8(2):95-102. and prioritization of these indicators through a Abstract: OBJECTIVE: (1) To introduce photovoice, a consensus-building Delphi process among nationally participatory action research methodology, for use by and internationally known reproductive health experts. MCH program managers to enhance community health Major criteria for the indicators were practicality, assessments and program planning efforts, (2) to feasibility, and measurability within China's rural enable community people to use the photovoice areas. We explain the importance of establishing these methodology as a tool to record, reflect, and indicators for application in rural China and other communicate their family, maternal, and child health developing countries as a complement to the World assets and concerns, and (3) to educate community Health Organization's reproductive health indicators for leaders about family, maternal, and child health issues global monitoring; present the identified indicators; from a grassroots perspective. METHODS: Photovoice and describe lessons learned from field testing in low-, is based upon the theoretical literature on education for middle-, and high-income counties of China's critical consciousness, feminist theory, and countryside. community-based approaches to documentary photography. Picture This Photovoice project took Wang CS, Chou P. Risk factors for low birth weight among place in Contra Costa, an economically and ethnically first-time mothers in southern Taiwan. J Formos Med diverse county in the San Francisco Bay area. Sixty Assoc 2001; 100(3):168-72. county residents of ages 13-50 participated in 3 Abstract: BACKGROUND AND PURPOSE: Low sessions during which they received training from the birth weight (LBW) greatly affects infant development, local health department in the techniques and process the family, and health care financial systems. of photovoice. Residents were provided with Nonetheless, the risk factors for LBW in Taiwan have disposable cameras and were encouraged to take not been investigated. The purpose of this study was to photographs reflecting their views on family, maternal, determine the risk factors for LBW in Kaohsiung and child health assets and concerns in their County. METHODS: In this cross-sectional study, we community, and then participated in group discussions recruited 1,147 first-time mothers, including all about their photographs. Community events were held adolescent mothers (< 20 years old) who gave birth to enable participants to educate MCH staff and during the period from June 1994 through May 1995 community leaders. RESULTS: The photovoice project and all adult mothers (> or = 20 years old) who gave provided MCH staff with information to supplement birth in January and February 1995. The subjects were existing quantitative perinatal data and contributed to interviewed during home visits or by telephone by an understanding of key MCH issues that participating public health nurses in each township. Logistic community residents would like to see addressed. regression analysis was used to identify the risk factors Participants' concerns centered on the need for safe for LBW in adolescent and adult mothers. RESULTS: places for children's recreation and for improvement in The prevalence of LBW in the study population was the broader community environment within county 6.2%, ranging from 7.6% in adolescent mothers to neighborhoods. Participants' definitions of family, 4.9% in adult mothers. Univariate analysis showed that maternal, and child health assets and concerns differed mothers who had low pregravid weight (< 45 kg), from those that MCH professionals may typically view infrequent prenatal visits (< 10), anemia, low as MCH issues (low birth weight, maternal mortality, gestational weight gain (< 10 kg), or habits of alcohol teen pregnancy prevention), which helped MCH consumption or cigarette smoking were more likely to program staff to expand priorities and include residents' give birth to LBW infants. In logistic regression foremost concerns. CONCLUSIONS: MCH analysis, after controlling for covariates, the significant professionals can apply photovoice as an innovative risk factors for LBW were low gestational weight gain participatory research methodology to engage (< 10 kg) and low pregravid weight (< 45 kg) for community members in needs assessment, asset adolescent mothers. Infrequent prenatal visits (< 10) mapping, and program planning, and in reaching policy was the only significant risk factor for adult mothers. makers to advocate strategies promoting family, CONCLUSIONS: In this study, the risk factors for maternal, and child health as informed from a LBW among adolescent and adult mothers were grassroots perspective. different. This suggests that programs for prevention of LBW should be tailored according to maternal age, 934
- 943. begin before conception,and continue with enhanced cooperation was over 80%. Over 98% doctors thought surveillance during prenatal visits. telemedicine system helpful. The doctors in VGHTPE are more satisfied with the facility than local doctors in Wang L. Determinants of child mortality in LDCs: empirical Kinmen. CONCLUSIONS: The clinical evaluation of findings from demographic and health surveys. Health the telemedicine showed positive results. It can be a Policy 2003; 65(3):277-99. useful tool to facilitate on-job training and education Abstract: Empirical studies on child mortality at the Tele-emergency medicine. disaggregated level-by social-economic group or geographic location-are more informative for designing Wang NE, Gisondi MA, Golzari M, van der Vlugt TM, health polices. Using Demographic and Health Survey Tuuli M. Socioeconomic disparities are negatively data from over 60 low-income countries, this study (1) associated with pediatric emergency department presents global patterns of the level and inequality in aftercare compliance. Acad Emerg Med 2003; child mortality and (2) investigates the determinants of 10(11):1278-84. child mortality, both at the national level and separately Abstract: OBJECTIVES: This study sought to identify for urban and rural areas. The global patterns of health demographic, socioeconomic, and clinical predictors of outcomes reveal two interesting observations. First, as aftercare noncompliance by pediatric emergency child mortality declines, the gap in mortality between department (ED) patients. METHODS: The authors the poor and the better-off widens. Second, while child conducted a prospective, observational study of mortality in rural areas is substantially higher than in pediatric patients presenting to a university teaching urban areas, the reduction in child mortality is much hospital ED from July 1, 2002, through August 31, slower in rural areas where the poor are concentrated. 2002. Demographic and clinical information was This suggests that health interventions implemented in obtained from guardians during the ED visit. Guardians the past decade may not have been as effective as were contacted after discharge to determine intended in reaching the poor. The analysis on compliance with ED aftercare instructions. Subjects mortality determination shows that at the national level were excluded if they were admitted or if guardians access to electricity, incomes, vaccination in the first were unavailable or unwilling to consent. Data were year of birth, and public health expenditure analyzed using multivariable logistic regression to significantly reduce child mortality. The electricity identify predictors of noncompliance from a list of effect is large and independent of the income effect. predetermined variables. RESULTS: Of the 409 While in urban areas, access to electricity is the only patients enrolled in the study, 111 were prescribed significant mortality determinant, in rural areas, medications and 364 were given specific follow-up vaccination in the first year of birth is the only instructions. Subtypes of the variable "insurance status" significant factor. were significantly associated with medication noncompliance in multivariable regression analysis. Wang LM, Huang YT, Chern CH et al. Tele-emergency "Insurance status" and "low-acuity discharge medicine: the evaluation of Taipei Veterans General diagnoses" were significantly associated with follow- Hospital and Kinmen-Granite Hospital in Taiwan. up noncompliance. CONCLUSIONS: Disparity in Zhonghua Yi Xue Za Zhi (Taipei) 2001; 64(11):621-8. health insurance has been shown to be a predictor of Abstract: BACKGROUND: The purpose of the project poor aftercare compliance for pediatric ED patients was to establish computer networks between selected within the patient population. hospitals through high-speed communication and high power computer processing to electronically exchange Wang Y, Ollendick TH. A cross-cultural and developmental medical information and to conduct clinical analysis of self-esteem in Chinese and Western examination and consultation. Quality medical services children. Clin Child Fam Psychol Rev 2001; 4(3):253- can thus be provided to patients in the remote rural 71. areas such as villages and small towns in the Abstract: In this review, we examine the construct of mountains, on the coasts and islets away from Taiwan. self-esteem from a cross-cultural perspective in It also intended to facilitate continuing education for Chinese and Western children and adolescents. We doctors in those areas. This study evaluates also explore the role of childrearing practices in the telemedicine between Taipei-Veterans General development of self-esteem in these different cultures. Hospital and Kinmen-Granite Hospital. METHODS: In doing so, we first review the concepts of emic (i.e., Patients were chosen from 1996-7 to 1997-6. The variations in patterns of behavior within a given evaluation criteria included consulting quality, culture) and etic research (i.e., variations in common satisfaction of the doctors, benefits for the patients, and patterns of behavior or activities across cultures). Then, the charge being rendered. RESULTS: The results of we invoke Berry's notions of "imposed-etic" and evaluation for telemedicine between Taipei-Veterans "derived-etic" approaches (J. Berry, 1989) in General Hospital (VGHTPE) and Kinmen-Granite understanding crucial cross-cultural differences that are hospital (GH) are as follows: 93.0% doctors used evident in the literature. We pose basic questions such telemedicine to seek a second opinion. After as: (1) What does self-esteem "look" like in Chinese teleconsultation, the ratio of the patients showing children? (2) How do childrearing practices in China 935
- 944. influence the developmentof self-esteem in children? studies. Arch Dis Child Fetal Neonatal Ed 2005; And, (3) what are the limitations of cross-cultural 90(3):F191. research in understanding a phenomenon such as self- Notes: GENERAL NOTE: KIE: KIE Bib: human esteem? We suggest that self-esteem does not "mean" experimentation/informed consent; human the same things across these collectivist and experimentation/minors individualistic cultures. We conclude our discourse with specific recommendations for clinical theory, Warner JO. Annus horribilis for British medicine. Pediatr research, and practice. Allergy Immunol 2001; 12(2):55-6. Ward C. Migrant mothers and the role of social support Warner JO. Child protection and allergy. Pediatr Allergy when child rearing. Contemp Nurse 2003-2004; 16(1- Immunol 2005; 16(8):621. 2):74-82. Abstract: To raise children in a new country without Warren AR, Nunez N, Keeney JM, Buck JA, Smith B. The the support of family and community may prove believability of children and their interviewers' hearsay problematic for some women. This study explored the testimony: when less is more. J Appl Psychol 2002; possible impact of a lack supportive social network on 87(5):846-57. mothering. A cross sectional design using both Abstract: Hearsay testimony from children's quantitative (questionnaire) and qualitative approaches interviewers is increasingly common in sexual abuse (interview) was used to investigate the child rearing trials, but little is known about its effects on juries. In 2 experience of migrant women from the United studies, the authors examined college students' Kingdom (UK) (N = 154) currently living in Western perceptions of 3 types of hearsay testimony (an actual Australia (WA); 40 women were selected for interview with a child or an adult interviewer providing interview. Bowlby's (1969) mother-infant attachment either the gist of what that child had said or a verbatim theory provides the theoretical framework to account of the interview). Interviewers were rated as investigate the perceived loss of attachment to the more accurate and truthful than the children. The homeland, attachment figure, country, culture and interview was rated as higher quality, and children's family. The results indicated that migrant women with statements, including their false statements, were children missed the close support of family networks; sometimes rated as more believable in the interviewer and indicate that all migrant mothers, regardless of gist hearsay condition. Mock jurors reacted differently origin, require a social support network to survive. to various types of hearsay testimony, and interviewer gist testimony may favor a child's case. Ward E. Whose life is it anyway? Lancet 2001; 358(9283):766. Warren JI, Hurt S, Loper AB, Bale R, Friend R, Chauhan P. Notes: GENERAL NOTE: KIE: KIE Bib: allowing to Psychiatric symptoms, history of victimization, and die/attitudes; treatment refusal violent behavior among incarcerated female felons: an American perspective. Int J Law Psychiatry 2002; Ward FR. Parents and professionals in the NICU: 25(2):129-49. communication within the context of ethical decision making--an integrative review. Neonatal Netw 2005; Warren K, Craciun G, Anderson-Butcher D. Everybody else 24(3):25-33. is: Networks, power laws and peer contagion in the Abstract: Communication between parents and aggressive recess behavior of elementary school boys. professionals in the NICU is a necessary part of Nonlinear Dynamics Psychol Life Sci 2005; 9(2):155- collaborative decision making in the provision of 73. family-centered care. Decisions with ethical Abstract: This paper develops a simple random components, those regarding treatment plans or network model of peer contagion in aggressive neonatal research enrollment, need to be made behavior among inner-city elementary school boys conjointly with parents and health care professionals. during recess periods. The model predicts a distribution This article reviews the present state of knowledge of of aggressive behaviors per recess period with a power how parents' input can be facilitated in regard to law tail beginning at two aggressive behaviors and decisions made about their children. Research studies having a slope of approximately -1.5. Comparison of involving decisions made with ethical components in these values with values derived from observations of the NICU since the advent of the Baby Doe regulations aggressive behaviors during recess at an inner-city reveal parents' frustration with communication elementary school provides empirical support for the practices, their need for control of information, and the model. These results suggest that fluctuations in trust in their children's health care providers that is aggressive behaviors during recess arise from the required to best facilitate their input into ethical interactions between students, rather than from decisions made about their children. variations in the behavior of individual students. The results therefore support those interventions that aim to Ward Platt M. Participation in multiple neonatal research change the pattern of interaction between students. 936
- 945. Warren SL, GunnarMR, Kagan J et al. Maternal panic using McNemar's chi2 for paired proportions. A paired disorder: infant temperament, neurophysiology, and Student's t-test was used to compare means of age, parenting behaviors. J Am Acad Child Adolesc marital-time and parity when measuring interview Psychiatry 2003; 42(7):814-25. mode effect and two-sample Student's t-test to compare Abstract: OBJECTIVE: To determine whether 4- and means for samples stratified by education level - 14-month-old infants of mothers with panic disorder determined during the exit interview. A Chi-Square (PD) would be more likely to show differences in (chi2test) was used to compare ability to use ACASI by temperament, neurophysiology (salivary cortisol and education level. RESULTS: Mean ages for intended sleep), and relationships with their mothers than time for breastfeeding as reported by ACASI were 11 controls. METHOD: Two cohorts were recruited: 4- months by ACASI and 19 months by FTF interviewing month-old infants with PD mothers (n = 25) and 4- (p < 0.001). Introduction of complementary foods at month-old controls (n = 24), and 14-month-old infants <or=3 months was reported more frequently by with PD mothers (n = 27) and 14-month-old controls (n respondents in ACASI compared to FTF interviews for = 18). Mothers completed diagnostic interviews and 7 of 13 complementary food items commonly utilized questionnaires concerning infant temperament, sleep, in the study area (p < 0.05). More respondents reported and parenting. Infant salivary cortisol samples and use of unsuitable utensils for infant feeding in ACASI standard observational procedures to measure infant than in FTF interviewing (p = 0.001). In other sensitive temperament, sleep, attachment, and parenting were questions, 7% more respondents reported unstable also used. RESULTS: Infants with PD mothers did not relationships with ACASI than when interviewed FTF show more high reactivity, behavioral inhibition, or (p = 0.039). Regardless of education level, respondents ambivalent/resistant attachment but did demonstrate used ACASI similarly and majority (65%) preferred it different neurophysiology (higher salivary cortisol and to FTF interviewing mainly due to enhanced usability more disturbed sleep) than controls. PD mothers also and privacy. Most respondents (79%) preferred ACASI displayed less sensitivity toward their infants and to FTF for future interviewing. CONCLUSION: reported parenting behaviors concerning infant sleep ACASI seems to improve quality of information by and discipline that have been associated with child increasing response to sensitive questions, decreasing problems. CONCLUSIONS: While infants with PD socially desirable responses, and by preventing null mothers did not show early behavioral differences from responses and was suitable for collecting data in a controls, they did display neurophysiological setting where formal education is low. divergences consistent with higher arousal/arousability. Such neurophysiological divergences (elevated salivary Wasserman D. Is there value in identifying individual cortisol and disturbed sleep) might be important early genetic predispositions to violence? J Law Med Ethics indicators of risk. Helping PD mothers parent their 2004; 32(1):24-33. more highly aroused/arousable infants could reduce the Notes: GENERAL NOTE: KIE: KIE Bib: behavioral development of psychopathology. genetics Waruru AK, Nduati R, Tylleskar T. Audio computer- Wasserman D. Killing Mary to save Jodie: conjoined twins assisted self-interviewing (ACASI) may avert socially and individual rights. Philos Public Policy Q 2001; desirable responses about infant feeding in the context 21(1):9-14. of HIV. BMC Med Inform Decis Mak 2005; 5:24. Notes: GENERAL NOTE: KIE: Wasserman, David Abstract: BACKGROUND: Understanding infant GENERAL NOTE: KIE: 15 refs. feeding practices in the context of HIV and factors that GENERAL NOTE: KIE: KIE Bib: allowing to put mothers at risk of HIV infection is an important die/infants; patient care/minors step towards prevention of mother to child transmission of HIV (PMTCT). Face-to-face (FTF) interviewing Wasterlain CG, Niquet J, Thompson KW et al. Seizure- may not be a suitable way of ascertaining this induced neuronal death in the immature brain. Prog information because respondents may report what is Brain Res 2002; 135:335-53. socially desirable. Audio computer-assisted self- Abstract: The response of the developing brain to interviewing (ACASI) is thought to increase privacy, epileptic seizures and to status epilepticus is highly reporting of sensitive issues and to eliminate socially age-specific. Neonates with their low cerebral desirable responses. We compared ACASI with FTF metabolic rate and fragmentary neuronal networks can interviewing and explored its feasibility, usability, and tolerate relatively prolonged seizures without suffering acceptability in a PMTCT program in Kenya. massive cell death, but severe seizures in experimental METHODS: A graphic user interface (GUI) was animals inhibit brain growth, modify neuronal circuits, developed using Macromedia Authorware and and can lead to behavioral deficits and to increases in questions and instructions recorded in local languages neuronal excitability. Past infancy, the developing Kikuyu and Kiswahili. Eighty mothers enrolled in the brain is characterized by high metabolic rate, exuberant PMTCT program were interviewed with each of the neuronal and synaptic networks and overexpression of interviewing mode (ACASI and FTF) and responses receptors and enzymes involved in excitotxic obtained in FTF interviews and ACASI compared 937
- 946. mechanisms. The outcomeof seizures is highly model- Abstract: Poverty, violence, lack of education, abuse dependent. Status epilepticus may produce massive and exploitation, and refugee status are among the neuronal death, behavioral deficits, synaptic primary determinants of the health of children reorganization and chronic epilepsy in some models, worldwide. There are 1.3 billion people living on less little damage in others. Long-term consequences are than 1 US dollars per day. Half the world's population, also highly age- and model-dependent. However, we 3 billion people, live on less than 1.30 US dollars per now have some models which reliably lead to day. Of the 4.4 billion people who live in developing spontaneous seizures and chronic epilepsy in the vast countries, 60% lack access to sanitation, 33% lack majority of animals, demonstrating that seizure- clean water, 20% have no health care, and 20% do not induced epileptogenesis can occur in the developing have enough dietary energy and protein.(1) The world's brain. The mode cell death from status epilepticus is 225 richest people have a combined wealth equivalent largely (but not exclusively) necrotic in adults, while to the annual income of the poorest 2.5 billion people, the incidence of apoptosis increases at younger ages. nearly half of the world's population.(1) This article Seizure-induced necrosis has many of the biochemical describes a number of the social, political, and features of apoptosis, with early cytochrome release environmental factors impacting children in the from mitochondria and capase activation. We speculate developing (southern hemisphere) world and how these that this form of necrosis is associated with seizure- are affected by actions taken in the developed (northern induced energy failure. hemisphere) world. Watanabe Y, Ando H, Seo T, Katsuno S, Marui Y, Horisawa Waterston T, Tonniges T. Advocating for children's health: a M. Two-dimensional alterations of myenteric plexus in US and UK perspective. Arch Dis Child 2001; jejunoileal atresia. J Pediatr Surg 2001; 36(3):474-8. 85(3):180-2. Abstract: PURPOSE: The purpose of this report is to investigate changes in the myenteric plexus associated Watson MR. Barriers to achieving and maintaining the oral with the dilated proximal segment of jejunoileal atresia health of Hispanics: working with the community to (JA). Two-dimensional morphologic changes in the develop a community-based oral health promotion myenteric nerve plexuses were investigated using program. Compend Contin Educ Dent 2002; 23(12 whole-mount preparation. METHODS: Proximal (P) Suppl):33-5. and distal (D) intestinal segments from 7 cases with JA and control (C) segments from 5 postmortem neonates Watson MR, Horowitz AM, Garcia I, Canto MT. A were investigated. The circumference of the jejunoileal community participatory oral health promotion segments was measured after fixation. Antibodies for program in an inner-city Latino community. J Public protein gene product 9.5 and neurofilament protein Health Dent 2001; 61(1):34-41. were used in whole-mount preparation. The sizes of Abstract: OBJECTIVES: This paper reports the neural networks were calculated by measuring the planning, implementation, process evaluation, and longest circular distance in a neural network (x) and the refinement of an oral health community participatory longest longitudinal distance (y), and the width of the project in Mount Pleasant, an inner-city Latino internodal strands (i) with a videomicrometer. neighborhood of Washington, DC. The main goal was RESULTS: Median circumference of the segments was to explore the feasibility of implementing such a 8.5 in P, 2.0 in D, and 2.0 cm in C. The neural project. METHODS: The PRECEDE-PROCEED networks in P were expanded longitudinally as well as model was used to guide the planning and process circularly (x = 817.10 microm, y = 561.26, i = 31.04: evaluation of this project, in conjunction with median) while comparing them to those in D (x = community organizational methods. A steering 431.40 microm y = 288.07, i = 26.05) or C (x = 285.03 committee, which met periodically, was formed to microm y = 372.20, c = 1113.57, i = 32.39). The nerve assist in program planning, implementation, and plexus was less expanded than the intestinal wall. evaluation. The needs assessment of the community CONCLUSIONS: Proximal intestinal segments identified extensive dental health problems among showed a restructuring that resulted in mild hypoplasia children and deficiencies in their parents' oral health of the enteric nerve plexuses in the proximal segments. knowledge, opinions, and practices. In response, The less expansion of the myenteric nerve plexus seen culturally appropriate health education and promotion in the proximal bowel in infants with JA suggests a activities were planned and implemented in histologic basis for the efficacy of tapering or plication collaboration with local community organizations, of the dilated bowel. volunteers, and local practitioners. Process evaluation was used to provide feedback into the refinement of the Waterston T. A general paediatrician's practice in children's community approach, which included record keeping rights. Arch Dis Child 2005; 90(2):178-81. and an inventory approach to activities completed and resources used. The overall impact and usefulness of Waterston T. Inequity in child health as a global issue. this program were assessed informally using an Pediatrics 2003; 112(3 Part 2):739-41. anonymous open-ended questionnaire directed to 938
- 947. members of thesteering committee, and an outreach Paediatr Nurs 2003; 15(4):40-3. survey using a convenience sample at a local Latino health fair. RESULTS: The implementation of such a Webb CP, Burleson JA, Ungemack JA. Treating juvenile community participatory approach was feasible and offenders for marijuana problems. Addiction 2002; 97 useful for building upon existing local resources and Suppl 1:35-45. addressing oral health concerns in a community not Abstract: AIMS: This study investigated the reached by traditional dental care and health promotion characteristics and substance abuse treatment initiatives. Individuals in this community showed a experience of two differentially defined groups of substantial interest in oral health matters and juvenile offenders, those who were referred or participated in a variety of oral health prevention otherwise involved with the legal system and those activities. The community approach adhered to who reported recent criminal behavior. DESIGN: Six community-based research principles. hundred adolescents from the Cannabis Youth Treatment (CYT) Project were classified by criminal Watson N, Milat AJ, Thomas M, Currie J. The feasibility justice system involvement and recent criminal and effectiveness of pram walking groups for behavior. Multivariate and repeated-measures postpartum women in western Sydney. Health Promot techniques explored substance use frequency, J Austr 2005; 16(2):93-9. substance use problems, psychological and social risk Abstract: ISSUE ADDRESSED: Women with children factors and treatment outcomes as functions of criminal under five are the least physically active population status. FINDINGS: Adolescents reporting criminal group. We provided postpartum women living in justice system involvement were comparable to western Sydney with the opportunity to participate in adolescents reporting no legal involvement. weekly pram walking groups and evaluated the effect Adolescents reporting past crime presented with of the intervention on self-reported physical activity, heavier substance use, more substance use problems mental health and social indicators. METHODS: and greater psychological and environmental risks. Mothers living in the intervention area (Blacktown Criminally active adolescents had greater reductions in LGA) and control area (Holroyd and Parramatta LGAs) substance use frequency and substance use problems completed a baseline questionnaire. Women in the during the course of treatment. CONCLUSION: intervention community were invited to participate in a Juvenile offender status, whether defined by criminal pram walking group starting in the next month. The justice system involvement or criminal behavior, does control group (n = 60) were also invited to participate not seem to mitigate the potential for adolescents to in a pram walking group starting six months later. A benefit from manual-guided outpatient treatments. follow-up questionnaire was completed by all mothers. RESULTS: There was no significant increase in the Webb G. Improving the care of Canadian adults with proportion of mothers in the intervention or control congenital heart disease. Can J Cardiol 2005; groups engaging in adequate physical activity from 21(10):833-8. baseline to follow-up. However, intervention mothers Abstract: Canadian children with congenital heart increased their sessions of vigorous exercise and disease (CHD) have been well cared for in the past control mothers increased the amount of time spent half-century. These childhood success stories have walking. There were no significant differences at resulted in there now being approximately 100,000 baseline or follow-up between the intervention and Canadian adults with CHD. Few of these patients have control groups in frequency of social contact or size of been cured or have normal hearts, and most were left social networks. Nor was there a significant difference with problems that will need to be addressed later in in satisfaction with social contact at baseline between life. Approximately 55,000 such patients need expert the two groups. However, at follow-up women in the care because their conditions are so rare or complicated intervention group were more satisfied with the quality that cardiologists and other caregivers have not been of their social contacts than the controls. trained to look after them. Moreover, these 55,000 CONCLUSIONS: Providing organised, community- Canadians face premature mortality, the need for based pram walking was not sufficient to increase further surgery or the prospect of major complications. overall physical activity levels among this group of They need expert care to optimize the quality of their postpartum women. The results suggest that the lives and to help them to avoid premature death. There friendships formed in the pram walking group boosted is no plan for the care of these patients. When they mothers' satisfaction with social contact and possibly reached 18 years of age, they were moved into an adult their mental health. care system that does not understand them, does not care about them and has not provided for their care. Watt RH. Congenital heart disease: an overview of the Provincial and federal Ministries of Health have not yet condition and treatment options. Lippincotts Case taken an interest in these patients. Canadian Manag 2004; 9(4):205-8. professionals have taken important steps in support of adults with CHD. They established the Canadian Adult Watt S. Safe administration of medicines to children: Part 1. Congenital Heart Network, and they developed a National Care Plan and management guidelines for 939
- 948. their care. Theyhave also made important offence re-enactment led to slightly better ability to contributions to the scientific literature, advancing the identify some types of negative consequences for abuse care of these patients. Waiting lists are much too long victims, and identify cognitive distortions about their for adult patients with CHD. There are serious local offending and women per se. Rapists in particular and regional obstacles to the care of these patients seemed more likely to benefit from offence re- because there are no provincial or regional plans for enactment. The non-reenactment group showed better their care. Cardiologists who treat adult patients with understanding of lifestyle disruption effects for sexual CHD cannot earn enough in a fee-for-service system. abuse victims. The differences between the groups There are serious human resource problems in were not very marked, and the study only involved Canadian Adult Congenital Heart Network centres that measures of cognitive empathy. Given the concerns need to be addressed. There also needs to be greater about offence re-enactment expressed by Pithers coordination and integration between the pediatric and (1997), this procedure should be used with caution and adult systems that care for these patients. Adults with future investigations should test specifically for CHD desperately need the help of the Heart and Stroke possible signs of damage caused by the procedure. Foundations, leaders in the Canadian health care community and, ultimately, the Ministries of Health to Webster SW, O'Toole R, O'Toole AW, Lucal B. help them protect their health and access expert care Overreporting and underreporting of child abuse: when needed in a timely way. The promises offered to teachers' use of professional discretion. Child Abuse them as children must also be honoured in their adult Negl 2005; 29(11):1281-96. years. Abstract: OBJECTIVE: According to mandatory reporting laws for professionals, the relationship Weberling LC, Forgays DK, Crain-Thoreson C, Hyman I. between initial recognition that a child may have been Prenatal child abuse risk assessment: a preliminary abused and the subsequent reporting of that suspected validation study. Child Welfare 2003; 82(3):319-34. case of child abuse to the responsible agency would, at Abstract: Workers need an efficient prenatal screener first glance, appear to be clear. However, this that can identify mothers at greatest risk of child abuse. relationship has developed into one of the major social Existing risk assessment methods are often invasive policy controversies of the recent past. Our major goal and difficult to administer. This study assessed child is to present research findings that address this social abuse risk in a sample of 49 expectant mothers using policy debate concerning the problems of the Brigid Collins Risk Screener (BCRS). At three underreporting and overreporting, focusing specifically months postpartum, high-risk mothers scored on teachers. METHOD: A factorial survey design, that significantly lower on the quality of infants' physical, combines the advantages of the factorial experiment social, and emotional environments than moderate or with those of surveys, was employed in a probability low-risk mothers. BCRS appears to offer a sample of teachers (N=480) who responded to noninvasive, efficient approach to assessing risk of vignettes in which case characteristics were child abuse. systematically manipulated. Teachers responded with judgments about whether the vignette was child abuse Webster D. In that case: a Lead Maternity Carer (LMC) is and the likelihood that they would report this suspected discussing newborn health checks with a pregnant case. Characteristics of the teachers and their work woman and her partner. Response. N Z Bioeth J 2003; setting (school) were also measured. RESULTS: When 4(1):42-3. comparing the teachers' recognition and reporting Notes: GENERAL NOTE: KIE: KIE Bib: informed scores, we found that they gave the same score for 63% consent/minors; mass screening of the vignettes they judged, gave higher reporting than recognition scores (overreporting) for 4% of the Webster SD, Bowers LE, Mann RE, Marshall WL. vignettes, and gave higher recognition than reporting Developing empathy in sexual offenders: the value of scores (underreporting) for 33% of the vignettes. offence re-enactments. Sex Abuse 2005; 17(1):63-77. Discrepancies between recognition and reporting (over Abstract: This paper describes an evaluation of and under reporting) were related to characteristics of different uses of role-play to enhance victim-specific the case, teacher, and school where the teacher was empathy in sexual offenders. Thirty-three men employed. CONCLUSIONS: Teachers in our Ohio participated in a treatment program involving offence sample evidence the use of professional discretion in re-enactment as described by Pithers (1994) and Mann, making judgments about the recognition and reporting Daniels, and Marshall (2002). A matched group of 33 of child abuse and do not appear to make these men participated in a treatment program that was judgments with equal certainty. Their use of discretion identical in all respects except that they did not is more likely to result in underreporting than complete offence re-enactments. Instead, they overreporting. completed extra role-plays designed to enhance empathy for the short and long-term consequences for Webster-Stratton C, Reid MJ, Hammond M. Preventing their victim(s). Results indicated that completing an conduct problems, promoting social competence: a parent and teacher training partnership in head start. J 940
- 949. Clin Child Psychol 2001; 30(3):283-302. considerably larger. At the same time, results showed Abstract: Studied the effectiveness of parent and that, for a given activity, users tended to follow their teacher training as a selective prevention program for own routine. Few relations were found among 272 Head Start mothers and their 4-year-old children frequency, duration, and amount of use. It was and 61 Head Start teachers. Fourteen Head Start concluded that among persons, frequency, duration, centers (34 classrooms) were randomly assigned to (a) and amount of product act in practice as independent an experimental condition in which parents, teachers, parameters. Diaries appear to be quite suitable for and family service workers participated in the gaining insight into frequently used products. prevention program (Incredible Years) or (b) a control Observations of usage, recorded on video, were condition consisting of the regular Head Start program. indispensable for obtaining particular information on Assessments included teacher and parent reports of product use. In addition, home visits enabled the child behavior and independent observations at home collection of specific measurements. Although diaries and at school. Construct scores combining and home visits are time-consuming, the combination observational and report data were calculated for provided insight into variation as well as relations negative and positive parenting style, parent-teacher among frequency, duration, and amount of use. bonding, child conduct problems at home and at school, and teacher classroom management style. Wei JS, Greer BT, Westermann F et al. Prediction of clinical Following the 12-session weekly program, outcome using gene expression profiling and artificial experimental mothers had significantly lower negative neural networks for patients with neuroblastoma. parenting and significantly higher positive parenting Cancer Res 2004; 64(19):6883-91. scores than control mothers. Parent-teacher bonding Abstract: Currently, patients with neuroblastoma are was significantly higher for experimental than for classified into risk groups (e.g., according to the control mothers. Experimental children showed Children's Oncology Group risk-stratification) to guide significantly fewer conduct problems at school than physicians in the choice of the most appropriate control children. Children of mothers who attended 6 therapy. Despite this careful stratification, the survival or more intervention sessions showed significantly rate for patients with high-risk neuroblastoma remains fewer conduct problems at home than control children. <30%, and it is not possible to predict which of these Children who were the "highest risk" at baseline (high high-risk patients will survive or succumb to the rates of noncompliant and aggressive behavior) showed disease. Therefore, we have performed gene expression more clinically significant reductions in these profiling using cDNA microarrays containing 42,578 behaviors than high-risk control children. After clones and used artificial neural networks to develop an training, experimental teachers showed significantly accurate predictor of survival for each individual better classroom management skills than control patient with neuroblastoma. Using principal component teachers. One year later the experimental effects were analysis we found that neuroblastoma tumors exhibited maintained for parents who attended more than 6 inherent prognostic specific gene expression profiles. groups. The clinically significant reductions in Subsequent artificial neural network-based prognosis behavior problems for the highest risk experimental prediction using expression levels of all 37,920 good- children were also maintained. Implications of this quality clones achieved 88% accuracy. Moreover, prevention program as a strategy for reducing risk using an artificial neural network-based gene factors leading to delinquency by promoting social minimization strategy in a separate analysis we competence, school readiness, and reducing conduct identified 19 genes, including 2 prognostic markers problems are discussed. reported previously, MYCN and CD44, which correctly predicted outcome for 98% of these patients. Weegels ME, van Veen MP. Variation of consumer contact In addition, these 19 predictor genes were able to with household products: a preliminary investigation. additionally partition Children's Oncology Group- Risk Anal 2001; 21(3):499-511. stratified high-risk patients into two subgroups Abstract: Little information is available on product use according to their survival status (P = 0.0005). Our by consumers, which severely hampers exposure findings provide evidence of a gene expression estimation for consumer products. This article signature that can predict prognosis independent of describes actual contact with several consumer currently known risk factors and could assist products, specifically dishwashing detergents, cleaning physicians in the individual management of patients products, and hair styling products. How and where with high-risk neuroblastoma. products are handled, as well as the duration, frequency, and amount of use were studied by means Weigl DM, Bar-On E, Katz K. Small-fragment wounds from of diaries, in-home observations, and measurements. explosive devices: need for and timing of fragment This study addressed the question, "To what extent are removal. J Pediatr Orthop 2005; 25(2):158-61. frequency, duration, and amount of use associated?" Abstract: The management of soft tissue small- Findings showed that there was a large intra- as well as fragment wounds caused by bombs remains interindividual variation in frequency, duration, and controversial. The authors analyzed the outcome of amount of use, with the interindividual variation being low-energy foreign body injuries in 10 pediatric 941
- 950. victims of suicidebomber attacks treated in their transitioning to or during adolescence; e.g., problems at institution over a 2-year period. Two died during home, legal and school difficulties, and relationship primary surgery. The eight survivors underwent a total losses. These findings are discussed in terms of of 10 procedures for removal of foreign bodies. Eriksonian developmental theory. We offer Average follow-up was 24.1 months. The indications recommendations for intervention and prevention of for the procedures were analyzed by the time of their suicide. performance: immediate, as part of the primary emergency operation (n = 2); intermediate, within 2 Weine S, Muzurovic N, Kulauzovic Y et al. Family weeks after injury (n = 3); and late, more than 2 weeks consequences of refugee trauma. Fam Process 2004; after injury (n = 5). The results showed that all 43(2):147-60. operations performed for objective indications were Abstract: OBJECTIVE: To construct a model on the done within the immediate or intermediate period, consequences of political violence for refugee families whereas those done for subjective reasons were all but based upon a qualitative investigation. METHODS: one performed in the late period. By the final follow-up This study used a grounded-theory approach to analyze visit, all foreign bodies had been removed. In qualitative evidence from the CAFES multi-family conclusion, fragment removal is best done during the support and education groups with Bosnian refugee primary procedure if it does not pose a significant risk families in Chicago. Textual coding and analysis was of complications. conducted using ATLAS/ti for Windows. RESULTS: A grounded-theory model of Family Consequences of Weigle CG, Markovitz BP, Pon S. The Internet, the Refugee Trauma (FAMCORT) was constructed that electronic medical record, the pediatric intensive care describes Displaced Families of War across four realms unit, and everything. Crit Care Med 2001; 29(8 of family life: (1) changes in family roles and Suppl):N166-76. obligations, (2) changes in family memories and Abstract: This article details how computers have communications, (3) changes in family relationships changed life for those of us in pediatric intensive care. with other family members; and (4) changes in family A week of clinical activity is described, with a focus on connections with the ethnic community and nation the interactions with computer systems that have state. In each realm, the model also specifies family become an integral part of patient-care activities for strategies, called Families Rebuilding Lives, for many of us. It becomes clear that the boundaries managing those consequences. CONCLUSIONS: between personal computers, hospital systems, and the Political violence leads to changes in multiple Internet are often not sharply defined. Resources that dimensions of family life and also to strategies for are used every week may include those residing on a managing those changes. Qualitative family research is personal digital assistant, on the hospital's electronic useful in better understanding refugee families and in medical record, or on a distant site on the World Wide helping them through family-oriented mental health Web. Key resources on the Internet (World Wide Web services. and e-mail) are identified. The technical underpinnings, particularly the network that provides the infrastructure Weingarten K. Witnessing the effects of political violence in for various resources, are described. families: mechanisms of intergenerational transmission and clinical interventions. J Marital Fam Ther 2004; Weil WB. Russian roulette: final 2. Pediatrics 2005; 30(1):45-59. 115(5):1451. Abstract: In this era of globalization, when news about political violence can haunt anyone, anywhere, those Weinberger LE, Sreenivasan S, Sathyavagiswaran L, whose families have suffered political violence in the Markowitz E. Child and adolescent suicide in a large, past are particularly vulnerable to current distress. urban area: psychological, demographic, and Skilled in understanding transgenerational processes, situational factors. J Forensic Sci 2001; 46(4):902-7. family therapists need to be familiar with the Abstract: We examined all completed suicides by mechanisms by which children are exposed to the children and adolescents in Los Angeles County who effects of political violence suffered by their elders-that died during 1996 and 1997. There were 46 subjects, is, the ways in which they become their witnesses. This aged 11 through 16. The majority of the decedents article presents a framework for understanding how the were males and over age 14. The predominant racial trauma of political violence experienced in one group was Hispanic. There was an almost even split generation can "pass" to another that did not directly between firearms and hanging as the means of death. experience it, and proposes a model to guide clinical Females had a statistically significantly higher rate of intervention. prior suicide attempts than males. Over one-third left a suicide note, almost one-half were noted to be Weis SE, Moonan PK, Pogoda JM et al. Tuberculosis in the depressed, and 22% tested positive for alcohol or illicit foreign-born population of Tarrant county, Texas by drugs. Less than one-quarter were in mental health immigration status. Am J Respir Crit Care Med 2001; treatment. Eighty-seven percent had difficulty 164(6):953-7. 942
- 951. Abstract: The epidemiologyof tuberculosis is changing can be so striking, another element may need to be in the United States as a result of immigration, yet the incorporated into risk characterization: a process of extent to which different classes of immigrants ethics assessment. A scheme for doing so can be contribute to overall morbidity is unknown. derived from the procedures of fuzzy logic, which Tuberculosis in nonimmigrant visitors is of particular allow rules to be formulated that are applicable to interest as they are currently exempt from screening ethical principles. Such an approach incorporates some requirements. We conducted a prospective survey of all of the tenets of the precautionary principle. culture-positive tuberculosis patients in Tarrant County, Texas from 1/98 to 12/00. Immigration status Weiss HB, Little PM, Bouffard SM. More than just being of foreign-born patients was classified as permanent there: balancing the participation equation. New Dir residents, undocumented, or nonimmigrant visitors. Of Youth Dev 2005; (105):15-31, 9-10. 274 eligible participants, 114 (42%) were foreign-born; Abstract: The research and evaluation evidence is of these, 67 (59%) were permanent residents, 28 (25%) mounting: out-of-school-time (OST) programs can were undocumented, and 19 (17%) were nonimmigrant keep young people safe, support working families, and visitors. Among the foreign-born, we observed improve academic achievement and social significant differences by immigration status in development. Over 6 million children are enrolled in multidrug resistance (p = 0.02), human after-school programs nationwide, but an estimated immunodeficiency virus (HIV) infection (p = 0.0007), 14.3 million children still care for themselves in the and hospitalization (p = 0.03 for ever/never, 0.01 for nonschool hours. Because of this discrepancy, OST duration). Compared with other immigrants, more stakeholders need information about how to maximize nonimmigrant visitors were multi-drug-resistant (16 % participation in OST programs. The Harvard Family versus 11% of undocumented residents and 1% of Research Project (HRFP) has developed a conceptual permanent residents), were HIV-positive (32% versus model, based on scholarly theory, empirical research, 0% of undocumented and 5% of permanent residents), and knowledge gained from providers, that describes were hospitalized (47% versus 36% of undocumented the characteristics that predict participation in OST and 19% of permanent residents), and had lengthy programs as well as the potential benefits of that hospitalizations (median [midspread] days = 87 [25 to participation. In the center of the model, participation 153] versus 8.5 [4 to 28] for undocumented and 10 [7 is conceived as a three-part construct of enrollment, to 24 d] for permanent residents). We found attendance, and engagement. This equation serves as nonimmigrant visitors to be an important source of the basis for framing this issue of New Directions for tuberculosis morbidity in Tarrant County. Further Youth Development. The chapter provides an overview studies in other regions of the U.S. are needed to of why participation in OST programs matters for determine if screening and treatment recommendations young people, describes some of the barriers and of persons who spend extended periods in the U.S. challenges to youth participation, teases out more should be raised to the standards set for permanent precise definitions of participation, and presents residents. HFRP's conceptual model of participation. It focuses on the participation equation and concludes by Weiss B. Ethics assessment as an adjunct to risk assessment highlighting some overarching themes that recur in the evaluation of developmental neurotoxicants. throughout the issue and that have an impact on future Environ Health Perspect 2001; 109 Suppl 6:905-8. directions for research and evaluation. Abstract: The conduct of experimental studies in humans is governed by a body of principles whose Weiss K. Authority as coercion:when authority figures abuse main precepts have evolved over the past few decades. their positions to perpetrate child sexual abuse. J Child Three of these provide the foundations for judging the Sex Abus 2002; 11(1):27-51. ethical adequacy of such an experiment. One addresses Abstract: ABSTRACT. This article discusses child the question of who receives the benefits of the sexual abuse by a person in a position of authority, research and who bears its burdens (justice). A second such as the child's teacher, guardian, relative, sports requires that the research maximize the potential coach, or other person with authority over a child benefits to the subjects and minimize the risk of harm because of his/her particular position. The article tracks (beneficence). The third, the source of guidelines for the recent trend toward recognizing position of informed consent, requires that subjects enter into the authority in both state legislation and judicial research voluntarily and with adequate information precedent. Understanding the confusion and (respect for persons). Unlike research conducted to intimidation surrounding a child's experiences as a evaluate drugs, however, environmental exposures to result of being sexually abused by a person in a potentially toxic chemicals do not survey those position of authority often explains why children often exposed for their consent, nor do they provide an fail to report or delay in reporting such abuse. Thus, appropriate calculus for measuring risks and benefits, existence of a perpetrator's position of authority in a which typically involve two different populations. particular case of child sexual abuse should influence a Especially for exposure to developmental court's rulings on the elements of sexual abuse or neurotoxicants, where the risk-benefit incompatibility assault in particular state statutes, as well as what 943
- 952. evidence should beadmissible. Ultimately, the author ROR encounters that a family receives during well- concludes that all states should recognize position of child visits and a child's home literacy profile, while authority in their child abuse statutes, that such statutes accounting for important confounders, such as the should be interpreted broadly by the courts, and, quality of the home environment. METHODS: A finally, that evidence of the defendant's prior acts of cross-sectional study was conducted of 137 children sexual abuse should almost always be admissible at (aged 18-30 months) who received pediatric well-child trial. care at the Yale-New Haven Hospital Primary Care Center. The number of ROR encounters that the family Weissenberger AA, Dell ML, Liow K et al. Aggression and received was determined though parent interview, psychiatric comorbidity in children with hypothalamic direct observation, and a review of the medical record. hamartomas and their unaffected siblings. J Am Acad After a brief waiting room interview, a home visit was Child Adolesc Psychiatry 2001; 40(6):696-703. conducted. An assessment of the child's home literacy Abstract: OBJECTIVE: To assess aggression and environment was completed on the basis of 10 psychiatric comorbidity in a sample of children with variables that were obtained from parent report and hypothalamic hamartomas and gelastic seizures and to direct observation within the home. These variables assess psychiatric diagnoses in siblings of study were summed to form a Child Home Literacy Index. subjects. METHOD: Children with a clinical history of The Home Observation for Measurement of the gelastic seizures and hypothalamic hamartomas (n = Environment, a standardized measure of the nurturing 12; age range 3-14 years) had diagnoses confirmed by quality of the home environment, was also video-EEG and head magnetic resonance imaging. administered. Hierarchical linear regression was Structured interviews were administered, including the conducted to determine the significance of ROR on a Diagnostic Interview for Children and Adolescents- child's home literacy environment. RESULTS: A total Revised Parent Form (DICA-R-P), the Test of Broad of 100 families completed both a waiting room Cognitive Abilities, and the Vitiello Aggression Scale. interview and a home visit. Families received between Parents were interviewed with the DICA-R-P about 0 and 6 books in the ROR program. A total of 93% of each subject and a sibling closest in age without families reported reading to their children, but only seizures and hypothalamic hamartomas. Patients were 35% of parents identified reading as a favorite activity seen from 1998 to 2000. RESULTS: Children with of their child and 45% of parents reported that this was gelastic seizures and hypothalamic hamartomas a favorite joint activity. Hierarchical linear regression displayed a statistically significant increase in demonstrated that increasing frequency of ROR comorbid psychiatric conditions, including encounters contributed a small but significant portion oppositional defiant disorder (83.3%) and attention- of the variance explaining a child's home literacy deficit/hyperactivity disorder (75%). They also profile (5%), with this model accounting for a total of exhibited high rates of conduct disorder (33.3%), 19% of the variance. CONCLUSIONS: A modest speech retardation/learning impairment (33.3%), and literacy intervention, such as ROR, can have a anxiety and mood disorders (16.7%). Significant rates significant impact on a child's home literacy of aggression were noted, with 58% of the seizure environment. patients meeting criteria for the affective subtype of aggression and 30.5% having the predatory aggression Welles-Nystrom B. Co-sleeping as a window into Swedish subtype. Affective aggression was significantly more culture: considerations of gender and health care. common (p < .05). Unaffected siblings demonstrated Scand J Caring Sci 2005; 19(4):354-60. low rates of psychiatric pathology on semistructured Abstract: The purpose of this study is to examine the parental interview and no aggression as measured by Swedish practice of co-sleeping and relate it to the the Vitiello Aggression Scale. CONCLUSIONS: cultural discourse on the gendered family and health. Children with hypothalamic hamartomas and gelastic The Swedish study, part of the International Study of seizures had high rates of psychiatric comorbidity and Parents, Children and Schools, focuses on some aggression. Parents reported that healthy siblings had Western parents' ideas about health, child development, very low rates of psychiatric pathology and aggression. child-rearing goals and parental practices. It also addressed specific questions regarding parents' theories Weitzman CC, Roy L, Walls T, Tomlin R. More evidence about the nature, gender and frequency of co-sleeping for reach out and read: a home-based study. Pediatrics in Swedish families. Quantitative and qualitative data 2004; 113(5):1248-53. were collected with five cohorts of parents and their 60 Abstract: OBJECTIVE: Reach Out and Read (ROR), a children who ranged in age from 6 months to 8 years. clinic-based literacy program, has been shown to The sample was balanced for sex and birth order. improve literacy outcomes in impoverished children. Parents completed batteries of standardized No study has used direct observation to assess a child's questionnaires and they were interviewed about their home literacy environment or to control for important beliefs and practices related to child rearing and child confounders, such as the quality of the home development. A questionnaire about co-sleeping was environment. The objective of this study was to sent post hoc to the families. The results showed that determine the relationship between the frequency of Swedish children often co-sleep with both their parents 944
- 953. until school age,when more boys than girls cease the the use of pulsed-field gel electrophoresis (PFGE). practice. This is an important finding, because much of RESULTS: From 1 October 2001 through 24 March the literature suggests that this practice exists primarily 2002, an estimated excess of 439 S. Oranienburg for infants in non-Western cultures who co-sleep with notifications was registered in Germany. their mothers. Co-sleeping in Sweden is perceived as a Simultaneously, an increase in S. Oranienburg normal family activity, which differed from the other infections was noted in other European countries in the societies studied. Thus, the study of practice has Enter-net surveillance network. In a multistate matched important methodological implications. When a family case-control study in Germany, daily consumption of practice is studied, carefully documented and chocolate (matched odds ratio [MOR]: 4.8; 95% understood in its many dimensions, it provides a confidence interval [CI]: 1.3-26.5), having shopped at a window into the culture in which the practice is large chain of discount grocery stores (MOR: 4.2; CI: embedded and may explain how gender relates to the 1.2-23.0), and consumption of chocolate purchased practice. For health-care professionals who encounter there (MOR: 5.0; CI: 1.1-47.0) were associated with families from diverse cultural backgrounds, this illness. Subsequently, two brands from the same methodological approach illustrates how parenting company, one exclusively produced for that chain, practices relate to health-care issues. tested positive for S. Oranienburg. In two other European countries and in Canada chocolate from Welsh JP, Ahn ES, Placantonakis DG. Is autism due to brain company A was ascertained that also contained S. desynchronization? Int J Dev Neurosci 2005; 23(2- Oranienburg. Isolates from humans and from 3):253-63. chocolates had indistinguishable PFGE profiles. No Abstract: The hypothesis is presented that a disruption source or point of contamination was identified. in brain synchronization contributes to autism by Epidemiological identification of chocolate as a vehicle destroying the coherence of brain rhythms and slowing of infections required two months, and was facilitated overall cognitive processing speed. Particular focus is by proxy measures. CONCLUSIONS: Despite the use on the inferior olive, a precerebellar structure that is of improved production technologies, the chocolate reliably disrupted in autism and which normally industry continues to carry a small risk of generates a coherent 5-13 Hz rhythmic output. New manufacturing Salmonella-containing products. electrophysiological data reveal that the continuity of Particularly in diffuse outbreak-settings, clear the rhythmical oscillation in membrane potential associations with surrogates of exposure should suffice generated by inferior olive neurons requires the to trigger public health action. Networks such as Enter- formation of neuronal assemblies by the connexin36 net have become invaluable for facilitating rapid and protein that mediates electrical synapses and promotes appropriate management of international outbreaks. neuronal synchrony. An experiment with classical eyeblink conditioning is presented to demonstrate that Werneck GL, Rodrigues L, Santos MV et al. The burden of the inferior olive is necessary to learn about sequences Leishmania chagasi infection during an urban outbreak of stimuli presented at intervals in the range of 250-500 of visceral leishmaniasis in Brazil. Acta Trop 2002; ms, but not at 700 ms, revealing that a disruption of the 83(1):13-8. inferior olive slows stimulus processing speed on the Abstract: First noted in the city of Teresina in 1981, the time scale that is lost in autistic children. A model is last decades have witnessed a remarkable increase in presented in which the voltage oscillation generated by urban transmission of American visceral leishmaniasis populations of electrically synchronized inferior (VL) in many Brazilian cities. Teresina, the site of this olivary neurons permits the utilization of sequences of study, has faced two large outbreaks of VL. The first stimuli given at, or faster than, 2 per second. It is occurred from 1981-1985 when almost 1000 new cases expected that the disturbance in inferior olive structure were reported. The second started in the 1990s, and in autism disrupts the ability of inferior olive neurons between 1993 and 1996 more than 1200 new cases to become electrically synchronized and to generate were detected. This report describes the prevalence of coherent rhythmic output, thereby impairing the ability infection with Leishmania chagasi in Teresina at the to use rapid sequences of cues for the development of end of the second outbreak and gives estimates of the normal language skill. Future directions to test the number of people who became infected during the hypothesis are presented. epidemic. Between June 1995 and May 1996, 200 households were chosen at random from a list of Werber D, Dreesman J, Feil F et al. International outbreak of addresses covering about 93% of Teresina's urban Salmonella Oranienburg due to German chocolate. households. In each household, one person over the age BMC Infect Dis 2005; 5(1):7. of 1 year was screened for Leishmania antibodies and Abstract: BACKGROUND: This report describes a skin-tested. Nearly 50% of persons had a positive large international chocolate-associated Salmonella leishmanin reaction, but only 13.9% had detectable outbreak originating from Germany. METHODS: We antibodies to L. chagasi. While prevalence estimates conducted epidemiologic investigations including a based on the leishmanin skin-test increased with age case-control study, and food safety investigations. (P<0.001), those based on serological tests showed a Salmonella (S.) Oranienburg isolates were subtyped by lesser, and non significant, variation with age (P=0.31). 945
- 954. Using a geometricgrowth equation, and assuming that 365(9466):1278-9. the annual distribution of clinical cases may serve as an approximation to what would have been the Whaley SE, O'Connor And MJ, Gunderson B. Comparison distribution of infections by year, we estimated that of the adaptive functioning of children prenatally over 320000 persons were infected during the exposed to alcohol to a nonexposed clinical sample. epidemic. Little is known about the epidemiology of Alcohol Clin Exp Res 2001; 25(7):1018-24. VL in urban areas, where social networks, population Abstract: BACKGROUND: Several studies show density, and relationships of housing with the natural impairments in the social and adaptive behaviors of environment are more varied and complex than in the children prenatally exposed to alcohol. However, there rural scene. In those areas, control interventions have remains limited consensus on whether the alcohol failed to eliminate transmission of the parasite and exposure directly affects social functioning or whether prevent new epidemics. Further epidemiological its effect is mediated by deficits in IQ. In addition, no studies of VL in urban areas might be needed to inform studies have investigated whether deficits in social control actions. functioning are significantly more pronounced in children prenatally exposed to alcohol than in children Werner MJ. Principles of child health care financing. referred to psychiatric treatment who were not American Academy of Pediatrics Committee on Child prenatally exposed. We explored the effect of alcohol Health Financing. Pediatrics 2003; 112(4):997-9. exposure on social and adaptive functioning and Notes: CORPORATE NAME: American Academy of explored whether or not social and adaptive Pediatrics Committee on Child Health Financing functioning are significantly more impaired in children Abstract: Child health care financing must maximize prenatally exposed to alcohol than in a clinical sample access to quality, comprehensive pediatric and prenatal of children. METHODS: A sample of 33 alcohol- health care. This policy statement replaces the 1998 exposed children was compared with a sample of 33 policy statement by the same title. Changes reflect clinic-referred nonexposed children. The groups were recent state and federal legislation that affect child compared on measures of communication, daily living health care financing. The principles outlined in the skills, and socialization. The groups were matched on statement will be used to evaluate the changing sex, age, IQ, and outpatient or inpatient status. structure of child health care financing. RESULTS: Analyses revealed that the prenatally alcohol-exposed children did not differ significantly West JC. Hospital may be liable for actions of nurse who from the nonexposed children in any of the domains of molested child. E.P. v. McFadden,-- So. 2d, 2000 WL adaptive functioning. However, with age, exposed 303063, No. 298 (Ct. Civ. App. Ala. March 24, 2000). children showed a more rapid decline in socialization J Healthc Risk Manag 2001; 21(2):46-7. standard scores compared with the nonexposed clinical sample. CONCLUSIONS: Young children who were West JC. Parents do not have authority to refuse to consent exposed to alcohol prenatally show deficits in all to resuscitation of fetus born alive. HCA, Inc. v. Miller. domains of adaptive functioning. Although these J Healthc Risk Manag 2001; 21(3):33-4. deficits do not seem to differ from those exhibited by Notes: GENERAL NOTE: KIE: 1 ref. young children with psychiatric problems but no GENERAL NOTE: KIE: KIE Bib: allowing to prenatal exposure, deficits in socialization behavior of die/infants; informed consent/minors; resuscitation prenatally exposed children may become more orders; treatment refusal/minors significant with age. Westermann G, Reck Miranda E. A new model of While A. Awful things can happen inside the home. Br J sensorimotor coupling in the development of speech. Community Nurs 2001; 6(7):369. Brain Lang 2004; 89(2):393-400. Abstract: We present a computational model that learns While A. Regardless of group, abuse is unacceptable. Br J a coupling between motor parameters and their sensory Community Nurs 2004; 9(2):90. consequences in vocal production during a babbling phase. Based on the coupling, preferred motor Whitbeck LB, Hoyt DR, McMorris BJ, Chen X, Stubben JD. parameters and prototypically perceived sounds Perceived discrimination and early substance abuse develop concurrently. Exposure to an ambient language among American Indian children. J Health Soc Behav modifies perception to coincide with the sounds from 2001; 42(4):405-24. the language. The model develops motor mirror Abstract: This study investigated internalizing and neurons that are active when an external sound is externalizing symptoms as potential mediators of the perceived. An extension to visual mirror neurons for relationship between perceived discrimination and oral gestures is suggested. early substance abuse among 195 American Indian 5 through 8 graders from three reservations that share a Wexler ID, Branski D, Kerem E. Treatment of sick children common culture (e.g., language, spiritual beliefs, and during low-intensity conflict. Lancet 2005; traditional practices) in the upper Midwest. The 946
- 955. findings indicated that, although perceived psychiatric inpatients. Predictors of eating disorder discrimination contributed significantly to internalizing features (dietary restraint, binge eating, and purging) symptoms among the adolescents, internalizing and body image dissatisfaction (BID) were tested symptoms were unrelated to early substance abuse. separately for the three ethnic groups. In addition to the Rather, the effects of perceived discrimination on early eating and BID variables, the following predictor substance abuse were mediated by adolescent anger variables were considered: depression, anxiety, and delinquent behaviors. The results are discussed in impulsivity, negative self-esteem, peer insecurity, and terms of the consequences of perceived discrimination abuse. RESULTS: Caucasians reported significantly on the development of American Indian early higher levels of dietary restraint and BID than Latinas adolescents. and African Americans, whereas reports of binge eating did not differ by ethnicity. Regression analyses White HR, Chen PH. Problem drinking and intimate partner revealed that the predictor variables accounted for violence. J Stud Alcohol 2002; 63(2):205-14. significant and substantial amounts of the variance in Abstract: OBJECTIVE: This study examined the role the four eating and body image domains. Different of problem drinking in intimate partner violence (IPV) psychological and social variables predicted eating perpetration and victimization for men and women. We disorder symptoms and BID across ethnic groups. assessed (1) whether the relationship between problem DISCUSSION: These findings suggest, for drinking and IPV was spurious and (2) if relationship psychiatrically hospitalized adolescent females, that dissatisfaction and partner drinking mediated the different patterns of factors may contribute to the effects of problem drinking on IPV. METHOD: Five maintenance of eating and body image disturbances waves of longitudinal data from a nonclinical sample across ethnic groups. Future research testing models of (N = 725; 400 women), aged 12 through 31 years, were the etiology or maintenance of these disturbances needs analyzed to determine the effects of problem drinking to include ethnicity to ascertain whether the on IPV after controlling for eight common risk factors. hypothesized components operate differently by Regression analyses were conducted to determine ethnicity. whether relationship dissatisfaction and partner drinking patterns mediated the effects of problem White SR, Henretig FM, Dukes RG. Medical management drinking on IPV after controlling for these same risk of vulnerable populations and co-morbid conditions of factors. RESULTS: With controls, problem drinking victims of bioterrorism. Emerg Med Clin North Am significantly predicted perpetration and victimization 2002; 20(2):365-92, xi. for men and women. Partner drinking was not related Abstract: Planning for the medical response to to perpetration or victimization for men. For women, bioterrorism has primarily focused around the needs of partner drinking was strongly related to perpetration the population as a whole. There has been little and victimization. It fully mediated the effects of discussion pertaining to certain vulnerable groups such problem drinking on perpetration, but did not mediate as children, pregnant women, or immunocompromised these effects on victimization. Relationship patients, yet they will likely comprise a significant dissatisfaction fully mediated the effects of problem subset of the exposed population. In addition, they will drinking on male and female perpetration and partially be at increased risk for morbidity and mortality mediated the effects on male victimization. following an attack. The emergency response to Relationship dissatisfaction did not mediate the effects bioterrorism will be more complex as it relates to these of problem drinking on female victimization. vulnerable populations. Careful consideration of their CONCLUSIONS: The relationship between problem special needs, some of which are presented in this drinking and IPV was not spurious for men or women. article, may refine our efforts. Heavier drinking by partners put women at greater risk for perpetration and victimization and mediated the Whitelaw A, Thoresen M. Clinical trials of treatments after effects of their own problem drinking on perpetration. perinatal asphyxia. Curr Opin Pediatr 2002; 14(6):664- Programs that prevent and treat problem drinking 8. among young men should have a beneficial impact on Abstract: Following critical hypoxia-ischemia during reducing IPV. labor and delivery, there is a window of therapeutic opportunity during hypoxic-ischemic encephalopathy. White MA, Grilo CM. Ethnic differences in the prediction of Meta-analysis of three randomized trials of eating and body image disturbances among female prophylactic barbiturate therapy for neonatal hypoxic- adolescent psychiatric inpatients. Int J Eat Disord ischemic encephalopathy showed no significant effect 2005; 38(1):78-84. on death or disability. One randomized trial of Abstract: OBJECTIVE: The current study examined allopurinol showed short-term benefits but was too predictors of eating and body image disturbances in small to test death or disability. No adequate trials of psychiatrically hospitalized female adolescents and dexamethasone, calcium channel blockers, or investigated whether the predictors differ by ethnicity. magnesium sulphate have yet been completed, but pilot METHOD: Participants were 427 (320 Caucasian, 53 studies in infants have shown the cardiovascular risks Latina, 54 African American) female adolescent of magnesium sulphate and calcium channel blockers. 947
- 956. There is considerableevidence from animal studies that carried out that yielded three components of infidelity: posthypoxic mild hypothermia reduces brain injury. sexual infidelity, emotional infidelity, and One small randomized trial of mild hypothermia found pornography. More importantly, this study revealed no adverse effects but was too small to examine death that online acts of betrayal do not fall into a discrete or disability. One large randomized trial of selective category of their own. A MANOVA was performed head cooling has finished recruitment and a number of and revealed a statistically significant difference on the large trials of systemic mild hypothermia are ongoing. combined dependent variables for the interaction of As time is critical with post-hypoxic interventions, the gender by age, age by relationship status, and Internet delay involved in obtaining informed parental consent sexual experience. The hypotheses were, in part, for such trials might obscure a clinically important supported. However, counter to what was predicted, in therapeutic effect. the main younger people were more likely to rate sexual acts as acts of betrayal than older individuals. It Whitfield A. The conjoined twins. Transcript of the speeches is concluded here that individuals do perceive some given at the BAFS annual dinner on 28 February 2002. online interactions to be acts of betrayal. In contrast to British Academy of Forensic Sciences. Med Sci Law some researchers' claims, it is suggested here that we 2002; 42(4):277-80. do need to consider how bodies are reconstructed online. Moreover, these results have important Whitfield CL, Dube SR, Felitti VJ, Anda RF. Adverse implications for any treatment rationale for infidelity childhood experiences and hallucinations. Child Abuse (both online and offline). Negl 2005; 29(7):797-810. Abstract: OBJECTIVE: Little information is available Wicks E. The greater good?: issues of proportionality and about the contribution of multiple adverse childhood democracy in the doctrine of necessity as applied in Re experiences (ACEs) to the likelihood of reporting A. Common Law World Rev 2003; 32(1):15-34. hallucinations. We used data from the ACE study to Notes: GENERAL NOTE: KIE: 70 fn. assess this relationship. METHODS: We conducted a GENERAL NOTE: KIE: KIE Bib: patient care/minors survey about childhood abuse and household Abstract: This article examines the criminal law dysfunction while growing up, with questions about doctrine of necessity as applied in the conjoined twins health behaviors and outcomes in adulthood, which case (Re A (Children) (Conjoined Twins: Surgical was completed by 17,337 adult HMO members in Separation) [2000] 4 All ER 961). It determines that order to assess the independent relationship of 8 the public law principle of proportionality underlies the adverse childhood experiences and the total number of doctrine, but identifies the preservation of life as the ACEs (ACE score) to experiencing hallucinations. We guiding principle behind the Court of Appeal's use of used logistic regression to assess the relationship of the necessity in Re A. The article is critical of this ACE score to self-reported hallucinations. RESULTS: elevation of the preservation of life under the doctrine We found a statistically significant and graded of necessity and argues for an alternative conception of relationship between histories of childhood trauma and necessity based upon fundamental constitutional histories of hallucinations that was independent of a principles such as human rights and democracy. The history of substance abuse. Compared to persons with 0 principle of democracy has particular pertinence to the ACEs, those with 7 or more ACEs had a five-fold issue of necessity because it may be endangered by this increase in the risk of reporting hallucinations. common law justificatory defence. This conflict CONCLUSION: These findings suggest that a history between democracy and necessity, it is argued, further of childhood trauma should be looked for among supports the need for the constitutional value of persons with a history of hallucinations. democracy to play a key role in any application of necessity in future cases. Whitfield L. e-novation. Child in mind. Health Serv J 2003; 113(5882):suppl 8-9. Widom CS, Czaja SJ. Reactions to research participation in vulnerable subgroups. Account Res 2005; 12(2):115- Whiting L, Whiting M, Whiting T, Whiting L. Smacking: a 38. family perspective. Paediatr Nurs 2004; 16(8):26-8. Notes: GENERAL NOTE: KIE: 27 refs. GENERAL NOTE: KIE: KIE Bib: behavioral Whitty MT. Pushing the wrong buttons: men's and women's research/special populations attitudes toward online and offline infidelity. Abstract: This paper describes the extent to which Cyberpsychol Behav 2003; 6(6):569-79. vulnerable individuals (defined by economic, social, Abstract: Despite current researchers' interest in the psychological, physical health, and child maltreatment study of online sexual addiction, there is a dearth of status) react to research participation. As part of an research available on what constitutes online infidelity. ongoing longitudinal study, participants (N=896) This paper attempts to redress this balance by completed a lengthy and intrusive in-person interview comparing 1,117 participants' attitudes toward online and provided a small amount of blood through finger and offline acts of infidelity. A factor analysis was pricks. At the end of the interview, participants were asked eight questions about their reactions to the 948
- 957. research experience. Vulnerableindividuals in general Wiener LS, Vasquez MJ, Battles HB. Brief report: fathering agreed more strongly about having an emotional a child living with HIV/AIDS: psychosocial adjustment reaction, but were not less willing to continue to and parenting stress. J Pediatr Psychol 2001; participate. In addition, psychologically vulnerable 26(6):353-8. individuals more strongly agreed they would continue Abstract: OBJECTIVE: To examine the psychosocial to participate, were treated with respect and dignity, stressors experienced by fathers of children diagnosed and found their participation meaningful. Compared to with HIV/AIDS. METHODS: Thirty-one fathers whites, nonwhites reported stronger agreement about whose children (ages 6 to 19) were participating in the meaningfulness of the research and the belief that pediatric HIV clinical trials completed self-report their responses would be kept private. Like others, measures of parenting stress, psychological distress, individuals vulnerable by virtue of their prisoner status and need for psychosocial services. RESULTS: Over or homelessness (past or current) agreed more strongly half of this sample experienced significantly elevated about having an emotional reaction to the interview, levels of both parenting stress and psychological but otherwise did not differ in their reactions. These distress compared to standardized norms. Ninety-seven results suggest that researchers and institutional review percent of these men reported the need for services boards should not be deterred from conducting research including gender-specific support groups, assistance on sensitive topics with potentially vulnerable with discipline, disease management, and assistance populations. with planning for the future. CONCLUSIONS: Elevated levels of parenting stress and psychological Wiehe VR. Empathy and narcissism in a sample of child distress in fathers of children living with HIV suggest abuse perpetrators and a comparison sample of foster the need for additional psychological intervention in parents. Child Abuse Negl 2003; 27(5):541-55. this population. Abstract: OBJECTIVE: The purpose of this research was to study the personality variables of empathy and Wierzba TF, El-Yazeed RA, Savarino SJ et al. The narcissism in a sample of child abuse perpetrators and a interrelationship of malnutrition and diarrhea in a comparison sample of foster parents, conceptualized as periurban area outside Alexandria, Egypt. J Pediatr nonabusive parents, in order to gain further Gastroenterol Nutr 2001; 32(2):189-96. understanding of perpetrators and to provide clues for Abstract: BACKGROUND: In the developing world, intervention. METHOD: The sample consisted of two children are often observed to have both diarrhea and groups: physically and emotionally abusive parents malnutrition. This observation has led many (n=52) and foster parents (n=101). Participants researchers to speculate that diarrhea may produce responded to three instruments: the Interpersonal malnutrition and that malnutrition may predispose to Reactivity Index (IRI), an instrument measuring diarrhea. In this study, the interrelationship between individual differences in empathy, and two instruments diarrhea and malnutrition was investigated among 143 measuring narcissism: the Narcissistic Personality Egyptian children less than 3 years of age. METHODS: Inventory (NPI) and the Hypersensitivity Narcissism For 22 months, children were followed for diarrhea at Scale (HSNS). RESULTS: Statistically significant twice weekly home visits and measured for nutritional differences were found between the two groups on status at approximately 3-month intervals. Nutritional three of the four subscales of the IRI: perspective- measurements were converted to z-scores based on the taking, empathic concern, and personal distress. Based National Center for Health Statistics/World Health on the definition of these subscales, the abusive parents Organization (NCHS/WHO) reference population. as compared to the foster parents were not able to take RESULTS: Three hundred fifty-eight diarrheal the perspective of another or see things from another's episodes were reported with only 1% of episodes viewpoint, showed less warmth, compassion and lasting 14 days or more. Stunting, wasting, and low concern for others, and experienced difficulty in tense weight-for-age were found in 19%, 3%, and 7%, of interpersonal situations. Statistically significant these children, respectively. When testing whether differences were found for the two groups on three of malnutrition predisposes to diarrhea, a weight-for-age the six subscales of the NPI: authority, exhibitionism, z-score of <-2 standard deviations was associated with and superiority, and on the HSNS. The abusive parents increased incidence of diarrhea (RR = 1.7, P < 0.01) demonstrated less self-confidence, a greater lack of but not height-for-age or weight-for-height. Diarrhea impulse control and were more narcissistic than their itself was associated with a subsequent attack of foster parent counterparts. CONCLUSIONS: The diarrhea (RR = 2.1, P < 0.001). During short intervals results suggest that it is how the perpetrators of follow-up (approximately 3 months), an association experience aversive behavior in their children that may was detected between diarrhea episodes and growth provoke them to physically and emotionally abuse their faltering for height-for-age z-score (-0.16, P < 0.05). children. Their self-centeredness in addition to their This association was reduced, however, when analyzed deficiencies in empathy may cause them to experience during 6-month intervals, if no diarrhea was reported in their children's misbehavior as an affront to their either the first or second half of this interval. authority. Implications for treatment are made from CONCLUSIONS: In a population with moderate this conceptualization of parental abuse. malnutrition, both low weight-for-age and diarrhea 949
- 958. itself are associatedwith increased diarrhea risk. as part of the longitudinal component of the World Diarrhea alone does not appear to contribute Health Organization (WHO) Multicentre Growth substantially to malnutrition when children have Reference Study (MGRS). Infants were followed from diarrhea-free time for catch-up growth. the age of four months until they could walk independently. Six milestones that are fundamental to Wiggins M, Oakley A, Roberts I et al. Postnatal support for acquiring self-sufficient erect locomotion and are mothers living in disadvantaged inner city areas: a simple to evaluate were assessed: sitting without randomised controlled trial. J Epidemiol Community support, hands-and-knees crawling, standing with Health 2005; 59(4):288-95. assistance, walking with assistance, standing alone, and Abstract: STUDY OBJECTIVE: To evaluate the effect walking alone. The information was collected by both of two forms of postnatal social support for the children's caregivers and trained MGRS disadvantaged inner city mothers on maternal and child fieldworkers. The caregivers assessed and recorded the health outcomes. DESIGN: Randomised controlled dates when the milestones were achieved for the first trial with economic and process evaluations and follow time according to established criteria. Using up at 12 and 18 months. The two intervention groups standardized procedures, the fieldworkers received either the offer of a year of monthly independently assessed the motor performance of the supportive listening home visits by a support health children and checked parental recording at home visits. visitor (SHV), or a year of support from community To ensure standardized data collection, the sites groups providing drop in sessions, home visiting and/or conducted regular standardization sessions. Data telephone support (CGS). Each was compared with a collection and data quality control took place control group that received standard health visitor simultaneously. Data verification and cleaning were services. SETTING: Two disadvantaged boroughs of performed until all queries had been satisfactorily London, United Kingdom. PARTICIPANTS: 731 resolved. women from culturally diverse backgrounds with infants. MAIN RESULTS: At 12 and 18 months, there Wildeman S, Downie J. Genetic and metabolic screening of was little impact for either intervention on the main newborns: must health care providers seek explicit outcomes: child injury (SHV: relative risk 0.99; 95% parental consent? Health Law J 2001; 9:61-111. confidence intervals 0.68 to 1.45, CGS: 0.91; 0.61 Notes: GENERAL NOTE: KIE: 181 fn. to1.36), maternal smoking (SHV: 0.86; 0.62 to 1.19, GENERAL NOTE: KIE: KIE Bib: genetic screening; CGS: 0.97; 0.72 to 1.33) or maternal depression (SHV: informed consent/minors; mass screening 0.86; 0.62 to1.19, CGS: 0.93; 0.69 to 1.27). SHV women had different patterns of health service use Wilder J, Granlund M. Behaviour style and interaction (with fewer taking their children to the GP) and had between seven children with multiple disabilities and less anxious experiences of motherhood than control their caregivers. Child Care Health Dev 2003; women. User satisfaction with the SHV intervention 29(6):559-67. was high. Uptake of the CGS intervention was low: Abstract: INTRODUCTION: Recent studies show that 19%, compared with 94% for the SHV intervention. the existing interaction patterns of children with CONCLUSIONS: There was no evidence of impact on multiple disabilities should be taken into consideration the primary outcomes of either intervention among this when planning communication interventions. For culturally diverse population. The SHV intervention children with disabilities, it is especially important that was associated with improvement in some of the the partner in interaction is sensitive and well aware of secondary outcomes. the importance of a qualitatively successful interaction. Wilder (unpublished report) found that the behaviour Wiggs L. Sleep problems in children with developmental style of 30 children with multiple disabilities was more disorders. J R Soc Med 2001; 94(4):177-9. related to the caregiver-perceived interaction than the communicative skills and functional abilities of the Wijma B, Gustafsson LE, Thapar-Bjorkert S, Swahnberg K. children. This study inductively explored the What is an error? J Psychosom Obstet Gynaecol 2005; caregivers' perceptions of interaction within seven 26(4):233-5. caregiver-child dyads. The research questions were: How do the caregivers perceive the interaction? How Wijnhoven TM, de Onis M, Onyango AW et al. Assessment do the caregivers perceive the children's behaviour of gross motor development in the WHO Multicentre style to be related to the interaction with the Growth Reference Study. Food Nutr Bull 2004; caregivers? METHOD: The children were selected 25(1):S37-45. individually from the participants in Wilder Abstract: The objective of the Motor Development (unpublished report) depending upon the responses the Study was to describe the acquisition of selected gross caregivers had given about the children's self- motor milestones among affluent children growing up regulation and reactivity in the Carolina Record of in different cultural settings. This study was conducted Individual Behaviour questionnaire. The study was in Ghana, India, Norway, Oman, and the United States undertaken by means of home visits where the caregivers participated in an interview asking about 950
- 959. their strategies forinteraction, how they perceived the documented in two states. In five programs, roles of the children and their own roles in interaction, immunoreactive trypsinogen exclusively was used to the caregivers' opinion of what an interaction identify at-risk infants. In seven programs, a second constituted of and the caregivers' aims and aspiration tier DNA test was also used, but these programs each for interaction. The data analysis was performed by had distinct strategies. In only two programs where meaning concentration and categorization through a DNA testing was performed and normal sweat tests pendulum between the parts and the entirety of the indicated carrier status, were results routinely provided interviews. In this way, hermeneutics and thematic to parents "in person" at a CF center. CONCLUSION: analysis were both being practised. RESULTS: The The diversity of approaches for screening approaches results of the interviews are presented as a model with and strategies has advantages for future policy categorizations as a network. The categorizations decisions, provided that data about the clinical and reflect the system of themes that permeate how the psychosocial impact of screening from these programs caregivers perceived interaction in the dyad. The are collected and disseminated. As additional states themes are: sharing of experience, successful determine that the resources are available, programs interaction, role of the child, role of the caregiver, can be designed with a more favorable benefit/risk interaction methods, obstacles and facilitators and aims balance as a result of the successes and challenges and aspirations. DISCUSSION: The caregivers faced by other states. perceived their own role in interaction to be of a sensitive leading kind. The caregivers lead the Wilgoren J. Kansas prosecutor demands files on late-term interaction by using their knowledge about the abortion patients. NY Times (Print) 2005; A1, A19. children's usual way of interacting, the children's Notes: GENERAL NOTE: KIE: KIE Bib: behaviour styles, functional abilities, the children's abortion/legal aspects current mood and situation as well as the whole context. They monitored the interaction such that, Wilke DJ, Kamata A, Cash SJ. Modeling treatment throughout an interaction sequence, the caregivers motivation in substance-abusing women with children. always tried to optimize the interaction between the Child Abuse Negl 2005; 29(11):1313-23. parties in the dyad. The behaviour style was a Abstract: OBJECTIVES: Children are often considered background factor that the caregivers had knowledge of a primary motivator for women seeking substance and scanned in their everyday turn taking. Although abuse treatment. This study tested a model predicting there were differences in the children's behaviour treatment motivation in substance-abusing mothers. styles, the caregivers discussed the same themes in the METHODS: This study was a secondary analysis of interviews. The behaviour style became a facilitator for the Drug Absue Treatment Outcome Study (DATOS). the whole interaction, forced the interaction in certain It used structural equation modeling to describe factors directions and made the interaction more complete with influencing motivation for treatment. DATOS is a turn taking of different kinds from both parties. The national study of substance abusers entering treatment. findings show that it is imperative to see caregivers as Treatment was provided by a sampling of community- experts on their children and to make them assertive in based programs, free-standing hospitals, hospital units, this in relation to professionals. Furthermore, as a county-funded programs, modified therapeutic successful interaction can boost the development of communities, and criminal justice programs. The children, it is essential to direct interventions to the subsample of women with children under the age of 18 everyday interaction in caregiver-child dyads. for whom custody of children could be determined was selected (n=1371). The variables comprising each Wilfond BS, Gollust SE. Policy issues for expanding factor were based on self-report, and standardized newborn screening programs: the cystic fibrosis scales measuring level of drug involvement, newborn screening experience in the United States. J psychological functioning, children, and a desire to Pediatr 2005; 146(5):668-74. stop using drugs were used. RESULTS: Drug Abstract: OBJECTIVE: To describe the screening involvement was positively related to poorer approaches and implementation strategies for cystic psychological functioning, child custody issues, and fibrosis newborn screening in the 12 programs that the desire to stop using drugs. Child custody issues had were offered in 11 states in 2002. STUDY DESIGN: a negative influence, while poorer psychological Telephone interviews conducted in the spring of 2003 functioning and a desire to stop using drugs positively with program representatives in the 11 states. influenced treatment motivation. CONCLUSIONS: Screening approaches were defined in four overlapping The negative influence that children have on treatment categories: state mandated screening, state-wide motivation may reflect the practical or emotional offering, hospital based screening, and screening with difficulties of having to leave children behind or in informed consent. RESULTS: Screening was state some instances having children placed in foster care. mandated in seven states but was routinely offered to Specifically, losing custody of children, particularly most infants in nine states. The primary care provider with little expectation they will be reunified, may serve or hospital determined if screening was done in three as a detriment to motivation. Popular beliefs hold that states (four programs). Informed consent was explicitly children serve as a primary source of a mother's 951
- 960. treatment motivation; howeverthis study found the Willgerodt MA, Kataoka-Yahiro M, Kim E, Ceria C. Issues opposite was true. Children should not automatically of instrument translation in research on Asian be considered a primary source of motivation for immigrant populations. J Prof Nurs 2005; 21(4):231-9. participation in treatment. Abstract: Health disparity research often includes non- English-speaking populations, and instrument Wilkes G. Abused child to nonabusive parent: resilience and translation is a major methodological issue with which conceptual change. J Clin Psychol 2002; 58(3):261-76. researchers must contend. Yet most existing nursing Abstract: Individuals who were abused as children and research do not adequately describe translation method have spontaneously, without intervention, been able to processes used. This article describes the procedures change their cognitive and behavioral patterns such that used to translate the Caregiver Reaction Assessment they do not abuse their own children represent a instrument into Ilocano for use in a study with elderly heretofore untapped source of information and Filipinos caring for their grandchildren and the understanding about the processes of conceptual Parenting Practice Interview into Korean for use in a change and resilience. This pilot study investigates the study of parenting practices among Korean immigrant nature of this conceptual change as an exemplar of parents. An explanation of Brislin's method for resilience. Birth order, gender, locus of control, and instrument translation is first provided, followed by a coping behaviors emerged as areas needing further detailed description of how this method was applied in study. Additionally, the belief on the part of the the two studies and the challenges encountered in abusing parents that abuse was not wrong needs further assessing translation accuracy. Achieving semantic and investigation as a possible precursor to this particular content equivalence posed a major challenge in both context for conceptual change. studies. Recommendations for cross-cultural nursing research are provided; the experiences described in this Wilkinson DL, Kurtz EM, Lane P, Fein JA. The emergency article illuminate translation issues to be considered by department approach to violently injured patient care: a nurse researchers. regional survey. Inj Prev 2005; 11(4):206-8. Abstract: OBJECTIVE: Since the early 1990s public Williams AC. Facial expression of pain: an evolutionary health workers have challenged healthcare practitioners account. Behav Brain Sci 2002; 25(4):439-55; to take an active role in violence prevention with discussion 455-88. patients aged 10-24 years. Emergency department (ED) Abstract: This paper proposes that human expression of clinicians are uniquely positioned to identify, assess, pain in the presence or absence of caregivers, and the and refer youth involved in violent events. The detection of pain by observers, arises from evolved objective of this study was to describe ED directors' propensities. The function of pain is to demand estimate of the number of violently injured youth seen, attention and prioritise escape, recovery, and healing; the presence of established protocols or guidelines for where others can help achieve these goals, effective handling youth violence, and the type of training communication of pain is required. Evidence is programs offered to ED physicians regarding this issue. reviewed of a distinct and specific facial expression of METHODS: The authors conducted a survey of EDs (n pain from infancy to old age, consistent across stimuli, = 64) in the Philadelphia metropolitan region to and recognizable as pain by observers. Voluntary determine the standard of ED care for violently injured control over amplitude is incomplete, and observers youths. Half of the EDs were in urban areas and half in can better detect pain that the individual attempts to suburban. RESULTS: A total of 41 out of 64 (64.1%) suppress rather than amplify or simulate. In many ED directors completed and returned the written clinical and experimental settings, the facial expression questionnaire. In addition to treating the specific of pain is incorporated with verbal and nonverbal vocal injuries sustained, ED responses to youth violence activity, posture, and movement in an overall category primarily involved talking with patients about the of pain behaviour. This is assumed by clinicians to be events surrounding the injury. The estimated number of under operant control of social contingencies such as violently injured youth seen per month varied sympathy, caregiving, and practical help; thus, strong considerably. Twenty four directors (58.5%) estimated facial expression is presumed to constitute and attempt that their institution treated fewer than 10 per month; to manipulate these contingencies by amplification of 10 (24.4%) reported 11-30, and seven (17.1%) mostly the normal expression. Operant formulations support large urban hospitals, saw more than 30 per month. skepticism about the presence or extent of pain, Although most hospitals reported that the staff counsels judgments of malingering, and sometimes the patients about safety concerns, only 17% offered their withholding of caregiving and help. To the extent that staff formal training programs on youth violence. pain expression is influenced by environmental CONCLUSIONS: To address the prevention of youth contingencies, however, "amplification" could equally violence, EDs need specific training programs for ED plausibly constitute the release of suppression staff, as well as systematic risk assessment and referral according to evolved contingent propensities that guide resources for structured intervention and follow up. behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate 952
- 961. improved assessment ofpain and reactions to it. extent to which a sample of primary care pediatricians diagnose and treat behavioral health problems and to Williams CL, Grechanaia T, Romanova O, Komro KA, identify factors that may contribute to their behavioral Perry CL, Farbakhsh K. Russian-American partners for health practice. METHODS: A standard interview was prevention. Adaptation of a school-based parent-child conducted with 47 pediatricians who work in primary programme for alcohol use prevention. Eur J Public care settings in a predominantly urban setting in North Health 2001; 11(3):314-21. Carolina. Pediatricians' responses to questions about Abstract: BACKGROUND: The Russian-American the estimated percentage of children in their practice Partners for Prevention was an adaptation and with a behavioral health disorder, tools used to make evaluation of the Slick Tracy Home Team Program diagnoses, frequent and infrequent diagnoses made, which was developed in Minnesota in order to delay comfort level with making a diagnosis, reasons for not the onset of drinking. The Slick Tracy Home Team making a diagnosis, use of psychotropic medications, Program was the first intervention of Project types of nonmedication interventions provided, Northland, a large 3 year community trial of the educational background, and needs involving efficacy of a public health intervention for under age behavioral health issues were evaluated. RESULTS: drinking. METHODS: The programme was Pediatricians estimated that the average percentage of administered through schools, but involved parents children in their practices with a behavioral health using engaging and fun homework activities. The disorder was 15%. The study did not find significant Russian version was implemented in fifth-grade differences in perceptions related to time in practice or classrooms in 20 Moscow schools with 1,212 students gender of the pediatric provider. The most frequent surveyed at baseline. Students were surveyed again behavioral health diagnosis was attention- after programme implementation (n = 1,182), of whom deficit/hyperactivity disorder (ADHD), and the 980 were present at baseline. Parents of 1,078 students majority incorporated behavioral questionnaires, were surveyed by telephone after programme expressed a high level of comfort with the diagnosis, implementation. RESULTS: The results demonstrated and frequently or occasionally prescribed stimulants. the successful recruitment and retention of 20 Moscow Variability was noted in both practice and comfort for schools in a research project, acceptability of other behavioral health disorders. Slightly fewer than programme materials in Russia, high participation half of the pediatricians frequently diagnosed anxiety rates, changes in students' knowledge about problems and depression. Those who make these diagnoses associated with under age drinking and some evidence commonly incorporated questionnaires and reported about increases in parent-child communication about frequent or occasional use of selective serotonin alcohol use. As in the USA, no changes in students' reuptake inhibitors. Comfort in making the diagnosis of alcohol use rates were observed at the end of the first anxiety was highly associated with use of selective year of the 3 year programme. CONCLUSION: serotonin reuptake inhibitors. The vast majority (96%) Russian youth, as compared to Americans, began of pediatricians provided nonmedication interventions, drinking at earlier ages, received fewer prevention including supportive counseling, education for coping messages from their parents, and had fewer prevention with ADHD, behavior modification, and/or stress programmes in school. The results suggested that management. Diagnosis and treatment of severe carefully implemented and evaluated replications of the behavioral health disorders were infrequent throughout US Project Northland interventions might provide the pediatric practices. Areas of greatest educational effective and appropriate school-based programmes for interest included psychopharmacology, diagnosis and Russia. treatment of depression and anxiety, and updates on ADHD. The majority of pediatric providers did not Williams-Evans SA, Sheridan DJ. Exploring barriers to identify a need for education about several high- leaving violent intimate partner relationships. ABNF J prevalence disorders that they do not frequently 2004; 15(2):38-40. diagnose or treat, including conduct disorder and Abstract: This article discusses the barriers abused substance abuse. CONCLUSIONS: Pediatricians in partners may have for not leaving the violent this sample frequently diagnosed and treated ADHD. relationship. The authors discuss procedures they will For all other behavioral health disorders, pediatricians use in testing two clinical screening tools: the reported variability in both comfort and practice. They HARASS tool and the Pitts-Williams Inquiry tool. frequently provided both pharmacologic and nonpharmacologic treatments for children and Williams J, Klinepeter K, Palmes G, Pulley A, Foy JM. adolescents with mild to moderate behavioral health Diagnosis and treatment of behavioral health disorders disorders but not for severe disorders. Although they in pediatric practice. Pediatrics 2004; 114(3):601-6. identified needs for additional education for anxiety Abstract: OBJECTIVE: There has been a strong push and depression, the majority did not identify toward the recognition and treatment of children with educational needs for several high-prevalence behavioral health problems by primary care behavioral health disorders, including conduct disorder pediatricians. This study was designed to assess the and substance abuse. 953
- 962. Williams O, ForsterG, Robinson A. Screening for sexually point in time when we should extend care to patients in transmitted infections in children and adolescents in the under serviced emerging countries. Development of United Kingdom: British Co-operative Clinical Group. local expertise will be required within those countries Int J STD AIDS 2001; 12(8):487-92. that are willing to commit resources to an organized Abstract: Our objectives were (1) to assess the number program of caring for people with congenital heart of young people aged under 16 years attending disease. Database technology is an essential tool for genitourinary medicine (GUM) departments in the UK ensuring and improving quality of care in every in 1998; (2) to identify clinical activity and policy; (3) congenital heart centre. Both Registry and Academic to determine the knowledge and training needs of databases have much to offer in improving care for healthcare professionals within GUM providing care future patients. Yet overzealous privacy laws threaten for this client group. In July 1999 a questionnaire was the knowledge base provided by computerized circulated via the 18 regional British Co-operative databases. We need to guide our legislators in ensuring Clinical Group (BCCG) representatives to the that the valuable resource provided by database consultants in charge of all 197 main GUM technology is not lost. departments in the UK. One hundred and sixty out of 197 (81%) completed questionnaires were returned and Williamson MA, Johnston CA, Symes SA, Schultz JJ. analysed. The reported number of under-16-year-olds Interpersonal violence between 18th century Native attending in 1998 varied considerably between clinics; Americans and Europeans in Ohio. Am J Phys for females ranging from 0 to 256 and for males Anthropol 2003; 122(2):113-22. between 0 and 50, with a male to female ratio of 1:4.4. Abstract: During the winter of 1778-1779, a garrison of The majority of responding clinics, 139/160 (87%) had 176 individuals lived within the walls of a been involved in the screening of abused Revolutionary era stronghold named Ft. Laurens on the children/adolescents for sexually transmitted infections banks of the Tuscarawas River, near the present-day (STIs). Most clinics were prepared to screen for STI town of Bolivar, Ohio. At least 21 individuals were (86%), HIV test (79%) and assess contraceptive needs buried in the fort's cemetery during its occupation, 13 (50%) in this age group. Staff involved in care included of whom were supposedly killed and scalped by Native health advisers (74), nurses (59), and doctors (138) in Americans while gathering firewood and foraging the responding clinics. Only 31/160 clinics (19%) had a horses. The purpose of this study is to build on written policy for the management of previous work by Sciulli and Gramly ([1989] Am J. children/adolescents attending their clinic. The Phys. Anthropol. 80:11-24) by adding a more detailed majority of respondents were aware of their child analysis of the traumatic lesions, in order to better protection policy [122/154 (79%)] and designated child understand what happened to the victims. Lesions were sexual abuse doctor, [125/157 (80%)] in their district. analyzed based on type, location, and dimensions, as When questioned on previous and current training well as their overall pattern on the skeleton. Results needs, 134/160 (84%) respondents identified their need indicate that multiple blows to the cranium were for further training in the area of adolescent sexual common. Out of 12 observable crania, the order of health and 124/160 (78%) in child sex abuse. The blows could be determined in only one case. Eleven of publication Physical Signs of Sexual Abuse in 12 of the observable crania from ambush victims and Children, was known to 112/160 (70%) respondents, of four of the seven nonambush victims exhibited lesions whom 58/112 (52%) who answered this question had consistent with scalping. Evidence of postcranial read the publication. Genitourinary physicians in the trauma was noted on four individuals: one was an UK are aware of the increasing number of children and ambush victim, and the other three were killed at other adolescents accessing their services, and recognize the times. No evidence of gunshot wounds was found. need to identify those in abusive situations. Written policies dealing with children and adolescents in GUM Williamson R. The balance between privacy, safety and clinics in the UK are lacking. This needs to be rectified community health. J Paediatr Child Health 2003; urgently. This survey identifies that further training in 39(7):507-8. the field of child sexual abuse and adolescent sexual health would be welcomed by the respondents. Willock J, Askew C, Bolland R, Maciver H, James N. Multicentre research: lessons from the field. Paediatr Williams WG. Surgical outcomes in congenital heart Nurs 2005; 17(10):31-3. disease: expectations and realities. Eur J Cardiothorac Abstract: Multicentre research can be used to explore Surg 2005; 27(6):937-44. and generate significant data in aspects of care that Abstract: The past 50 years of congenital heart surgery affect small numbers of children. This article describes has produced enormous progress. Current results the problems and benefits encountered by a group of surpass expectations. Yet there are important residual nurses from 11 hospitals undertaking a multicentre problems in patients growing up after heart surgery for study of pressure ulcers in children and young people congenital heart disease. Our system of care must in England and Wales. Multicentre research can evolve to care for these people throughout their lives. generate a large amount of useful data contributing to The evolution of congenital heart surgery has reached a 954
- 963. high quality evidence-basedcare and can provide orientation positively related to substance use. nurses with a valuable learning and networking Structural modeling analysis indicated that the relation experience. of time perspective measures to substance use was indirect, mediated through behavioral coping and anger Wills TA, Resko JA, Ainette MG, Mendoza D. Role of coping. Proximal factors for substance use were parent support and peer support in adolescent substance negative affect, peer substance use, and resistance use: a test of mediated effects. Psychol Addict Behav efficacy. Results are discussed with respect to 2004; 18(2):122-34. epigenetic models and the role of executive functions Abstract: This research tested comparative effects of in self-control ability. parent and peer support on adolescent substance use (tobacco, alcohol, and marijuana) with data from 2 Wills TA, Sandy JM, Yaeger AM, Cleary SD, Shinar O. assessments of a multiethnic sample of 1,826 Coping dimensions, life stress, and adolescent adolescents, mean age 12.3 years. Multiple regression substance use: a latent growth analysis. J Abnorm analyses indicated that parental support was inversely Psychol 2001; 110(2):309-23. related to substance use and that peer support was Abstract: The relation of seven coping dimensions to positively related to substance use, as a suppression substance (tobacco, alcohol, marijuana) use was tested effect. Structural modeling analyses indicated that with a sample of 1,668 participants assessed at mean effects of support were mediated through pathways age 12.5 years and two yearly follow-ups. An involving good self-control, poor self-control, and risk- associative latent-growth model showed one index of taking tendency; parent and peer support had different engagement (behavioral coping) to be inversely related patterns of relations to these mediators. The mediators to initial level of adolescent use and growth over time had pathways to substance use through positive and in peer use. Three indices of disengagement (anger negative recent events and through peer affiliations. coping, helpless coping, and hangout coping) were Effects for gender and ethnicity were also noted. positively related to initial levels of peer use and Mechanisms of operation for parent and peer support adolescent use and to growth in adolescent use. Life are discussed. stress was positively related to initial levels for peer use and adolescent use and to growth in adolescent use. Wills TA, Sandy JM, Yaeger AM. Stress and smoking in Moderation tests indicated that effects of coping were adolescence: a test of directional hypotheses. Health significantly greater at higher level of stress; behavioral Psychol 2002; 21(2):122-30. coping buffered the effects of disengagement. Effects Abstract: The authors conducted a comparative test of of life stress were greater for girls than for boys. the hypotheses that (a) stress is an etiological factor for Results are discussed with reference to mechanisms of smoking and (b) cigarette smoking causes increases in coping-substance use relationships. stress (A. C. Parrott, 1999). Participants were a sample of 1,364 adolescents, initially surveyed at mean age Willumsen E, Hallberg L. Interprofessional collaboration 12.4 years and followed at 3 yearly intervals. Measures with young people in residential care: some of negative affect, negative life events, and cigarette professional perspectives. J Interprof Care 2003; smoking were obtained at all 4 assessments. Latent 17(4):389-400. growth modeling showed negative affect was related to Abstract: The article discusses interprofessional increase in smoking over time; there was no path from collaboration with young people experiencing initial smoking to change in negative affect. psychosocial problems living in residential care in Comparable results were found for negative life events, Norway. The professionals involved (n = 23) were with no evidence for reverse causation. Results are social workers, psychologists, teachers, discussed with respect to theoretical models of nicotine doctors/psychiatrists, unqualified graduates and other effects and implications for prevention. staff. The aim was to explore the professionals' contributions and grasp a sense of the wholeness of the Wills TA, Sandy JM, Yaeger AM. Time perspective and collaboration process. A grounded theory approach was early-onset substance use: a model based on stress- applied. During the analysis five categories emerged coping theory. Psychol Addict Behav 2001; 15(2):118- regarding professionals contributions; knowledge of 25. own and others' agency/service, problem perception, Abstract: This research tested the relation of time priority, commitment and space for action. Three perspective to early-onset substance use (tobacco, categories emerged regarding interprofessional alcohol, and marijuana) with a sample of 454 interaction; building networks, developing trust and elementary school students with a mean age of 11.8 using flexibility. The core category was identified as years. An adaptation of the Zimbardo Time Perspective 'readiness to act'. The findings show an apparent Inventory (P. G. Zimbardo & J. N. Boyd, 1999) was contradiction between health and social policy that administered with measures derived from stress-coping encourages the standardisation of services and theory. Independent effects showed future orientation responding flexibly to the needs of young people for inversely related to substance use and present 'tailor made' solutions through access to a range of services. A further finding was extensive use of 955
- 964. flexibility and willingnessto go beyond boundaries self-described as sexually abused reported leading to the distinction between routinized and remembering the abuse with the help of a therapist or radical coordination. other professional person. CONCLUSIONS: The findings indicate that, among women who report CSA, Wilmshurst LA. Treatment programs for youth with forgetting and subsequently remembering abuse emotional and behavioral disorders: an outcome study experiences is not uncommon. According to the of two alternate approaches. Ment Health Serv Res women surveyed, however, very few (1.8%) of those 2002; 4(2):85-96. who felt abused recovered memories of CSA with help Abstract: Youth with severe emotional and behavioral from therapists or other professionals. As one of the disorders (EBD) were randomly assigned for 3 months few studies of CSA memories in a nationally of intensive treatment to a 5-day residential program representative sample, this study suggests that (5DR Program) or a community-based alternative, therapist-assisted recall is not a major source of CSA family preservation program (FP Program). Programs memories among women in the US general population. differed not only in method of service delivery (residential unit vs. home-based), but also in treatment Wilson J. Family breakdown - how important is it for British philosophy (solution focused brief therapy vs. general practice? Br J Gen Pract 2004; 54(504):558-9. cognitive behavioral). Results confirmed high rates of comorbidity in this population for externalizing and Wilson JJ, Pine DS, Cargan A, Goldstein RB, Nunes EV, internalizing disorders. A significant Treatment x Weissman MM. Neurological soft signs and disruptive Program interaction was evident for internalizing behavior among children of opiate dependent parents. disorders. At 1-year follow-up, significantly higher Child Psychiatry Hum Dev 2003; 34(1):19-34. percentages of youth from the FP Program revealed a Abstract: The present study investigates the reduction of clinical symptoms for ADHD, as well as, relationship between neurological soft signs and general anxiety and depression, whereas significant psychiatric symptoms among children of opiate proportion of youth from the 5DR Program dependent parents. A consecutive series of 102 demonstrated clinical deterioration and increased children of opiate dependent parents received symptoms of anxiety and depression. Results have standardized psychiatric and neurological assessments. implications for future treatment of youth with EBD Symptoms of externalizing but not internalizing and suggest that greater emphasis be placed on disorders associated with poor performance on the soft research linking treatment to specific symptom sign exam, controlling for age, intelligence, and clusters, especially highly comorbid clusters in this socioeconomic status. Given the importance of hard to serve population. externalizing disorders in the development of substance use disorders, studies of children at high risk for Wilsnack SC, Wonderlich SA, Kristjanson AF, Vogeltanz- substance use disorder should also consider screening Holm ND, Wilsnack RW. Self-reports of forgetting and and assessment of children for soft neurological signs. remembering childhood sexual abuse in a nationally representative sample of US women. Child Abuse Negl Wilson P, McConnachie A, O'Donnell CA, Ross S, Moffat 2002; 26(2):139-47. KJ, Drummond N. Assessing dissatisfaction with an Abstract: OBJECTIVE: The purpose of this article is to out of hours service: reasons and remedies. Health Bull describe patterns of forgetting and remembering (Edinb) 2001; 59(1):37-44. childhood sexual abuse (CSA) in a nationally Abstract: OBJECTIVE: To identify characteristics representative sample of US adult women. METHOD: associated with dissatisfaction following contact with The respondents were a national probability sample of an out of hours co-operative in Glasgow, and to 711 women, aged 26 years to 54 years, residing in identify reasons for this dissatisfaction. To make noninstitutional settings in the contiguous 48 states. In recommendations for good practice in the light of these a 1996 face-to-face interview survey, trained female findings. DESIGN: Survey of attenders during one interviewers asked each respondent whether she had week of operation of an out of hours co-operative. experienced any sexual coercion by family members or Analysis of factors associated with dissatisfaction. nonfamily members while growing up; whether she SETTING: The Glasgow Emergency Medical Service, believed that she had been sexually abused (by family October 1996. SUBJECTS: Questionnaires were members or others); and whether she had ever received from 1115 patients or their carers, forgotten the CSA experiences and, if so, how she had representing a 69.3% response rate. RESULTS: subsequently remembered them. RESULTS: Twenty- Dissatisfaction was associated with unmet one and six-tenths percent of respondents reported expectations, particularly among those expecting home having sexually coercive experiences while growing visits. Parents of young children, more affluent up; of these, 69.0% indicated that they felt they had patients, and those experiencing problems with daytime been sexually abused. More than one-fourth of services also tended to be dissatisfied. Seventy four respondents who felt sexually abused reported that they (7%) respondents indicated that they were very had forgotten the abuse for some period of time but dissatisfied with aspects of the service. A high later remembered it on their own. Only 1.8% of women 956
- 965. proportion of thisdissatisfaction was related to fruit and vegetable promotion intervention should aim telephone contact. Transport to out of hours centres to increase fruit and vegetable accessibility and should caused problems for some patients, particularly for include educational and motivational activities tailored those with young children. Perceptions of dismissive to these personal and environmental factors. These attitudes by medical staff, and of incorrect diagnoses indications should be further evaluated in quantitative and treatment were causes of strong dissatisfaction. research among representative samples. Patients with adverse medical outcomes were also likely to be very dissatisfied. CONCLUSION: Clear Wise LA, Zierler S, Krieger N, Harlow BL. Adult onset of reasons for dissatisfaction were found among our major depressive disorder in relation to early life sample. In most cases, remedial management action violent victimisation: a case-control study. Lancet could be taken to reduce the likelihood of major 2001; 358(9285):881-7. dissatisfaction with the service. Abstract: BACKGROUND: Major depressive disorder is a significant cause of morbidity among women in the Wimmer H, Hutzler F, Wiener C. Children with dyslexia USA. Women are twice as likely as men to be and right parietal lobe dysfunction: event-related diagnosed with major depressive disorder, yet no potentials in response to words and pseudowords. known risk factors can account for this sex difference. Neurosci Lett 2002; 331(3):211-3. We aimed to assess violent victimisation as a risk Abstract: Hari and Renvall (Trends Cogn. Sci., 5 factor for depression in women. METHODS: We (2001) 525) proposed that dyslexic children suffer from undertook a case-control study to assess the association sluggish attention deployment due to a right parietal between violent victimisation early in life and major lobe dysfunction. To examine this hypothesis, good depressive disorder in women. We randomly selected a and poor readers (12, 11-year-old boys in each group) population-based sample of women, aged 36-45 years, had to read familiar words (low attentional demand) from the greater Boston area. In 1999, 236 cases and and pseudowords (high attentional demand). The 496 controls (n=732) completed a self-administered amplitude of the event-related potential at around 100 questionnaire designed to ascertain a lifetime history of ms post-stimulus (N1) in response to words and exposure to violent victimisation. Our main outcome pseudowords was used as measure of attention measure was major depressive disorder, assessed by deployment. Consistent with the attention deficit/right structured clinical interview for Diagnostic Statistical parietal lobe dysfunction hypothesis, poor readers Manual IV (DSM-IV) criteria. FINDINGS: 363 (50%) showed lower N1 amplitudes in response to of 732 respondents reported experience or fear of abuse pseudowords, but not in response to words at central as a child or adolescent. 68 were excluded because they sites of the right hemisphere. However, poor readers reported violence as an adult only. Compared with also showed lower N1 amplitudes to both words and women who reported no abuse, risk of depression was pseudowords at left frontal sites suggestive of an early increased in women who reported any abuse as a child deficit in activating phonological codes. or adolescent (relative risk 2.5, 95% CI 1.9-3.0), physical abuse only (2.4, 1.8-3.0), sexual abuse only Wind M, Bobelijn K, De Bourdeaudhuij I, Klepp KI, Brug J. (1.8, 1.2-2.8), and both physical and sexual abuse (3.3, A qualitative exploration of determinants of fruit and 2.5-4.1). Severity of abuse had a linear dose-response vegetable intake among 10- and 11-year-old relation with depression. INTERPRETATION: Our schoolchildren in the low countries. Ann Nutr Metab results suggest a positive association between violent 2005; 49(4):228-35. victimisation early in life and major depressive Abstract: BACKGROUND: For the development of disorder in women. fruit and vegetable promotion interventions, insight is needed into determinants of health behaviour. This Wise PH. The transformation of child health in the United study presents results of focus group interviews held States. Health Aff (Millwood) 2004; 23(5):9-25. with 10- to 11-year-old schoolchildren from Ghent Abstract: Social trends and medical progress have (Belgium-Flanders) and Rotterdam (the Netherlands) to fueled major changes in the epidemiology of child explore personal beliefs and motivations and health in the United States. Injuries remain a major environmental factors related to schoolchildren's fruit contributor to childhood illness and death. However, and vegetable intake, to inform the Pro Children among noninjury causes, chronic illness now accounts intervention development. METHODS: Twelve focus for the majority of children's hospital days and deaths. groups were held with 92 schoolchildren. The Although mortality rates for all children have fallen interviews were recorded and transcribed and NVivo dramatically, social disparities persist. Approximately was used to analyse the transcripts. RESULTS: half of all excess deaths among African American Positive health beliefs, taste preferences, lack of children occur during infancy, primarily from knowledge and practical barriers were identified as extremely premature births, and the remaining portion, personal factors related to fruit and vegetable intake. primarily from homicide and serious chronic Home and school availability of fruits and vegetables, conditions.These challenges may require changes in as well as parenting practices were identified as today's child health practices and policies. important environmental factors. CONCLUSION: A 957
- 966. Witte C. Cordblood storage: property and liability issues. J have helpful aspects. Leg Med 2005; 26(2):275-92. Wolchik SA, Sandler IN, Millsap RE et al. Six-year follow- Wocial LD. Neonatal care for premature infants. Hastings up of preventive interventions for children of divorce: a Cent Rep 2005; 35(1):6-7; author reply 7. randomized controlled trial. JAMA 2002; Notes: GENERAL NOTE: KIE: KIE Bib: allowing to 288(15):1874-81. die/infants; patient care/minors Abstract: CONTEXT: Compared with their peers with nondivorced parents, adolescents with divorced parents Wolak J, Finkelhor D, Mitchell K. Internet-initiated sex are more likely to have mental health problems, drop crimes against minors: implications for prevention out of school, and become pregnant. The long-term based on findings from a national study. J Adolesc effects of intervention programs for this population are Health 2004; 35(5):424.e11-20. unknown. OBJECTIVE: To evaluate the long-term Abstract: PURPOSE: To describe the characteristics of effectiveness of 2 programs designed to prevent mental episodes in which juveniles became victims of sex health problems in children with divorced parents. crimes committed by people they met through the DESIGN AND SETTING: Six-year follow-up of a Internet. METHODS: A national survey of a stratified randomized controlled trial of 2 intervention programs random sample of 2574 law enforcement agencies (mother program: 11 group and 2 individual sessions; conducted between October 2001 and July 2002. mother plus child program: mother program and 11 Telephone interviews were conducted with local, state, group sessions for children) and a control condition and federal law enforcement investigators concerning (books on postdivorce adjustment), which was 129 sexual offenses against juvenile victims that conducted in a large metropolitan US city from April originated with online encounters. RESULTS: Victims 1998 through March 2000. PARTICIPANTS: A total in these crimes were primarily 13- through 15-year-old of 218 families (91% of the original sample) with teenage girls (75%) who met adult offenders (76% adolescents aged between 15 and 19 years were older than 25) in Internet chat rooms. Most offenders reinterviewed. MAIN OUTCOME MEASURES: did not deceive victims about the fact that they were Externalizing and internalizing problems, diagnosed adults who were interested in sexual relationships. mental disorders, drug and alcohol use, and number of Most victims met and had sex with the adults on more sexual partners. RESULTS: Eleven percent of than one occasion. Half of the victims were described adolescents in the mother plus child program (95% as being in love with or feeling close bonds with the confidence interval [CI], 3.8%-18.2%) had a 1-year offenders. Almost all cases with male victims involved prevalence of diagnosed mental disorder compared male offenders. Offenders used violence in 5% of the with 23.5% (95% CI, 13.8%-33.2%) of adolescents in episodes. CONCLUSIONS: Health care professionals the control program (P =.007). Adolescents in the and educators, parents and media need to be aware of mother plus child program had fewer sexual partners the existence, nature and real life dynamics of these (mean [SE], 0.68 [0.16]) compared with adolescents in online relationships among adolescents. Information the control program (1.65 [0.37]; P =.01). Adolescents about Internet safety should include frank discussion with higher initial mental health problems whose about why these relationships are inappropriate, families were in the mother plus child program had criminal, and detrimental to the developmental needs lower externalizing problems (P =.007) and fewer of youth. symptoms of mental disorder (P =.02) compared with those in the control program. Compared with controls, Wolak J, Mitchell KJ, Finkelhor D. Escaping or connecting? adolescents whose mothers participated in the mother Characteristics of youth who form close online program and who had higher initial mental health relationships. J Adolesc 2003; 26(1):105-19. problems had lower levels of externalizing problems Abstract: We used data from a US national sample of (P<.001); fewer symptoms of mental disorder (P Internet users, ages 10-17 (N=1501), to explore the =.005); and less alcohol (P =.005), marijuana (P =.02), characteristics of youth who had formed close and other drug use (P =.01). CONCLUSIONS: In relationships with people they met on the Internet adolescents of divorced parents, the mother program (n=210). Girls who had high levels of conflict with and the mother plus child program reduced symptoms parents or were highly troubled were more likely than of mental disorder; rates of diagnoses of mental other girls to have close online relationships, as were disorder; levels of externalizing problems; marijuana, boys who had low levels of communication with alcohol, and other drug use; and number of sexual parents or were highly troubled, compared to other partners. boys. Age, race and aspects of Internet use were also related. We know little about the nature or quality of Wolf LE, Lo B, Beckerman KP, Dorenbaum A, Kilpatrick the close online relationships, but youth with these SJ, Weintrub PS. When parents reject interventions to sorts of problems may be more vulnerable to online reduce postnatal human immunodeficiency virus exploitation and to other possible ill effects of online transmission. Arch Pediatr Adolesc Med 2001; relationships. At the same time, these relationships may 155(8):927-33. Abstract: In a recent Oregon case, the state successfully 958
- 967. sued for custodyof an infant to prevent his human between child maltreatment, clinically relevant immunodeficiency virus (HIV)-infected mother from adjustment problems, and dating violence in a breastfeeding him and to require antiretroviral community sample of adolescents. METHOD: prophylaxis. As more HIV-infected women give birth, Adolescents from 10 high schools (N= 1,419; response pediatricians may increasingly face dilemmas when rate = 62%) in southwestern Ontario completed parents reject medical recommendations to forego questionnaires that assessed past maltreatment, current breastfeeding and to administer antiretroviral adjustment, and dating violence. Logistic regression prophylaxis to the infant. Such disagreements create was used to compare maltreated and nonmaltreated ethical dilemmas because pediatricians have an youths across outcome domains. RESULTS: One third obligation to both protect the infant and respect (n = 462) of the school sample reported levels of parental decision making. Pediatricians need to balance maltreatment above the cutoff score on the Childhood these obligations in deciding whether to ask the courts Trauma Questionnaire. Girls with a history of to intervene on the infant's behalf. To that end, we maltreatment had a higher risk of emotional distress analyze the legal and ethical issues that arise when an compared with girls without such histories (e.g., odds HIV-infected mother refuses interventions to reduce ratios [OR] for anger, depression, anxiety, and neonatal transmission of HIV to her infant, provide an posttraumatic stress-related problems were 7.1, 7.2, approach for addressing these disagreements, and 9.3, and 9.8, respectively). They were also at greater present illustrative scenarios in which pediatricians risk of violent and nonviolent delinquency (OR = 2.7) should, may, and should not seek a court order to and carrying concealed weapons (OR = 7.1). Boys with intervene. histories of maltreatment were 2.5 to 3.5 times as likely to report clinical levels of depression, posttraumatic Wolf RC, Bond KC. Exploring similarity between peer stress, and overt dissociation as were boys without a educators and their contacts and AIDS-protective maltreatment history. They also had a significantly behaviours in reproductive health programmes for greater risk of using threatening behaviors (OR = 2.8) adolescents and young adults in Ghana. AIDS Care or physical abuse (OR = 3.4) against their dating 2002; 14(3):361-73. partners. CONCLUSIONS: Maltreatment is a Abstract: This analysis explores the similarity between significant risk factor for adolescent maladjustment and peer educators and their contacts. To examine shows a differential pattern for male and female interpersonal communication in the context of peer adolescents. education, this study tested a new approach using multiple semi-structured interviews and network Wolfersdorf M. [Post-traumatic stress disorder in police with analysis to collect data from 106 peer educators and long-term exposure to homicide and child abuse. A 526 of their contacts. These evaluation activities were previously unrecognized occupational disease conducted at three sites in Ghana during April 1998, in exemplified by 2 case reports]. Psychiatr Prax 2003; 30 peri-urban and rural locations, and in in-school and Suppl 2:S88-9. out-of-school targeted settings. It was found that in Abstract: In this paper we discuss two cases of PTSD their peer counselling and peer promotion activities of policemen according to their occupational duties. peer educators tend to reach people who are like themselves (53% within 2 years of age, 59% same sex, Wolfram-Gabel R, Sery FG, Sick H. Microvascularisation of 70% same ethnicity, and 65% same school status) the male urethra in neonates and infants. Surg Radiol however, this trend is not uniform among all youth and Anat 2004; 26(6):488-93. varies by demographic characteristics and their cultural Abstract: The microvascularisation of the male urethra environment. By examining the social networks of peer was studied in neonates and infants by injection of educators, it is possible to gain a better understanding agarised China ink into the circulation. The purpose of of the process of peer education counselling in the this study was to specify the angioarchitecture of each context in which it occurs. The study also shows that tunic of the urethral wall. The disposition of the controlling for other factors, contacts of peer educators microvascularisation networks varies depending on the who are highly similar regarding age, sex, ethnicity, urethral parts considered: only the mucous membrane and school status, are 1.74 times more likely (95% CI: networks are uniform throughout the entire urethra. 1.18, 2.56) to have done something to protect The sub-mucous networks are significantly increased themselves from AIDS in the past three months. The in the spongy part. The muscular networks disappear in results have relevance for programme managers and the spongy part. planners, researchers, and international agencies serving youth. Wolfram-Gabel R, Sick H. Microvascularization of the mucocutaneous junction of the eyelid in fetuses and Wolfe DA, Scott K, Wekerle C, Pittman AL. Child neonates. Surg Radiol Anat 2002; 24(2):97-101. maltreatment: risk of adjustment problems and dating Abstract: The aim of this study was to specify the violence in adolescence. J Am Acad Child Adolesc microvascularization of the junctional region between Psychiatry 2001; 40(3):282-9. the integuments of the superficial surface of the free Abstract: OBJECTIVE: To examine the relationship 959
- 968. margin of theeyelid and the palpebral conjunctival Inst Mech Eng [H] 2005; 219(1):63-70. mucosa. The study was carried out using histological or Abstract: Recent reassessment of the literature on the transparified slices of upper and lower eyelids taken shaken baby syndrome (SBS) has revealed a lack of from fetuses and neonates, in which the vascular scientific evidence and understanding of all aspects of system was injected with agarized China ink. The the syndrome. In particular, studies have been unable mucocutaneous junction of the eyelid is located at the to clarify the mechanisms of injury, indicating that posterior border of the free margin and extends to its impact, rather than shaking alone, is necessary to cause deep surface. It has vascular similarities to the oral the type of brain damage observed. Rigid-body cavity and the nasal pyramid. Under a thickened modelling (RBM) was used to investigate the effect of avascular epithelium, there is a papillary network neck stiffness on head motion and head-torso impacts composed of characteristic loops that are less raised as a possible mechanism of injury. Realistic shaking than in the lips but more developed than in the nose. data obtained from an anthropometric test dummy The superficial and deep vascular reticular networks (ATD) was used to simulate shaking. In each study are comparable in fundamental arrangement to those of injury levels for concussion were exceeded, though other junctional zones. Thus, the palpebral impact-type characteristics were required to do so in mucocutaneous junction shows cutaneous-type the neck stiffness study. Levels for the type of injury microvascularization, just like the other junctional associated with the syndrome were not exceeded. It is zones of the head. unlikely that further gross biomechanical investigation of the syndrome will be able to significantly contribute Wolfram-Gabel R, Sick H. Microvascularization of the to the understanding of SBS. Current injury criteria are mucocutaneous junction of the nose. Surg Radiol Anat based on high-energy, single-impact studies. Since this 2002; 24(1):27-32. is not the type of loading in SBS it is suggested that Abstract: The aim of this study was to describe the their application here is inappropriate and that future microvascularization of the area of junction located studies should focus on injury mechanisms in low- between the integuments of the nasal ala and the energy cyclic loading. respiratory mucosa. This study is part of an overall study on the microvascularization of the Wolke D, Samara MM. Bullied by siblings: association with mucocutaneous junctions of the head. It was peer victimisation and behaviour problems in Israeli undertaken on histological or clarified sections of noses lower secondary school children. J Child Psychol from fetuses, newborns and adults whose vascular Psychiatry 2004; 45(5):1015-29. system was injected with Indian ink agar. The Abstract: BACKGROUND: The association of mucocutaneous junction of the nose shows similarities bullying victimisation by siblings with a) involvement with the mucocutaneous junction of the oral cavity. in bullying at school and b) behaviour problems among Under a well-defined avascular and thick epithelium lower secondary school children in Israel was lies a vascular papillary network with typical loops less investigated. METHOD: Self-report questionnaires of high than in the lips. The angioarchitectonics of sibling victimisation, peer bullying experiences and superficial and deep vascular reticular networks is behaviour problems were completed by 921 pupils similar to that of the lips but they are less dense. aged 12-15 (mean age 13.7 years). RESULTS: Of the sample, 16.2% were directly bullied by their siblings at Wolfram-Gabel R, Sick H. Microvascularization of the home and 11.9% were direct victims of bullying by mucocutaneous junctions of the head in fetuses and peers at school every week. More than half of victims neonates. Cells Tissues Organs 2002; 171(4):250-9. of bullying by siblings (50.7%) were also involved in Abstract: The mucocutaneous junctions of the head bullying behaviour at school compared to only 12.4% (oral, nasal and palpebral) are transitional zones of those not victimised by siblings, indicating a strong between the integuments and the mucosa. Their link between intrafamilial and extrafamilial peer microvascularization is studied in the heads of fetuses relationships. Children with poor sibling and peer and neonates by injection of agarized China ink into relationships were at a highly increased risk for the vascular system. These zones are situated deep with behaviour problems. Ethnic (Israeli Jewish vs. Arab) respect to the free edge of the oral or nasal cavity or and sex differences were small compared to the effects relative to the free margin of the eyelid. They present of sibling relationship on behaviour problems. cutaneous-type microvascularization with a papillary CONCLUSION: Intervention strategies directed at network and reticular networks. Long capillary loops reducing bullying in school should take into account connected to the deep reticular network are their main pupils' experiences of victimisation by siblings at feature. In the lips and eyelids, the morphology of the home. networks and their relationship with the orbicular muscles are suggestive of a functional structure. Wolke D, Woods S, Stanford K, Schulz H. Bullying and victimization of primary school children in England Wolfson DR, McNally DS, Clifford MJ, Vloeberghs M. and Germany: prevalence and school factors. Br J Rigid-body modelling of shaken baby syndrome. Proc Psychol 2001; 92(Pt 4):673-96. Abstract: Differences in definitions and methodologies 960
- 969. for assessing bullyingin primary school children interest were formed: 96 youths reported both self- between countries have precluded direct comparisons injurious behaviors and the intent to hurt or kill of prevalence rates and school factors related to themselves, and formed the "suicidal behaviors" group; bullying. A total of 2377 children in England (6-year- and, 1213 adolescents reported neither self-injurious olds/Year 2: 1072; 8-year-olds/Year 4: 1305) and 1538 behaviors nor intent to hurt self or die, and formed the in Germany (8-year-olds/Year 2) were questioned control group. The participants also responded to individually using an identical standard interview. In questions about depressive symptoms, anxiety, suicidal both countries the types of bullying to victimize others ideation and attempt, alcohol/drug use, stressful life were similar: boys were most often perpetrators, most events, and family relationships. They indicated bullies were also victims (bully/victims), most bullying whether anyone they knew had attempted or completed occurred in playgrounds and the classroom, and SES suicide in the previous 12 months. Logistic regression and ethnicity only showed weak associations with indicated that depressive symptoms, stressful life bullying behaviour. Major differences were found in events, suicidal ideation and exposure to suicide victimization rates with 24% of English pupils attempt (but not completed suicide) contributed unique becoming victims every week compared with only 8% variance to the presence of suicidal behaviors, after in Germany. In contrast, fewer boys in England controlling for demographic variables. Depression (and engaged every week in bullying (2.5-4.5%) than at trend levels, suicidal ideation) moderated the effect German boys (7.5%), while no differences were found of exposure to suicide attempt by others on suicidal between girls. In England, children in smaller classes behaviors. Our results indicate that completed suicide were more often victimized. Further study of the group in the social network increases risk for suicidal of bully/victims, schooling differences in England vs. behaviors, but not when other risk factors are Germany and implications for prevention of bullying controlled. By contrast, a suicide attempt are discussed. independently increases risk for suicidal behaviors. Furthermore, those youths who experience depressive Woller W, Kruse J. [Personality disorders and symptoms or suicidal ideation are at particularly high psychopathology following trauma. Reflection on risk for engaging in suicidal behaviors when an diagnostic classification]. Nervenarzt 2003; exposure to suicide attempt occurs. 74(11):972-6. Abstract: Pervasive personality disorders have been Wong WC. Acceptability study of sex workers attending the shown to be long-term sequelae of cumulative HIV/ AIDS clinic in Ruili, China. Asia Pac J Public childhood physical and sexual traumatization. This Health 2003; 15(1):57-61. finding is not reflected in DSM-IV and ICD-10 Abstract: A charitable clinic was set up to provide classifications where post-traumatic stress disorder is HIV/STD education and care to commercial sex confined to intrusions, avoidance, numbing, and workers in Ruili. Despite regular promotion of the hyperarousal. However, there is growing evidence that clinic, few people had utilised the service. Therefore, a trauma etiology should be taken into account in qualitative study was carried out among 89 sex workers planning treatment for personality disorders. It is not between March and April 2001 to look at the yet clear whether childhood traumatization is more background of our target group, their medical-seeking strongly associated with borderline personality disorder behaviours and the range of services expected. The than with other personality disorders. The finding of a turnover rates of sex workers were high. They had substantial overlap between borderline personality good awareness but poor knowledge of STD/HIV. disorder and dissociative identity disorder gives rise to Many self-medicated or sought advice from peers. discussions concerning the relationship of these two They had a serious concern for private practitioners or pathologies. the quality of drugs from pharmacy stores. They found our clinic inconvenient and did not meet their needs. Wong JP, Stewart SM, Ho SY, Rao U, Lam TH. Exposure to Subsequently, we refurbished the clinic, implemented suicide and suicidal behaviors among Hong Kong changes and retrained our staff. The number of patients adolescents. Soc Sci Med 2005; 61(3):591-9. treated three weeks after re-opening of the clinic has Abstract: Suicidal behaviors (deliberate self-injury with increased by three folds, with many of them still sex the intent to hurt or kill oneself) have been little workers, and the clinic's income increased by 58%. Our examined outside the West. The aims of this study experience has important implications for policymakers were to (a) determine the correlates of suicidal and other NGOs working with sex workers. behaviors, and (b) examine whether depression and suicide ideation moderated the effects of exposure to Woo P. Cytokines and juvenile idiopathic arthritis. Curr completed and attempted suicide on suicidal behaviors Rheumatol Rep 2002; 4(6):452-7. among a community sample of Hong Kong youth ages Abstract: Cytokines are a large group of polypeptides 12-17. Adolescents responded to questions regarding and small proteins that are effector molecules for cells self-injurious behaviors, and also indicated presence of involved in immune and inflammatory responses. intention to hurt or kill themselves in the past 12 There are agonists and antagonists that interact with months. Based on their responses, two groups of each other to maintain a dynamic equilibrium, and 961
- 970. ensure eventual recoveryof any perturbation, for toddlers 19 to 35 months of age had received their example, by trauma or infection, of the network toward basic immunization series of 4 doses of diphtheria and inflammation. The imbalance between pro- and anti- tetanus toxoids and acellular pertussis (DTaP) vaccine, inflammatory cytokines and the T helper cell subtypes 3 doses of inactivated poliovirus vaccine, 1 dose of is considered important in the pathogenesis of measles-mumps-rubella (MMR) vaccine, and 3 doses autoimmune diseases, including juvenile idiopathic of Haemophilus influenzae type b (Hib) vaccine. arthritis. The measurement of cytokines and Children who are members of a racial or ethnic chemotactic cytokines in body fluids and synovial minority, who are poor, or who live in inner-city or tissue has provided insight into the type of immune and rural areas have lower immunization rates than do inflammatory reaction and the possible presence or children in the general population. Additional absence of regulation. Differences between subtypes of challenges to vaccine delivery include the introduction juvenile idiopathic arthritis have been identified with of new childhood vaccines, ensuring a dependable these measurements. But cytokine measurements in supply of vaccines, bolstering public confidence in serum are not useful for diagnostic purposes, because vaccine safety, and sufficient compensation for vaccine of the variability during 24 hours, the collection and administration. Recent research has demonstrated assay methods, as well as the ease of degradation for specific and practical changes physicians can make to most cytokines. The recent interest in the genetic improve their practices' effectiveness in immunizing polymorphisms of cytokine genes and their association children, including the following: 1) sending parent with juvenile idiopathic arthritis has provided reminders for upcoming visits and recall notices; 2) association with a number of cytokine alleles. using prompts during all office visits to remind parents Confirmation of linkage with disease is only available and staff about immunizations needed at that visit; 3) for tumor necrosis factor and interleukin-6 at present. repeatedly measuring practice-wide immunization rates These genetic variants may be the basis of genetic over time as part of a quality improvement effort; and susceptibility to the persistent imbalance in the 4) having in place standing orders for registered nurses, inflammatory and immune networks, and determine the physician assistants, and medical assistants to identify phenotype and severity of disease. opportunities to administer vaccines. Pediatricians should work individually and collectively at local and Wood D. Effect of child and family poverty on child health national levels to ensure that all children receive all in the United States. Pediatrics 2003; 112(3 Part childhood immunizations on time. Pediatricians also 2):707-11. can proactively communicate with parents to ensure Abstract: Poverty has been described as an economic they understand the overall safety and efficacy of state that does not allow for the provision of basic vaccines. family and child needs, such as adequate food, clothing, and housing. However, the debate about the Woodruff TJ, Parker JD, Kyle AD, Schoendorf KC. effects of poverty on the growth, development, and Disparities in exposure to air pollution during health of children is as much involved with the culture pregnancy. Environ Health Perspect 2003; 111(7):942- or general context of poverty as it is with the 6. economics of poverty. This culture of poverty is in part Abstract: Previous research shows poorer birth mediated through environmental deprivations, such as outcomes for racial and ethnic minorities and for failing schools, gangs, drugs, violence, and struggling persons with low socioeconomic status (SES). We families. Heclo(1) described this sociocultural and evaluated whether mothers in groups at higher risk for environmental dimension of poverty as "a condition of poor birth outcomes live in areas of higher air pollution misery, hopelessness, and dependency." The subject of and whether higher exposure to air pollution this article is to review the literature on the effects of contributes to poor birth outcomes. An index poverty on US children as mediated through economic, representing long-term exposure to criteria air ecologic, and family influences. pollutants was matched with birth certificate data at the county level for the United States in 1998-1999. We Wood DL. Increasing immunization coverage. American used linear regression to estimate associations between Academy of Pediatrics Committee on Community the air pollution index and maternal race and Health Services. American Academy of Pediatrics educational attainment, a marker for SES of the Committee on Practice and Ambulatory Medicine. mother, controlling for age, parity, marital status, and Pediatrics 2003; 112(4):993-6. region of the country. Then we used logistic regression Notes: CORPORATE NAME: American Academy of models both to estimate likelihood of living in counties Pediatrics Committee on Community Health Services with the highest levels of air pollution for different CORPORATE NAME: American Academy of racial groups and by educational attainment, adjusting Pediatrics Committee on Practice and Ambulatory for other maternal risk factors, and to estimate the Medicine effect of living in counties with higher levels of air Abstract: Despite many recent advances in vaccine pollution on preterm delivery and births small for delivery, the goal for universal immunization set in gestational age (SGA). Hispanic, African-American, 1977 has not been reached. In 2001, only 77.2% of US and Asian/Pacific Islander mothers experienced higher 962
- 971. mean levels ofair pollution and were more than twice MEASURES: Frequency of presentations; presentation as likely to live in the most polluted counties compared characteristics; psychosocial characteristics; and with white mothers after controlling for maternal risk presence or absence of follow-up. RESULTS: Two factors, region, and educational status [Hispanic hundred twelve children and adolescents presented to mothers: adjusted odds ratio (AOR) = 4.66; 95% EDs 216 times. Of the 212 patients, 49 (23%) were 14 confidence interval (95% CI), 1.92-11.32; African- years or younger, and the youngest was aged 10 years. American mothers: AOR = 2.58; 95% CI, 1.00-6.62; The majority (82%) came after hours and were brought Asian/Pacific Islander mothers: AOR = 2.82; 95% CI, in by emergency services (77%). In 13% of 1.07-7.39]. Educational attainment was not associated presentations, verbal and/or physical aggression was with living in counties with highest levels of the air present, and a threat of self-harm was present in 2% of pollution index (AOR = 0.95; 95% CI, 0.40-2.26) after cases. A mental health worker was consulted about the adjusting for maternal risk factors, region of the child or adolescent in only 6% of presentations. Most country, and race/ethnicity. There was a small increase children and adolescents (85%) were discharged from in the odds of preterm delivery (AOR = 1.05; 95% CI, the ED. Of concern, in 56% of presentations, a follow- 0.99-1.12) but not SGA (AOR = 0.96; 95% CI, 0.86- up plan was not recorded. There was documentation of 1.07) in a county with high air pollution. Additional mental health follow-up in only 14% of presentations risk of residing in areas with poor air quality may and follow-up from drug and alcohol services in only exacerbate health problems of infants and children 1%. Forensic history, school functioning, and a history already at increased risk for poor health. of past mental health problems were not documented in more than 60% of the medical records examined. Woods CR. Syphilis in children: congenital and acquired. CONCLUSIONS: When children or adolescents Semin Pediatr Infect Dis 2005; 16(4):245-57. present to an ED with acute alcohol intoxication/self- Abstract: Syphilis rates in women and congenital poisoning, their risk factors for psychosocial syphilis rates have declined steadily in the United dysfunction appear to be inadequately assessed, States in recent years. However, syphilis remains a documented, and followed up. Clear guidelines for worldwide public health problem, with more than 12 assessment and referral pathways must be established million cases in adults and more than half a million in EDs. pregnancies affected yearly. Prenatal screening and treatment programs are limited or nonexistent in many Woollard M, Jewkes F. 5 Assessment and identification of developing countries. The genome of Treponema paediatric primary survey positive patients. Emerg Med pallidum, one of the smallest among prokaryotes, has J 2004; 21(4):511-7. been sequenced, but methods for continuous in vitro cultivation of the microbe remain elusive. There are no Workowski KA, Levine WC. Selected topics from the promising candidates for future vaccines at this time. Centers for Disease Control and Prevention Sexually Serologic testing, for both specific treponemal and Transmitted Diseases Treatment Guidelines 2002. HIV nontreponemal antibodies, continues to be a primary Clin Trials 2002; 3(5):421-33. means of diagnosis. Penicillin remains the drug of choice for congenital and acquired syphilis in Worku A, Addisie M. Sexual violence among female high childhood. The diagnosis of syphilis beyond early school students in Debark, north west Ethiopia. East infancy raises concerns for possible child sexual abuse, Afr Med J 2002; 79(2):96-9. although progression of congenital syphilis may Abstract: OBJECTIVES: To assess the prevalence, account for some cases. Syphilis is a potentially outcome and awareness of sexual violence among high eradicable disease, but this can be achieved only with school female students. DESIGN: A school-based sustained international will and cooperation to fund the cross-sectional survey. SETTING: Debark Town, necessary screening and treatment programs. north-west Ethiopia. SUBJECTS: Two hundred and sixteen female high school students, grade 9-11 were Woolfenden S, Dossetor D, Williams K. Children and included for the quantitative study. For the qualitative adolescents with acute alcohol intoxication/self- data, 16 individuals for the focus group discussion (10 poisoning presenting to the emergency department. well-recognised female figures in the town and six high Arch Pediatr Adolesc Med 2002; 156(4):345-8. school students) and head of the police department for Abstract: OBJECTIVE: To describe the presentations, in-depth interview were enrolled. RESULTS: Sixty two characteristics, and follow-up care of children and per cent of the respondents had heard of sexual adolescents aged 10 to 18 years who present to violence committed on young females. Sexual violence emergency departments (EDs) with acute alcohol was reported by 65.3% of the respondents. The intoxication/self-poisoning. DESIGN: Retrospective prevalence of performed and attempted rape were 8.8% medical record review. SETTING: Five EDs in and 11.5%, respectively. The age range of performed Western Sydney, Australia. PARTICIPANTS: Patients rape victims was between 12 and 21 years. Of the 19 aged 10 to 18 years who presented to EDs with acute (8.8%) who reported rape being performed on them, alcohol intoxication/self-poisoning between January 1, unwanted pregnancy, suicide attempt, vaginal 1996, and December 31, 2000. MAIN OUTCOME 963
- 972. discharge and abortionwere the consequences in 21%, Wray J. Choice: fad or fashion? Pract Midwife 2005; 8(3):4- 15.8%, 10.5% and 5.3%, respectively. CONCLUSION: 5. Sexual violence is a major public health problem with high rates of underreporting. Sex education should be Wray J. Confidentiality and teenage pregnancy--the affinity given on a regular basis and policy making bodies and gap. RCM Midwives 2005; 8(12):493. the police be well aware of this high magnitude and take strong measures to reduce it. Wray J. Postnatal home visits: the parents' views. Pract Midwife 2004; 7(9):38-40. Worobey J, Pisuk J, Decker K. Diet and behavior in at-risk children: evaluation of an early intervention program. Wray S, Levy-Milne R. Weight management in childhood: Public Health Nurs 2004; 21(2):122-7. Canadian dietitians' practices. Can J Diet Pract Res Abstract: This study describes outcomes for children 2002; 63(3):130-3. enrolled in the Prevention-Oriented System for Child Abstract: Canadian dietitians specializing in pediatric Health Project, an early intervention program aimed at practice were surveyed to provide a preliminary profile improving health and developmental status in at-risk of the strategies they use to manage overweight youth. families. Through a series of home visits by public The survey was mailed to 298 dietitians belonging to health nurses, 60 families received lessons on nutrition- the Dietitians of Canada's (DC) Pediatric Nutrition and and health-related topics determined by the child and Consulting Dietitians' Networks and to the head family's needs. On two occasions, some 8 months dietitians in Canadian pediatric hospitals across the apart, the children were evaluated using the country. It was also posted on the DC website and sent Developmental Assessment of Young Children, and by electronic mail. Of the 164 respondents, 65 reported their energy intake over the previous day was recorded. that they provide an intervention program to Analyses of the dietary and behavioral records overweight youth. Growth charts, ideal body weight, indicated that the children's scores on the physical and body mass index were mostly used to assess and subtest improved significantly. A number of nutrition- monitor overweight. However, about 20% of the development associations were found at follow-up, respondents did not define overweight in their client suggesting that the intervention was successful. population. The majority of the clients were girls aged Implications of the results for at-risk children are seven to 18. Most respondents used the healthful discussed. lifestyle approach via one-on-one consultation, included parents and collaborated with two or more Wozniak J, Biederman J, Kwon A et al. How cardinal are health professionals for the management of these cardinal symptoms in pediatric bipolar disorder? An children. As the discussion on best practices for the examination of clinical correlates. Biol Psychiatry prevention and treatment of overweight youth 2005; 58(7):583-8. continues, we need further evidence to determine what Abstract: BACKGROUND: The main goal of this strategies, if any, support positive outcomes in this study was to test whether the hypothesized cardinal group. symptom of euphoria results in differences in clinical correlates in bipolar youth ascertained with no a priori Wright C, Lee RE. Investigating perinatal death: a review of assumptions about cardinal symptoms. METHODS: the options when autopsy consent is refused. Arch Dis Subjects (n = 86) satisfying DSM-IV criteria for Child Fetal Neonatal Ed 2004; 89(4):F285-8. bipolar disorder with and without the proposed cardinal Abstract: Autopsy remains the best method of symptom of euphoria were compared in their bipolar investigating perinatal deaths. Recent years have, symptom pattern, functioning and patterns of however, seen a decline in autopsy rates. This review comorbidity. RESULTS: Among Criterion A looks at some of the options available for investigating (abnormal mood), we found that severe irritability was perinatal deaths when the family decline to give the predominant abnormal mood rather than euphoria consent for standard autopsy. (94% vs. 51%). We also found that among Criterion B items, grandiosity was not uniquely overrepresented in Wright DC, Woo WL, Muller RT, Fernandes CB, youth with mania, nor did the rate of grandiosity differ Kraftcheck ER. An investigation of trauma-centered whether irritability or irritability and euphoria were the inpatient treatment for adult survivors of abuse. Child Criterion A mood symptom. Neither symptom profile, Abuse Negl 2003; 27(4):393-406. patterns of comorbidity nor measures of functioning Abstract: OBJECTIVE: The purpose of this study was differed related to the presence or absence of euphoria. to examine a comprehensive inpatient treatment CONCLUSIONS: These findings challenge the notion program designed for adult survivors of childhood that euphoria represents a cardinal symptom of mania abuse with posttraumatic stress disorder (PTSD). in children. Instead they support the clinical relevance METHOD: One hundred and thirty-two formerly of severe irritability as the most common presentation abused individuals completed clinician-administered of mania in the young. They also support the use of and self-administered measures of PTSD unmodified DSM-IV criteria in establishing the symptomatology at admission and discharge. All diagnosis of mania in pediatric populations. 964
- 973. participants experienced arange of physical, sexual, Wu P, Hoven CW, Liu X, Cohen P, Fuller CJ, Shaffer D. and/or emotional abuse as children prior to the age of Substance use, suicidal ideation and attempts in 17. Approximately one-third of these individuals also children and adolescents. Suicide Life Threat Behav completed measures at 3-months postdischarge and 1- 2004; 34(4):408-20. year postdischarge. Data were collected using a Abstract: Using data from a community sample of clinician-administered PTSD measure and self- youth ( N = 1,458; ages 9-17), this study assessed the administered PTSD measure at admission and association between adolescent substance use/abuse discharge. On admission, all participants met criteria and suicidal behaviors. Suicide attempts were strongly for a diagnosis of PTSD. RESULTS: Analyses associated with alcohol abuse and dependence, revealed that the program was effective in reducing followed by frequent cigarette smoking. The symptoms from admission to discharge. Additionally, associations remained significant even after controlling treatment gains were maintained at 1-year for depression. The associations between substance postdischarge. CONCLUSION: The findings of this use/abuse and suicidal ideation were no longer investigation suggest that the current intensive significant after controlling for depression. These inpatient group treatment program appears to reduce findings highlight the important role that substance use PTSD symptoms effectively for a sample of adult plays in adolescent suicidal behaviors. survivors of abuse. Wuest J, Merritt-Gray M, Ford-Gilboe M. Regenerating Wright RJ, Steinbach SF. Violence: an unrecognized family: strengthening the emotional health of mothers environmental exposure that may contribute to greater and children in the context of intimate partner violence. asthma morbidity in high risk inner-city populations. ANS Adv Nurs Sci 2004; 27(4):257-74. Environ Health Perspect 2001; 109(10):1085-9. Abstract: Although concern for their children's well- Abstract: In the United States, rising trends in asthma being is pivotal in mothers' decisions to leave abusive prevalence and severity, which disproportionately partners, rarely is lone-parent family life after leaving impact minorities and the urban poor, have not been framed as beneficial for family members' emotional fully explained by traditional physical environmental health. In this feminist grounded theory study of family risk factors. Exigencies of inner-city living can health promotion in the aftermath of intimate partner increase psychosocial risk factors (e.g., stress) that violence, we learned that families strengthen their confer increased asthma morbidity. In the United emotional health by purposefully replacing previously States, chronic exposure to violence is a unique stressor destructive patterns of interaction with predictable, existing in many high-risk urban neighborhoods. In this supportive ways of getting along in a process called paper, we describe a series of cases that exemplify a regenerating family. These findings add to our temporal association between exposure to violence and knowledge of family development and how families the precipitation of asthma exacerbations in four urban promote their health when they have experienced pediatric patients. In the first three cases, the nature of intimate partner violence. the exposure is characterized by the proximity to violence, which ranged from direct victimization Wyatt J. Medical paternalism and the fetus. J Med Ethics (through either the threat of physical assault or actual 2001; 27 Suppl 2:ii15-20. assault) to learning of the death of a peer. The fourth Notes: GENERAL NOTE: KIE: Wyatt, John case characterizes a scenario in which a child was GENERAL NOTE: KIE: 14 refs. exposed to severe parental conflict (i.e., domestic GENERAL NOTE: KIE: KIE Bib: abortion; fetuses; violence) in the hospital setting. Increasingly, studies professional patient relationship have begun to explore the effect of living in a violent Abstract: A number of developments in the medical environment, with a chronic pervasive atmosphere of field have changed the debate about the ethics of fear and the perceived or real threat of violence, on abortion. These developments include: advances in health outcomes in population-based studies. Violence fetal physiology, the increase in neonatal intensive care exposure may contribute to environmental demands and the survival rates of premature infants. This paper that tax both the individual and the communities in discusses the idea of selective termination and the which they live to impact the inner-city asthma burden. effects that these decisions have on disabled people of At the individual level, intervention strategies aimed to today. It presents a critique of the counselling services reduce violence exposure, to reduce stress, or to that are provided for the parents of a disabled fetus and counsel victims or witnesses to violence may be discusses how this is viewed from a social perspective. complementary to more traditional asthma treatment in The article ends with an argument that the mother these populations. Change in policies that address the deserves to be autonomous in the decision of abortion. social, economic, and political factors that contribute to The easiest and most fair way to develop her autonomy crime and violence in urban America may have broader is to consider the relationship between a professional impact. and a mother as an expert-expert relationship. Here both parties are considered experts in diagnostic Wrisley BA. Reframing the issue: a new child maltreatment information, treatment options, possibilities, and their prevention message. N C Med J 2005; 66(5):367-9. history, family roots, philosophy and way of life, 965
- 974. respectively. therapy, although the exact mechanism is uncertain. This case cautions physicians to monitor methionine Wylie JL, Jolly A. Patterns of chlamydia and gonorrhea levels in CBS-deficient patients on betaine and to infection in sexual networks in Manitoba, Canada. Sex consider betaine as an adjunct, not an alternative, to Transm Dis 2001; 28(1):14-24. dietary control. Abstract: BACKGROUND: The use of sexual network analysis has the potential to further our understanding Yamada H. Japanese mothers' views of young children's of sexually tranmitted disease (STD) epidemics and areas of personal discretion. Child Dev 2004; contribute to the development of more effective 75(1):164-79. targeted control strategies. GOAL: To use sexual Abstract: Sixty-four Japanese mothers of 3- to 6-year- network analysis to study transmission patterns of olds were interviewed concerning their conceptions of chlamydia and gonorrhea in Manitoba, Canada. children's areas of personal control. Mothers granted STUDY DESIGN: Routinely collected case/contact children choices regarding recreational activities, information gathered by public health nurses was used clothes, and friends to foster autonomy and to construct the sexual network. RESULTS: competence, but they set limits around daily routines, Components within the sexual network ranged in size recreational activities, and interpersonal confrontation from 2 to 82 people. Two types of components, based on moral, conventional, and prudential concerns. designated radial and linear, were described. Large Mothers believed in reaffirming children's personal linear components resembled the theoretical structure boundaries when children failed to follow through with of STD core groups. Geographic analysis of the largest their initial decisions. Mothers experienced conflict components demonstrated the potential for STD with children around daily routines and recreational transmission between isolated rural communities and activities and used various resolution strategies. within different areas of an urban center. Mothers perceived child resistance as egocentric CONCLUSIONS: The application of sexual network whereas fewer considered it as establishing personal analysis on a provincial basis demonstrated the boundaries. Some age and gender differences were importance of a centralized, coordinated approach to observed. Results supported the heterogeneity of social STD control. The analysis highlights the need for a judgments and practices of individuals within cultures. greater understanding of the causative factors promoting the formation of different component types, Yamawaki S. [Early childhood trauma and stress-related the homogeneity and heterogeneity of behaviors within psychiatric disorders: neuroscience perspective]. and between components, and the temporal stability of Seishin Shinkeigaku Zasshi 2005; 107(5):506-13. these patterns. Abstract: Morphometric studies using magnetic resonance imaging have reported smaller than normal Yaghmai R, Kashani AH, Geraghty MT et al. Progressive volumes of the hippocampus in stress-related cerebral edema associated with high methionine levels psychiatric disorders such as major depression, post- and betaine therapy in a patient with cystathionine traumatic stress disorders (PTSD) etc... On the other beta-synthase (CBS) deficiency. Am J Med Genet hand, epidemiological studies have suggested that early 2002; 108(1):57-63. childhood trauma including child abuse and sexual Abstract: Cystathionine beta-synthase (CBS) abuse is associated with markedly elevated rates of deficiency, the most common form of homocystinuria, major depression and PTSD. Psychoanalysist and child is an autosomal recessive inborn error of homocysteine psychiatrists have reported that mother-child metabolism. Treatment of B6-nonresponsive patients relationship and fostering environment in early centers on lowering homocysteine and its disulfide childhood strongly affect the later mental development derivatives (tHcy) by adherence to a methionine- and increase the prevalence rate of various psychiatric restricted diet. However, lifelong dietary control is disorders, but its biological mechanism has not been difficult. Betaine supplementation is used extensively elucidated. Recent progress of neuroscience research in CBS-deficient patients to lower plasma tHcy. With has brought a possibility to elucidate molecular betaine therapy, methionine levels increase over biological mechanism of this developmental baseline, but usually remain below 1,500 micromol/L, psychological issue. The author reviews recent and these levels have not been associated with adverse neuroscience researches focused on the effect of early affects. We report a child with B6-nonresponsive CBS childhood trauma on the stress vulnerability and the deficiency and dietary noncompliance whose pathogenesis of stress-related psychiatric disorders. methionine levels reached 3,000 micromol/L on betaine, and who subsequently developed massive Yancey AK, Siegel JM, McDaniel KL. Role models, ethnic cerebral edema without evidence of thrombosis. We identity, and health-risk behaviors in urban investigated the etiology by determining methionine adolescents. Arch Pediatr Adolesc Med 2002; and betaine metabolites in our patient, and several 156(1):55-61. possible mechanisms for her unusual response to Abstract: BACKGROUND: The assumption that role betaine are discussed. We conclude that the cerebral models or mentors constructively influence adolescent edema was most likely precipitated by the betaine 966
- 975. psychological functioning hasprompted societal (Madr) 2004; 32(4):197-203. investment in mentoring programs. However, there has Abstract: BACKGROUND: The contribution of indoor been little empirical evaluation of the relationship fungal exposure to childhood asthma is not completely between role model or mentor characteristics and clear. OBJECTIVE: To investigate airborne fungal health behaviors. OBJECTIVES: To describe role flora within the homes of asthmatic and control model selection in urban adolescents and examine the children, and to assess the influence of housing relationships between role model characteristics, characteristics regarding indoor fungi. METHODS: psychosocial functioning, and health-risk behaviors. Forty-seven atopic asthmatic and 23 nonatopic control DESIGN: Cross-sectional survey. PARTICIPANTS: A children were studied. Allergen sensitivity was population-based, multiethnic sample of Los Angeles determined by skin prick tests. A thorough assessment, County adolescents aged 12 to 17 years was generated using a questionnaire and inspection surveys, was from a 3-stage, area-probability sampling frame. Of carried out. Home visits were made between October 877 adolescents identified, 749 are included in this 2000 and February 2001. Samples of airborne fungal analysis. METHODS: In-person, in-home interviews spores were collected from four rooms by the "open were conducted. MAIN OUTCOME MEASURES: Petri dish" method. Indoor temperature and humidity Substance use, academic performance, and self- were measured. RESULTS: The total indoor fungal perception (measures of ethnic identify and self- colony counts from the living rooms and bedrooms esteem). Ethnic identity was measured by an adaptation were significantly higher in the asthma group than in of a scale developed by Phinney (J Adolesc Res. controls (p = .012 and p = .003, respectively). The most 1992;7:156-176) to assess commonalities across ethnic commonly isolated genus was Cladosporium. Twelve groups. RESULTS: Fifty-six percent of adolescents of the asthmatic patients (25.53 %) were found to be identified a role model. Higher levels of ethnic identity sensitive to fungal allergens. The factors found to be were associated with moving from identifying no role associated with indoor fungal growth in logistic model to identifying a figure primarily available regression were visible fungal patches in the bathrooms through the media to identifying a known individual, [(odds ratio (OR) = 5.75; 95 % CI 1.19 to 27.70)], and familial or nonfamilial (P<.001). Having a role model, the age of the house [OR = 4.24; 95 % CI 1.34 to particularly an individual known to the adolescent, was 13.45]. Total fungal colony numbers did not correlate also associated with higher self-esteem (P<.001) and with indoor temperature or humidity. CONCLUSION: higher grades (P<.05). For white males without Fungal colony numbers were higher in the homes of custodial fathers, having a role model was associated asthmatic children than in those of controls. Therefore, with decreased substance use (P<.05). CONCLUSION: indoor fungal exposure may contribute to childhood Role model selection is associated with protective asthma. Bathrooms were the main source of fungal psychosocial characteristics. propagules. Old houses were more prone to fungal growth. Yang JW, Kuppermann N, Rosas A. Child abuse presenting as pseudorenal failure with a history of a bicycle fall. Ybarra ML, Mitchell KJ. Exposure to internet pornography Pediatr Emerg Care 2002; 18(2):91-2. among children and adolescents: a national survey. Cyberpsychol Behav 2005; 8(5):473-86. Yates A. Biologic perspective on early erotic development. Abstract: Estimates suggest that up to 90% or more Child Adolesc Psychiatr Clin N Am 2004; 13(3):479- youth between 12 and 18 years have access to the 96, vi. Internet. Concern has been raised that this increased Abstract: Neurobiologic researchers can understand accessibility may lead to a rise in pornography seeking children's sexuality in less moral and more biologic among children and adolescents, with potentially terms. Genetically programmed levels of serious ramifications for child and adolescent sexual neurotransmitters and hormones establish a baseline development. Using data from the Youth Internet trajectory of erotic interest and activity across the Safety Survey, a nationally representative, cross- lifespan. Environmental influences also contribute. sectional telephone survey of 1501 children and Intense early stimulation can affect the brain and create adolescents (ages 10-17 years), characteristics a condition of hyper eroticism, whereas too little associated with self-reported pornography seeking stimulation can limit the ability to bond and impair the behavior, both on the Internet and using traditional sexual response. Children who are erotically methods (e.g., magazines), are identified. Seekers of challenged or challenging are viewed correctly as pornography, both online and offline, are significantly having a brain imbalance, rather than as victims or as more likely to be male, with only 5% of self-identified being morally deficient. This should pave the way for seekers being female. The vast majority (87%) of youth more humane, objective, and effective interventions. who report looking for sexual images online are 14 years of age or older, when it is developmentally Yazicioglu M, Asan A, Ones U et al. Indoor airborne fungal appropriate to be sexually curious. Children under the spores and home characteristics in asthmatic children age of 14 who have intentionally looked at from Edirne region of Turkey. Allergol Immunopathol pornography are more likely to report traditional exposures, such as magazines or movies. Concerns 967
- 976. about a largegroup of young children exposing medical records. The survival for each case was themselves to pornography on the Internet may be determined as the duration between the date of overstated. Those who report intentional exposure to diagnosis and date of death, date of loss to follow-up or pornography, irrespective of source, are significantly the closing date of the study (December 31(st), 1999). more likely to cross-sectionally report delinquent Cumulative observed and relative survival was behavior and substance use in the previous year. calculated by the Hakulinen Method. For comparison Further, online seekers versus offline seekers are more of results with other populations, age-standardized likely to report clinical features associated with relative survival (ASRS) was calculated by directly depression and lower levels of emotional bonding with standardizing age specific relative survival to the their caregiver. Results of the current investigation specific age distributions of the estimated global raise important questions for further inquiry. Findings incidence of major cancers in 1985. The log rank test from these cross-sectional data provide justification for was used in univariate analysis to identify the longitudinal studies aimed at parsing out temporal potentially important prognostic variables. The sequencing of psychosocial experiences. variables showing statistical significance in univariate analysis were introduced stepwise into a Cox Ye DQ, Zhu JM, Zhang YQ et al. [A survey on violence Regression model to identify the independent among primary and secondary school students in Hefei predictors of survival. RESULTS: The 5-year relative city]. Zhonghua Liu Xing Bing Xue Za Zhi 2004; survival rates were 46.2% for breast, 47.7% for the 25(1):6-8. cervix and 25.4% for the ovary. Higher survival was Abstract: OBJECTIVE: To explore the features of observed for those younger than 35 years for all these violence among primary and secondary school students three sites. For each, survival declined with advancing in Hefei, and to set up intervention measures for age. Single patients who remained unmarried had violence prevention. METHODS: Four schools in better survival. For all sites Muslims had a better and Hefei were randomly sampled in the study. A total of Christians a lower survival as compared to Hindus. 3064 students completed a questionnaire. RESULTS: Education did not appear to be of significance. Survival 16.22% of the pupils reported having suffered from decreased rapidly with advancing clinical extent of violence at least once every month. The rate was higher disease for all sites. With localized cancer, 5-year rates in boys than that in girls's (chi(2) = 25.13, P = 0.000). ranged from 54.7% to 69.3%, for regional spread The major assaulters were from classmates (45.80%), 20.4% to 41.6% and distant metastasis not a single site with hand beating (37.42%), insulting (31.21%), recorded more than 5%. On multivariate analysis, age threatening (20.88%), and 10.49% using sticks and and extent of disease emerged as independent sharp weapons. Most violence occurred at school predictors of survival for all the sites. CONCLUSION: (46.08%), followed by at home (28.41%) and outside All the sites included in the study demonstrated of schools (25.51%), with significant difference (P = moderate survival rates with significant variation. 0.000). As a result, 3.33% ended up with fractures, and Comparison with other populations revealed lower 0.51% with disability. 97 pupils reported having survival rates as compared to developed countries, assaulted others frequently (3.21%). Being irritated particularly for breast and ovary. In Indian populations (47.38%) was the major reason for the violence to survival proportions did not show much variation for occur. CONCLUSION: Violence among primary and these cancers. Early detection and treatment are clearly secondary school students in Hefei city was serious important factors to reduce the mortality from these that called for targeted education be strengthened and cancers. school environment be improved. Yeole BB, Sunny L, Swaminathan R, Sankaranarayanan R, Yeole BB, Kumar AV, Kurkure A, Sunny L. Population- Parkin DM. Population-based survival from colorectal based survival from cancers of breast, cervix and ovary cancer in Mumbai, (Bombay) India. Eur J Cancer in women in Mumbai, India. Asian Pac J Cancer Prev 2001; 37(11):1402-8. 2004; 5(3):308-15. Abstract: Survival estimates of patients registered by Abstract: BACKGROUND: Breast, cervix and ovarian population-based cancer registries reflect the average cancers contribute more than 45% of the total in prognosis from a given cancer as they are based on women in Mumbai and survival proportions for these unselected patients with a wide range of natural neoplasms are very high in most developed populations histories and treatment patterns. In this paper, we in the World. The authors here report and discuss the report the survival experience of colorectal cancer population-based survival for these cancers in Mumbai, patients in Mumbai (Bombay), India. Follow-up India. METHODS: Follow-up information on 4865 information on 1642 colorectal cancer patients cancers of breast, cervix and ovary, registered in the registered by the Bombay Population-based Cancer Mumbai Population Based Cancer Registry for the Registry for the period 1987-1991 was obtained by period 1992-1994 was obtained by a variety of matching with death certificates from the Bombay vital methods, including matching with death certificates statistics registration system, postal/telephone from the Mumbai vital statistics registration system, enquiries, home visits and scrutiny of medical records. postal/telephone enquiries, home visits and scrutiny of Cumulative observed and relative survival proportions 968
- 977. were calculated byHakulinen's method. For income (stability and level) were associated with comparison of results with other populations, age- preschool children's developmental outcomes standardised relative survival (ASRS) was calculated (Woodcock-Johnson [W-J] Achievement Test scores by directly standardising age-specific relative survival and the Behavior Problem Index [BPI]) through to the specific age distributions of the world standard investment and family process pathways. Results cancer patient population in 1985. The log-rank test supported the hypothesis that distinct mediating was used to identify the potential prognostic variables mechanisms operate on the association between which were introduced step-wise into a Cox regression income and different child outcomes. Much of the model to identify the independent predictors of association between income and children's W-J scores survival. The 5-year relative survival was 36.6% for was mediated by the family's ability to invest in colon and 42.2% for rectal cancer. Age, site of cancer providing a stimulating learning environment. In and clinical stage of disease emerged as independent contrast, family income was associated with children's predictors of survival. Age-specific 5-year relative BPI scores primarily through maternal emotional survival declined with advancing age. Survival at 5 distress and parenting practices. Level of income was years was 61.2% for localised colon cancer; 31.9% for associated with W-J letter-word scores and income regional and 9.0% for distant metastatic disease. These stability was associated with W-J applied problem were 65.7, 25.6 and 4.3%, respectively for rectal scores and BPI, even after all controls were included in cancers. Comparison of the results with other the models. populations revealed significant variations, which seem to be related to differences in detection and treatment. Yin Z, Hanes J Jr, Moore JB, Humbles P, Barbeau P, Gutin The prognosis from colorectal cancer in Mumbai and B. An after-school physical activity program for developing countries, may be further improved through obesity prevention in children: the Medical College of early detection linked with treatment. Georgia FitKid Project. Eval Health Prof 2005; 28(1):67-89. Yeong EK, Hsiao TC, Chiang HK, Lin CW. Prediction of Abstract: This article describes the process of setting burn healing time using artificial neural networks and up a 3-year, school-based after-school physical activity reflectance spectrometer. Burns 2005; 31(4):415-20. intervention in elementary schools. The primary aim of Abstract: BACKGROUND: Burn depth assessment is the study is to determine whether adiposity and fitness important as early excision and grafting is the will improve in children who are exposed to a fitogenic treatment of choice for deep dermal burn. Inaccurate versus an obesogenic environment. Eighteen schools assessment causes prolonged hospital stay, increased were randomized to the control (obesogenic) or medical expenses and morbidity. Based on reflected intervention (fitogenic) group. The study design, burn spectra, we have developed an artificial neural program components, and evaluation of the network to predict the burn healing time. PURPOSE: intervention are described in detail. The intervention Our study is to develop a non-invasive objective consists of (a) academic enrichment, (b) a healthy method to predict burn-healing time. METHODS AND snack, and (c) physical activity in a mastery-oriented MATERIALS: Burns less than 20% TBSA was environment. Successful implementation would show included. Burn spectra taken on the third postburn day the feasibility of schools' being able to provide a using reflectance spectrometer were analyzed by an fitogenic environment. Significant differences between artificial neural network system. RESULTS: Forty-one the groups would provide evidence that a fitogenic spectra were collected. With the newly developed environment after school has positive health benefits. If method, the predictive accuracy of burns healed in less feasibility and efficacy are demonstrated, than 14 days was 96%, and that in more than 14 days implementing an after-school program like this one in was 75%. CONCLUSIONS: Using reflectance elementary schools could play a major role in spectrometer, we have developed an artificial neural preventing and reducing childhood obesity. network to determine the burn healing time with 86% overall predictive accuracy. Yip R. Iron supplementation: country level experiences and lessons learned. J Nutr 2002; 132(4 Suppl):859S-61S. Yeung WJ, Linver MR, Brooks-Gunn J. How money matters Abstract: Iron supplementation is a commonly used for young children's development: parental investment strategy to meet the increased requirements of at-risk and family processes. Child Dev 2002; 73(6):1861-79. groups, such as women of childbearing age, especially Abstract: This study used data from the Panel Study of during pregnancy. Other at-risk groups for which iron Income Dynamics and its 1997 Child Development supplementation may be appropriate include infants, Supplement to examine how family income matters for young children, adolescents and the elderly. There is a young children's development. The sample included need to consider iron supplementation as part of a 753 children who were between ages 3 and 5 years in comprehensive strategy for the prevention of iron 1997. Two sets of mediating factors were examined deficiency, and not just as a treatment for anemia that that reflect two dominating views in the literature: (1) is stopped as soon as clinical improvement is noted. the investment perspective, and (2) the family process Experience in developing countries indicates that often perspective. The study examined how two measures of the poorest women with the most deficient intakes are 969
- 978. the least likelyto receive iron supplements during stimulus processing engage distinct spatially localized pregnancy. Providing supplements to women during gamma networks at functionally relevant areas, and (ii) antenatal care visits is useful but often inadequate, so the neuronal substrates of gamma band networks and other delivery channels must also be explored, the ability to synchronize them in relation to task- including private sector markets and community specific processes are available in all age groups from networks. Communication efforts must be expanded to 9 to 16 years. However, the mode and efficiency with increase understanding of the importance of taking which gamma networks can be entrained depends on supplements and to address any fears or the age. This age-dependent reactivity of GBRs to misconceptions relating to supplementation. Overall, different task variables may reflect a transition in we must increase the capacity of individuals and processing strategies emerging at approximately 12-13 communities to define, analyze and act to address their years in relation to the maturation of cognitive and own health needs. executive brain functions. Yonge O, Haase M. Munchausen syndrome and Yorke S. Brassed off with knee-jerk reactions. Nurs Times Munchausen syndrome by proxy in a student nurse. 2001; 97(32):21. Nurse Educ 2004; 29(4):166-9. Abstract: Most faculty are not prepared for the Yost NP, Bloom SL, McIntire DD, Leveno KJ. A possibility of encountering Munchausen syndrome prospective observational study of domestic violence (MS) in nursing students and Munchausen syndrome during pregnancy. Obstet Gynecol 2005; 106(1):61-5. by proxy (MSP) in nursing students' children. When Abstract: OBJECTIVE: To assess whether women confronted with MS or MSP, their first reaction is often reporting domestic violence are at increased risk for hostility coupled with a sense of betrayal. Given that adverse pregnancy outcomes. METHODS: A screening individuals with this condition are attracted to helping questionnaire, previously validated for the professions, the authors describe both conditions in a identification of female victims of domestic violence, case in which a nursing student presented with MS and was offered to women presenting to our Labor and the student's daughter was a victim of MSP. The focus Delivery Unit. The survey prompted women to indicate is on protection of any children and the public, whether her partner or family member physically hurt psychiatric treatment for the offender, and assistance her, insulted or talked down to her, threatened her with for faculty. harm, or screamed or cursed at her. The primary study outcome was to detect a 3-fold increase in low birth Yordanova J, Kolev V, Heinrich H, Woerner W, weight infants (< or = 2,500 g) in women reporting Banaschewski T, Rothenberger A. Developmental physical abuse, compared with those not reporting event-related gamma oscillations: effects of auditory domestic violence. RESULTS: A total of 16,041 attention. Eur J Neurosci 2002; 16(11):2214-24. women were approached to be interviewed. Of these, Abstract: This study describes maturational changes in 949 (6%) women responded affirmatively to one or topographical patterns, stability, and functional more of the survey questions, and another 94 (0.6%) reactivity of auditory gamma band (31-63 Hz) declined to be interviewed. The incidence of low birth responses (GBRs) as brain electrical correlates relevant weight infants was significantly increased in women for cognitive development during childhood. GBRs of who reported verbal abuse, compared with the no- 114 healthy children from 9 to 16 years were elicited in abuse group (7.6% versus 5.1%, respectively, P = an auditory focused attention task requiring motor .002). Physical abuse was associated with an increased responding to targets, and analyzed by means of the risk of neonatal death (1.5% versus 0.2%, P = .004). wavelet transform (WT). The effects of age and task Interestingly, women who declined to be interviewed variables (attended side and stimulus type relevance) had significantly increased rates of low birth weight were examined for GBR power and phase-locking infants (12.8% versus 5.1%, P < .001), preterm birth at within 120 ms after stimulation. Similar to the 32 weeks of gestation or less (5.3% versus 1.2%, P = spontaneous gamma band power, the power and phase- .002), placental abruptions (2.1% versus 0.2%, P < synchronization of GBRs did not depend on the age. .001), and neonatal intensive care admissions (7.4% However, the functional reactivity of GBRs at specific versus 2.2%, P = .008) when compared with women in locations changed in the course of development. In 9- the no-abuse group, respectively. CONCLUSION: 12-year-old children, GBRs at frontal locations were Women who declined to be surveyed regarding larger and better synchronized to target than to domestic violence were at increased risk for adverse nontarget stimulus type, and were larger over the left pregnancy outcome. LEVEL OF EVIDENCE: II-2. hemisphere (contralateral to the responding hand), thus manifesting sensitivity to external stimulus features Youd J. Lost generation? Emerg Nurse 2005; 12(9):15-7. and motor task. In 13-16-year-old adolescents, GBRs at parietal sites were enhanced by active attending to the Young B, Dixon-Woods M, Findlay M, Heney D. Parenting side of stimulation, thus being associated with a in a crisis: conceptualising mothers of children with maintenance of attentional focus to stimulus location. cancer. Soc Sci Med 2002; 55(10):1835-47. The results indicate that (i) specific aspects of task- 970
- 979. Abstract: Much researchon the experiences of parents development, even allowing for the coexistence of of children with cancer has been conducted within a conduct problems. Hyperactivity predicted academic discourse of psycho-pathology, or has tended to see problems and interpersonal relationship problems. parents mostly as a proxy source of information on the Relationships with parents, by contrast, were not well-being of their children. Using empirical data from portrayed to be as problematic as relationships with semi-structured interviews with 20 mothers of a child peers and the opposite sex. Their psychological, social with cancer, in one area of the UK, we draw on and occupational functioning was objectively rated to sociological literatures on motherhood, childhood, be more deviant and their self-report showed them to caring, and chronic illness to suggest a more helpful be more ambivalent about their future. There was a and informative way of understanding their trend for hyperactivity to be self-reported as a risk for experiences. We suggest that mothers, although not ill the development of continuing symptomatology but themselves, experience many of the consequences of neither hyperactivity nor conduct problems were self- chronic illness. Biographical disruption begins for them reported to be a risk for antisocial behaviour, substance when they first notice something wrong with their misuse or low self-esteem in adolescence. However, child, and intensifies with diagnosis, altering their they were at risk for the development of state anxiety. sense of self and their social identity. The diagnosis CONCLUSIONS: The results suggested girls' pattern brings with it a set of new responsibilities and role of functioning may differ from that of boys because expectations, including an obligation of 'proximity'- girls self-report a more pervasive range of social being physically close to their child at all times to dysfunction than that previously reported in boys. provide 'comfort' and 'keep-watch'. For mothers, caring evokes an intense emotional interdependence with their Young SE, Smolen A, Corley RP et al. Dopamine sick child, and involves a range of technical tasks and transporter polymorphism associated with externalizing emotional work, including acting as 'brokers' of behavior problems in children. Am J Med Genet 2002; information for their child and managing their 114(2):144-9. cooperation with treatment. Managing these Abstract: Early childhood externalizing behavior is a obligations was achieved at high cost to the mothers stable and heritable pattern of aggressive and themselves, and resulted in severe role strain by delinquent behavior that often leads to the development compromising their ability to function in other roles, of serious psychiatric disorders such as conduct including their role as the mother of their other disorder and attention deficit hyperactivity disorder. children. Against the backdrop of a severe and life- We examined the relationship between parent reported threatening illness, everyday concerns about their externalizing behavior (assessed at ages 4, 7, and 9 child's diet or appropriate discipline take on a new years) and the VNTR polymorphism of the 3' significance and carry a heightened potential for untranslated region of SLC6A3 (DAT1) in a generating conflict and distress for mothers. In community sample of 790 children ascertained as part presenting their accounts, mothers draw on prevailing of our longitudinal twin and adoption studies. We cultural discourses about motherhood, childhood and applied the sibling-based methodology developed by cancer, and these clearly influence the context in which Fulker et al. [1999: Am J Hum Genet 64:259-267] for they care for their child, and shape their reflexive estimating allelic association with quantitative traits, constructions of their experiences. Caring for a child while controlling for population stratification. An with cancer had many adverse implications for the extension of these methods allowed for the inclusion of quality of life of the women we studied. Mothers of a monozygotic twins, dizygotic twins, siblings, and child with cancer warrant study in their own right, and singletons. We have demonstrated that the 9-repeat such study benefits from interpretive perspectives. variant of the DAT1 is a significant risk allele for externalizing behavior at ages 4 (P=0.001) and 7 years Young S, Heptinstall E, Sonuga-Barke EJ, Chadwick O, (P=0.02). Although the effect size was negligible at age Taylor E. The adolescent outcome of hyperactive girls: 9 (P=0.92), a formal test of the developmental decrease self-report of psychosocial status. J Child Psychol in effect across the three ages was non-significant Psychiatry 2005; 46(3):255-62. (P=0.70). Abstract: BACKGROUND: The aim of the study was to clarify the developmental risk associated with Youngstrom E, Weist MD, Albus KE. Exploring violence hyperactive behaviour in girls in a longitudinal exposure, stress, protective factors and behavioral epidemiological design. METHODS: This was problems among inner-city youth. Am J Community investigated in a follow-up study of girls who were Psychol 2003; 32(1-2):115-29. identified by parent and teacher ratings in a large Abstract: This study examined relationships between community survey of 6- and 7-year-olds as showing violence exposure, other stressors, family support, and pervasive hyperactivity or conduct problems or the self-concept on self-reported behavioral problems comorbid mixture of both problems or neither problem. among 320 urban adolescents (aged 11-18) referred for They were later investigated, at the age of 14 to 16 mental health treatment. Overall, participants reported years, with a detailed self-report interview technique. high levels of violence exposure, with a median of six RESULTS: Hyperactivity was a risk factor for later past encounters with violence as a witness, victim, or 971
- 980. through the experiencesof associates. All forms of compared to Trondheim concerning the awareness of, violence exposure (witnessing, being a victim, and positive attitudes towards, safety issues (e.g. knowing of victims) were correlated with internalizing alcohol and driving, speeding and children's safety in and externalizing behavioral problems for males and traffic). 56.0% of respondents in Harstad reported females. Total violence exposure predicted behavioral having acquired information, or good advice, about problems among participants, even after controlling for traffic safety from the reports. CONCLUSIONS: the effects of other risk, demographic and protective Traffic injuries in children can be prevented by factors. Family support and self-concept moderated the community-based interventions. Distributing written influence of life stress and cumulative risk on problem information may enhance the program's sustainability. behavior outcomes, but these protective variables did not significantly moderate violence exposure. Ytterstad B, Norheim AJ. The epidemiology of injuries in Svalbard compared with Harstad. Int J Circumpolar Yozwiak JA, Golding JM, Marsil DF. The impact of type of Health 2001; 60(2):184-95. out-of-court disclosure in a child sexual assault trial. Abstract: STUDY OBJECTIVE: To survey all injuries Child Maltreat 2004; 9(3):325-34. treated in Longyearbyen hospital, Svalbard and to Abstract: This study investigated the impact of type of describe the injury epidemiology for Svalbard out-of-court disclosure in a child sexual assault case (residents and visitors), comparing it with Harstad. involving a 6-year-old alleged victim. Community SETTING: The Norwegian arctic archipelago, participants read a fictional criminal trial summary of a Svalbard and the mainland city Harstad during three child sexual assault case in which the alleged victim's years from 8 March 1997. PARTICIPANTS: The out-of-court disclosure of the assault was: (a) complete person years of the study were 4211 for Svalbard on two occasions or (b) incomplete at first, but later residents and 69,014 for Harstad. MEASUREMENTS included the full account of the incident. The results AND MAIN RESULTS: The variables followed the showed that there were more guilty verdicts, higher Nordic system. Of 630 recorded injuries, 107 were ratings of the defendant's guilt, and greater belief of the snowmobile related. Crude injury rates (per 1000 alleged victim when there was full disclosure on two person years) [corrected] for Svalbard residents were occasions compared to when there was a delay in full for men 100.9 and for women 76.3. Corresponding disclosure. These results are discussed in terms of the rates were not significantly higher for men in Harstad impact the nature of out-of-court disclosure can have (115.4, p = 0.19) and for women (80.1, p = 0.56). when a child testifies in a sexual assault case. Home injuries were more prevalent in Harstad (30.5%) compared to Svalbard residents (13.1%, p < 0.001) and Ytterstad B. The Harstad Injury Prevention Study. A decade visitors (8.9%, p < 0.001). Work and leisure related of community-based traffic injury prevention with injuries were more prevalent for Svalbard visitors emphasis on children. Postal dissemination of local (38.8% and 48.7%) and residents (27.2% and 41.9%) injury data can be effective. Int J Circumpolar Health compared to Harstad (13.2% and 34.8%) (both p < 2003; 62(1):61-74. 0.001). 43.5% of Svalbard visitors sustained work Abstract: OBJECTIVES: To evaluate the outcome of a related injuries at sea. These injuries had higher AIS community-based program for reducing traffic injury (abbreviated injury scale) mean score (1.83) than rates with special focus on children and to assess the visitors' work injuries occurring on land (1.41) (p < impact of a Traffic Injury Report (TIR) in terms of 0.05) and residents' work injuries (1.29) (p < 0.001). awareness and attitudes about safety issues. SETTING: Harstad had lowest AIS score for work related injuries The Norwegian cities Harstad (23 000) and Trondheim (1.24). The violence rate (per 1000 person years) was (140 000), during ten years. METHODS: The outcome 0.9 for Svalbard residents, less than a third of the was evaluated using hospital-based injury recording. Harstad rate (p < 0.02). There was one Svalbard Sustainability of the prevention program was promoted resident fatality (drowning). by disseminating information on the community's traffic injury profile. Reports containing information Yu BP, Chung HY. Stress resistance by caloric restriction about traffic injuries were distributed quarterly to all for longevity. Ann N Y Acad Sci 2001; 928:39-47. Harstad households, containing victim stories and Abstract: Hardly an aspect of aging is more important statistics on medical data and the location of the than an organism's ability to withstand stress or to accidents. The impact of the reports was evaluated, resist both internally and externally imposed insults. using a questionnaire mailed to persons 18-80 years We know that as organisms loose their ability to resist old. RESULTS: From the first two years (mean rate these insults, aged organisms suffer more than the 116.1/10,000 person years), to last two years, a young. Therefore, a prime strategy for an organism's significant 59% [confidence interval (CI): 42% to 71%] survival has been the evolutionarily adapted defense reduction of traffic injury rates was observed for systems that guard against insult. For better Harstad children. Overall rates for all ages decreased survivability, an organism's defense system must be 37% [CI:47% to 24%] in Harstad increased by 3% maximized to its full effect through well-coordinated [CI:-4% to 10%] in Trondheim (reference city). networks of diverse biologically responsive elements. Significantly higher scores were found in Harstad Although terms like stress, resistance, and adaptability 972
- 981. have long beenused in biology, they remain present within individual lamellae. Elastic fibers mechanistically and quantitatively poorly defined. In a appeared to be long (>200 microm) and straight in gerontological context, stress resistance or outer anulus, whereas in inner anulus, they nearly ran susceptibility are often discussed in association with an parallel to each other and at an angle of approximately organism's vulnerability to disease and age-related 60 degrees or 120 degrees to those in adjacent damage. However, to date, there is no clear molecular lamellae. However, in scoliotic discs, elastic fibers delineation of cellular and molecular mechanisms for were sparse, and the collagen and elastic fiber networks such complex biological phenomena. The life- were disorganized with loss of lamellar structure. Cell prolonging action of caloric restriction (CR) seems to clusters, one of typical degenerative feature, were seen offer an excellent opportunity for investigating the in scoliotic discs but not in age-matched control discs. interrelationship between stress and the aging process. CONCLUSIONS: Our results reveal an abundant and As an omnipotent intervention, CR provides a unique organized network of elastic fibers in the adolescent opportunity to probe the organism's ability to withstand (12 and 17-year-olds) human IVD, and suggest that age-related stress as a survival strategy. In this context, elastic fiber network plays a significant biomechanical the antiaging action of CR can be viewed as role. This network is sparse and disrupted in scoliotic "nutritional stress," because the organism's reduced discs, and could be involved in the progression of the caloric intake seems to be a stimulatory metabolic spinal deformity. response for survivability. Recent gerontologic research has provided sufficient experimental data Zaba R, Bukartyk-Rusek B. [School hygiene in the past, supporting this antiaging property of CR, of which present and future--in the opinion of the Inspector of several pertinent, key examples are discussed below. Pediatrics and School Medicine and member of the European Society for Social Pediatrics (ESSOP)]. Yu J, Fairbank JC, Roberts S, Urban JP. The elastic fiber Wiad Lek 2002; 55 Suppl 1:615-9. network of the anulus fibrosus of the normal and Abstract: Yesterday. School hygiene acted in a clear scoliotic human intervertebral disc. Spine 2005; way. Physician, pediatrician, nurse and hygienist were 30(16):1815-20. employed at school and were responsible for carrying Abstract: STUDY DESIGN: Immunohistochemical out periodic examination, vaccination of school study of elastic fibers in human intervertebral discs children and youth. They also supervised groups of (IVD) collected at surgery from patients with scoliosis. children with posture defects, obesity, underweight, OBJECTIVES: To compare the elastic fiber network in circulatory system and respiratory tract (asthma, scoliotic discs (idiopathic scoliosis or neuromuscular anaphylaxis), diseases nervous system disorders and scoliosis) to that of control (normal) discs. To study also propagated health education at school. Inspector of whether the change in elastic fiber organization could Pediatrics and School Medicine was in charge of contribute to the progression of spinal deformity. School Medical Care. Today. Reform of the Public SUMMARY OF BACKGROUND DATA: Elastin and Health System. Medical examination and services have elastic fibers have been identified previously in human their value in money. A school physician, some IVD but were believed to contribute little to the tissue's hygienists and school nurses have been dismissed to mechanical properties. However, a recent decrease the financial costs of school hygiene. All immunohistochemical study has revealed an abundant medical services must be bought by the National and organized elastic fiber network in bovine IVD, Health Service. Public and private medical services at indicating that elastic fibers could play an important doctors and nurses are organized at schools. Each mechanical role. This article reports the organization of service performs examinations, vaccinations bought by elastic fibers in human IVD and the changes of elastic the National Health Service or parents. A pupil is a fiber organization in scoliosis. METHODS: Intact subject of buying medical services. He may be wedges of IVD were obtained from patients vaccinated by a nurse but a medical examination must undergoing surgery for scoliosis (aged 12-22 years). be either bought or performed by home doctor. The Control discs were obtained from a patient (aged 12 supervision of school children with different illnesses years) with a spinal tumor and a trauma patient (aged is not conducted by a school doctor. At present all the 17 years). The discs were dissected to give radial slices threats of contemporary world such as alcohol, and were snap frozen. Frozen sections were cut and tobacco, drug addiction, nervous system illnesses and digested with hyaluronidase to remove allergies which are destructive for youth start when glycosaminoglycans. Micrographs of the sections were they are teenagers. School is an important place for examined by polarized light to visualize collagen carrying out on a large scale prophylactic services with organization. The elastic fiber network was visualized medical teams of paediatricians, rehabilitation immunohistochemically or by histochemical staining specialists and psychologists. Tomorrow. School with orcein. RESULTS: A highly organized elastic Hygiene at School. Not at home doctor's. fiber network, similar to that described in bovine discs, Recommendations, Daily Hygiene: personal, oral, food was revealed in the control human discs. In the anulus mental.... Hygiene of studying, rest and daily effort. fibrosus of control discs, dense elastic fibers were Struggle with mass media, alcohol, drug, Internet, located between adjacent lamellae, with fibers also Computer addiction, violence, stupidity and poverty. 973
- 982. School Hygiene shouldbe adjusted to youth's health concepts and presented lower academic performance in needs in accordance with the recommendations of reading and arithmetic than did children of European Society for Social Pediatrics (ESSOP) and nonalcoholic parents. Based on the responses given by Committee on Public Education, American Academy the mothers, the children of alcoholic parents presented of Pediatrics and reinforced, it should not be more behavioral problems than did those of eliminated. nonalcoholic parents. CONCLUSIONS: The results of this study confirm those of other studies and call Zalkind HJ, Allen PW. Strengthening families: the role of attention to the need to be aware of the potential community-based and grassroots organizations. N C vulnerabilities of children of alcoholic parents and, Med J 2005; 66(5):383-5. especially, to try to minimize such vulnerabilities, thereby altering the course of psychological suffering Zandi PP, Klein AP, Addington AM et al. Multilocus that can mark their lives. linkage analysis of the German asthma data. Genet Epidemiol 2001; 21 Suppl 1:S210-5. Zavela KJ. Developing effective school-based drug abuse Abstract: We analyzed data from the German Asthma prevention programs. Am J Health Behav 2002; Genetics Group with three methods that utilize 26(4):252-65. pedigree-specific nonparametric linkage scores to Abstract: OBJECTIVE: To research effective drug facilitate the search for multiple independent and prevention strategies for school-aged populations from interacting susceptibility loci. The three methods drug prevention programs funded by the USDHHS included a conditional analysis, logistic regression, and Center for Substance Abuse Prevention (CSAP). neural networks. Although there were differences, the METHOD: Nine directors and staff members from three methods identified many of the same model CSAP-funded programs were interviewed. susceptibility loci. The most consistent evidence was RESULTS: Fifteen strategies that focus on building provided for loci on chromosomes 1, 2, 6, 9, and 15. trusted relationships, selecting well-qualified staff Both the conditional and the logistic regression using existing communication networks, and providing analyses suggested an epistatic relationship between timely evaluation feedback are discussed, with loci on chromosomes 2 and 9. The logistic regression examples from the agencies cited. CONCLUSION: analysis further revealed evidence for locus Formulating effective partnerships that support both heterogeneity between loci on chromosomes 6 and 15. the goals of the outside agency with drug prevention Finally, the neural network analysis identified a resources and the mission of a school can contribute potential locus on chromosome 17 that was not toward effective school-based drug prevention identified in the other analyses. programs. Zanoti-Jeronymo DV, Carvalho AM. Self-concept, academic Zebrowitz LA, Fellous JM, Mignault A, Andreoletti C. Trait performance and behavioral evaluation of the children impressions as overgeneralized responses to adaptively of alcoholic parents. Rev Bras Psiquiatr 2005; significant facial qualities: evidence from connectionist 27(3):233-6. modeling. Pers Soc Psychol Rev 2003; 7(3):194-215. Abstract: OBJECTIVE: It has been shown that being Abstract: Connectionist modeling experiments tested the child of an alcoholic is a risk factor for the anomalous-face and baby-face overgeneralization development of alcoholism in adulthood. Due to the hypotheses proposed to explain consensual trait suffering caused by living with alcoholic parents, other impressions of faces. Activation of a neural network vulnerabilities appear in such children. Among these unit trained to respond to anomalous faces predicted are low self-esteem, poor academic performance and impressions of normal adult faces varying in behavioral problems. This work aims to comparatively attractiveness as well as several elderly stereotypes. evaluate children of alcoholic parents and children of Activation of a neural network unit trained to respond nonalcoholic parents. METHODS: The study design to babies' faces predicted impressions of adults varying was quasi-experimental, involving two comparison in babyfaceness as well as 1 elderly stereotype. Thus, groups. Two groups of 20 children were selected. The similarities of normal adult faces to anomalous faces or groups consisted of 10- to 12-year-old male and female babies' faces contribute to impressions of them quite children. One group comprised children of alcoholic apart from knowledge of overlapping social parents, whereas the other comprised children of stereotypes. The evolutionary importance of nonalcoholic parents. The self-concepts of these appropriate responses to unfit individuals or babies is children were evaluated using the Piers-Harris presumed to produce a strong response preparedness Children's Self-Concept Scale as well as the Academic that is overgeneralized to faces resembling the unfit or Performance Test. Their mothers participated in the babies. study by answering questions related to the behavior of their children on the Rutter A2 scale of Child Behavior. Zeigler VL. Ethical principles and parental choice: treatment RESULTS: The results showed that the children of options for neonates with hypoplastic left heart alcoholic parents tended to have more negative self- syndrome. Pediatr Nurs 2003; 29(1):65-9. 974
- 983. Abstract: Nurses caringfor children with congenital among Arab girls. CONCLUSIONS: Sexual heart disease face unique challenges, especially when harassment is prevalent in Israeli schools. The pattern caring for neonates diagnosed with hypoplastic left of victimization is different for boys and girls and for heart syndrome (HLHS). The treatment options for students in Jewish and Arab schools. These patterns are these neonates present difficult choices for the child's a complex phenomenon that must be considered in the decision makers and are not without significant life- intervention and policy measures addressing sexual altering consequences. In order to assist in the harassment at school. decision-making process, nurses as patient and family advocates should acknowledge the unique role they Zelnik N, Newfield RS, Silman-Stolar Z, Goikhman I. play in the informed consent process, while Height distribution in children with Tourette syndrome. simultaneously identifying specific ethical principles J Child Neurol 2002; 17(3):200-4. that are components of this process. By incorporating Abstract: Tourette syndrome is characterized by motor the principles of autonomy, beneficence, and veracity and vocal tics, frequently accompanied by attention- into specific nursing interventions, nurses can assist deficit hyperactivity disorder (ADHD), obsessive- families in making informed decisions regarding a compulsive disorder, coprolalia, aggressive or self- treatment option that is best for the child as well as the injurious behavior, and learning disabilities. We family. investigated the height distribution and clinical characteristics of 38 consecutive patients with Tourette Zeira A, Astor RA, Benbenishty R. School violence in syndrome. Seventeen patients with Tourette syndrome Israel: findings of a national survey. Soc Work 2003; (44.7%) were in the lower height quartile versus 25% 48(4):471-83. from a control group of 44 patients with ADHD (P Abstract: The authors report preliminary findings of a <.05). The mean standard deviation score differential national survey on school violence in Israel. The (patient height - [target height]) was -1.12 +/- 0.82 for national representative sample was stratified on school patients in the first quartile (group A) compared with type--elementary, middle, and high schools--and 0.42 +/- 0.63 in taller patients with Tourette syndrome ethnicity--Jewish and Arab students. A total of 15,916 (group B) (P < .001). The mean birthweight of boys in students from 603 classes and 232 schools participated group A versus group B was 3023 +/- 351 g and 3363 in the study, resulting in a 91 percent response rate. +/- 486 g, respectively (P <.02); birthweight correlated Findings revealed high rates of violence in all areas and with standard deviation score (r=.43). Current weight among all age groups, but relatively higher rates of relative to height was normal. Conduct disorder and/or low-level violent behaviors and lower rates of more self-injurious behavior were more common in group A severe violent events. The authors report on age- patients (P < .05). Relative short stature appears related, gender, and cultural differences and discuss common in Tourette syndrome, and its presence with social workers' roles in shaping national policy and other features may implicate a neurotransmitter system professional discourse on school violence. that interacts with neuroendocrine pathways, controlling height. Zeira A, Astor RA, Benbenishty R. Sexual harassment in Jewish and Arab public schools in Israel. Child Abuse Zerquera JT, Alonso MP, Bejerano GL, Lopez JO, Negl 2002; 26(2):149-66. Rodriguez NA. Assessment of the doses received by Abstract: OBJECTIVE: Current empirical literature on the Cuban population from 40K contained in the body: sexual harassment in schools is mostly based on modelling based on a neural network. Radiat Prot nonrepresentative samples of middle-class high-school Dosimetry 2003; 104(3):237-43. Caucasian female students. Thus the scope of research Abstract: Potassium-40 constitutes the main natural regarding gender, age, and cultural differences is very source of potassium present in the body, which limited. This article reports on findings on sexual influences the effective dose received by people. With harassment in Jewish and Arab schools in Israel with the aim of assessing the contribution of this component regard to gender, age, and cultural differences. to the doses received by the Cuban population, a study METHOD: The study is part of the first national survey intended to assess the doses was developed. For this on school violence in Israel. The representative sample purpose, a representative sample of the Cuban includes 10,400 students in grades 7 through 11 population was selected according to age and sex. The attending public schools in Israel. Students were asked measurements were made using the whole-body to report whether they were victims of specific acts of counter (WBC) of the Center for Radiation Protection sexual harassment in school during the month before and Hygiene (CPHR). For dose estimations, a uniform the survey. RESULTS: Overall, 29.1% of the students distribution of potassium for the whole body was were victims of at least one act of harassment. The assumed. The methodology used was the one more common acts were to show offensive pictures or recommended by the ICRP. The values of annual to send obscene letters, to take off or to try to take off effective dose range between 93 and 209 microSv for part of the student's clothing, and to try to kiss a females and between 123 and 212 microSv for males. student. The most vulnerable groups are the Arab boys The annual average effective dose for members of the and 8th grade students. Report rates were the lowest public was estimated as 150 +/- 40 microSv, taking 975
- 984. into account theexperimental data and the specific Zink T, Elder N, Jacobson J, Klostermann B. Medical features of the Cuban population. With the dose values management of intimate partner violence considering obtained, it was possible to model dose estimates by the stages of change: precontemplation and means of a neural network, which was trained with the contemplation. Ann Fam Med 2004; 2(3):231-9. results obtained and using as starting data the sex, age, Abstract: BACKGROUND: We undertook a study to height and corporal weight of people studied. The understand how women who are victims of intimate modelobtained allows consideration of the anatomical partner violence (IPV) want physicians to manage features of each person in the estimation of doses. these abusive relationships in the primary care office. METHODS: Thirty-two mothers in IPV shelters or Zilberman ML, Blume SB. [Domestic violence, alcohol and support groups in southwestern Ohio were interviewed substance abuse]. Rev Bras Psiquiatr 2005; 27 Suppl to explore their abuse experiences and health care 2:S51-5. encounters retrospectively. The interviews were taped Abstract: Domestic violence and substance abuse are and transcribed. Using thematic analysis techniques, common in primary care patients. Although these transcripts were read for indications of the stages of problems are associated with severe physical and change and for participants' desires concerning psychological sequelae, they are often undiagnosed. appropriate physician management. RESULTS: This article provides an overview of the prevalence of Participants believed that physicians should screen these problems, the health-related consequences for women for IPV both on a routine basis and when adults, children and elderly, as well as the challenges symptoms indicating possible abuse are present, even if for clinicians in screening, assessment and referral. the victim does not disclose the abuse. Screening is an important tool to capture those women early in the Zimba EW, McInerney PA. The knowledge and practices of process of victimization. When a victim does not primary care givers regarding home-based care of recognize her relationship as abusive, participants HIV/AIDS children in Blantyre (Malawi). Curationis recommended that physicians raise the issue by asking, 2001; 24(3):83-91. but they also warned that doing more may alienate the Abstract: Knowledge is one of the major factors that victim. Participants also encouraged physicians to promotes adherence to treatment regimens. With the explore clues that victims might give about the abuse. current trends worldwide of home and community- In later contemplation, victims are willing to disclose based services for the management of HIV/AIDS the abuse and are exploring options. Physicians were patients, knowledge of care givers about the home care encouraged to affirm the abuse, know local resources of these patients will determine the success of the for IPV victims, make appropriate referrals, educate programs. The purpose of this descriptive study was to victims about how the abuse affects their health, and explore the knowledge and practices of primary care document the abuse. Participants identified a variety of givers of HIV/AIDS children in the provision of home internal and external factors that had affected their care services. In this study an attempt was made to processes. CONCLUSIONS: In hindsight, IPV victims describe the factors which are associated with recommended desired actions from physicians that knowledge. Thirty-six primary care givers were could help them during early stages of coming to terms randomly selected from three major home based care with their abusive relationships. Stage-matched centres in Blantyre City, Malawi. A structured interventions may help physicians manage IPV more interview schedule was used to collect data. Data were effectively and avoid overloading the victim with analysed manually and by computer, using the information for which she is not ready. Statistical Package for Social Science (SPSS). The findings revealed a gap in knowledge since in many Zink T, Kamine D, Musk L, Sill M, Field V, Putnam F. instances taking a child to the hospital for the What are providers' reporting requirements for children management of minor ailments was the action of who witness domestic violence? Clin Pediatr (Phila) choice, thus perpetuating the problem of overburdening 2004; 43(5):449-60. hospital resources. Lack of prior preparation for home Abstract: Each year, 3.3 to 10 million children are based care was found to be the major factor exposed to domestic violence/abuse (DV). Providers' contributing to the lack of knowledge. reporting obligations for these children are unclear. Recommendations proposed include the need to put The child maltreatment statutes available on state's web into place mechanisms that will ensure that all the sites (through August 2003) were reviewed. Only primary care givers are adequately prepared in good Alaska defines DV in the presence of a child as child time for home care service. Ensuring regular home abuse within its juvenile code. Within their child abuse visits was also thought to be helpful for efficient and definition and reporting statutes, many states include effective supervision and reinforcement of information language such as "substantial risk" or "imminent given to fill the gaps in knowledge wherever necessary. danger" of "physical harm" or "mental injury." Although knowledge of the state law is an important Zink T. On my mind: meeting Daniel. Arch Pediatr Adolesc first step, abiding by it may be challenging because Med 2005; 159(8):704-5. most statutes are open to wide interpretation. As a result, providers are encouraged to seek advice from 976
- 985. local child maltreatmentspecialists who understand the 52. local legal interpretations and resources. Abstract: In the interest of more systematically documenting the early signs of autism, and of testing Zink T, Sill M. Intimate partner violence and job instability. specific hypotheses regarding their underlying J Am Med Womens Assoc 2004; 59(1):32-5. neurodevelopmental substrates, we have initiated a Abstract: OBJECTIVE: Research has shown that longitudinal study of high-risk infants, all of whom intimate partner violence (IPV) affects the physical and have an older sibling diagnosed with an autistic mental health of victims. It can also compromise work spectrum disorder. Our sample currently includes 150 performance, leading to job loss. We explored the infant siblings, including 65 who have been followed to potential link between job loss and IPV as part of a age 24 months, who are the focus of this paper. We larger study on IPV and health care. METHODS: have also followed a comparison group of low-risk Thirty-two mothers in Midwestern IPV shelters or infants. Our measures include a novel observational support groups were interviewed to gather information scale (the first, to our knowledge, that is designed to about their abuse histories, health care experiences, and assess autism-specific behavior in infants), a demographic characteristics. Interviews were audio computerized visual orienting task, and standardized taped, transcribed, and reviewed for themes. measures of temperament, cognitive and language RESULTS: Half of participants had lost jobs because development. Our preliminary results indicate that by of IPV. Reasons included: the abuser told the victim to 12 months of age, siblings who are later diagnosed quit, in order to be safe, excessive absences because of with autism may be distinguished from other siblings covering up the abuse, and health issues exacerbated by and low-risk controls on the basis of: (1) several IPV. CONCLUSION: Job instability was common specific behavioral markers, including atypicalities in among IPV victims in this study. Although this study eye contact, visual tracking, disengagement of visual did not address cause and effect, evidence of job attention, orienting to name, imitation, social smiling, instability may be another "red flag symptom" reactivity, social interest and affect, and sensory- indicating that providers should screen for IPV. oriented behaviors; (2) prolonged latency to disengage visual attention; (3) a characteristic pattern of early Zipitis CS, Paschalides C. Caring for a child with spina temperament, with marked passivity and decreased bifida: understanding the child and carer. J Child activity level at 6 months, followed by extreme distress Health Care 2003; 7(2):101-12. reactions, a tendency to fixate on particular objects in Abstract: Spina bifida is a common congenital the environment, and decreased expression of positive abnormality, which causes significant physical and affect by 12 months; and (4) delayed expressive and psychological morbidity in affected children and which receptive language. We discuss these findings in the also affects their carers. This small-scale study looked context of various neural networks thought to underlie at the health problems of a child with a neurodevelopmental abnormalities in autism, including myelomeningocoele. It also addresses the psychosocial poor visual orienting. Over time, as we are able to problems that his mother, his main carer, faced and the prospectively study larger numbers and to examine social networks involved in his care. The evidence interrelationships among both early-developing supporting various aspects of spina bifida prevention behaviors and biological indices of interest, we hope and management is explored. Furthermore, a literature this work will advance current understanding of the review is included, with regards to physical and neurodevelopmental origins of autism. psychological issues for child and carer. This study aims to raise awareness of the problems faced by Zwick EB, Leistritz L, Milleit B et al. Classification of children with myelomeningocoele and their families. In equinus in ambulatory children with cerebral palsy- particular, we aim to educate health care professionals discrimination between dynamic tightness and fixed on the importance of perceived stress by carers of such contracture. Gait Posture 2004; 20(3):273-9. children, and suggest ways to reduce psychosocial Abstract: In this study a generalised dynamic neural morbidity. network (GDNN) was designed to process gait analysis parameters to evaluate equinus deformity in Zoloth L. Nursing father and nursing mothers: notes toward ambulatory children with cerebral palsy. The aim was a distinctive Jewish view of reproductive ethics. Annu to differentiate dynamic calf muscle tightness from Soc Christ Ethics 2001; 21:325-37. fixed muscle contracture. Patients underwent clinical Notes: GENERAL NOTE: KIE: Zoloth, Laurie examination and had instrumented gait analysis before GENERAL NOTE: KIE: 24 fn. evaluating their equinus under anaesthesia and muscle GENERAL NOTE: KIE: KIE Bib: bioethics; relaxation at the time of surgery to improve gait. The contraception; reproduction performance of the clinical examination, the subjective interpretation of gait analysis results, and the Zwaigenbaum L, Bryson S, Rogers T, Roberts W, Brian J, application of the neural network to assess ankle Szatmari P. Behavioral manifestations of autism in the function were compared to the examination under first year of life. Int J Dev Neurosci 2005; 23(2-3):143- anaesthesia. Evaluation of equinus by a Neural Network showed high sensitivity and specificity values 977
- 986. with a likelihoodratio of +14.63. The results indicate from fixed calf muscle contracture with considerable that dynamic calf muscle tightness can be differentiated precision that might facilitate clinical decision-making. 978