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Parental separation: effects on children; implications for services.

It is commonly assumed that the children of separated or divorced parents are disadvantaged financially and in terms of social development. A small-scale study was designed involving 14 volunteer parents who were separated from their spouses/partners and their 28 children, ranging in age from 5 to 12 years. Structured interviews examined the families' attitudes and feelings about the separation, the mental health of the parents, the emotional and behavioural reactions of the children, and the families' use of services. The results suggested that over 60% of the girls showed internalizing, and over 60% of the boys displayed externalizing behavioural difficulties. About 40% of the children suffered psychosomatic disorders. Nearly 75% of the parents suffered depression before and after separation. Depression, itself, may act to exacerbate children's emotional and behavioural difficulties. Although all the parents had received medication for their depression, few of the children had received any help for their difficulties. The urgent need for services to help such children is discussed.

Child↗

Sure Start graduates: predictors of attainment on starting school.

BACKGROUND: We report the analysis of the services used and the outcomes for children who used four Sure Start programmes prior to starting school in 2003. METHODS: A cohort study compared the intervention group both to classmates who lived in the areas covered by Sure Start but did not access it, and to a random sample of children in the same Local Education Authority who did not have access because they lived outside these areas. The impact of service use variables on various outcomes for users was explored using multiple linear regression analysis. RESULTS: No differences were found in school attainment between users and non-users on average. However, in one of the four areas, users' outcomes were consistently worse. By contrast, in one area, they appeared to be marginally superior on non-academic developmental scores. When we controlled for between-area differences, we also found an association between high use of Sure Start and personal and social development scores. IMPLICATIONS: Much of the variation in outcomes remains to be explained. Tentative findings suggest stronger associations between Sure Start use and better non-academic developmental outcomes. These findings add to our understanding of the impact of focused, high-quality pre-school provision. Methodological issues raised include rater bias, recruitment bias and a need to measure both frequency and type of service use.

Age Factors↗

Hip fracture: family caregivers' burden and related factors for older people in Taiwan.

AIMS: The purpose of this study was to explore the burden experienced by caregivers during the transition from hospital to home. BACKGROUND: With a growing older population, home-based care has gradually gained more recognition. Most older people with hip fracture in Taiwan have to be discharged at a relatively early stage. Therefore, the caregiving tasks falls on the families. METHODS: A total of 98 older people with hip fracture and their caregivers were interviewed. The sample was selected from three medical centres in Taipei, and questionnaires were collected at one week and one month following hospital discharge. RESULTS: (i) Family caregivers were usually women (63.3%) with spouses being the primary caregivers in most cases (30.6%). About one-third of caregivers took care of other family members on top of their responsibilities caring for the sick elders at home, and 77.6% shared the care tasks with others. (ii) The caregivers experienced moderate burdens. About 91.8% of caregivers reported 'I feel sad watching the elder's health deteriorating', 84.9% reported 'I must keep an eye on the elder constantly' and 56.7% reported 'Taking care of the sick elder at home makes me feel exhausted'. (iii) Caregiver burden and the functional level of older people were adversely correlated. (iv) Caregivers who were unable to access other resources for help and/or had provided care to the older person prior to the fracture resulting in hospitalization experienced a higher burden. CONCLUSIONS: These findings should be helpful in the formulation of evidence-based discharge planning and home health care services. RELEVANCE TO CLINICAL PRACTICE: Comprehensive discharge planning and developing social support systems for family caregivers to reduce caregivers burden are needed.

Activities of Daily Living↗

Reflections on possible virtues of European medical education.

Political and social development in Europe will lead to increased mobility of doctors between countries as well as opening up new possibilities and horizons for educational institutions. In this emerging process the charge that universities are too traditional to change may not be valid when the virtues of academic traditions in Europe are considered. When those virtues are taken into account, they are seen to facilitate the integration of more current goals for future development into undergraduate medical curricula. The use of external examiners between different countries in Europe will promote greater quality in European medical education.

Curriculum↗

Dialysis and renal transplantation in children: long term and recent experience.

The outcome of 38 children with endstage renal failure who entered a dialysis and renal transplant programme over a period of 16 years is reported. The initial care was given in an adult programme but in 1985 this was changed to a comprehensive and specifically paediatric programme. Patient survival was 97, 86 and 80% at 1, 5 and 10 years respectively. Thirty-four of the patients spent a mean period of 19 months (range 1-160 months) on dialysis with the preferred form of dialytic therapy being continuous ambulatory peritoneal dialysis. Primary cadaveric graft survival was 72 and 42% at 1 and 3 years respectively; although since 1985 1 year graft survival has risen to 90%. The major long term problems have been growth failure and poor social development. Eighty-seven per cent of children have been able to continue normal schooling, and of the 18 who have left school 14 (78%) are employed or undertaking tertiary education. Thus dialysis and transplantation has allowed not only excellent patient survival but also the achievement of satisfactory educational standards and subsequent employment for the majority of patients.

Adolescent↗

History and characteristics of Okinawan longevity food.

Okinawan food culture in the Ryukyu island is one of the world's most interesting culture because its consumers have the longest life expectancies and low disability rates. It is a product of cultural synthesis, with a core of Chinese food culture, inputs through food trade with South-East Asia and the Pacific and strong Japanese influences in eating style and presentation. The Satsamu sweet potato provides the largest part of the energy intake (and contributes to self-sufficiency), there is a wide array of plant foods including seaweed (especially konbu) and soy, and of herbaceous plants, accompanied by fish and pork, and by green tea and kohencha tea. Infusing multiple foodstuff and drinking the broth is characteristic. Raw sugar is eaten. The concept that 'food is medicine' and a high regard accorded medical practice are also intrinsic of Okinawan culture. Again, food-centered and ancestral festivities keeep the health dimensions well-developed. Pork, konbu and tofu (soy bean-curd) are indispensable ingredients in festival menus, and the combination of tofu and seaweed are used everyday. Okinawan food culture is intimately linked with an enduring belief of the system and highly developed social structure and network.

Diet↗

Using village theatre to increase knowledge about eclampsia in Bangladesh.

OBJECTIVE: To assess the impact of a theatre based educational initiative on the knowledge and attitudes to eclampsia and its treatment in a rural Bangladeshi village. METHODS: An established theatre company, Theatre Centre for Social Development, performed scenarios regarding eclamptic pregnant women to a diverse audience of village observers. Before the performance 15 men and 15 women were randomly selected from the audience and asked a series of questions regarding eclampsia. After the performance the series of questions were repeated to the same people. RESULTS: The plays were enthusiastically received by the villagers. The level of knowledge of the villagers interviewed increased significantly after seeing the two plays. CONCLUSION: The intervention successfully raised both the awareness of eclampsia and the level of knowledge of effective treatments for eclampsia. Village theatre has shown the potential to be a very effective tool in Bangladeshi rural society.

Adolescent↗

What's in a look?

The most common behavioral technique used to study infant perception, cognition, language, and social development is some variant of looking time. Since its inception as a reliable method in the late 1950s, a tremendous increase in knowledge about infant competencies has been gained by inferences made from measures of looking time. Here we examine the logic, utility, and future prospects for further gains in our understanding of infant cognition from the use of looking time measures.

Attention↗

Maternal depression and motherese: temporal and intonational features.

Children of depressed parents are at increased risk for depression and other developmental problems. Recent research indicates that disturbances exist in face-to-face interactions between depressed mothers and their infants. In the present study, the effects of maternal depression on motherese, an interactive behavior that plays a significant role in affective, cognitive, and social development, were examined. 2 paralinguistic features of motherese were examined: temporal parameters of utterances and pauses and the frequency of use of 5 types of intonation contours typically found in motherese utterances. Face-to-face interactions between 36 mothers and their 3-4-month-old infants were audio-recorded, and hard copy records of pitch contours and relative intensity were produced for 2-min interaction sequences. Results indicated that depressed mothers failed to modify their behavior according to the behavior of the infant. They were significantly slower to respond to an infant vocalization, had more variable utterances and pauses, and were less likely to utilize the exaggerated intonation contours that are characteristic of motherese. The results provide evidence for a mechanism through which maternal depression increases the infant's risk for psychopathology.

Child Language↗

Self-restraint as a mediator of family influences on boys' delinquent behavior: a longitudinal study.

In the course of social development, family influences seem to become partly internalized and transformed into personality characteristics that regulate behavior outside the family sphere. In a longitudinal study of 81 boys and their families, we hypothesized that individual differences in boys' self-restraint would serve as a mediator between family factors in preadolescence and sons' delinquent behavior 4 years later. Measures were derived from principal components analyses of multiple indices of each construct as assessed by multiple informants. As expected, parenting practices measured at both pre- and mid-adolescence predicted delinquent acts only indirectly via their association with boys' self-restraint. In addition, general family functioning at preadolescence, independent of other scores, predicted boys' levels of self-restraint 4 years later. There was no evidence that boys' self-restraint at preadolescence systematically affected the quality of parenting that they subsequently received. Parents' and families' role in children's development of self-regulatory skills may be a primary vehicle by which they ultimately influence adolescents' problem behaviors.

Adolescent↗

Less is more: executive function and symbolic representation in preschool children.

Executive function is recognized as a critical component of children's cognitive and social development. In two studies, a measure of executive function that had been used in research with chimpanzees was adapted for preschoolers. On this task, called Less Is More, children must point to a smaller reward (two candies) to receive a larger reward (five candies). In Study 1 (N= 101), performance was significantly related to age (3 vs. 4), verbal ability, and established measures of executive function. In Study 2 (N= 128), symbolic representations substituted for real candies in this task. Three-year-olds' performance improved significantly as a function of symbolic distancing. This research has implications for the role of symbol systems in the development of executive control over thought and action.

Age Factors↗

Body dysmorphic disorder and cosmetic dermatology: more than skin deep.

Body dysmorphic disorder (BDD) is relatively common in cosmetic practise, yet it remains under-recognized. BDD patients are unnaturally concerned with minimal or non-existent flaws, most commonly in the skin (e.g. facial acne or scarring) and hair (e.g. hair loss). Many patients develop social avoidance and suffer occupational or academic impairment. More severely ill patients may become housebound or even attempt suicide. Despite the minimal or non-existent nature of the perceived appearance flaws, patients with BDD may request dermatological treatments such as isotretinoin or dermabrasion. Although treatment outcome has received little investigation, it appears that most patients are dissatisfied with dermatological treatment and, even if the outcome is objectively acceptable, they do not worry any the less about their appearance afterwards. In contrast, a majority of patients respond to serotonin reuptake inhibitors or cognitive behavioural therapy. Treatment of these patients is best given by an experienced health professional. This may be a mental health professional or a dermatologist with an interest in psychological medicine.

Journal Article↗

Spatial learning deficits in preschool children of alcoholics.

When compared with nonalcoholics, chronic alcoholics and their children show significant deficits in the processing of visuospatial information. The literature supports two possible explanations of a visuospatial processing deficit in the child of an alcoholic (COA) when compared with the child of a nonalcoholic (NCOA). Either the COA may suffer cognitive disruptions produced by personal and social development within an alcoholic family, or the COA may inherit or very early develop alterations in central nervous system substrates of neurocognitive operations. The present study was designed to continue our examinations of visuospatial information processing differences and the source of these differences in COAs. An evaluation of very young subjects not only assisted in providing a more complete view of visuospatial processing across the COA's life span, but also helped explain why the deficit occurs. Thirty matched male and female preschool children, aged 35.8-51.6 months, served as participants. Fifteen children were COAs from families in which the biological father and two other relatives had an alcoholism history. The other group of 15 children were NCOAs. Each child performed a visuospatial learning task similar to the task used in previous studies of older COAs. The visuospatial learning performance of the preschool COAs was inferior to that displayed by preschool NCOAs. The patterns of correct, error, and nonresponses emitted by the preschool COAs and the interrelationships of these data closely resembled the data from our previous studies of older children, adolescent, and adult COAs.(ABSTRACT TRUNCATED AT 250 WORDS)

Attention↗

Parental rearing behaviour, family atmosphere and adult depression: a pilot study with psychiatric inpatients.

In a sample of 72 depressed inpatients the relationships between severity of depression, emotional family atmosphere and perceived parental rearing were studied at admission, discharge and follow-up. The results indicate that paternal rejection and overprotection might be of particular importance for developing social skills used to form close relationships, whereas maternal emotional warmth seems to have a preventive effect by promoting emotional stability.

Child↗

Performance of the Hamilton Depression Rating Scale in depressed patients in the United Arab Emirates.

Cross-cultural variation in the frequencies and modes of expression of depressive symptoms may influence the validity of depression rating scales. The most widely used instrument for this purpose, namely Hamilton's Depression Rating Scale (HDRS), has not been systematically evaluated in Arab countries. This study evaluates the face validity of the HDRS-21 by studying symptom frequencies, factor structure and symptom clusters in 100 UAE depressed patients. Concurrent validity is tested by comparing total HDRS scores with global estimates of severity made by clinicians, admission status, impairment of social and occupational functioning, and the endogenicity score of the Newcastle (NC) Diagnostic Index. Total HDRS scores show highly significant agreement with three independent measures of severity of depression. Rank orders of the most and least frequent symptoms are consistent with studies of similar design. Marked differences lie in more retardation and somatization and fewer cognitive components in the present study. Principal-component analysis confirmed the heterogeneous structure of the scale, separating a group of core depressive symptoms, and endogenous, somatization, anxiety and psychotic symptom components. The internal consistency (reliability) of the whole scale is moderate, and improves in the core symptom factor. The main conclusion is that the HDRS is sensitive to severity of depression in the UAE culture. However, it measures heterogeneous aspects, and its internal consistency suffers as a result. High levels of retardation and somatization contribute significantly to the total score in socially developing communities.

Adolescent↗

Adolescents with cystic fibrosis in The Netherlands.

In a survey-study of all living Dutch patients with cystic fibrosis (CF) born before 1971 data have been gathered on sex, age, age at diagnosis; height and weight; treatment and social development. The group consists of 102 schoolchildren (8-11 years), 179 adolescents (12-21 years) and 28 young adults (22-40 years). Males are in the majority, especially in the 12 to 17 age group (61%). In 51% of all patients CF was diagnosed before the age of 2, and in 75% before the age of 5. Male CF patients are on average 6 cm (0.84 SD) shorter than normal and female patients 3 cm (0.48 SD). As far as weight for height is concerned, 54% of the CF patients fall below the 10th percentile. Weight for height is slightly lower in females than in males. CF patients usually leave primary school at an older age than their healthy peers. In comparison to healthy adolescents of the same age, adolescents with CF attend full-time day-school for a longer time, more of them receive general education and fewer take vocational training. Adolescents and young adults with CF do not stay longer than normal in the protective environment of their parental home.

Adolescent↗

Congenital adrenal hyperplasia in Sweden 1969-1986. Prevalence, symptoms and age at diagnosis.

A retrospective study of all Swedish patients with congenital adrenal hyperplasia (CAH) born 1969-1986, was conducted to elucidate possible benefits of neonatal screening for CAH. Information was obtained about 150 patients (67 male, 83 female). One hundred and forty-three cases were regarded as classical and seven as non-classical (symptoms after 5 years of age or cryptic). All but two (one girl with 11-hydroxylase deficiency and one boy with beta-hydroxysteroid-dehydrogenase deficiency) had 21-hydroxylase deficiency. The prevalence was 1:11,500. Ninety-three patients (48 male, 45 female) displayed salt loss, all before the age of 3 months. Two boys had died and many children had been critically ill during the first weeks of life. The median age at diagnosis for boys in this group was 21 days. Gender assignment was a major problem in 38 of 57 girls with ambiguous genitalia noticed during the first day. Fifteen of these girls were considered to be male for their first 40 days (median), before the CAH diagnosis was established. Patients in whom the first symptom was manifested after the age of one year often showed growth acceleration, which frequently was overlooked. Median diagnostic delay in this group was 17 months. Possible benefits of neonatal screening are: avoidance of a serious salt-loss crisis; earlier diagnosis and correct gender assignment in virilized girls; decreased virilization, growth acceleration and premature pubarche in prepubertal children; and reduced negative consequences for psycho-social development and final height.

Adrenal Hyperplasia, Congenital↗

The need for universal neonatal hearing screening--some aspects of epidemiology and identification.

The devastating consequences of a congenital/early-acquired hearing disability on the speech language and social development of a child and the estimated prevalence rates of at least 1-1.5/1000 live births of congenital permanent hearing impairment are important health problems. Universal neonatal hearing screening programs have provided the opportunity to detect neonates with permanent congenital hearing loss, and thus initiate auditory rehabilitation before the age of 3 mo. Universal neonatal hearing screening represents secondary prevention of hearing impairment/deafness, and the world-wide documented delayed identification of children with congenital/early-acquired hearing impairment will no doubt be improved with the implementation of universal neonatal hearing screening programs.

Age of Onset↗