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1.
J Dev Behav Pediatr ; 42(4): 340-342, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33859122

RESUMO

CASE: Phillip is a young man born with hypoplastic left heart syndrome referred to your practice for a range of mental health concerns. He underwent palliation to an extracardiac Fontan in infancy and experienced multiple complications over the next decade including valvular regurgitation and arrhythmias necessitating a pacemaker. Phillip continued to have systolic heart failure with New York Heart Association class II symptoms, managed with 4 medications and anticoagulation.Despite this complex history, Phillip had intact cognitive abilities, achieved typical milestones, and performed well academically in secondary school. His first year of college proved to be more challenging, and Phillip presented to the outpatient psychiatry service with an acute depressive episode. His family history included depression, without known attention-deficit/hyperactivity disorder (ADHD). Treatment, including a selective serotonin reuptake inhibitor, cognitive behavioral therapy, and family support, led to near resolution of his symptoms of depression.In subsequent appointments, Phillip described a long history of inattention and disorganization with onset in childhood. This contributed to the decision to leave college, despite remission of symptoms of depression. Phillip was unable to study for any extended period without "perfect conditions," described as the absence of potential distractions except for background music. Despite attempts to maintain "perfect conditions," Phillip was often off task and "hyperfocusing" on irrelevant topics. Phillip struggled with planning and time management and would misplace items daily. Moreover, although the importance of self-care was well understood, Phillip often forgot to take his cardiac medication or to exercise, and he admitted to inconsistent sleep habits because of losing track of time.Based on a comprehensive psychiatric evaluation including retrospective report from a parent, Phillip was diagnosed with ADHD, coexisting with major depressive disorder, in remission. Significant ADHD symptoms were documented by interview, self-report, and administration of an abbreviated neuropsychological battery.Considering concerns regarding use of stimulants in a patient with congenital heart disease, including death, stroke, and myocardial infarction,1,2 how would you assess the risks-benefits of use of stimulants with Phillip? REFERENCES: 1. Wilens TE, Prince JB, Spencer TJ, et al. Stimulants and sudden death: what is a physician to do? Pediatrics. 2006;118:1215-1219.2. Zito JM, Burcu M. Stimulants and pediatric cardiovascular risk. J Child Adolesc Psychopharmacol. 2017;27:538-545.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Transtorno Depressivo Maior , Cardiopatias Congênitas , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/terapia , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
2.
Z Kinder Jugendpsychiatr Psychother ; 48(5): 393-406, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32100618

RESUMO

From home treatment to psychiatric ward-equivalent treatment (StäB) - A systematic review of outpatient treatment in Germany Abstract. Objective: In the past, home treatment was not available in Germany for children and adolescents with mental health problems. However, enactment of the PsychVVG law on 1 January 2017 has changed this, so that intensive home treatment (stationsäquivalente Behandlung, StäB) can now be offered as an alternative to inpatient treatment. This literature review a) analyzes existing German home treatment studies for effectiveness, b) determines from international reviews criteria for effective home treatment, and c) aligns these with the standardized StäB criteria. Method: We performed a systematic literature search in PubMed, Scopus, PsycINFO, and Cochrane Library referencing "hometreatment AND children" as well as "hometreatment AND adolesc*. Results: Flexibility, mobility, multiprofessionality, a wide spectrum of possible interventions, the option of inpatient admission, 24/7 availability as well as daily treatment sessions have been found to be factors for effective home treatment. In German studies, home treatment was shown to enhance psychosocial functioning, parental competences, long-term effectiveness, and acceptance by the families. The highest effect for home treatment was demonstrated in children and adolescents with externalizing disorders. Conclusion: Intensive home treatment (StäB) meets the criteria identified in the literature and is a good addition to existing treatment options for children and adolescents with mental health problems in Germany.


Assuntos
Assistência Ambulatorial , Transtornos Mentais/terapia , Adolescente , Criança , Alemanha , Humanos , Pacientes Ambulatoriais , Unidade Hospitalar de Psiquiatria
3.
Zhongguo Gu Shang ; 32(11): 1044-1047, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31870054

RESUMO

OBJECTIVE: To investigate clinical effect of minimally invasive osteotomy and external fixation with the center of roration of angulation (CORA) in treating cubitus varus in adolescents. METHODS: From August 2013 to August 2017, 15 patients with cubitus varus caused by supracondylar fracture of humerus were treated with minimally invasive osteotomy and external fixation with the CORA. Among them, including 9 males and 6 females; 11 patients on the left side and 4 patients on the right side; aged from 13 to 16 years old with an average of 14.5 years old. The time from injury to operation was for 6 to 10 years with an average of 7.5 years. Five patients had a history of recurrence after cubitus varus surgery. Correction time. fracture healing time, carrying angle were observed, Laupattarakasem standard was used to evaluate clinical effect. RESULTS: All patients were followed up from 12 to 30 months with an average of 24 months; correction time ranged from 3 to 5 weeks with an average of 4 weeks; fracture healing time ranged from 4 to 6 months with an average of 5 months; carrying angle before operation ranged from -12° to -23°, and improved 9° to 14° after operation. According to Laupattarakasem evaluation criteria, 11 patients got an excellent result, 3 good and 1 fair. CONCLUSIONS: Minimally invasive osteotomy and external fixation with CORA in treating cubitus varus deformity in adolescents has advantages of less trauma, less blood loss, earlier exercise, speed and angle of correction could controlled without hospitalized for fixation.


Assuntos
Articulação do Cotovelo , Fixação de Fratura , Fraturas do Úmero , Adolescente , Feminino , Humanos , Fraturas do Úmero/cirurgia , Úmero , Masculino , Rotação
4.
BMC Womens Health ; 18(1): 96, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29902989

RESUMO

BACKGROUND: Adolescent pregnancies present a great public health burden in Kenya and Sub-Saharan Africa (UNFPA, Motherhood in Childhood: Facing the challenge of Adolescent Pregnancy, 2013). The disenfranchisement from public institutions and services is further compounded by cultural stigma and gender inequality creating emotional, psychosocial, health, and educational problems in the lives of vulnerable pregnant adolescents (Int J Adolesc Med Health 15(4):321-9, 2003; BMC Public Health 8:83, 2008). In this paper we have applied an engagement interview framework to examine interpersonal, practical, and cultural challenges faced by pregnant adolescents. METHODS: Using a qualitative study design, 12 pregnant adolescents (ages 15-19) visiting a health facility's antenatal services in Nairobi were interviewed. All recruited adolescents were pregnant for the first time and screened positive on the nine-item Patient Health Questionnaire (PHQ-9) with 16% of 176 participants interviewed in a descriptive survey in the same Kangemi primary health facility found to be severely depressed (Osok et al., Depression and its psychosocial risk factors in pregnant Kenyan adolescents: a cross-sectional study in a community health Centre of Nairobi, BMC Psychiatry, 2018 18:136 https://doi.org/10.1186/s12888-018-1706-y). An engagement interview approach (Social Work 52(4):295-308, 2007) was applied to elicit various practical, psychological, interpersonal, and cultural barriers to life adjustment, service access, obtaining resources, and psychosocial support related to pregnancy. Grounded theory method was applied for qualitative data sifting and analysis (Strauss and Corbin, Basics of qualitative research, 1990). RESULTS: Findings revealed that pregnant adolescents face four major areas of challenges, including depression, anxiety and stress around the pregnancy, denial of the pregnancy, lack of basic needs provisions and care, and restricted educational or livelihood opportunities for personal development post pregnancy. These challenges were related both to existing social and cultural values/norms on gender and traditional family structure, as well as to service structural barriers (including prenatal care, mental health care, newborn care, parenting support services). More importantly, dealing with these challenges has led to negative mental health consequences in adolescent pregnant girls, including feeling insecure about the future, feeling very defeated and sad to be pregnant, and feeling unsupported and disempowered in providing care for the baby. CONCLUSIONS: Findings have implications for service planning, including developing more integrated mental health services for pregnant adolescents. Additionally, we felt a need for developing reproductive education and information dissemination strategies to improve community members' knowledge of pregnant adolescent mental health issues.


Assuntos
Países em Desenvolvimento , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde Mental , Gravidez na Adolescência/psicologia , Gestantes/psicologia , Adolescente , Ansiedade/etiologia , Estudos Transversais , Cultura , Depressão/etiologia , Emoções , Feminino , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Quênia , Saúde Mental , Poder Familiar , Gravidez , Cuidado Pré-Natal , Pesquisa Qualitativa , Normas Sociais , Estigma Social , Estresse Psicológico/etiologia , Adulto Jovem
5.
BMC Health Serv Res ; 18(1): 203, 2018 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-29566681

RESUMO

BACKGROUND: Children and young people (CYP) with learning disabilities (LD) are a vulnerable population with increased risk of abuse and accidental injury and whose parents have reported concerns about the quality, safety and accessibility of their hospital care. The Care Quality Commission's (CQC) view of best practice for this group of patients includes: access to senior LD nurse provision; a clearly visible flagging system for identifying them; the use of hospital passports; and defined communication strategies (Glasper, Comp Child Adolesc Nurs 40:63-67, 2017). What remains unclear is whether these recommendations are being applied and if so, what difference they are making. Furthermore, what we do not know is whether parental concerns of CYP with LD differ from parents of other children with long-term conditions. The aims of this study were to 1) describe the organisational context for healthcare delivery to CYP with LD and their families and 2) compare staff perceptions of their ability to identify the needs of CYP with and without LD and their families and provide high quality care to effectively meet these needs. METHODS: Individual interviews (n = 65) and anonymised online survey (n = 2261) were conducted with hospital staff working with CYP in 15 children's and 9 non-children's hospitals in England. The majority of interviews were conducted over the telephone and recorded and transcribed verbatim. Health Research Authority was obtained and verbal or written consent for data collection was obtained from all interview participants. RESULTS: The nature and extent of organisational policies, systems and practices in place within hospitals to support the care of CYP with LD differs across England and some uncertainty exists within and across hospitals as to what is currently available and accessed. Staff perceived that those with LD were included less, valued less, and less safe than CYP without LD. They also reported having less confidence, capability and capacity to meet the needs of this population compared to those without LD. CONCLUSION: Findings indicate inequality with regards the provision of high quality hospital care to children and young people with LD that meets their needs. There is a pressing need to understand the impact this has on them and their families. TRIAL REGISTRATION: The study has been registered on the NIHR CRN portfolio 20461 (Phase 1), 31336 (Phases 2-4).


Assuntos
Atitude do Pessoal de Saúde , Serviços de Saúde da Criança/organização & administração , Disparidades em Assistência à Saúde , Deficiências da Aprendizagem/epidemiologia , Recursos Humanos em Hospital/psicologia , Criança , Inglaterra/epidemiologia , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
7.
Br J Dev Psychol ; 35(1): 21-36, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28112413

RESUMO

To examine the culturally embedded nature of religious practices, we conducted a mixed-methods study in which Muslim American adolescents described how and why their religious practices had changed in recent years (see Etengoff & Daiute, 2013, J. Adolesc. Res., 28, 690). Participants included 201 Muslim adolescents (ages 13-19) from predominantly immigrant families; all were contestants in a Muslim Inter-Scholastic Tournament regional competition. Participants completed surveys including an item regarding whether their religious practices had changed, and for those who answered affirmatively, open-ended questions about the change. Additional measures assessed ethnic identity and perceived discrimination. As hypothesized, the 60% of participants who reported a change in religious practices described this shift as a response to new contexts, people, and religious knowledge. Those who reported a change also reported higher levels of ethnic identity exploration and perceived discrimination. Overall, Muslim American adolescents' descriptions portrayed religious practices as developing through reciprocal interactions with culture. More generally, participants' descriptions point to the viability of a model in which religious practices change and in turn are changed by cultural contexts. Statement of contribution What is already known on this subject? Religious development is viewed as taking place in relational systems with reciprocity between individuals and surrounding contexts. Variations in contexts predict variations in religious development, but mechanisms of development are not well understood. Muslim Americans, including adolescents, show high levels of religious involvement and experience unique cultural and religious contexts. Muslim American emerging adults describe their religious practices as responsive to sociocultural contexts. What does the study add? This study focuses on Muslim American adolescents, a group that has received little research attention, especially in regard to religious development. Participants reported a wide array of changes in religious practices, and they described these changes as responses to social and cultural influences. Participants' descriptions of changing practices can be understood through a Vygotskian framework in which religious practices are cultural tools that both respond to and shape surrounding cultural contexts.


Assuntos
Islamismo/psicologia , Preconceito/etnologia , Religião e Psicologia , Identificação Social , Adolescente , Adulto , District of Columbia/etnologia , Feminino , Humanos , Masculino , Adulto Jovem
8.
Clin J Oncol Nurs ; 20(4): 391-6, 2016 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-27441511

RESUMO

BACKGROUND: The adolescent and young adult (AYA) cancer community has demonstrated a need for psychosocial help transitioning from acute cancer care to survivorship while navigating appropriate developmental challenges. OBJECTIVES: The purpose of this integrative literature review is to examine the transition of AYAs from life as patients with cancer to life as cancer survivors and to evaluate the most effective, therapeutic ways to make this transition. METHODS: This integrative literature review focused on articles published from 2008-2015 using PubMed, CINAHL®, and PsycINFO. Key search terms were cancer, [adaptation, psychological], adolesc*, and young adult. Outcomes were evaluated using the Adaptation Model of Nursing. FINDINGS: Twenty-two studies met the inclusion criteria, but only four empirically examined interventions. Eighteen studies demonstrated AYAs' unmet needs and suggested important therapeutic components. The four empirically examined interventions were dynamic group therapy, online cognitive-behavioral therapy, an online cancer forum, and an educational cancer retreat. Eighteen therapeutic themes were identified as integral to a complete and healthy transition. Five of these themes seemed to be of particular importance.


Assuntos
Adaptação Psicológica , Neoplasias/psicologia , Neoplasias/terapia , Qualidade de Vida/psicologia , Sobreviventes/psicologia , Cuidado Transicional , Adolescente , Feminino , Humanos , Masculino , Adulto Jovem
9.
J Int AIDS Soc ; 16: 18466, 2013 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-23714198

RESUMO

INTRODUCTION: Informing children of their own HIV status is an important aspect of long-term disease management, yet there is little evidence of how and when this type of disclosure takes place in resource-limited settings and its impact. METHODS: MEDLINE, EMBASE and Cochrane Databases were searched for the terms hiv AND disclos* AND (child* OR adolesc*). We reviewed 934 article citations and the references of relevant articles to find articles describing disclosure to children and adolescents in resource-limited settings. Data were extracted regarding prevalence of disclosure, factors influencing disclosure, process of disclosure and impact of disclosure on children and caregivers. RESULTS: Thirty-two articles met the inclusion criteria, with 16 reporting prevalence of disclosure. Of these 16 studies, proportions of disclosed children ranged from 0 to 69.2%. Important factors influencing disclosure included the child's age and perceived ability to understand the meaning of HIV infection and factors related to caregivers, such as education level, openness about their own HIV status and beliefs about children's capacities. Common barriers to disclosure were fear that the child would disclose HIV status to others, fear of stigma and concerns for children's emotional or physical health. Disclosure was mostly led by caregivers and conceptualized as a one-time event, while others described it as a gradual process. Few studies measured the impact of disclosure on children. Findings suggested adherence to antiretroviral therapy (ART) improved post-disclosure but the emotional and psychological effects of disclosure were variable. CONCLUSIONS: Most studies show that a minority of HIV-infected children in resource-limited settings know his/her HIV status. While caregivers identify many factors that influence disclosure, studies suggest both positive and negative effects for children. More research is needed to implement age- and culture-appropriate disclosure in resource-limited settings.


Assuntos
Revelação/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Adolescente , Criança , Pré-Escolar , Países em Desenvolvimento , Humanos , Lactente , Adulto Jovem
11.
J Adolesc Health ; 48(4): 351-7, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21402263

RESUMO

PURPOSE: Although the Child Abuse Potential (CAP) Inventory is generally considered to be a reliable screening tool for assessing child physical abuse risk, there is concern that it may lack internal consistency when completed by adolescents (Blinn-Pike and Mingus, J Adolesc 2000;23:107-11). This concern has been reflected in subsequent reviews summarizing the CAP's psychometric properties (Walker and Davies, J Fam Violence 2010;25:215-27), and calls for data on the reliability of the CAP Inventory as completed by adolescents have been issued (Blinn-Pike, J Adolesc Health 2002;30:148). The purpose of this study was to provide additional data examining the internal consistency of the CAP Inventory as completed by adolescents in a variety of contexts. METHOD: This study included five samples comprising 3,281 adolescent and adult respondents who completed the CAP Inventory. Two samples included at-risk mothers who were enrolled in home-visiting services and were participating in program evaluations. Three samples included college students the majority of whom were nonparents participating in the research to explore the risk of physical abuse among children. RESULTS: The analyses showed high internal consistency estimates for the CAP Inventory abuse scale as completed by adolescent mothers (Kuder-Richardson reliability coefficient range = .90-.96). Moreover, regardless of the sampling technique, parental status, or demographic characteristics, our analyses revealed overall good to excellent internal consistency estimates for the CAP Inventory abuse scale as completed by adolescent respondents. Indeed, the internal consistency estimates obtained from adolescent respondents were similar to the estimates obtained for adult respondents in each of these same samples. CONCLUSION: Our results provide strong support for a claim of good to excellent internal consistency of the CAP Inventory with adolescent samples.


Assuntos
Maus-Tratos Infantis/psicologia , Inventário de Personalidade , Inquéritos e Questionários/normas , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pais/psicologia , Psicometria , Reprodutibilidade dos Testes , Adulto Jovem
12.
Eur Child Adolesc Psychiatry ; 19(1): 25-36, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19543936

RESUMO

To examine the relations between maternal representations, infant socio-emotional difficulties, and mother-child relational behavior, 49 clinic-referred infants and their mothers were compared to 30 non-referred controls. Clinic-referred infants' psychiatric status was determined with the DC 0-3-R classification of Zeanah and Benoit (Child Adolesc Psychiatry Clin N Am 4:539-554, 1995) and controls were screened for socio-emotional difficulties. Mothers were interviewed with the parent development interview (Aber et al. in The parent development interview. Unpublished manuscript, 1985) and dyads were observed in free play and problem-solving interactions. Group differences emerged for maternal representations and relational behaviors. Representations of clinic-referred mothers were characterized by lower joy, coherence, and richness, and higher anger experienced in the mother-infant relationship compared to controls. During free play, clinic-referred mothers showed lower sensitivity and higher intrusiveness and provided less adequate instrumental and emotional assistance and support during problem solving. Referred children showed lower social engagement during free play. Associations were found among maternal representations, maternal interactive behavior, child social engagement, and the child's ability to self-regulate during a challenging task. These findings provide empirical support for theoretical and clinical perspectives suggesting a reciprocal link between maternal negative representations and mother and child's maladaptive behaviors in the context of early socio-emotional difficulties and mental health referrals.


Assuntos
Comportamento Materno/psicologia , Transtornos Mentais/epidemiologia , Saúde Mental/estatística & dados numéricos , Relações Mãe-Filho , Mães/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Sintomas Afetivos/epidemiologia , Sintomas Afetivos/psicologia , Ira , Comportamento Infantil/psicologia , Pré-Escolar , Emoções , Feminino , Humanos , Lactente , Comportamento do Lactente/psicologia , Controle Interno-Externo , Entrevista Psicológica/métodos , Masculino , Transtornos Mentais/psicologia , Mães/psicologia , Jogos e Brinquedos/psicologia , Resolução de Problemas , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Comportamento Social , Adulto Jovem
13.
Pharmacol Biochem Behav ; 93(3): 258-62, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19041886

RESUMO

Although previous studies have shown that the Balloon Analogue Risk Task (BART; [Lejuez, C.W., Read, J.P., Kahler, C.W., Richards, J.B., Ramsey, S.E., Stuart, G.L., et al. (2002). Evaluation of a Behavioral Measure of Risk Taking: The Balloon Analogue Risk Test (BART). J Exp Psychol, Appl, 8, 75-84.; Lejuez, C., Aklin, W., Jones, H., Richards, J., Strong, D., Kahler, C.W., et al. (2003a). The Balloon Analogue Risk Task (BART) Differentiates Smokers and Nonsmokers. Exp Clin Psychopharmacol, 11, 26-33.; Lejuez, C., Aklin, W., Zvolensky, M., & Pedulla, C. (2003b). Evaluation of the Balloon Analogue Risk Task (BART) as a Predictor of Adolescent Real-world Risk-taking Behaviors. J Adolesc, 26, 475-479.]) can be used to index real-world risk-taking behavior, questions remain regarding how performance on the task may vary as a function of reward/loss value and how this relationship may differ as a function of relevant personality traits. The present study examined BART score at 1, 5, and 25 cents per pump and how this relationship differed at low and high levels of impulsivity and sensation seeking. Results indicated that riskiness on the BART decreased as reward/loss magnitude increased. Further, this decrease was most prominent in those low in Impulsivity/Sensation Seeking, whereas those high in Impulsivity/Sensation Seeking were largely insensitive to variation in reward/loss magnitude. Findings are discussed in terms of sensitivity to reward and loss, and how these processes can be studied further using the BART including extensions to cognitive modeling and the measurement of neurobehavioral functioning.


Assuntos
Comportamento Exploratório/fisiologia , Comportamento Impulsivo/psicologia , Recompensa , Assunção de Riscos , Adolescente , Tomada de Decisões , Feminino , Humanos , Individualidade , Masculino , Testes Neuropsicológicos , Desempenho Psicomotor/fisiologia , Adulto Jovem
14.
Encephale ; 34(3): 270-3, 2008 Jun.
Artigo em Francês | MEDLINE | ID: mdl-18558148

RESUMO

OBJECTIVE: The aim of the study was to evaluate the relative contributions of cannabis use and depressive symptoms in the prediction of suicidal ideation. METHOD: A random sample of 491 high-school students from the department of Haute-Garonne, France (290 girls, mean age=16.6+/-1.4; 201 boys, mean age=17.3 years+/-1.6) completed a questionnaire assessing cannabis use, the CES-D (center for epidemiological studies-depression scale) completed by the three-item sub-scale measuring suicidal ideation proposed by Garrison et al. (J Am Acad Child Adolesc Psychiatry 30 (1991) 636-641). RESULTS: In the total sample, 15% of girls (n=44) and 23% of boys (n=46) reported having used cannabis at least once a month during the last three months. The mean CES-D score for girls was significantly higher than for boys (20.6+/-11 versus 18.4+/-10.9, t=2.4, p=0.01). According to the cut-off score of 24, 22% of boys and 36% of girls exhibited a moderate to severe depressive symptomatology (p=0.02). The mean suicidal ideation score was not significantly higher in girls than in boys (1.3+/-2 versus 0.95+/-1.9, t=1.7, p=0.10). At least, the occasional wish to kill oneself was reported by 17% of boys and 20% of girls (p=0.40). The contribution of cannabis use and depressive symptomatology in the prediction of suicidal ideation were tested with a hierarchical multiple regression analysis, to determine whether cannabis use improved prediction of suicidal ideation beyond that afforded by CES-D scores. In the first step, including age and sex as covariates, the model accounted for a significant and important part of the variance of suicidal ideation (41%). Age and sex were not significant predictors. The second step, with cannabis use added to the prediction of suicidal ideation, afforded an increase of 1% in predictable variance. Cannabis use (beta=0.08, t=2.2, p=0.03) was significantly but weakly related to suicidal ideation, while depressive symptoms (beta=0.63, t=17.8, p<0.001) remained the main predictor. In a second regression analysis conducted among cannabis users, frequency of use was almost a significant predictor (beta=0.11, t=1.84, p=0.07). DISCUSSION: This result suggests an association between suicidal ideation, depressive symptoms and cannabis use in adolescents. Cannabis use appeared to be an independent predictor of suicidal ideation after controlling for depressive symptoms. However, the increment of variance accounted for by cannabis use was small. This suggests that cannabis use contributes to suicidal ideation independently from depressive symptoms, but weakly. A limitation to the study was the absence of control for other potential confounding variables. The association between cannabis use and suicidal ideation may be linked to common risk factors such as borderline personality disorder traits, sociodemographic and family factors. In this study, cannabis use does not appear as an important risk factor for suicidal ideation in adolescents.


Assuntos
Transtorno Depressivo/epidemiologia , Abuso de Maconha/epidemiologia , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Índice de Gravidade de Doença , Inquéritos e Questionários
15.
Vaccine ; 25(20): 4038-45, 2007 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-17395338

RESUMO

In the 2003-2004 influenza season, the predominant circulating influenza A (H3N2) virus in the United States was similar antigenically to A/Fujian/411/2002 (H3N2), a drift variant of A/Panama/2007/99 (H3N2), the vaccine strain. That year, a field study of trivalent live-attenuated influenza vaccine (LAIV-T) was conducted in Temple-Belton, Texas, as part of a larger community-based, non-randomized, open-label study in three communities that began in August 1998 [Gaglani MJ, Piedra PA, Herschler GB, Griffith ME, Kozinetz CA, Riggs MW, et al. Direct effectiveness of the trivalent, cold-adapted, influenza virus vaccine (CAIV-T) against the 2000-2001 influenza A (H1N1) and B epidemic in healthy children. Arch Pediatr Adolesc Med 2004;158:65-73; Piedra PA, Gaglani MJ, Kozinetz CA, Herschler G, Riggs M, Griffith M, et al. Herd immunity in adults against influenza-related illnesses with use of the trivalent-live attenuated influenza vaccine (CAIV-T) in children. Vaccine 2005;23:1540-8; Piedra PA, Gaglani MJ, Riggs M, Herschler G, Fewlass C, Watts M, et al. Live attenuated influenza vaccine, trivalent, is safe in healthy children 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age in a community-based, nonrandomized, open-label trial. Pediatrics 2005;116:397-407]. Participants were healthy children aged 5-18 years. The analysis here concerns 6403 children in the Scott & White Health Plan (SWHP) database living within zip codes of the Temple-Belton area, of whom 1706 received LAIV-T and 548 received trivalent inactivated vaccine (TIV) in 2003, 983 had been previously vaccinated in 1998-2001, but not in 2002-2003 or 2003, and 3166 had never been vaccinated. The main outcome measure was medically-attended acute respiratory illness (MAARI). Surveillance culture results were incorporated into the analysis to estimate efficacy against culture-confirmed influenza illness. Vaccine effectiveness of LAIV-T against MAARI was 26% (95% confidence interval (CI) 11, 39). Vaccine efficacy of LAIV-T against culture-confirmed influenza illness including surveillance cultures of children in the SWHP database in the validation calculation was 56% (95% CI 24, 84). LAIV-T was cross-protective with a drift variant strain in 2003-2004, evidence that such vaccines could be important for preparing for a pandemic and for annual influenza.


Assuntos
Vírus da Influenza A Subtipo H3N2/imunologia , Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Administração Intranasal , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Imunidade Coletiva , Influenza Humana/epidemiologia , Influenza Humana/imunologia , Influenza Humana/virologia , Masculino , Texas/epidemiologia
16.
Behav Brain Res ; 130(1-2): 97-102, 2002 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-11864724

RESUMO

Noradrenaline: Hechtman (J Psychiat Neurosci 1994;19:193) argued for a role for frontal dopamine (DA) and noradrenaline (NA) in ADHD, where Oades (Prog Neurobiol 1987;29:365) has described lateralised functional impairments. Mechanisms (e.g. via alpha-2 sites) for stimulating low NA activity in ADHD children (J Am Acad Child Adolesc Psychiatry 1997;36:1688) in order to promote interactions with mesocortical DA have been discussed (J Psychopharmacology 1997;11:151; Psychiatr Res 1994;52:305). We described with indicators of overall transmitter metabolism (monoamines, metabolites in 24 h urine samples (Behav Brain Res 1997;88:95)) significantly lower utilisation ratios (MHPG/NA) in ADHD children with respect to healthy controls. Interestingly, a comparison of between catecholamine levels (DA/NA) showed a correlation with the conditioned blocking measure of selective attention recorded at the time of collection. This measure was negatively associated with blocking in controls. These results are consistent with reports of lower DOPEG and increased DOPAC in ADHD urine (J Child Adolesc Psychopharmacol 1996;6:63) and indicate that the relatively hyperactive DA versus NA systems may have functional consequences. Serotonin: the relevance for ADHD of an association of impulsivity with low serotonin (5-HT) metabolism (Behav Brain Sci 1986;9:319) has long been played down. Yet, some symptoms have been related to CSF measures of the metabolite 5-HIAA, and in particular the HVA/5-HIAA ratio has been reported to correlate with ratings of activity (Psychiatr Res 1994;52:305). We find that while urinary measures of 5-HIAA are somewhat higher, the ratio HVA/5-HIAA is markedly lower in ADHD children versus controls. In these ADHD children 5-HIAA levels were negatively related to d-prime measures in a continuous performance task (CPTax), and the HVA/5-HIAA was negatively associated with conditioned blocking. These results suggest a relatively low DA versus 5-HT activity may have functional consequences, albeit in a subgroup of ADHD. This is consistent with drug-induced prolactin changes reported by Verbaten et al. (Eur Child Adolesc Psychiatry 1999;8:30).


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/metabolismo , Dopamina/metabolismo , Norepinefrina/metabolismo , Serotonina/metabolismo , Humanos
17.
Arch Pediatr Adolesc Med ; 154(12): 1237-41, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11115309

RESUMO

OBJECTIVE: To learn whether cigarette smoking by persons other than parents significantly contributes to the passive environmental tobacco smoke (ETS) exposure of infants. STUDY DESIGN: A cohort of infants prospectively followed up from birth to age 2 years with monthly questionnaires concerning smoking by different categories of adults coming into contact with the infants. SETTING: Health maintenance organization members residing in several suburban communities of Detroit, Mich, defined by contiguous ZIP codes. SUBJECTS: Ninety-seven (83%) of 117 healthy, full-term infants, thought to be at high risk of allergic disease based on cord blood IgE, who were born to eligible mothers and who completed 24 months of follow-up. MAIN OUTCOME MEASURES: Average of bimonthly urinary cotinine-creatinine ratios (CCRs) during the 2 years of the study. RESULTS: There were significant correlations (r

Assuntos
Exposição Ambiental , Poluição por Fumaça de Tabaco , Adulto , Cotinina/urina , Creatinina/urina , Exposição Ambiental/análise , Feminino , Humanos , Recém-Nascido , Masculino , Michigan , Estudos Prospectivos , Análise de Regressão , Inquéritos e Questionários
18.
Arch Pediatr Adolesc Med ; 154(8): 791-5, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10922275

RESUMO

OBJECTIVE: To evaluate the effectiveness of increased primary care access created by North Carolina's Medicaid managed care plan, Carolina Access (CA), in reducing unnecessary emergency department (ED) use in Guilford County. METHODS: Emergency department records of pediatric visits before and after the implementation of CA were analyzed. Variables included patient age, International Classification of Diseases, Ninth Revision discharge diagnosis, insurance status, date of visit, time of visit, and ZIP code. Visits were classified as either urgent or nonurgent based on discharge diagnosis. Rates of ED use per 1000 persons were calculated using county population and Medicaid enrollment figures. RESULTS: A total of 54,742 ED visits occurred between January 1, 1995, and December 31, 1997. Thirty-eight percent of these visits were by children (defined as those aged 0-18 years in this study) enrolled in the Medicaid program. After the implementation of CA, monthly ED rates per 1000 children with Medicaid insurance decreased 24% from 33.5 +/- 5.3 to 25.6 +/- 2.3 (P<.001), which translates to 158 fewer visits per month by children enrolled in the Medicaid program. Nonurgent visits among the population enrolled in the Medicaid program decreased from an average monthly rate per 1000 of 17.9 +/- 3.5 to 11.2 +/- 2.5 after the implementation of CA (P<.001), accounting for most of the decrease in total visits. (All data are given as mean +/- SD.) The rates of total and nonurgent visits among the population not enrolled in the Medicaid program increased slightly. CONCLUSIONS: For children with Medicaid insurance, we found a strong temporal relation between decreased visits to the ED and increased access to primary care services, services that were made available by the implementation of North Carolina's Medicaid managed care plan, CA. Specific services that may be responsible for the decreased ED use include the expanded availability of primary care physicians and the use of telephone triage systems. No similar decrease in ED use was seen among the non-Medicaid-insured group. Arch Pediatr Adolesc Med. 2000;154:791-795


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde , Programas de Assistência Gerenciada/organização & administração , Medicaid/organização & administração , Atenção Primária à Saúde/organização & administração , Adolescente , Criança , Pré-Escolar , Feminino , Mau Uso de Serviços de Saúde , Humanos , Lactente , Masculino , Medicaid/estatística & dados numéricos , North Carolina/epidemiologia , Distribuição de Poisson , Atenção Primária à Saúde/estatística & dados numéricos , Análise de Regressão , Estados Unidos
19.
Arch Pediatr Adolesc Med ; 154(8): 817-21, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10922279

RESUMO

BACKGROUND: Infants with fever and cerebrospinal fluid (CSF) pleocytosis are routinely admitted to the hospital for parenteral antibiotic therapy for potential bacterial meningitis pending results of CSF culture. Published estimates suggest that 90% of all episodes of meningitis are caused by enterovirus. Enteroviral polymerase chain reaction (ePCR) has a sensitivity of 92% to 100% and a specificity of 97% to 100% in CSF. OBJECTIVE: To compare a management strategy using ePCR with current practice to determine potential savings by allowing earlier discharge. METHODS: Decision analysis comparing 2 strategies for the care of a retrospective cohort of infants with fever and CSF pleocytosis: standard practice vs ePCR testing of all CSF samples. Model assumptions include the following: (1) standard practice patients continue parenteral antibiotic therapy until CSF cultures are negative at 48 hours, (2) patients with positive ePCR results would be discharged after 24 hours, (3) patients with positive ePCR results have a negative CSF culture, and (4) costs are calculated from actual patient charges with a cost-to-charge ratio of 0.65. SUBJECTS: All infants aged 28 days to 12 months admitted to an urban teaching hospital with fever, CSF pleocytosis, and a negative CSF Gram stain from January 1996 through December 1997. OUTCOME MEASURE: Total cost of hospitalization. RESULTS: A total of 126 infants were identified. One hundred twelve (89%) were discharged with a diagnosis of aseptic meningitis; 72% of these cases occurred during the peak enterovirus season (June to October). Three of 3 patients with positive CSF cultures had bacterial growth within 24 hours of admission. Mean length of stay for patients with aseptic meningitis was 2.3 days (SD, +/-1.4 days). Total cost of hospital care for all 126 infants was $381,145. In our patient population, total patient costs would be reduced by the ePCR strategy if enterovirus accounts for more than 5. 9% of all meningitis cases. Varying the sensitivity of the ePCR assay from 100% to 90% changes the "break-even" prevalence from 5.8% to 6.5%. Total cost savings of 10%, 20%, and 30% would occur at an enteroviral meningitis prevalence of 36.3%, 66.7%, and 97.1%, respectively. CONCLUSIONS: Enteroviral PCR analysis of CSF for infants admitted to the hospital with meningitis can result in cost savings when the prevalence of enteroviral meningitis exceeds 5.9%. Limiting use of ePCR to the enterovirus season would increase cost savings. A prospective study is needed to validate these results. Arch Pediatr Adolesc Med. 2000;154:817-821


Assuntos
Técnicas de Apoio para a Decisão , Testes Diagnósticos de Rotina/economia , Infecções por Enterovirus/diagnóstico , Febre/virologia , Hospitalização/economia , Meningite Viral/diagnóstico , Reação em Cadeia da Polimerase/economia , Boston , Líquido Cefalorraquidiano/citologia , Redução de Custos , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por Enterovirus/economia , Febre/economia , Custos Hospitalares , Hospitais Pediátricos/economia , Humanos , Lactente , Recém-Nascido , Meningite Viral/líquido cefalorraquidiano , Meningite Viral/economia , Sensibilidade e Especificidade
20.
Arch Pediatr Adolesc Med ; 154(8): 822-6, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10922280

RESUMO

OBJECTIVE: To determine the optimal timing of cranial ultrasound scans (USs) for identifying preterm neonates weighing less than 1500 g at birth who develop intracranial complications of prematurity. DESIGN/SETTING: Observational study at an urban county hospital. METHODS: Serial USs from neonates with less than 1500-g birth weight (BW) admitted to the neonatal intensive care unit between January 1995 and December 1996 were reviewed by a pediatric neuroradiologist in a blinded random manner. RESULTS: Two hundred forty-eight neonates (78%) underwent at least 3 USs, 32 (10%) had 2 USs and 37 (12%) only 1 US. The initial US was normal in 156 neonates (49%) and abnormal in 161 (57%). The principal abnormalities included intraventricular hemorrhage (IVH) (n = 74), periventricular echogenicity (PVE) (n = 68), ventriculomegaly (n = 7), and solitary cysts (n = 9). Severe IVH (n = 17) occurred in 13 (11.4%) of 114 neonates at less than 1000-g BW and 4 (5%) of 79 neonates of BW 1000 to 1250 g. In 11 cases (65%), the severe IVH was clinically unsuspected. For neonates weighing less than 1000 g, IVH was diagnosed by days 3 to 5 in 10 (77%) of 13, by days 10 to 14 in 11 (84%) of 13, and by day 28 in all neonates; for neonates 1001 to 1250 g, IVH was diagnosed in 1 (24%) of 4 by days 3 to 5, 2 (50%) of 4 by days 10 to 14, and 3 (75%) of 4 by day 28. One infant's condition was diagnosed on routine US before discharge from the hospital. Cystic periventricular leukomalacia (PVL) was noted in 9 neonates; in 4 of the 9 cases, increased PVE was present on the initial US and cyst formation was obvious by the second US. For 4 neonates (3 with BW <1000 g), all routine USs were negative and cystic PVL was noted on the predischarge US in these cases. Nonobstructive ventriculomegaly in the absence of IVH or cystic PVL was observed in 14 neonates. In 6, it was noted on the initial screening US; in 4 of the cases, it evolved after the third screening US. Two hundred fifty-six neonates had a US before discharge from the hospital; 181 (72%) were normal and 75 (28%) abnormal. Nine significant lesions were identified by the US before discharge from the hospital (ie, severe IVH [n = 1], cystic PVL [n = 4], and ventriculomegaly [n = 4]). CONCLUSIONS: The following screening protocol is recommended: (1) Neonates of less than 1000-g BW: initial US on days 3 to 5 (should identify at least 75% of cases of IVH and some PVE abnormalities); second US on days 10 to 14 (should detect at least 84% of IVH and identify early hydrocephalus and early cyst formation); third scan on day 28 (should detect all cases of IVH, as well as assess PVE and ventricular size); and final scan before discharge from the hospital (should detect approximately 20% of significant late-onset lesions). (2) Neonates of 1000- to 1250-g BW: initial US at days 3 to 5 (should detect at least 40% of significant abnormalities); a second scan at day 28 (should detect at least 70% of significant abnormalities); and a predischarge scan (should detect all late-onset significant lesions). (3) Neonates of 1251- to 1500-g BW: an initial scan at days 3 to 5; and a second scan before discharge from the hospital if the clinical course is complicated. Arch Pediatr Adolesc Med. 2000;154:822-826


Assuntos
Protocolos Clínicos , Doenças do Prematuro/diagnóstico por imagem , Recém-Nascido de muito Baixo Peso , Hemorragias Intracranianas/diagnóstico por imagem , Leucomalácia Periventricular/diagnóstico por imagem , Fatores Etários , Peso ao Nascer , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Ultrassonografia
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