Intraocular pressure control after contact transscleral diode cyclophotocoagulation in eyes with intractable glaucoma

In the child health promotion program in Sweden, the public health nurse is responsible for the majority of the work. The purpose of this study was to test the following hypotheses: (1) there are differences in CHP program utilization between mothers in different social positions; (2) there are differences in CHP program utilization between Swedish and foreign-born mothers; (3) there are differences in the way mothers in different social positions value formal and informal social support as a means for solving health problems; and (4) there are differences in the way Swedish and foreign-born mothers value formal and informal social support as a means to solve health problems. A random sample was drawn of 10% of all children born in a particular month. A national postal questionnaire was sent to 850 mothers with children about four to five months old. The response rate was 80%. The CHP program was utilized by 99.6% of the families. When given scenarios describing various problem situations, the mothers stated that they mostly would turn to the public health nurse irrespective of the type of problem. There was no support in this study for the first two hypotheses that there are differences in CHP program utilization between mothers in different social positions and between Swedish and foreign-born mothers. There was support in this study for the two last hypotheses that there are differences in the way mothers in different social positions and the Swedish and foreign-born mothers value nurses, other health care services, relatives/friends, and literature/mass media as a means to solve health problems.     

The effects of vasoconstrictors on distribution of ischemic tissue flow in isolated perfused rat liver

Discusses plans of marriage among students and the problems of student families. Comprehensive sociohygienic study of the health status and communal conditions was carried out among the students of the Russian Peoples' Friendship University, including married students with children. This social group is characterized by a peculiar life style, intensive intellectual and social activity; moreover, it is the most favorable period for marriage and childbirth. Special attention is paid to difficulties (material, communal, educational, etc.) experienced by the female students becoming mothers in the course of studies. Specific medicodemographic tendencies brought the authors to a conclusion that development and introduction of programs of medicosocial support for student families, specifically, mothers, is needed, which should be aimed at the soonest possible solution of the acute problems of maintaining the health of mothers and their children.     

Expressed emotion in families of clinically referred and nonreferred children: Toward a further understanding of the expressed emotion index.

As assessed from a 5-min speech sample, level of expressed emotion (EE) in parents significantly discriminated between families of 7- to 16-year-old children who were referred for mental health treatment and a nonclinical comparison group; however, both groups contained a relatively high proportion of high-EE families. Furthermore, EE independently predicted clinical-nonclincal group status when considered in conjunction with overall family functioning and level of psychological distress in mothers. Findings support the relevance of EE, although the measure showed poor specificity and an analysis of the components that comprise the EE index indicated that only certain components were pertinent. The need to reassess the meaning of the EE construct and strengthen its applicability for the general clinical population of children and families is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing conduct problems among children brought to women's shelters: Intervention effects 24 months following termination of services.

This study evaluated the long-term effects of Project SUPPORT, an intervention designed to reduce conduct problems among children in domestically violent families. Participating mothers had sought shelter because of domestic violence and had at least one child (4-9 years old) exhibiting clinical levels of conduct problems. Results indicated that at 2 years posttreatment, 15% of children in families in the Project SUPPORT condition exhibited clinical levels of conduct problems compared with 53% of those in the existing services condition. In addition, mothers of children in the Project SUPPORT condition reported their children to be happier, to have better social relationships, and to have lower levels of internalizing problems, relative to children in the comparison condition. Mothers in the Project SUPPORT condition were less likely to use aggressive child management strategies and were less likely to have returned to their partners during the follow-up period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health maintenance organizations and children with special health needs. A suitable match?

OBJECTIVE: To address how well health maintenance organizations (HMOs) meet the needs of almost 700,000 children with disabilities due to chronic conditions enrolled in these plans. DESIGN: A cross-sectional survey. MEASUREMENTS/MAIN RESULTS: Health maintenance organizations offered better protection than conventional plans against out-of-pocket expenses and were much more likely than fee-for-service plans to cover ancillary therapies, home care, outpatient mental health care, and medical case management. In addition, few HMOs maintained exclusions for preexisting conditions. Other aspects of HMO policies, however, were found to operate against the interest of families with chronically ill children. In particular, HMOs commonly made specialty services available only when significant improvement was expected within a short period. Also, HMOs typically placed limits on the amount and duration of mental health, ancillary services, and certain other services frequently needed by chronically ill children. Probably the most serious problems for chronically ill children enrolled in HMOs were the lack of choice among and access to appropriate specialty providers. PARTICIPANTS: Individual HMO plans. SELECTION PROCEDURE: A sample of 95 geographically representative HMOs were selected; 59 (62%) responded. INTERVENTIONS: None. CONCLUSIONS: Health maintenance organizations offer several advantages over traditional fee-for-service plans for families whose children have special health needs. However, the results also indicate that HMOs do not always operate effectively as service provision systems for these children. To a large extent, the availability and quality of services available to a child with special needs is likely to depend on the parents' ability to maneuver within the system.     

Coping and parenting: Mediators of 12-month outcomes of a family group cognitive–behavioral preventive intervention with families of depressed parents.

Objective: In a randomized clinical trial with 111 families of parents with a history of major depressive disorder (86% mothers, 14% fathers; 86% Caucasian, 5% African-American, 3% Hispanic, 1% American Indian or Alaska Native, 4% mixed ethnicity), changes in adolescents' (mean age = 11 years; 42% female, 58% male) coping and parents' parenting skills were examined as mediators of the effects of a family group cognitive–behavioral preventive intervention on adolescents' internalizing and externalizing symptoms. Method: Changes in hypothesized mediators were assessed at 6 months, and changes in adolescents' symptoms were measured at a 12-month follow-up. Results: Significant differences favoring the family intervention compared with a written information comparison condition were found for changes in composite measures of parent–adolescent reports of adolescents' use of secondary control coping skills and direct observations of parents' positive parenting skills. Changes in adolescents' secondary control coping and positive parenting mediated the effects of the intervention on depressive, internalizing, and externalizing symptoms, accounting for approximately half of the effect of the intervention on the outcomes. Further, reciprocal relations between children's internalizing symptoms and parenting were found from baseline to 6-month follow-up. Conclusion: The present study provides the first evidence for specific mediators of a family group cognitive–behavioral preventive intervention for families of parents with a history of major depressive disorder. The identification of both coping and parenting as mediators of children's mental health outcomes suggests that these variables are important active ingredients in the prevention of mental health problems in children of depressed parents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shoshin syndrome: two case reports representing opposite ends of the same disease spectrum

The purpose of this article is to describe how nurses can assist the new mother of a high-risk infant, especially a preterm infant, in identifying and obtaining the social support needed to help the family adapt in the first few weeks after the birth. The interventions recommended are based on a research study conducted by the authors and colleagues and summarized within this article. Because support was more important than these mothers expected it to be, it is important that nurses in prenatal, postpartum, neonatal, home health, and extended care settings recognize the need to assist women in identifying their support needs. In addition, nurses can help the mothers identify individuals within their social network who could assist them with those needs. Meeting the social support needs of a mother is important for her own mental and physical health and well-being. It also helps her meet the social and developmental needs of her infant.     

Factors associated with child mental health service use in the community

OBJECTIVE: To determine the association of parent, family, and child factors with mental health services need and utilization. METHOD: Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years. RESULTS: 3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral. CONCLUSION: Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples.     

Comparability and representativeness of clinical homeless, community homeless, and domiciled clinic samples: Physical and mental health, substance use, and health services utilization.

Evaluating the representativeness of homeless samples is important for generalizing research findings on the homeless and designing interventions targeting their health needs. The present study contrasts homeless and domiciled free-clinic users (216 homeless [132 men, 84 women], 212 domiciled [102 men, 110 women]) and 531 community homeless persons (388 men, 143 women) on latent variables representing substance use, mental and physical health, appearance, life satisfaction, and health services utilization (HSU). Homeless clinic patients equalled the community sample in substance abuse and psychological problems but exceeded the sample in HSU and cleanliness. Homeless clinic users reported more substance abuse, poorer health, greater mental illness and mental HSU, less cleanliness, and lower life satisfaction than domiciled patients. Relationships among the variables are reported, and implications concerning health needs among the homeless are discussed (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who is for children?

Discusses some of the unmet needs of children in the areas of mental health care, day care, and foster and institutional care. It is argued that children with serious emotional problems do not get the treatment they need because adequate funds have not been set aside for children's mental health and because few incentives exist to serve children in community settings or in the most familylike settings possible. Specific functions that can be served by psychologists are presented, and strategies for creating public and private sector policies more responsive to the needs of children and their families are outlined. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing conduct problems among children of battered women.

This study was an experimental evaluation of an intervention designed to reduce conduct problems among children of battered women. Participants were 36 families (mothers and children) in which the mother had sought shelter because of relationship violence and had at least 1 child (4-9 years old) with clinical levels of conduct problems. The intervention consisted of 2 primary components: (a) providing instrumental and emotional support and (b) teaching child management skills to mothers. Families were randomly assigned to either the intervention condition or the existing services comparison condition and were assessed on 5 occasions over 16 months after shelter departure. Compared with families receiving existing services, children in the intervention condition improved at a faster rate, the proportion of children displaying clinical levels of conduct problems was greatly diminished, and mothers displayed greater improvements in child management skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services for children: The state of the art.

Throughout this century, people in the United States have been concerned about the serious deficiencies in the mental health care of our children. Despite eloquent needs assessment and recommendations for remediation, most of the unserved needs and deficiencies of our mental-health-care-delivery system remain the same. This article reviews the current status of mental health services to children, youth, and families to highlight the necessity of an integrated system of mental health care. The development of a continuum of care that is coordinated across the mental health and non-mental-health systems that naturally occur in all children's lives has the potential to vastly improve mental health services to children, youth, and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction: Methodological issues in school-based mental health services research.

New research directions on the effectiveness of mental health services for children and adolescents offer the opportunity for school psychology to apply its knowledge base to the systemic juncture between mental health and school systems. Models of service delivery to children, adolescents, and their families that integrate school, mental health, and other service sectors are being actively studied to answer questions about the outcomes of these services for children with mental health problems. The papers in this journal were first presented at the 6th Annual Research Conference of the Florida Mental Health Institute on "A System of Care for Children's Mental Health: Expanding the Research Base." The papers describe state-of-the art studies of school-based mental health interventions for children, adolescents, and their families. In each of the papers, particular attention is paid to the salient methodological issues researchers face in conducting these studies within school settings. It is hoped that these articles will foreground the healthy and creative tensions that exist between different research paradigms and multiple service communities, especially mental health and school systems, by encouraging new research on important and as yet unanswered questions about the effectiveness of school-based service delivery to children and adolescents with mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opportunities in public policy to support infant and early childhood mental health: The role of psychologists and policymakers.

Infant and early childhood mental health practices can be supported by policies and professional standards of care that foster the healthy development of young children. Policies that support infants and toddlers include those that strengthen their families to provide a family environment that promotes mental wellness. Policy issues for infants, toddlers, and young children have come to the forefront of thinking as children need a “voice” to advocate for their support and care. This article (a) highlights several important policy areas that support the social–emotional development of very young children and (b) gives examples of current policy accomplishments and challenges. The article offers a policy agenda to promote the mental health of infants and young children and suggests ways that psychologists can engage with policymakers to promote policies that foster infant mental health, including contributing to the knowledge base that informs policy decisions, educating the public and policymakers about early childhood development and mental wellness, forming community partnerships to identify and address infant mental health risks, and participating in the development of policy recommendations that improve access to evidence-based practices in infant mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legal and social contexts and mental health among lesbian and heterosexual mothers.

This study examines the role of legal and social context (the level of legal and social support offered by one's country of residence) and sexual orientation in the mental health of lesbian and heterosexual mothers. Participants were sampled from the United States and Canada because the two countries have many similarities (North American location, reliance on English language, and democratic structures) but provide different legal and social rights to their lesbian citizens. The study included 52 lesbian mothers and 153 heterosexual mothers in the United States and 35 lesbian mothers and 42 heterosexual mothers in Canada. Although there were no differences between heterosexual mothers as a function of legal and social context, lesbian mothers from the United States reported more family worries about legal status and discrimination (but not more general family worries) and more depressive symptoms than did lesbian mothers in Canada. Results indicate that legal and social context moderates the role of sexual orientation in maternal mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for homelessness among schizophrenic men: a case-control study

OBJECTIVES: To identify risk factors for homelessness among the severely mentally ill, we conducted a case-control study of 100 indigent schizophrenic men meeting criteria for literal homelessness and 100 such men with no homeless history. METHODS: Subjects were recruited from shelter, clinic, and inpatient psychiatric programs in Upper Manhattan. Clinical interviewers employed standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use. RESULTS: Homeless subjects showed significantly higher levels of positive symptoms, higher rates of a concurrent diagnosis of drug abuse, and higher rates of antisocial personality disorder. Homeless subjects experienced greater disorganization in family settings from birth to 18 years and less adequate current family support. Fewer homeless subjects than subjects in the never-homeless comparison group had a long-term therapist. These differences remained when demographic variables were adjusted statistically. CONCLUSIONS: Homeless schizophrenic men differed from their domiciled counterparts in all three domains we investigated; family background, nature of illness, and service use history. Findings are discussed in relation to policy and programs for the severely mentally ill.     

Meeting mental health needs following a natural disaster: Lessons from Hurricane Katrina.

Hurricane Katrina had a devastating impact on hundreds of thousands of Louisiana and Mississippi families. Housing was destroyed, jobs were lost, and family members were separated, sometimes in different states and without communication. Postdisaster stress reactions were common, with vulnerable individuals most affected. Mental health services were not adequate to meet immediate needs, and postdisaster mental health issues often emerge over time. This article describes the mental health needs of dislocated and evacuee children and families and the steps that were taken to develop mental health programs that would be sustainable over time to meet this new level of need. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trajectories of emotional well-being in mothers of adolescents and adults with autism.

Raising an adolescent or adult child with a developmental disability confers exceptional caregiving challenges on parents. We examined trajectories of 2 indicators of emotional well-being (depressive symptoms and anxiety) in a sample of primarily Caucasian mothers (N = 379; M age = 51.22 years at Time 1) of adolescent and adult children with an autism spectrum disorder (ASD; M age = 21.91 years at Time 1, 73.2% male). We also investigated within-person associations of child context time-varying covariates (autism symptoms, behavior problems, residential status) and maternal context time-varying covariates (social support network size and stressful family events) with the trajectories of emotional well-being. Data were collected on 5 occasions across a 10-year period. Average patterns of stable (depressive symptoms) and improved (anxiety) emotional well-being were evident, and well-being trajectories were sensitive to fluctuations in both child and maternal context variables. On occasions when behavior problems were higher, depressive symptoms and anxiety were higher. On occasions after which the grown child moved out of the family home, anxiety was lower. Anxiety was higher on occasions when social support networks were smaller and when more stressful life events were experienced. These results have implications for midlife and aging families of children with an ASD and those who provide services to these families. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Are social supports in late midlife a cause or a result of successful physical ageing?

BACKGROUND: Many studies have noted a strong association between poor social support and premature mortality. A limitation of such studies has been their failure to control adequately for confounders that damage both social supports and physical health. METHODS: A 50-year prospective multivariate study of 223 men was used to examine the possible causal relationships between social supports and health. Alcohol abuse, prior physical health and mental illness prior to age 50 were controlled. Relative social supports were quantified over the period from age 50 to 70. RESULTS: Adequacy of social supports from age 50 to 70 was powerfully correlated with physical health at age 70 (P < 0.001). However, such social supports were also powerfully predicted by alcohol abuse (P < 0.001), smoking (P < 0.001) and indicators of major depressive disorder (P < 0.01) assessed at age 50. When prior smoking, depression and alcohol abuse were controlled, then the association of physical health with social supports was very much attenuated. Some facets of social support like religion and confidantes were unassociated with health even at a univariate level. Surprisingly, in this sample friends seemed more important for sustained physical health than closeness to spouse and to children. CONCLUSIONS: While social supports undoubtedly play a significant role in maintaining physical well-being in late life, much of the association between poor social supports and mortality may be mediated by alcoholism, smoking and pre-morbid psychopathology.     

Challenges to implementing the current pediatric cholesterol screening guidelines into practice

OBJECTIVE: The Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program (NCEP) recommends selective screening of children for high blood cholesterol. We determined the number of children, who, according to the guidelines, should be targeted for cholesterol screening. DESIGN: Population survey. SETTING: Permanent household residents in Otsego County, NY. PARTICIPANTS: Total population-based sample of 17,444 households (86.6% response rate) including 44,565 participants, of whom 10,457 were children, aged 2 through 19 years. MAIN OUTCOME MEASURES: Percent of children qualifying for cholesterol screening under the NCEP Children's Panel guidelines. RESULTS: Children from two-parent families were more likely to have known family history of coronary heart disease (CHD) before 60 years of age (41.8% vs 25.8%, P < .001), and twice as likely as children from single-parent families to have known parental hypercholesterolemia (18.8% vs 9.5%, P < .001). Only 39% of parents reported having had their cholesterol level checked; they were better educated and more likely to have health insurance. Parents with a first-degree relative with CHD before 60 years of age were more likely to report having their cholesterol level checked and to report a high cholesterol level. We calculated that 27% of children (18% of children from single-parent households and 29% of children from two-parent households) would report a known family history of premature CHD (ie, CHD before 55 years of age) and qualify for lipoprotein analysis, and that 11% of children would qualify for total cholesterol screening because of known parental hypercholesterolemia without a family history of premature CHD. Thirty-five percent of children had incomplete or unavailable family health history and/or unknown parental cholesterol status. CONCLUSIONS: In this population, 38% of children would be targeted for cholesterol screening, exceeding the estimate of the NCEP Children and Adolescents Panel. The selection process, however, would tend to miss children from single-parent families, children with incomplete family health history, and children whose parents have not had their cholesterol levels measured. The currently recommended pediatric cholesterol screening policy needs to be evaluated further in additional communities and population settings. Alternative cholesterol screening strategies are needed when family health history is incomplete and/or parental cholesterol status is unknown.