The problems of the employment of child and adolescent psychotherapeutical care

We attempted to clarify the questions as to which variables were important for the acceptance or nonacceptance of a psychotherapy offer to the patients of our department. 1. We attempted to interpret some of the interpersonal variables hermeneutically: pressure of suffering and ability to suffer. We reflected these concepts as regards their ontogenesis and their significance for the initial contact with the therapist and the later compliance with the doctor-patient-relationship. 2. Other variables could be dealt with empirically. A group of patients whose psychotherapy was offered within one year of their initial contact with the clinic was examined. Here it was a question of 106 children and adolescents, 62 of these boys and 40 girls. No statistically significant influence upon the acceptance or refusal of an offer of therapy appeared in the variables--age and sex of the patients; distance between place of residence and clinic; the mother's occupation; psychiatric illnesses in relatives. On the other hand, a statistically significant influence is exercised by the variables--time interval between offer of therapy and its acceptance; therapy with psychopharmaceuticals at the same time; necessity of a depth psychologically-oriented individual therapy.     

Use of health care by young Asian New Zealanders: findings from a national youth health survey

Aim: To examine the use of health services and perceived barriers to accessing health care among young Asian New Zealanders. Methods: Secondary analysis of data from Youth2000, a cross‐sectional survey of secondary school students in New Zealand (NZ) conducted in 2001. Of the 9567 survey participants (aged 12–18 years), this study was restricted to students who identified with an ‘Asian’ ethnic category (n = 922). Results: Chinese and Indian students (the largest Asian ethnic groups in NZ) reported levels of overall health comparable to NZ European (NZE) students. However, relative to NZE students, Chinese students were more likely to report (i) not having a usual location for health care (adjusted OR 3.28; 95% CI: 2.51–4.43); and (ii) having problems getting health care when they needed it (adjusted OR 1.61; 95% CI: 1.32–1.96). Asian students who had been in NZ for 5 years or less (compared with NZ‐born students), as well as those who did not speak English at home (compared with those who did) were less likely to report having a usual source of health care, even after adjusting for their overall health (adjusted OR 2.13, 95% CI: 1.27–3.56; and adjusted OR 1.69, 95% CI: 1.11–2.56, respectively). Conclusion: Young Asian New Zealanders are less likely to access health care than their NZE counterparts. The perceived barriers require explicit attention within the broader platforms of health‐care quality, and professional and cultural competence of health‐care services.     

Substance use in maltreated youth: findings from the national survey of child and adolescent well-being

The purpose of this study was to describe the characteristics associated with different levels of substance use in a national probability sample of maltreated 11- to 15-year-olds (n = 1,179). Bivariate (chi-square tests) and multivariate (logistic regression) analyses were used to examine the association of adolescent substance use with demographics, placement type, and youth and family characteristics. Seventy-one percent of youth reported no use, 20% reported low levels of substance use, and approximately 9% reported moderate to high levels of use. Youth substance use was similar across placement types. Conduct problems and low caregiver relatedness were more prevalent for youth reporting higher levels of substance use. High levels of conduct problems increased the odds of substance use, whereas high caregiver monitoring decreased the odds of substance use. Caregiver monitoring may be a key tactic in attempts to reduce the likelihood of substance use in maltreated youth, regardless of placement type.     

The US gun stock: results from the 2004 national firearms survey.

OBJECTIVES: To examine the size and composition of the privately held firearm stock in the US; and to describe demographic patterns of firearm ownership and motivations for ownership. Design, SETTING AND PARTICIPANTS: A nationally representative household telephone survey of 2770 adults aged>or=18 years living in the US, conducted in the spring of 2004. MAIN OUTCOME MEASURE: Responses to questions regarding firearm ownership, the number and types of guns owned, and motivations for ownership. RESULTS: 38% of households and 26% of individuals reported owning at least one firearm. This corresponds to 42 million US households with firearms, and 57 million adult gun owners. 64% of gun owners or 16% of American adults reported owning at least one handgun. Long guns represent 60% of the privately held gun stock. Almost half (48%) of all individual gun owners reported owning>or=4 firearms. Men more often reported firearm ownership, with 45% stating that they personally owned at least one firearm, compared with 11% for women. CONCLUSIONS: The US population continues to contain at least one firearm for every adult, and ownership is becoming increasingly concentrated. Long guns are the most prevalent type of gun in the US but handgun ownership is widespread. Ownership demographic patterns support findings of previous studies.     

Adolescent immunization practices: a national survey of US physicians

BACKGROUND: Adolescent immunization rates remain low. Hence, a better understanding of the factors that influence adolescent immunization is needed. OBJECTIVE: To assess the adolescent immunization practices of US physicians. DESIGN AND SETTING: A 24-item survey mailed in 1997 to a national sample of 1480 pediatricians and family physicians living in the United States, randomly selected from the American Medical Association's Master List of Physicians. PARTICIPANTS: Of 1110 physicians (75%) who responded, 761 met inclusion criteria. OUTCOME MEASURES: Immunization practices and policies, use of tracking and recall, opinions about school-based immunizations, and reasons for not providing particular immunizations to eligible adolescents. RESULTS: Seventy-nine percent of physicians reported using protocols for adolescent immunization, and 82% recommended hepatitis B immunization for all eligible adolescents. Those who did not routinely immunize adolescents often cited insufficient insurance coverage for immunizations. While 42% of physicians reported that they review the immunization status of adolescent patients at acute illness visits, only 24% immunized eligible adolescents during such visits. Twenty-one percent used immunization tracking and recall systems. Though 84% preferred that immunizations be administered at their practice, 71% of physicians considered schools, and 63% considered teen clinics to be acceptable alternative adolescent immunization sites. However, many had concerns about continuity of care for adolescents receiving immunizations in school. CONCLUSIONS: Most physicians supported adolescent immunization efforts. Barriers preventing adolescent immunization included financial barriers, record scattering, lack of tracking and recall, and missed opportunities. School-based immunization programs were acceptable to most physicians, despite concerns about continuity of care. Further research is needed to determine whether interventions that have successfully increased infant immunization rates are also effective for adolescents.     

The mPINC survey: Impacting US maternity care practices

The Centers for Disease Control and Prevention administered the original Maternity Practices in Infant Nutrition and Care (mPINC) survey, a census of all US birth facilities, from 2007 to 2015 to monitor infant feeding‐related maternity care practices and policies. The purpose of this paper is to describe the many uses of mPINC data. Hospitals, organizations and governments (federal, state and local) have used the mPINC survey as a tool for improving care among the populations they serve. Nationally, the mPINC survey has been used to document marked improvements in infant feeding‐related maternity care. Researchers have used the mPINC data to examine a variety of questions related to maternity care practices and policies. The newly revised mPINC survey (2018) has been designed to capture changes that have occurred over the past decade in infant feeding‐related US maternity care. Hospitals, organizations, governments and researchers will be able to continue using this important tool in their efforts to ensure US maternity care practices and policies are fully supportive of breastfeeding.     

Emergency physician perspectives on child passenger safety: a national survey of attitudes and practices

ObjectiveTo understand attitudes and self-reported practices of pediatric and general emergency physicians regarding child passenger safety.MethodsWe conducted a cross-sectional mailed national survey of 600 pediatric emergency medicine (PEM) physicians and 600 emergency medicine (EM) physicians who provide clinical care in the United States randomly sampled from the American Medical Association Physician Masterfile. Survey questions explored attitudes related to the role of the physician and the emergency department (ED) in child passenger safety and self-reported frequency of performing specific child passenger safety practices.ResultsResponses were received from 638 of 1000 (64%) eligible physicians with a valid mailing address. Surveys were completed by 367 PEM and 271 EM physicians. Regardless of their training background, emergency physicians overwhelmingly agreed that it is their role to educate parents about child passenger safety (95% PEM vs 82% EM) and that they can make a difference in how parents restrain their child (92% PEM vs 93% EM). Physicians were similar in their views that the most appropriate person to provide child passenger safety information in their ED was a nurse/midlevel provider followed by a physician. Self-report of child passenger safety practices in response to 2 hypothetical scenarios showed physicians infrequently provide best-practice safety recommendations to families.ConclusionsEmergency physicians are supportive of the ED as a setting to promote child passenger safety, yet do not consistently promote child passenger safety themselves. Differences between PEM and EM physicians’ attitudes toward child passenger safety may necessitate different approaches on injury prevention in general and pediatric EDs.     

Pediatrician characteristics associated with child abuse identification and reporting: results from a national survey of pediatricians

Pediatrician experience with child protective services (CPS) and factors associated with identifying and reporting suspected child physical abuse were examined by a survey of members of the American Academy of Pediatrics (AAP). Respondents provided information about their demographics and experience, attitudes and practices with child abuse. They indicated their diagnosis and management of a child in a purposely ambiguous clinical vignette. Pediatricians who had received recent child abuse education were more confident in their ability to identify and manage child abuse. High confidence in ability to manage child abuse and positive attitude about domestic violence screening and value of anticipatory guidance predicted that pediatricians would have high suspicion that the child in the vignette was abused and that they would report the child to CPS. Future efforts to improve medical intervention in child abuse should focus on physician attitudes and experience, as well as cognitive factors.     

Factors associated with attention deficit/hyperactivity disorder among US children: Results from a national survey

ABSTRACT: BACKGROUND: The purpose of this study was to investigate the association between Attention Deficit/Hyperactivity Disorder (ADHD) and various factors using a representative sample of US children in a comprehensive manner. This includes variables that have not been previously studied such as watching TV/playing video games, computer usage, family member's smoking, and participation in sports. METHODS: This was a cross-sectional study of 68,634 children, 5-17 years old, from the National Survey of Children's Health (NSCH, 2007-2008). We performed bivariate and multivariate logistic regression analyses with ADHD classification as the response variable and the following explanatory variables: sex, race, depression, anxiety, body mass index, healthcare coverage, family structure, socio-economic status, family members' smoking status, education, computer usage, watching television (TV)/playing video games, participation in sports, and participation in clubs/organizations. RESULTS: Approximately 10% of the sample was classified as having ADHD. We found depression, anxiety, healthcare coverage, and male sex of child to have increased odds of being diagnosed with ADHD. One of the salient features of this study was observing a significant association between ADHD and variables such as TV usage, participation in sports, two-parent family structure, and family members' smoking status. Obesity was not found to be significantly associated with ADHD, contrary to some previous studies. CONCLUSIONS: The current study uncovered several factors associated with ADHD at the national level, including some that have not been studied earlier in such a setting. However, we caution that due to the cross-sectional and observational nature of the data, a cause and effect relationship between ADHD and the associated factors can not be deduced from this study. Future research on ADHD should take into consideration these factors, preferably through a longitudinal study design.