Sleep problems and mental health in primary school new entrants: Cross‐sectional community‐based study

Aims: To determine at school entry (i) the prevalence and types of child sleep problems; (ii) sleep difficulties and hygiene practices associated with sleep problems; and (iii) their associations with child health‐related quality of life, mental health and parent mental health. Methods: We conducted a cross‐sectional community‐based study at 22 primary schools in Melbourne, Australia. One thousand five hundred and twelve (70%) parents of children in the first 6 months of the child's first year of primary school took part. Parent report of child sleep problems (none, mild, and moderate/severe); sleep difficulties; pre‐bedtime activities (television in bedroom, television or electronic games before bedtime, television or electronic games >2 h/day) and caffeine intake; child mental health (Strengths and Difficulties Questionnaire), health‐related quality of life (Pediatric Quality of Life Inventory); and parent mental health (Depression Anxiety Stress Scale‐21). Results: 38.6% of children had a parent‐reported sleep problem (27.9% mild, 10.8% moderate/severe). Sleep problems were characterised by problematic sleep difficulties but not poor sleep hygiene practices. Moderate/severe sleep problems were associated with poorer child mental health (mean difference ?0.8; 95% confidence interval (CI) ?1.1 to ?0.5, P < 0.001), health‐related quality of life (mean difference ?9.9; 95% CI ?11.9 to ?7.9, P < 0.001) and parent mental health (mean difference 9.8; 95% CI 7.7–11.9, P < 0.001). Conclusions: In new school entrants, sleep problems are common and associated with poorer child mental health, health‐related quality of life and parent mental health. Future research needs to determine if systematically addressing sleep problems improves these outcomes.     

High-deductible health plans and the new risks of consumer-driven health insurance products

Consumer-driven health care is the most noteworthy development in health insurance since the widespread adoption of health maintenance organizations and preferred provider organizations in the 1980s. The most common consumer-driven health plan is the high-deductible health plan, which is essentially a catastrophic health insurance plan, often linked with tax-advantaged spending accounts, with very high deductibles, fewer benefits, and higher cost-sharing than conventional health maintenance organization or preferred provider organization plans. The financial risks are significant under high-deductible health plans, especially for low- to moderate-income families and for families whose children have special health care needs. Of concern for pediatricians are the potential quality risks that are predictable in high-deductible health plans, in which families are likely to delay or avoid seeking care, especially preventive care (if it is not exempted from the deductible), when they are faced with paying for care before the deductible is met. This policy statement provides background information on the most common consumer-driven health plan model, discusses the implications for pediatricians and families, and offers recommendations pertaining to health plan product design, education, practice administration, and research.     

Malaria: new challenges,new treatments

Malaria remains a challenge of global significance. This article has attempted to illustrate why the problems of malaria are intensifying, how control policy has changed, and the direction in which it is likely to evolve. The disease has, at last, been recognized as an urgent health priority by WHO and by international governments, which makes one hope that the current horrifying situation in Africa, where a child dies from malaria every 30 seconds, may soon become history.     

Adolescents with special health needs: prevalence, severity, and access to health services

The health care needs of disabled adolescents are examined using data from a nationally representative sample of 15,181 randomly selected adolescents aged 10 to 18 years from the 1984 National Health Interview Survey. More than 6% of adolescents, or nearly 2 million nationwide, suffered some degree of disability or limitation in their usual activities in 1984. The leading causes of disability were mental disorders and respiratory diseases. Adolescents living in poverty and in households where the adult members had completed little formal education exhibited increased risk of disability. Disabled adolescents were shown to have three times as many physician contacts annually and spend nine times as many days hospitalized as their nondisabled counter-parts. One in every seven adolescents with a disability was found to be uninsured--exposing their families to extreme financial risks. The great cost of insurance was cited as the primary reason for absence of coverage for 70% of all adolescents without coverage. Public policy implications of these results are discussed.     

It's time: A new era for paediatrics and child health in Australia

The Australian College of Paediatrics (ACP) was established in 1978; part of the stated rationale was to ‘acquire equal status to other colleges in medicine’ . . . and to become . . . ‘to which governments, or other organisations dealing with children, could officially turn to for advice’. After less than 2 decades, the ACP ceased to exist, and paediatricians became members of the Paediatrics and Child Health Division of the Royal Australasian College of Physicians (RACP). Many would now argue that the decision to dissolve the ACP and instead become a division within the RACP, though not taken lightly and made for what seemed at the time to be good reasons, might have been a mistake. While there have been some benefits, overall the public profile and national influence of paediatricians has been diminished. Paediatricians as a group have had little influence on policy formulation as it pertains to children and families, and the present administrative arrangements within the RACP raise considerable bureaucratic barriers for paediatricians to be able to contribute in a constructive and timely manner. It is suggested that paediatricians cannot be effective advocates for the health and wellbeing of children when they are but a relatively small and powerless group that resides within a large body of professionals whose primary interest is in various aspects of adult medicine. It is time that paediatricians (re)established their own college and controlled their own destiny. While such a step is not without its challenges, many would argue that it is an essential and timely step if we are to address our political and public health responsibilities.