Youth justice and health: An argument against proposed changes to the Youth Criminal Justice Act

The Canadian Paediatric Society is deeply concerned about the negative effects on the developmental, psychological and emotional health of young offenders if the Youth Criminal Justice Act is amended as proposed. Changing Canada's youth crime law to achieve stiffer sentences for youth 14 years of age and older who are convicted of serious violent offences is contrary to the United Nations Convention on the Rights of the Child. Treating adolescents as adults puts them at serious health and human rights risks - including trauma, violence and abuse - and interferes with their overall development. Furthermore, rates of mental illness are higher among youth in custody. Youth should only serve their sentence in a facility that is exclusively limited to youth, and considers the rights of youth as well as their mental, physical, developmental and educational needs.     

An emerging income differential for adolescent emotional problems

Background: While there is considerable evidence of income gradients in child and adolescent behaviour problems, evidence relating to children and young people’s emotional difficulties is more mixed. Older studies reported no income differentials, while recent reports suggest that adolescents from low‐income families are more likely to experience emotional difficulties than their more affluent peers. Methods: We compared the association between low‐ versus medium‐/high‐family income and parent‐reported emotional difficulties in 15‐ and 16‐year‐olds in three large nationally representative cohorts studied in 1974, 1986 and 1999/2004. We then examined whether increases in the income differential could be accounted for by changes in the association of a range of sociodemographic factors (family type or size, maternal education or housing tenure) with either family income or emotional difficulties. Finally, in the most recent cohorts, we considered whether the effects of these sociodemographic variables were mediated by more proximal family factors (maternal distress, stressful life events or family dysfunction). Results: An increasing income differential in adolescent emotional problems emerged over the period, with standardized coefficients for associations with low income increasing from .07 in 1974 and 1986 to .30 in 1999/2004. This was due partially (～10%) to sociodemographic risk factors for emotional difficulties becoming more strongly associated with low‐income families over time, and partially (～40%) to the increasing impact of these risk factors. In the most recent cohorts, about 40% of the effects of sociodemographic risks appear to have been mediated by more proximal family factors. Conclusions: These findings have implications for our understanding of the health burden of emotional problems, recognition of the health burden associated with inequality and public concern about the consequences of social change.     

Anxiety in children and adolescents with chronic physical illnesses: a meta-analysis

To compare levels of anxiety of children with chronic illness with healthy peers and population norms. Meta-analysis integrated results from 332 studies. Children with chronic illness had elevated levels of anxiety (d=0.18 standard deviation units). Strongest elevations were found for chronic fatigue syndrome, migraine/tension headache, sensory impairment and epilepsy. Paediatricians should screen for anxiety symptoms in children at risk and offer interventions, if needed.     

The interface of child mental health and juvenile diabetes mellitus

Diabetes mellitus is a common childhood illness, and its management is often complicated by mental health challenges. Psychiatric comorbidities are common, including anxiety, depression, and eating disorders. The illness can profoundly affect the developing brain and family functioning and have lifelong consequences. The child mental health provider can provide valuable assistance to support the child and family and assessment and treatment of comorbid mental health problems and to promote positive family functioning and normal developmental progress.     

Neuropharmacology of drugs and alcohol in mother and fetus

Epidemiological evidence suggests that an adverse prenatal environment can have profound long-term health consequences throughout postnatal life. This chapter discusses the underlying mechanisms implicated in the consumption of mood-altering recreational drugs and teratogenicity in the fetus. The way metabolic parameters in pregnancy influence the pharmacokinetic characteristics of drugs and alcohol and the developmental stage of neurotoxicity are reviewed. The general underlying mechanisms that link multifaceted interactions between drug characteristics, gene polymorphisms, dietary deficiencies, changed endocrine indices and fetal programming are outlined, with specific examples throughout the text. As developmental injury is of significant social concern, the final section questions whether society provides adequate support for making appropriate and informed lifestyle choices to alleviate preventable transgenerational harm.     

Feeding disorders in ex-prematures: causes - response to therapy - long term outcome

Feeding disorders in ex-prematures do exist and may constitute a major challenge to their families’ well being. A cases series of 86 ex-prematures with severe feeding disorders was analysed regarding co-morbidity, response to therapy and the long-term outcome after treatment. These children with a gestational age of <37 weeks had been referred for hospital rehabilitation because of severe feeding disorders, defined as tube feeding or average feeding times of more than 30 minutes. Behavioural therapy was the key element of the treatment. Ex-prematures accounted for 86/266 patients admitted for treatment of feeding disorders between 1995 and 2004. Whereas only 40.8% of these had cerebral palsy, 51.1% had a diagnosis of mental retardation and 87% had interaction problems. Response to treatment up to discharge was achieved in 61.6%. Univariat analyses showed that tube feeding at admission and swallowing difficulties were the best predictors of failure to respond to the intervention. Long-term follow-up data that were collected for 53 of the 86 children with similar initial response to therapy (64.2%) compared to children with no follow-up data (57.6%). Success of therapy after discharge was maintained in 94.1%; however, 25% of the children with normal BMI’s at discharge and sustained success of therapy fell below the 3rd BMI percentile. Cerebral palsy, mental retardation and interaction problems appear to be important risk factors for severe feeding disorders in ex-prematures. A therapeutic intervention based on behavioural therapy achieved sustained success in almost two thirds of the children.     

Lack of recognition and complexity of foetal alcohol neuroimpairments

AIMS: To obtain the recorded prevalence of foetal alcohol syndrome (FAS) and foetal alcohol spectrum disorders (FASD) in Norway, and evaluate the effect of a general information program to increase the recognition of FAS/FASD for health care and social workers. METHODS: A questionnaire regarding prevalence of FAS/FASD was sent to all Norwegian paediatric and child psychiatry departments. In the region Hordaland county, an information program was carried out to educate health-care and social workers on symptoms and signs of FAS/FASD, and referral was encouraged for suspected cases. Referred children received a neuropaediatric evaluation, and the effect of the information program on recorded FAS/FASD was recorded. RESULTS: Based on the national survey, a prevalence of 0.3 per 1000 was calculated. After the information program, the estimated prevalence in Hordaland County increased to 1.5 per 1000. In 5 years, 25 children were diagnosed with FAS and 22 with FASD. One-third of all children were mentally retarded. Microcephaly and neuroimpairments were more common among FAS children. Almost all children met the criteria of ADHD. CONCLUSION: The rate of FAS/FASD may be greatly underestimated because of lack of knowledge. An information program aimed at health-care and social workers is effective.     

Psychosocial work environment of hospital workers: validation of a comprehensive assessment scale

BACKGROUND: Studies have shown that adverse workplace factors can increase the risk of ill-health in hospital workers, but more comprehensive measures of the psychosocial work environment are needed. OBJECTIVES: To test a comprehensive and theory-based psychosocial work environment questionnaire and analyze associations with mental health in a sample of Danish hospital workers. DESIGN AND PARTICIPANTS: Questionnaire-based cross-sectional study with 343 female employees from a large Danish hospital, including patient care workers (nurses, nurse assistants, midwives) and laboratory technicians. METHODS: The psychosocial work environment was measured with 14 scales from the Copenhagen psychosocial questionnaire, version I, covering three main areas: demands at work, work organization and interpersonal relations at work. We further measured self-rated mental health and sociodemographic and employment characteristics of the participants. Cronbach's alphas, analyses of covariance, one-sample t-tests, partial correlations and linear regression models were used to analyze data. RESULTS: Of the 14 work psychosocial workplace scales 12 showed a satisfactory internal consistency (alpha>0.70). Patient care workers had more quantitative, emotional and cognitive demands (all p-values <0.001), higher work pace (p<0.001) and more role conflicts (p=0.01) than laboratory technicians, but also better work organization, including more influence at work, better possibilities for development and a higher meaning of work (all p-values <0.001). Both patient care workers and laboratory technicians had substantially higher scores on the demand scales and lower scores on the influence at work scale than the general Danish working population. Further analyses showed that high levels of demands at work and low levels of work organization and problematic interpersonal relations at work were associated with lower self-rated mental health. CONCLUSION: The Copenhagen psychosocial questionnaire is a suitable instrument to measure the psychosocial work environment of hospital workers. The comprehensive assessment of the psychosocial work environment helps tailoring interventions to the specific needs of different occupational groups.