Volume 23, Issue 3

No abstract available

Suicide attempts are known to peak in the spring, overlapping with the time of year when 25-hydroxyvitamin D [25(OH)D] levels are at their nadir in the northern hemisphere because of negligible skin production of vitamin D owing to low levels of ultraviolet B radiation. Low levels of 25(OH)D, the vitamin D metabolite used to diagnose vitamin D deficiency, have been associated with certain pro-suicidal factors such as exacerbation of depression, anxiety, psychosis, and certain medical conditions. Therefore, we hypothesize that vitamin D deficiency could also be associated with increased risk of completed suicides. Here, we briefly review the literature on vitamin D, its deficiency, and its reported association with certain risk factors for suicide.

One of the most frequently reported behavioral concerns among children with autism spectrum disorder (ASD) is high rates of activity and inattention, symptoms that are often associated with attention deficit hyperactivity disorder (ADHD). Although there is a considerable body of research regarding the appropriate treatment of ADHD symptoms among typically developing children, the research among children with ASD is more limited. The evidence to date suggests that medication response rates among children with ASD are considerably lower than among typically developing children and that children with ASD tend to be at greater risk for experiencing side effects. The purpose of the present paper is to review the available research on the treatment of ADHD symptoms in children with ASD. This paper summarizes the data on a range of pharmacological options and provides specific recommendations for how best to clinically manage these symptoms.

Introduction: Premature infants, especially very low birth weight infants, and fetal growth restriction are a challenge for healthcare professionals alike owing to the consequences of these conditions. Objective: To provide information for gynecologists, pediatricians and neonatologists to identify correct outcome expectations to help them plan their preventive and therapeutic actions. Searches were made on the MEDLINE database. Results: According to several follow-up studies, there is an increasing evidence for a link between early life exposures (prenatal and postnatal) and long-term outcomes. An adverse in utero environment will induce fetal reprogramming of neuroendocrine axes with permanent alterations of the physiology and metabolism of various body structures and functioning of neuroendocrine axes in later life, leading to a variety of different conditions, such as persistence of neurodevelopmental disability, changes in growth pattern, in body metabolism, in pubertal development, lower educational achievement and even psychological disturbances with possible alterations of sexual behavior in female adolescents and young adults. In addition, short-term transitory consequences can be also present, such as anomalies in genital appearance. Conclusions: Outcome studies on the impact that prematurity, low birth weight and intrauterine growth restriction have on pubertal development, sexuality and fertility are still scarce. Long-term outcomes of small for gestational age or preterm adolescents are complex and multifactorial, with interactions between genetic and environmental influences involving different pathways of adaptive responses during crucial phases of prenatal growth.

Adolescent suicide research has mostly focused on demographic risk factors. Such studies focus on who is at risk, but do not explain why certain adolescents are at risk for suicide. Studies of the neurobiology of adolescent suicide could clarify why some youths are more suicidal than others and help to find biological markers of suicidal behavior in teenagers. Over the past decade the role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of suicidal behavior has attracted significant attention of scientists. BDNF is involved in the pathophysiology of many psychiatric disorders associated with suicidal behavior including depression, post-traumatic stress disorder, schizophrenia, and obsessive-compulsive disorder. BDNF dysregulation could be associated with increased suicidality independently of psychiatric diagnoses. BDNF plays an important role in the regulation and growth of neurons during childhood and adolescence. Prominent among the brain regions undergoing developmental change during adolescence are stressor-sensitive areas. The serotonin dysfunction found in adolescent and adult suicidal behavior could be related to the low level of BDNF, which impedes the normal development of serotonin neurons during brain development. BDNF dysfunction could play a more significant role in the pathophysiology of psychiatric disorders and suicidal behavior in adolescents than in adults. Treatment-induced enhancement in the BDNF function could reduce suicidal behavior secondary to the improvement in psychiatric pathology or independently of improvement in psychiatric disorders. It is interesting to hypothesize that BDNF could be a biological marker of suicidal behavior in adolescents or in certain adolescent populations.

There is a lack of clarity in the literature about what nursing research is or ought to be. There are ample guidelines and texts on how to do nursing research and on syllabus development and countless arguments on why nursing research is synonymous with qualitative approach. This suggests concerns within the profession that nursing research has been developing in a direction of its own that could have had very little influence on health care policy development. Some claim the opposite that nursing practice, in particular in North America, has been evidence-based for the past three decades. In this context, evidence-based is often interpreted as taking part in randomised clinical trials. In this paper, we use historical observations to identify areas of interest which include all issues related to education and training, expertise and working environment for future research.

Background: Juvenile primary fibromyalgia syndrome (JPFS) is a chronic condition characterized by widespread musculoskeletal pain and discrete tender points with no objective evidence of a muscle disease but with disordered central pain processing. Very little is known about the prevalence and treatment on inpatient psychiatric units. Objective: The purpose of this study was to determine the effect of an intervention for JPFS in adolescent females admitted to a psychiatric hospital. Methods: In total, 30 patients with JPFS were assigned to either the intervention (n=15) or control group (n=15). The intervention group attended a fibromyalgia seminar followed by an audio-guided total body relaxation exercise. The control group participated in a seminar on skin care. Both groups completed a visual analog scale for affective states and somatic sensations before and after the seminar. Results: Participants in the intervention group, but not the control group, demonstrated significant improvement in concentration, self-confidence, restfulness and comfort level (p<0.001 to p<0.05). They also reported a reduction in stress level, muscle tightness, stomach upset and feeling down (p<0.001 to p<0.05) immediately after the intervention. Conclusions: This study provides evidence that a combined intervention can be used in the inpatient psychiatric setting to improve functioning and overall well-being of patients with comorbid psychiatric disorders and JPFS during acute hospitalization.

Method: This cross-sectional observational study was performed in 2007 by convenience sampling of 1031 full-time undergraduate students registered in years 1, 2 and 3 in the academic year 2007/2008, administering a basic demographics questionnaire along with the standardised General Health Questionnaire-28 (GHQ-28) to each participant. Results: The population of full-time students at the University of the West Indies (UWI) was found to be mentally healthy (median GHQ score was 5.00; GHQ=6 considered “mentally unhealthy”). However, median GHQ scores were lowest (4.00) in the Faculties of Medical Sciences and Social Sciences, but highest (6.00) in the Faculty of Humanities and Education. Furthermore, analysis showed that females were less mentally healthy than males attending the UWI. With regard to ethnicity, the African group was the most mentally healthy group whereas the group of mixed ethnicity was the least. Religion was also shown to significantly affect the GHQ (4.00 for Christians and Hindus, 6.00 for Muslims and 8.00 for those categorized as ‘other’). Most interesting was the relationship of GHQ scores with the manner in which participants related to their lecturers, classmates, guardians, siblings and friends; it was found that the better one related to these people, the lower one’s GHQ score was and hence one was considered more mentally healthy. Conclusions: UWI full-time undergraduate students are mentally healthy, but gender, ethnicity, religion, quality of relationships and faculty of study still contribute to significant differences within the population. This allows high-risk individuals to be identified and indicates where steps can be taken to improve mental health.

Chronic illness can lead to anxiety and depression in both parents and their adolescents. The identification of predictor variables would greatly assist pediatricians and parents in identifying children at risk for prolonged depression. Findings indicate that age and gender of the adolescent and duration of illness did not affect the depression score, but type of illness affected the score significantly. This article illustrates the fact that pediatricians can use the Beck Depression Inventory to identify depression and guide parents and adolescents to adequate medical care.

The purpose of this article is to examine the relationship between intelligence (IQ) and self-efficacy in children and adolescents living in the United States and Nicaragua. The sample consisted of 90 (46 male, 44 female) students (mean age=11.57 years, SD=3.0 years) referred by school administrators and faculty. United States (US) participants (n=27) resided in rural counties in the Northwest. The other group consisted of 63 students from Central America. A comparison between groups revealed that in the US, sample higher grades and IQ scores are typically associated with higher levels of self-efficacy. However in the Nicaraguan sample, both IQ scores and grades were not associated with self-efficacy, although age was correlated with self-efficacy. Results suggest that the construct of self-efficacy might change depending on whether one belongs to an individualistic or collectivistic society. Additionally, the effects of socioeconomic factors might influence perceived ability even more than intellectual abilities.

Background: The aim of this study was to determine the prevalence of asthma and the association between asthma and quality of life in sixth, seventh, and eighth graders in the city of Manisa. Method: The population of this cross-sectional study includes the sixth, seventh, and eighth grades of primary schools located in the city of Manisa (n=59, 135). The study sample included 763 students from nine schools with different socioeconomic features selected by the Directorate of National Education. Data were collected under the supervision of the researcher with a socio-demographic questionnaire, International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire and Kiddo-KINDL, a quality of life scale. Descriptive statistics, Student’s t-test and χ 2 -test were used for the evaluation of the data. Results: In total, 83 children (10.9%) were diagnosed with asthma by doctors and 82 children (10.7%) had wheezing or asthmatic attacks in the past 12 months. The children with life-long asthma had significantly lower scores for quality of life than those without asthma (p<0.05). Conclusion: The prevalence of asthma is different in different geographical regions in Turkey. Our results are similar to the results of Western society and asthma has a negative effect on the quality of life of children.

Background: The association between Hirschsprung’s disease (HSCR) and central nervous system (CNS) anomalies and syndromes is interesting because of similar developmental pathways. In addition to associated syndromes (e.g., Trisomy 21), these include brain anomalies, mental retardation and growth, ear and hearing deformities, eye hypoplasia, and craniofacial abnormalities, suggesting an neurocristopathy. This group of patients present with neurological challenges and have special challenges in management especially in the older child and adolescent. Methods: We retrospectively investigated 32 patients with significant HSCR-associated neurological challenges out of a local database of 555 HSCRs (6%). Data were analyzed with details of neurological problem, treatment, complications, and mortality. Long-term outcome was assessed clinically. Results: A total of 32 neurologically challenged children were studied. The male/female ratio was 1.7:1 and all ethnic groups were affected. Abnormalities and syndromes included Down (n=16) and probable Mowat-Wilson (n=2) syndromes. Other abnormalities included ophthalmic problems (n=8), CNS and brain abnormalities (n=8). Mortality (22%) was mostly related to enterocolitis, particularly in Trisomy 21, ophthalmic problems (n=8), CNS and brain abnormalities (n=8). Follow-up age range was 1–34 years (8 years, adolescence and beyond). The outcome was variable, concomitant medical problems were common. Several patients failed to achieve satisfactory continence. Conclusion: The association of neurological difficulties in patients with HSCR presents many challenges. Management could involve the exploration and evaluation of alternative treatment choices.

The Tier 2 Program of the Project P.A.T.H.S. targets adolescents with greater psychosocial needs. Based on subjective outcome evaluation data collected from 2173 participants recruited in 52 schools, 257 conclusions were reported by the program implementers in the evaluation reports. These conclusions were further analyzed via secondary data analyses. Although most of the conclusions concerning perceptions of the Tier 2 Program, instructors, and program effectiveness were positive in nature, there were also conclusions on the difficulties encountered and suggestions for improvements. Consistent with the previous evaluation findings, the present study suggests that the Tier 2 Program was well received by different stakeholders and the program was beneficial to the development of the program participants in the first year of the Experimental Implementation Phase.

A total of 216 schools participated in the Project P.A.T.H.S. in the 2008/2009 school year. After completion of the Tier 1 Program, subjective outcome evaluation data were collected from 3274 program implementers. Based on the consolidated data with schools as units, results showed that participants had positive perceptions of the program, implementers and benefits of the program. More than four-fifths of the implementers regarded the program as helpful to the program participants. Multiple regression analysis revealed that perceived qualities of the program and the program implementers predicted perceived effectiveness of the program. Grade differences were not significant, except in the perception of the program for the Secondary 1 and Secondary 3 programs. The present study provides additional support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong.

The current study reviews the work being carried out in the Naomi Therapeutic Center in Kiryat Yam, Israel. The staff in this Center decided to provide a holistic response (which includes occupational therapy, speech therapy and art therapy) to 50 elementary school special education students in five booster classes. The goal of the study was to enable these students to improve their self-image, demonstrate fewer classroom adaptive behavioral problems and bring them to function better in class by the end of the school year. Findings demonstrate that in the study group, students’ self-image scores were significantly higher at the end of the intervention program than they were prior to the intervention (p=0.040). In addition, the study group demonstrated a significant difference in adaptive behavior scores before and after the intervention, indicating fewer adaptive classroom behavior problems towards the end of the intervention (p=0.034). Finally, findings indicate that there was a significant improvement in students’ functioning on all of the occupational therapy categories.

Background: Children’s (0–14 years) mortality rates in the USA and 19 Western countries (WCs) were examined in the context of a nation-specific measure of relative poverty and the Gross Domestic Product Health Expenditure (GDPHE) of countries to compare the effectiveness and efficiency of health care systems “to meet the needs of its children” (UNICEF). Method : World Health Organisation child mortality rates per million were analysed for 1979–1981 and 2003–2005 to determine any significant differences between the USA and the other WCs over these periods. Child mortality rates are correlated with all countries GDPHE and ‘relative poverty’, defined by ‘Income Inequalities’, i.e., the gap between top and bottom 20% of incomes. Findings : Outputs: The mortality rate of every country fell substantially ranging from falls of 46% in the USA to 78% in Portugal. The highest current mortality rates are: USA, 2436 per million (pm), New Zealand 2105 pm, Portugal 1929 pm, Canada 1877 pm and the UK 1834 pm; the lowest are: Japan 1073 pm and Sweden 1075 pm, Finland 1193 pm and Norway 1200 pm. A total of 16 countries rates fell significantly more than the USA over these periods. Inputs: The USA had the greatest GDPHE and widest Income Inequality gap. There was no significant correlation between GDPHE and mortality but highly significant correlations with children’s deaths and income inequalities. The five widest income inequality countries had the six worst rates, the narrowest four had the lowest. Conclusions : Despite major improvements in every WC, based upon financial inputs and child mortality outputs, the USA health care system appears the least efficient and effective in “meeting the needs of its children”.

The present paper is based on research that investigated the quality of life of students with visual impairments, included in the regular education system, according to their own perceptions as reported in individual open interviews. The research comprised 19 students between the ages of 14 and 19 years. The main findings revealed three major themes: life in school with a focus on teachers’ behavior towards the pupil; peers’ reactions and the impact of stigma; family coping with the disability. Mixed feelings appeared in the first two themes. Regarding their teachers, the students reported support while at the same time they also felt a lack of sincere respect. Concerning peers, students felt that stigma affected their friendship behavior. Finally, most reports indicated satisfaction with the family bonds. Yet, there is almost no direct reference to the visual problem.

Background: The aim of this study was to evaluate the link between romantic relationship and/or sexual activity of adolescents, and family structure. Methods: Medical records of 1087 adolescent girls were evaluated for age, statute (student, working, out-of-school), incidence of romantic relationship and sexual activity, and family structures. Results: Teenager students had significantly less romantic relationships and experience of sexual intercourse than other groups. Parent-adolescent communication was negatively correlated with absence of romantic relationship and sexual intercourse. Conclusion: Adolescents who have left school and are working constitute a population having higher romantic relationships and sexual intercourse experiences compared with the student adolescents. Good relationships with parents were associated with less risky sexual behavior. Close relationships with school delay the onset of sexual activity.

The present study used functional magnetic resonance imaging (fMRI) to compare the neural activation patterns of children diagnosed with autistic disorder (AD), attention deficit hyperactivity disorder (ADHD), and typically developing controls (TCs) in response to a task involving evaluation of facial expressions. Substantially greater functional activity was noted in TCs compared to both subjects diagnosed with AD and ADHD. Consistent with previous studies, differences in functional activation of the amygdala, fusiform gyrus, cerebellum, mesolimbic, and temporal lobe cortical regions of the brain during a task evaluating facial expressions were noted in AD compared to TCs. Differences in the neural activity in these brain regions were also observed in children diagnosed with AD compared to those diagnosed with ADHD. Overall decreased neural activity was observed during the faces task performance in the AD group compared to the other two groups, a finding consistent with studies using adults. Both TC and ADHD control groups showed increased inferior frontal cortex activity compared to the AD group. Significant activity was present in both TC and ADHD control groups in the insula which was absent in the AD group; this is consistent with other studies showing dysfunction of the mesolimbic system in children with AD. Although frontostriatal and mesolimbic systems appear to be affected in AD, these deficits were not in the same attentional networks which are dysfunctional in children diagnosed with ADHD.

Background: Increased consumption of sugar-sweetened beve­rages (SSBs) over the past two decades has been implicated in the increased incidence of metabolic disorders in the pediatric population, but whether racial differences exist with regard to SSB intake among adolescents is unknown. Objective: To evaluate racial trends in SSB consumption in US adolescents. Study group: In total, 10,201 individuals aged 12–19 years from the National Health and Nutrition Examination Survey (NHANES) during the years 1988–1994 and 1999–2004 were included in the study. Methods: Multivariate linear regression analyses were performed to determine SSB consumption trends. Results: From 1988 to 2004, SSB intake increased more in adolescents from racial minorities than in their Caucasian counterparts. Although other Hispanics and non-Hispanic whites consumed more SSBs than other racial groups at the beginning of the study, the amount of SSBs consumed by other racial groups increased in the interval time such that total SSB consumption in each racial group was comparable by the end of the study period. Sex-related differences in SSB consumption trends among racial groups were also observed. Conclusions: SSB consumption trends have differed among racial groups and between the sexes over the past two decades, with SSB intake having increased more dramatically in racial minorities during this time than in non-Hispanic whites. Although other Hispanics and non-Hispanic whites consumed more SSBs than other racial groups in 1988–1991, SSB consumption among adolescents from all racial groups was comparable by 2003–2004. Furthermore, adolescents from most racial groups consumed more SSBs in 1994–2004 than in 1988–1994, paralleling the increase in pediatric obesity and metabolic syndrome.

Background: Few studies have focused on identifying predictors of medical consultation for pain in healthy children and adolescents. Objective: This investigation sought to identify parent and child laboratory and non-laboratory predictors of pediatric healthcare utilization for pain problems. Study group: Participants were 210 healthy children and adolescents (102 girls), aged 8–17 years who took part in a laboratory pain session. Methods: Three months after the laboratory session, participants were contacted by telephone to ascertain whether they had experienced pain and whether they had seen a healthcare professional for pain. Zero-order correlations among sociodemographic status, child laboratory pain responses, parent physical/mental health status and medical consultation for pain were conducted to identify relevant correlates of pediatric healthcare utilization; these correlates were subjected to multivariate analyses. Results: Bivariate analyses indicated that higher anticipated pain and bother for the cold pressor task, as well as poorer parent physical health status, were associated with pediatric medical consultation for pain, but only among girls. Sequential logistic regression analyses controlling for child age indicated that only parent physical health status, not the laboratory indicators, significantly predicted healthcare consultation for pain among girls. No parent or child correlates of care-seeking for pain emerged for boys. Conclusion: The findings suggest that parents’ perceived physical health plays a role in determining whether medical care is sought for pain complaints in healthy girls. These results suggest that interventions to assist parents in managing their own physical health problems could lead to reductions in medical consultation for girls’ pain.

Background: Little is known about how Muslim youth in non-Muslim countries perceive depression and its treatment and prevention. Objective: We investigated the barriers and suggest treatment models for depressive disorders in Muslim adolescents and young adults residing in the United States. Methods: We conducted a thorough literature review to identify previous study on the beliefs of American Muslim adolescents about depression and its treatment. We identified the gaps and developed a survey to ascertain this information from American Muslim adolescents. Results: The survey was administered to a convenience sample of 125 Muslim subjects (60.0% males) aged 14–21 years. The sample was ethnically diverse with Pakistani (44.8%) encompassing the majority of the sample. Most responders believed that recitation from the Koran relieves mental distress. Multiple linear regression analysis revealed that those who reported strong emotional support from parents or a greater acceptance of taking depression medication prescribed from a physician were more likely to accept a physician’s diagnosis, whereas believing in prayer to heal depression was associated with a lower likelihood of the same. Youth were accepting of Internet and preventive approaches. Conclusion: Planning of culturally sensitive mental health services is useful to accommodate the needs of Muslim youth served by primary care physicians and mental health practitioners in the United States. Muslim adolescents tend to be more traditional with family, social, and religious values. This value system plays an important role in their likelihood of seeking and accepting professional help for depression.