Child Health Survey Research Articles

Predicting proprotein convertase subtilisin kexin type-9 loss of function mutations using plasma PCSK9 concentration

Low plasma proprotein convertase subtilisin kexin type-9 (PCSK9) concentration has been associated with loss of function (LOF) PCSK9 mutations in several studies. However, the current standard for detection of these LOF mutations is through gene sequencing. Gene sequencing is labor intensive and expensive. Identifying a simple test to help predict PCSK9 LOF mutations would help to better target subjects requiring gene sequencing. Determine the diagnostic accuracy of plasma PCSK9 concentration in detecting PCSK9 LOF mutations using genotyping as the gold standard. We carried out a retrospective analysis of 1412 French-Canadian participants of the Quebec Child and Adolescent Health and Social Survey who had been screened for the PCSK9 R46L and Leucine insertion (InsLEU) LOF mutations by genotyping. Their plasma PCSK9 concentrations were measured using a well-described enzyme-linked immunosorbent assay. We used the Youden index to determine the optimal cutoff for PCSK9 concentration to predict mutation status. We further investigated the use of low-density lipoprotein cholesterol (LDL-C) concentration in combination with plasma PCSK9 concentration to refine the prediction of mutation status. Plasma PCSK9 had a moderate accuracy (area under the curve, 0.71) in detecting the PCSK9 R46L mutation with a sensitivity of 71% and specificity of 70% at cutoff of 70ng/mL. Combining PCSK9 and LDL-C increased the diagnostic accuracy for the detection of the R46L mutation (area under the curve, 0.75). However, plasma PCSK9 concentration was no better than chance at detecting PCSK9 InsLEU mutation. This analysis suggests that plasma PCSK9 combined with LDL-C concentrations might be useful to predict certain PCSK9 LOF mutations such as the R46L mutation but may fail to predict others such as the InsLEU mutation.

Health-related Quality of Life in Children and Adolescents With β-Thalassemia Major on Different Iron Chelators in Basra, Iraq.

Few studies have investigated the quality of life of children with thalassemia in the Middle East or Mediterranean region, especially Iraq. Therefore, this study was performed to assess the health-related quality of life (HRQoL) of patients with β-thalassemia major compared with healthy children and adolescents in the same age group and to evaluate the effects of different iron chelators on HRQoL measurements. A case-control study was performed on patients with β-thalassemia major registered at the Center for Hereditary Blood Diseases in Basra from February 2012 through July 2013. The group included children and adolescents aged 2 to 17 years old. HRQoL was assessed using the Pediatric Quality of Life (PedsQL) Generic Core Scale questionnaire, version 4.0, for children 2 to 12 years old and the Short Form-36 health survey questionnaire, version 2 (SF-36v2), for children and adolescents aged 13 to 17 years old. A total of 209 age-matched and sex-matched children and adolescents were included in the control group. The study did not find a significant difference in PedsQL scores among different age groups or different iron chelators, whereas there were significant differences in all of the SF-36v2 domains, with the best quality of life observed in the deferasirox group, followed by the deferoxamine group and the combined therapy group (P<0.05). The use of deferasirox among patients aged 13 to 17 years old was associated with higher SF-36v2 scores than in the other groups (P<0.05). However, for younger patients, the PedsQL scores were not significantly different for different iron chelators. The use of oral deferasirox significantly improved the quality of life of adolescents with β-thalassemia major. However, this effect was less prominent among patients aged 2 to 12 years old.

Household food security and breast-feeding duration among Canadian Inuit.

There have been few studies investigating the association between food security and breast-feeding duration and none have been conducted among Canadian Inuit, a population disproportionately burdened with food insecurity. We evaluated the association between household food security and breast-feeding duration in Canadian Inuit children. Data were obtained from the Nunavut Inuit Child Health Survey, a population-based cross-sectional survey. The Canadian Territory of Nunavut in 2007 and 2008. Caregivers of Inuit children aged 3-5 years. Participating children were randomly sampled from community medical centre lists. Out of 215 children, 147 lived in food-insecure households (68·4 %). Using restricted mean survival time models, we estimated that children in food-secure households were breast-fed for 16·8 (95 % CI 12·5, 21·2) months and children in food-insecure households were breast-fed for 21·4 (95 % CI 17·9, 24·8) months. In models adjusting for social class, traditional knowledge and child health, household food security was not associated with breast-feeding duration (hazard ratio=0·82, 95 % CI 0·58, 1·14). Our research does not support the hypothesis that children living in food-insecure households were breast-fed for a longer duration than children living in food-secure households. However, we found that more than 50 % of mothers in food-insecure households continued breast-feeding well beyond 1 year. Many mothers in food-secure households also continued to breast-feed beyond 1 year. Given the high prevalence of food insecurity in Inuit communities, we need to ensure infants and their caregivers are being adequately nourished to support growth and breast-feeding, respectively.

Tendencia de la Operación Cesárea en la República de Guatemala: Propuesta de intervención ¡Al menos intentémoslo!

Objetivo: Determinar la tendencia de la operación cesárea de los años 2011 al 2014 en hospitales públicos, hospitales privados, hospitales del Instituto Guatemalteco de Seguridad Social y hospitales de la Asociación ProBienestar de la Familia de la República de Guatemala y sugerir posibles intervenciones para disminuir las altas tasas identificadas. Material y métodos: Análisis secundarios fueron realizados de las bases de datos proporcionadas por el Registro Nacional de las Personas (RENAP) para los años 2011 al 2014. Estas bases contienen los datos de cada nacimiento en particular ocurrido en la República de Guatemala, por departamento, tipo de parto e institución que asistió a la embarazada. Resultados: Un total de 665,446 nacimientos institucionales fueron analizados durante los cuatro años de estudio. Los hospitales privados presentaron la mayor incidencia de operación cesárea con un 68%, seguido por los hospitales de APROFAM (55%), IGSS (42%) y hospitales públicos (34%). Este análisis se relaciona con el número de parto institucional para cada departamento del país. Existe una diferencia del doble de operación cesárea entre el sistema público a nivel nacional con un total de 37 instituciones de salud que presentaron una tasa de operación cesárea de 34% contra 198 instituciones privadas que presentaron una tasa de operación cesárea de 68%. Diferencias para cada departamento son presentadas. Finalmente, el análisis por regiones de salud demostró que la tasa de operación cesárea fue mayor (47%) para la región metropolitana y la región que menor tasa de operación cesárea presentó fue la región de Petén, con 24%. Estos datos son similares a los reportados por la Encuesta Nacional de Salud Materno Infantil (ENSMI) 2014 – 2015. Conclusiones: La diferencia entre las tasas de operación cesárea de los hospitales que forman parte del sistema de salud nacional es preocupante. Los hospitales privados no sólo presentan tasas mayores que el resto de hospitales sino que su tendencia sigue en aumento. No existe monitoreo y vigilancia de esta situación a nivel nacional, y estos datos demuestran que en los próximos años la incidencia de cesárea puede ser mayor, dada la nula vigilancia por parte de las autoridades de salud. Se presenta una propuesta de clasificación que permite conocer la situación actual a lo interno del sistema de salud o a nivel de servicio hospitalario, y qué grupo de pacientes operadas contribuye más a las altas tasas de operación cesárea. Esto sin duda permite implementar acciones que disminuyan estas altas tasas de operación cesárea.

Child feeding and stunting prevalence in left-behind children: a descriptive analysis of data from a central and western Chinese population

ObjectivesTo examine the effect of parental rural-to-urban internal migration on nutritional status of left-behind children and how this is related to guardianship.MethodsWe used UNICEF China’s maternal and child health survey data to investigate stunting prevalence and feeding practices in children left behind by rural-to-urban internal migrant parents. We also assessed the effects of primary guardianship which is related closely with parental migration.ResultsOf 6136 children aged 0–3 years, over one-third was left behind by one or both parents. About 13 % were left behind by mothers, leaving guardianship primarily to grandmothers. Left-behind status was not associated with stunting, yet children who were cared for primarily by their fathers had a 32 % increase of stunting compared to children cared for by the mothers [adjusted odds ratio (aOR) = 1.32; 95 % confidence interval = 1.04–1.67]. Children with migrant mothers were less likely to receive age-appropriate breastfeeding (aOR = 0.04;0.02–0.10) and a minimum acceptable diet (aOR = 0.56;0.39–0.79) compared with non-left-behind children.ConclusionsGuardian’s feeding behaviours varied, and was inappropriate for both children affected and not affected by parent’s rural-to-urban internal migration. Community-based infant and young child feeding counselling and support should be provided to all caregivers.

Disparities in adversity among children with autism spectrum disorder: a population-based study.

People with autism spectrum disorders (ASDs) experience disparities in health. An important but overlooked risk factor for health disparities in the ASD population is adverse childhood experiences (ACEs). The purpose of this study was to identify the prevalence of ACEs among families of children with and without ASD, using a population-based sample. Data from the 2011 to 2012 National Survey of Child Health were analyzed to estimate prevalence of ACEs among families of children with and without ASD, age 3 to 17 years (ASD=1611; estimated population=1 165 34). The child's ASD status was obtained from parent report; ACEs were assessed with the modified Adverse Childhood Experiences Scale. Bivariate and multinomial logistic regression analyses were utilized to investigate the relationship between ACEs and childhood ASD status. ASD status among children was significantly and independently associated with higher probability of reporting one to three ACEs (adjusted relative risk ratio [aRRR] 1.53; 95% CI: 1.16-2.0; p<0.010) and four or more ACEs (aRRR 1.99; 95% CI: 1.35-2.91; p<0.010). Children with ASD may experience a greater number of family and neighborhood adversities, potentially compromising their chances for optimal physical and behavioral health outcomes. Assessment and reduction of ACEs among families of young people with ASD could potentially contribute to the reduction of population health disparities.

Forests, Trees, and Micronutrient-Rich Food Consumption in Indonesia.

Micronutrient deficiency remains a serious problem in Indonesia with approximately 100 million people, or 40% of the population, suffering from one or more micronutrient deficiencies. In rural areas with poor market access, forests and trees may provide an essential source of nutritious food. This is especially important to understand at a time when forests and other tree-based systems in Indonesia are being lost at unprecedented rates. We use food consumption data from the 2003 Indonesia Demographic Health Survey for children between the ages of one and five years and data on vegetation cover from the Indonesian Ministry of Forestry to examine whether there is a relationship between different tree-dominated land classes and consumption of micronutrient-rich foods across the archipelago. We run our models on the aggregate sample which includes over 3000 observations from 25 provinces across Indonesia as well as on sub-samples from different provinces chosen to represent the different land classes. The results show that different tree-dominated land classes were associated with the dietary quality of people living within them in the provinces where they were dominant. Areas of swidden/agroforestry, natural forest, timber and agricultural tree crop plantations were all associated with more frequent consumption of food groups rich in micronutrients in the areas where these were important land classes. The swidden/agroforestry land class was the landscape associated with more frequent consumption of the largest number of micronutrient rich food groups. Further research needs to be done to establish what the mechanisms are that underlie these associations. Swidden cultivation in is often viewed as a backward practice that is an impediment to food security in Indonesia and destructive of the environment. If further research corroborates that swidden farming actually results in better nutrition than the practices that replace it, Indonesian policy makers may need to reconsider their views on this land use.

Factors associated with nutritional outcomes in the mother-child dyad: a population-based cross-sectional study.

To estimate factors associated with double burden of nutritional outcomes in the mother-child dyad at the household level (child stunting and/or maternal overweight). Cross-sectional study using the Brazilian Demographic and Health Survey. Nutritional outcomes were: mother with normal weight and child with normal height; overweight mother and child with normal height; mother with normal weight and short-stature child; and overweight mother and child with short stature (double burden). The child was classified as short when height-for-age Z-score was <-2 and the mother as overweight when BMI was ≥25·00 kg/m2. Socio-economic status, environment, social vulnerability, maternal characteristics and the child's food intake were the exposure factors. The hierarchical approach for multinomial logistic regression modelling was used to assess the associations. National Demographic and Health Survey of Children and Women conducted in Brazil, 2006-2007. Mother-child dyads (n 3676). After adjustments, lower maternal educational level (OR=3·53; 95 % CI 1·33, 9·33) and inadequate household (non-masonry house; OR=2·54; 95 % CI 1·39, 4·66) were associated with the double burden of malnutrition. Mother's short stature (OR=3·41; 95 % CI 1·76, 6·61), child's vegetable intake on less than or equal to 4 d/week (OR=2·21; 95 % CI 1·03, 4·75) and inadequate household (non-masonry house; OR=2·29; 95 % CI 1·36, 3·87) were associated with child's short stature. The lack of breast-feeding (OR=2·00; 95 % CI 1·07, 3·72) was associated with maternal overweight. The present findings contribute to establishing strategies promoting health and healthy diets, by considering the growth deficit and overweight/obesity concomitantly.

Reducing health inequalities among girls and adolescent women living in poverty: the success of Bangladesh

Background: Bangladesh has made dramatic improvements in the health of girls and women in the last 20 years. This paper examines whether gender inequalities in health are evident among older children and adolescents among extremely poor households and identifies future health challenges for improving the health of girls and women.Subjects and Methods: Gender inequalities in health were examined using data from a school health survey of school children and adolescents (n = 900, 6.5–13.5 years). Anthropometric status, household possessions and number of siblings were measured. Under-nutrition was assessed as stunting (height-for-age z-score) and thinness (BMI-for-age z-score).Results: The prevalence of under-nutrition was high (35.3% stunting; 42.4% thinness), but there were no significant differences according to gender or socio-economic indicators (via possession score). Girls had more younger siblings (p < 0.05), while boys had more older siblings (p < 0.05).Conclusions: These findings accord with the national picture of successful reductions in gender inequalities in health through low cost, community-based health programmes and education policies targeting the poorest sectors. The prevalence of under-nutrition, however, remains high. Reproductive behaviours may still be influenced by poverty and the gender of existing offspring. Future challenges lie in reducing the adverse health consequences to women and their infants associated with early age at marriage and childbirth.

Increasing Child Immunization Through Uninterrupted Power

We study the effect of a unique electrification upgradation program, Jyotigram Yojana (JGY), in India on child vaccination rate. We match precise JGY rollout data with the third wave of the Reproductive and Child Health Survey (DLHS-III).We find that higher program exposure, measured by percentage of villages that implemented the JGY program in a district, leads to higher probability of receiving a wide range of basic child vaccines. An examination of underlying mechanisms indicates that electrification upgradation program increases vaccination rate by improving health service delivery at local primary healthcare facilities and improving access to health related information through television.

Competing Factor Models of Child and Adolescent Psychopathology.

Co-occurring psychological disorders are highly prevalent among children and adolescents. To date, the most widely utilised factor model used to explain this co-occurrence is the two factor model of internalising and externalising (Achenbach 1966). Several competing models of general psychopathology have since been reported as alternatives, including a recent three factor model of Distress, Fear and Externalising Dimensions (Krueger 1999). Evidence for the three factor model suggests there are advantages to utilising a more complex model. Using the British Child and Adolescent Mental Health Survey 2004 data (B-CAMHS; N=7997), confirmatory factor analysis was used to test competing factor structure models of child and adolescent psychopathology. The B-CAMHS was an epidemiological survey of children between the ages of 5 and 16 in Great Britain. Child psychological disorders were assessed using the Strength and Difficulties Questionnaire (Goodman 1997), and the Development and Wellbeing Assessment (Goodman et al. 2000). A range of covariates and risk variables including trauma, parent mental health and family functioning where subsequently utilised within a MIMIC model framework to predict each dimension of the 2 and three factor structure models. Two models demonstrated acceptable fit. The first complimented Achenbach's Internalising and Externalising structure. The three factor model was found to have highly comparable fit indices to the two factor model. The second order models did not accurately represent the data nor did an alternative three factor model of Internalising, Externalising and ADHD. The two factor and three factor MIMIC models observed unique profiles of risk for each dimension. The findings suggest that child and adolescent psychopathology may also be accurately conceptualised in terms of distress, fear and externalising dimensions. The MIMIC models demonstrated that the Distress and Fear dimensions have their own unique etiological profile of risk. This study directly informs future measurement models of child and adolescent psychopathology and demonstrates the effectiveness of a three factor model.

Diagnostic efficiency of the SDQ for parents to identify ADHD in the UK: a ROC analysis.

Early, accurate identification of ADHD would improve outcomes while avoiding unnecessary medication exposure for non-ADHD youths, but is challenging, especially in primary care. The aim of this paper is to test the Strengths and Difficulties Questionnaire (SDQ) using a nationally representative sample to develop scoring weights for clinical use. The British Child and Adolescent Mental Health Survey (N = 18,232 youths 5–15 years old) included semi-structured interview DSM-IV diagnoses and parent-rated SDQ scores. Areas under the curve for SDQ subscales were good (0.81) to excellent (0.96) across sex and age groups. Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 21.3×. For discriminating ADHD from other diagnoses, accuracy was fair (<0.70) to good (0.88); Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 4.47×. The SDQ is free, easy to score, and provides clinically meaningful changes in odds of ADHD that can guide clinical decision-making in an evidence-based medicine framework.

Undernutrition among children under 5 years of age in Yemen: Role of adequate childcare provided by adults under conditions of food insecurity.

Objective: This study examined the associations between the adequacy of childcare provided by adult caretakers and childhood undernutrition in rural Yemen, independent of household wealth and food consumption.Methods: We analyzed data of 3,549 children under the age of 5 years living in rural areas of Yemen based on the 2013 Yemen Baseline Survey of Mother and Child Health. Nutritional status was evaluated by the presence of underweight, stunting, and wasting according to the World Health Organization child growth standards. The impact of childcare including leaving children alone, putting older children into labor force, and the use of antenatal care while pregnant on child undernutrition was assessed and adjusted for food consumption by children, household composition, demographic and educational background of caretakers, and household wealth.Results: The prevalence of underweight, stunting, and wasting was 46.2%, 62.6%, and 11.1%, respectively. Not leaving children alone, keeping children out of the labor force, and use of antenatal care were associated with a lower risk of underweight (odds ratio [OR] = 0.84, P = 0.016; OR = 0.84, P = 0.036; and OR = 0.85, P = 0.042) and stunting (OR = 0.80, P = 0.004; OR = 0.82, P = 0.024; and OR = 0.78, P = 0.003). After further adjustment for food consumption, the associations between adequate childcare indicators and lower odds of stunting remained significant (OR = 0.73, P = 0.025; OR = 0.72, P = 0.046; and OR = 0.76, P = 0.038).Conclusions: A marked prevalence of stunting among rural children in Yemen was observed. Adequate childcare by adult caretakers in families is associated with a lower incidence of underweight and stunting among children under 5 years of age. Promoting adequate childcare by adult household members is a feasible option for reducing undernutrition among children in rural Yemen.

Distinct relationships between social aptitude and dimensions of manic-like symptoms in youth.

Difficulties with interpersonal relationships have been reported in children and adolescents with manic symptoms, even if they do not fulfil criteria for a manic episode. The role of social aptitude (SA) in youths with manic symptoms has never been examined in the general population. Moreover, no study has examined whether SA is differentially associated with dimensions of manic symptoms. We hypothesised that youth with predominantly undercontrol manic symptoms (characterised by irritability) would show lower levels of SA; conversely, youth with predominantly exuberant symptoms would show better than average social skills. Our sample comprised 5325 participants from the 2004 British Child and Adolescent Mental Health Survey (B-CAMHS04), mean age 10.3 years, SD = 3.3, 48 % girls. Manic symptoms were assessed with the Development and Wellbeing Assessment by interviewing parents and young people. Children and adolescents with manic symptoms had a lower SA score, compared to the general population by parent report, but not by self-report. SA score was higher in youths with predominantly exuberant manic symptoms compared to the general population; whereas the youths with predominantly undercontrol manic symptoms had lower SA scores by parent and self-report. Our results provide further evidence for the distinction between exuberant and undercontrol manic symptoms and highlight the need to focus on SA in future research.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-015-0800-7) contains supplementary material, which is available to authorized users.

Success rates for consent and collection of prenatal biological specimens in an epidemiologic survey of child health.

The National Children's Study (NCS) Vanguard Study began enrollment in January 2009 as an initial pilot study for a planned large-scale, longitudinal U.S. cohort study of the effect of environmental influences on child health and development, with biological and environmental sample collection conducted in seven locations from April 2009 to October 2010. We sought to determine rates of consent for, and success of collection of, maternal and paternal biospecimens before and during pregnancy in the NCS Vanguard Study. Samples of blood, saliva, vaginal swabs, urine, hair, and nails were collected before and during pregnancy. All specimens were sent to a central repository for processing, storage, and quality assessment. Of 780 pregnant women asked to consent to sample collection, 773 (>99%) agreed, and of 295 nonpregnant women, 292 (99%) agreed. Of 440 fathers asked to consent to sample collection, 435 (99%) agreed. Frequency of successful collection of biospecimens varied depending on sample and visit type. In descending order, the ranges over all visit types of the proportion of expected samples successfully collected from women were: urine, 92.5 to 95.7%; hair, 89.6 to 92.5%; vaginal swab, 84.2 to 88.5%; blood, 74.9 to 78.5%; 2-day saliva, 65.8 to 81.6%; and nails, 76.4 to 76.7%. For fathers, rates were highest for urine (94.9%) and lowest for hair (63.0%). High rates of consent for and collection of a wide variety of biospecimens can be achieved in prospective epidemiologic cohort studies of pregnant women. Ease of sample collection may be a primary factor influencing successful biospecimen collection.

Subjective health complaints in adolescent victims of cyber harassment: moderation through support from parents/friends- a Swedish population-based study.

BackgroundVictimization in cyberspace has emerged as a new public health issue among the young. The main purpose of this study was to analyze associations between cyber victimization defined as cyber harassment (CH) (a somewhat broader concept than cyberbullying) and subjective health complaints (SHC), to study whether these associations were modified by parental/friend support (measured as communication), and to explore the influence of traditional bullying victimization (TBV) on the association between CH and SHC.MethodsThe study population consisted of 8544 students in 9th grade (around 15 years old) who participated in the 2012 Scania public health survey of children and adolescents. The survey was a cross-sectional total-population study conducted in school, with a response rate of 83 %.Main and interaction (stress-buffering) effects of social support on the relationship between CH and SCH were investigated by hierarchical multiple linear regression analyses, adjusted for potential confounders, including TBV.ResultsThe past-year prevalence of CH (once or several times) was 14 % among boys and 20 % among girls. Having been cyber harassed once or several times during the past year was associated with higher levels of SHC, controlling for age, parental occupation, parental origin, daily smoking, intense alcohol consumption, and disability. Among both boys and girls, the associations were stronger for CH occurring several times than for CH occurring only once. Main effects of parental/friend support were seen for both boys and girls, while stress-buffering effects were indicated for boys only. Additional analysis further adjusting for TBV did not change the associations substantially, indicating that CH has an effect of its own on SHC.ConclusionIntervention programs aimed at improving the quality of peer and family relationships among children and adolescents might reduce the incidence of both cyber harassment and traditional bullying and lower the prevalence of psychosomatic complaints.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2239-7) contains supplementary material, which is available to authorized users.

Racial Disparities in Child Adversity in the U.S.

Childhood adversity is an under-addressed dimension of primary prevention of disease in children and adults. Evidence shows racial/ethnic and socioeconomic patterning of childhood adversity in the U.S., yet data on the interaction of race/ethnicity and SES for exposure risk is limited, particularly with consideration of immigration history. This study examined racial/ethnic differences in nine adversities among children (from birth to age 17 years) in the National Survey of Child Health (2011-2012) and determined how differences vary by immigration history and income (N=84,837). We estimated cumulative adversity and individual adversity prevalences among white, black, and Hispanic children of U.S.-born and immigrant parents. We examined whether family income mediated the relationship between race/ethnicity and exposure to adversities, and tested interactions (analyses conducted in 2014-2015). Across all groups, black and Hispanic children were exposed to more adversities compared with white children, and income disparities in exposure were larger than racial/ethnic disparities. For children of U.S.-born parents, these patterns of racial/ethnic and income differences were present for most individual adversities. Among children of immigrant parents, there were few racial/ethnic differences for individual adversities and income gradients were inconsistent. Among children of U.S.-born parents, the Hispanic-white disparity in exposure to adversities persisted after adjustment for income, and racial/ethnic disparities in adversity were largest among children from high-income families. Simultaneous consideration of multiple social statuses offers promising frameworks for fresh thinking about the distribution of disease and the design of targeted interventions to reduce preventable health disparities.

Parental perceptions of avoidability of their child's emergency department visit

ObjectivesTo identify the factors associated with paediatric emergency department (ED) visits and parental perceptions of the avoidability of their child's ED visit.DesignCross-sectional study by performing secondary analysis of 2010–2011 Iowa...

Mental health related contact with education professionals in the British Child and Adolescent Mental Health Survey 2004

Purpose – The purpose of this paper is to describe mental health-related contact with educational professionals amongst children in the British Child and Adolescent Mental Health Survey (BCAMHS) 2004. Design/methodology/approach – BCAMHS 2004 was a community-based survey of 5,325 children aged 5-16, with follow-up in 2007. This paper reports the percentage of children with a psychiatric disorder that had mental health-related contact with education professionals (categorised as teachers or specialist education services) and the percentage with specific types of psychiatric disorders amongst those contacting services. Findings – Two-thirds (66.1 per cent, 95 per cent CI: 62.4-69.8 per cent) of children with a psychiatric disorder had contact with a teacher regarding their mental health and 31.1 per cent (95 per cent CI: 27.5-34.7 per cent) had contact with special education either in 2004 or 2007, or both. Over half of children reporting special education contact (55.1 per cent, 95 per cent CI: 50.0-60.2 per cent) and almost a third reporting teacher contact in relation to mental health (32.1 per cent, 95 per cent CI: 29.7-34.6 per cent) met criteria for a psychiatric disorder. Practical implications – Many children in contact with education professionals regarding mental health experienced clinical levels of difficulty. Training is needed to ensure that contact leads to prompt intervention and referral if necessary. Originality/value – This is the first paper to report on mental health-related service contact with education professionals in the 2004 BCAMHS survey along with its 2007 follow-up. It identifies high levels of teacher contact which represent challenges in supporting staff with training, resources and access to mental health services.

Factors associated with symptoms of reproductive tract infection/sexually transmitted infection and treatment seeking behavior among men in Tamil Nadu, India

The International Conference on Population and Development (ICPD) Programme of Action paid attention to male sexual and reproductive health issues including RTI/STI as well as infertility, sexual dysfunction and sexual violence. In India, male reproductive health problems had been recognized as a public health issue. This paper is an attempt to examine the determinants of prevalence of RTI/STI and treatment seeking behavior and their socio-economic and demographic characteristics in Tamil Nadu, India by using the data of the District Level Household Survey-Reproductive and Child Health Survey, 2002-04. The logistic regression and multinomial logistic regression models were used to determine factors associated with symptoms of RTI/STI and treatment seeking behavior for RTI/STI symptoms respectively. The study results indicated that about 2.8% of respondents reported at least one symptom of RTI/STI. One-fifth (19.5%) of them had reported two or more symptoms. Among those who reported symptoms, 45.5% of men sought treatment from some sources. Multivariate analysis revealed that men residing in the Inland region, belonging to Muslim, men with high standard of living, and aware about HIV/AIDS were sig-nificantly less likely to report symptoms of RTI/STI. Men whose wife reported experience of symptoms of RTI/STI are significantly more likely to report symptom of RTI/STI. Further, men whose wife experienced symptoms of RTI/STI, and who ever discussed RTI/STI symptoms with their wife were significantly more likely to seek treatment from pubic as well as private health facility. The study suggests that there is an urgent need to address public health care services and a need to take necessary steps to provide quality health care and user friendly sexual and reproductive health care services.South East Asia Journal of Public Health Vol.4(2) 2014: 7-15