The generational transmission of socioeconomic inequalities in child cognitive development and emotional health

Socioeconomic inequalities in the health of adults have been largely attributed to lifestyle inequalities. The cognitive development (CD) and emotional health (EH) of the child provides a basis for many of the health-related behaviours which are observed in adulthood. There has been relatively little attention paid to the way CID and EH are transmitted in the foetal and childhood periods, even though these provide a foundation for subsequent socioeconomic inequalities in adult health. The Mater-University of Queensland Study of Pregnancy (MUSP) is a large, prospective, pre-birth cohort study which enrolled 8556 pregnant women at their first clinic visit over the period 1981-1983. These mothers (and their children) have been followed up at intervals until 14 years after the birth. The socioeconomic status of the child was measured using maternal age, family income, and marital status and the grandfathers' occupational status. Measures of child CD and child EH were obtained at 5 and 14 years of age. Child smoking at 14 years of age was also determined. Family income was related to all measures of child CD and EH and smoking, independently of all other indicators of the socioeconomic status of the child. In addition, the grandfathers' occupational status was independently related to child CD (at 5 and 14 years of age). Children from socioeconomically disadvantaged families (previous generations' socioeconomic status as well as current socioeconomic status) begin their lives with a poorer platform of health and a reduced capacity to benefit from the economic and social advances experienced by the rest of society. (C) 2003 Elsevier Ltd. All rights reserved.

The use of email in a child and adolescent mental health service: are staff ready?

All staff members of a child and adolescent mental health service were invited to participate in a survey about the use of email. Sixty-two of the 105 staff members responded to the survey, a participation rate of 59%. Of the respondents, 32 were allied health staff, 10 were nurses, seven were administrative staff, six were medical staff, three were operational staff and four were acting in a combination of these roles. The respondents reported extensive work-related email usage and considered that they were confident in using email despite low levels of training. However, they did not feel that they understood the legal and ethical issues involved. Furthermore, there was limited incorporation of email into standard record keeping. The majority of respondents thought that increased use of email would lead to a greater workload, a consequence they considered would probably increase over time. Many commented on the quick and practical use of this medium, but were wary about using email with individuals outside the service organization, especially if it were to contain clinical material. There was low use of email directly with clients, and clinicians were ambivalent about incorporating email into therapy. The results suggest that it is timely to consider the utility and appropriateness of email communication with clients and external service providers, and to formulate guidelines and procedures to ensure the confidentiality of client information and the safety of clients and staff.

Interagency collaboration between child protection and mental health services: Practices, attitudes and barriers

Objective: The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. Method: A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers. 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). Results: Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. Conclusions: Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level. (c) 2005 Published by Elsevier Ltd.

PRN Sedation-patterns of prescribing and administration in a child and adolescent mental health inpatient service

Objective: To identify utilisation rates of prn (pro re nata) sedation in children and adolescents receiving inpatient psychiatric treatment, and to compare correlates of prn prescribing and administration. Method A retrospective chart review examined 122 medical charts from a child and youth mental health inpatient service. Results 71.3% of patients were prescribed prn sedation and 50.8% were administered prn sedation. Patients received an average of 8.0 doses of prn sedation, with 9.8% receiving 10 or more doses. Chlorpromazine and diazepam were the most commonly utilised agents. Prescribing of prn sedation was only related to use of regular medications (p < 0.01), and non-parent carers (p < 0.01). In contrast, administration of prn sedation was associated with multiple diagnoses (p < 0.01), pervasive development disorder (p < 0.01), mental retardation (p < 0.01) ADHD (p < 0.01), longer hospital admission (p < 0.01), use of atypical antipsychotics (p < 0.01) and polypharmacy (p < 0.01). Conclusions Despite lack of data to inform practice, prn sedation is widely utilised, especially in complex patients. Future research in this area needs to incorporate nurses and examine whether patients benefit from prn sedation, which drugs and dosing patterns optimise safety and efficacy, and what is the role of prn sedation in the context of other medication.

Psychotropic medication utilization in a child and adolescent mental health service

Objectives: This study aimed to identify rates and correlates of psychotropic drug utilization in children and adolescents in inpatient and outpatient settings. Methods: A retrospective chart review examined 122 inpatient and 126 outpatient charts from a metropolitan child and youth mental health service in Brisbane, Australia. Results: Inpatients received more psychotropic medication than outpatients (71% vs. 25%; p < 0.01). Patients receiving medication were older, had longer hospital admissions, and more complex presentations, including history of abuse or suicide attempts and more diagnoses (all p < 0.01). Selective serotonin reuptake inhibitors (SSRIs) were the most frequently used drug class (44% inpatients; 14% outpatients), primarily indicated for mood disorders (31%). SSRIs and newer antidepressants (ADs) were used more frequently in patients with a high suicide risk (p < 0.01). Atypical antipsychotics (APs) were also used (inpatients 23%; outpatients 3%), primarily for behavioral disturbances. Half of those receiving medication (51%) received polypharmacy (> 1 concurrent drug), with up to four drugs used at one time. Rates of polypharmacy were highest among patients receiving antipsychotics. Conclusions: Use of psychotropic medication is frequent in this population. Future research should initially focus on inpatients and intensive treatment settings and examine both safety and efficacy of interventions for depression in young people, atypical antipsychotics for behavioral disturbances, and polypharmacy.

The health of children in immigration detention: how does Australia compare?

We live in an age when the number of refugees worldwide is increasing. All of them have suffered physically or emotionally to a varying degree in their country of origin. The transit to a country of resettlement is fraught with further difficulties or the risk of death. This article explores the different approach taken to the management of this issue by Denmark and Iceland, in comparison to that of Australia. In particular, the different approaches to health care for children and their families are identified. The management of these issues by Denmark and Iceland would appear to be a model to follow. Outcomes of the different managements have not been assessed.

'I could do with a pair of wings': Perspectives on physical activity, bodies and health from young Australian children

There is little research that reports children's perspectives on physical activity, bodies and health. This paper, drawn from a larger multi-method study on physical activity in the lives of seven- and eight-year-old Australian children, attempts to 'give a voice' to 13 children's views. Interviews focused on children's activity preferences and related decision making and motivations pertaining to these activities, as well as how they thought about the relationships between physical activity, health and their bodies. Data suggest some tensions surrounding the importance of fun for children alongside their awareness of 'healthist' discourses that require self-monitoring and improvement.

Eating disorders and oral health: A review of the literature

This article is a review of the recent literature pertaining to the oral sequelae of eating disorders (EDs). Dentists are recognized as being some of the first health care professionals to whom a previously undiagnosed eating disorder patient (EDP) may present. However, despite the prevalence (up to 4 per cent) of such conditions in teenage girls and young adult females, there is relatively little published in the recent literature regarding the oral sequelae of EDs. This compares unfavourably with the attention given recently in the dental literature to conditions such as diabetes mellitus, which have a similar prevalence in the adult population. The incidence of EDs is increasing and it would be expected that dentists who treat patients in the affected age groups would encounter more individuals exhibiting EDs. Most of the reports in the literature concentrate on the obvious clinical features of dental destruction (perimolysis), parotid swelling and biochemical abnormalities particularly related to salivary and pancreatic amylase. However, there is no consistency in explanation of the oral phenomena and epiphenomena seen in EDs. Many EDPs are nutritionally challenged; there is a relative lack of information pertaining to non-dental, oral lesions associated with nutritional deficiencies.

Obesity in pre-school children: Issues and challenges for community based child health nurses

Childhood obesity is becoming a topical issue in both the health literature and the popular media and increasingly child health nurses are observing preschool children who appear to be disproportionately heavy for their height when plotted on standardised growth charts. In this paper literature related to childhood obesity in New Zealand and internationally is explored to identify current issues, and the implications of these issues for nurses in community based child health practice are discussed. Themes that emerged from the literature relate to the measurement of obesity, links between childhood and adult obesity and issues for families. A theme in the literature around maternal perception was of particular interest. Studies that investigated maternal perceptions of childhood obesity found that mothers identified their child as being overweight or obese only when it imposed limitations on physical activity or when the children were teased rather than by referring to individual growth graphs. The implications for nursing in the area of child health practice is discussed as nurses working in this area need an understanding of the complex and often emotive issues surrounding childhood obesity and an awareness of the reality of people's lives when devising health promotion strategies.