Mental health problems of homeless children and families: longitudinal study

Objective: To establish the mental health needs of homeless children and families before and after rehousing. Design: Cross sectional, longitudinal study. Setting: City of Birmingham. Subjects: 58 rehoused families with 103 children aged 2-16 years and 21 comparison families of low socioeconomic status in stable housing, with 54 children. Main outcome measures: Children’s mental health problems and level of communication; mothers’ mental health problems and social support one year after rehousing. Results: Mental health problems remained significantly higher in rehoused mothers and their children than in the comparison group (mothers 26% v 5%, P=0.04; children 39% v 11%, P=0.0003). Homeless mothers continued to have significantly less social support at follow up. Mothers with a history of abuse and poor social integration were more likely to have children with persistent mental health problems. Conclusions: Homeless families have a high level of complex needs that cannot be met by conventional health services and arrangements. Local strategies for rapid rehousing into permanent accommodation, effective social support and health care for parents and children, and protection from violence and intimidation should be developed and implemented.

Key messages

• Homeless children and their mothers have a high level of mental health problems
• Homeless families experience many risk factors, such as domestic violence, abuse, and family and social disruption
• In two fifths of children and a quarter of mothers, mental health problems persisted after rehousing
• In contrast with a comparison group of families of low socioeconomic status, a substantial proportion of homeless families remained residentially and socially unstable

     

Longevity of screenwriters who win an academy award: longitudinal study

ObjectiveTo determine whether the link between high success and longevity extends to academy award winning screenwriters.DesignRetrospective cohort analysis.ParticipantsAll screenwriters ever nominated for an academy award.ResultsA total of 850 writers were nominated; the median duration of follow up from birth was 68 years; and 428 writers died. On average, winners were more successful than nominees, as indicated by a 14% longer career (27.7 v 24.2, P=0.004), 34% more total films (23.2 v 17.3, P<0.001), 58% more four star films (4.8 v 3.1, P<0.001), and 62% more nominations (2.1 v 1.3, P<0.001). However, life expectancy was 3.6 years shorter for winners than for nominees (74.1 v 77.7 years, P=0.004), equivalent to a 37% relative increase in death rates (95% confidence interval 10 to 70). After adjustment for year of birth, sex, and other factors, a 35% relative increase in death rates was found (7% to 70%). Additional wins were associated with a 22% relative increase in death rates (3% to 44%). Additional nominations and additional other films in a career otherwise caused no significant increase in death rates.ConclusionThe link between occupational achievement and longevity is reversed in screenwriters who win academy awards. Doubt is cast on simple biological theories for the survival gradients found for other members of society.

What is already known on this topic

High achievement has been associated with decreased all cause mortality for people in many different occupationsSuch an association is compatible with behavioural and biological theories for the role of social determinants

What this study adds

Screenwriters nominated for an academy award show a paradoxical survival pattern, where greater success is associated with a large decrease in life expectancyThe paradox is not easily explained by talent, prestige, financial earnings, material conditions, reverse causality, measurement error, or simple demographicsIt might reflect the unusual lifestyles of writers, where success is not linked to exemplary conduct or control; this underscores the importance of behaviour     

Potential for prediction of psychosis and bipolar disorder in Child and Adolescent Mental Health Services: a longitudinal register study of all people born in Finland in 1987

Current strategies to predict psychosis identify only a small proportion of individuals at risk. Additional strategies are needed to increase capacity for pre­diction and prevention of serious mental illness, ideally during childhood and adolescence. One possible approach would be to investigate systems in which psychosis risk factors are concentrated during childhood. One notable such system is represented by Child and Adolescent Mental Health Services (CAMHS). Although psychotic disorders are uncommon in CAMHS, many risk factors for psychosis are highly prevalent in young people who enter this system. We hypothesized, therefore, that youth attending CAMHS would be a high‐risk group for psychosis if followed into adulthood and, furthermore, that CAMHS systems would capture a substantial proportion of future psychosis cases. We constructed a total population cohort study of all Finns born in 1987 (N=55,875), linking together extensive register data on health care contacts from birth through age 28 years. We identified all individuals diagnosed with a psychotic or bipolar disorder by age 28 (N=1,785). The risk of psychosis/bipolar disorder by age 28 years was 1.8% for individuals who had not attended CAMHS during childhood or adolescence, whereas it was 12.8% for those with a history of any outpatient CAMHS contact (odds ratio, OR=7.9, 95% CI: 7.2‐8.7). Furthermore, the risk of psychosis/bipolar disorder by age 28 years was 2.3% for individuals without a history of inpatient CAMHS admission, whereas it was 24.0% for those with a history of inpatient CAMHS admission (OR=13.3, 95% CI: 11.9‐14.9), and 36.5% for those with a history of inpatient CAMHS admission in adolescence (age 13‐17 years) (OR=24.2, 95% CI: 21.2‐27.6). Individuals who attended CAMHS but received no mental disorder diagnosis had an equally high risk of subsequently developing a psychosis/bipolar disorder as individuals who did receive a diagnosis (OR=0.9, 99.5% CI: 0.7‐1.1). Compared to other CAMHS attendees, individuals who developed psychosis or bipolar disorder were more likely to have had an initial CAMHS diagnosis of depressive or other mood disorder (OR=2.3, 99.5% CI: 1.6‐3.0) and disruptive behaviour disorder (OR=1.7, 99.5% CI: 1.2‐2.5). Of all psychosis/bipolar diagnoses by age 28 years, 50.2% occurred in individuals who had, at some point in childhood or adolescence, attended CAMHS, indicating that CAMHS represent not only a high‐risk but also a high‐capacity system for prediction of psychosis/bipolar disorder. These findings suggest an enormous, untapped potential for large‐scale psychosis/bipolar disorder prediction and prevention research within existing specialist CAMHS.     

Knee arthroplasty: disabilities in comparison to the general population and to hip arthroplasty using a French national longitudinal survey

Background

Knee arthroplasty is increasing exponentially due to the aging of the population and to the broadening of indications. We aimed to compare physical disability and its evolution over two years in people with knee arthroplasty to that in the general population. A secondary objective was to compare the level of disabilities of people with knee to people with hip arthroplasty.

Methodology/Principal Findings

16,945 people representative of the French population were selected in 1999 from the French census and interviewed about their level of disability. This sample included 815 people with lower limb arthroplasty. In 2001, 608 of them were re-interviewed, among whom 134 had knee arthroplasty. Among the other participants re-interviewed, we identified 68 who had undergone knee arthroplasty and 145 hip arthroplasty within the last two years (recent arthroplasty). People with knee arthroplasty reported significantly greater difficulties than the general population with bending forward (odds ratio [OR] = 4.7; 95% confidence interval [CI]: 1.7, 12.6), walking more than 500 meters (OR = 6.0; 95% CI: 1.5, 24.7) and carrying 5 kg kilograms for 10 meters (OR = 4.6; 95% CI: 1.3, 16.4). However, the two years evolution in disability was similar to that in the general population for most activities. The level of mobility was similar between people with recent knee arthroplasty and those with recent hip arthroplasty. Nevertheless, people with recent knee arthroplasty reported a lower level of disability than the other group for washing and bending forward (OR = 0.3; 95% CI: 0.1, 0.6 and OR = 0.4; 95% CI: 0.1, 0.9, respectively).

Conclusions/Significance

People with knee arthroplasty reported a higher risk of disability than the general population for common activities of daily living but a similar evolution. There was no relevant difference between recent knee and hip arthroplasties for mobility.     

A longitudinal study of medication exposure and xerostomia among older people

Objective: To describe the incidence of xerostomia among a population of older people over a 6‐year period, with particular attention to medications as risk factors. Background: Understanding the natural history of xerostomia requires longitudinal epidemiological research, but only one study has examined changes in xerostomia over time. While medication is a recognised risk factor for dry mouth, the role of particular medication categories continues to be controversial. Materials and methods: Older South Australians (aged 60+) underwent an interview and dental examination at baseline, and these assessments were repeated 2, 5 and 11 years afterward. Medication data were collected at baseline, 5 and 11 years. Xerostomia data were collected at 5 and 11 years using the Xerostomia Inventory (XI) and a standard question. Results: Of the 1205 dentate participants assessed at baseline, 669 remained after 5 years, and 246 were assessed at 11 years. Medication prevalence increased over the observation period, such that 94.8% of the cohort were taking at least one medication by 11 years. The prevalence of xerostomia increased from 21.4% to 24.8% between 5 and 11 years (p > 0.05), and the mean XI score increased from 20.0 (SD, 6.7) to 21.5 (SD, 7.9; p < 0.001). Some 14.7% of participants were incident cases of xerostomia, while 11.4% were remitted cases; 10.1% were cases at both 5 and 11 years. After controlling for gender and ‘baseline’ xerostomia severity (represented by the XI score at 5 years), participants who commenced taking daily aspirin after 5 years had over four times the odds of becoming incident cases, while those who commenced taking a diuretic after 5 years had nearly six times the odds of doing so. Conclusions: While the overall prevalence of xerostomia increased during the observation period, there was considerable instability, with one‐quarter of the cohort changing their status. Medication exposure was strongly associated with the incidence of the condition, with recent exposure to diuretics or daily aspirin strongly predicting it.     

Mental health and illness in Vietnamese refugees.

Despite their impressive progress in adapting to American life, many Vietnamese still suffer from wartime experiences, culture shock, the loss of loved ones, and economic hardship. Although this trauma creates substantial mental health needs, culture, experience, and the complexity of the American resettlement system often block obtaining assistance. Vietnamese mental health needs are best understood in terms of the family unit, which is extended, collectivistic, and patriarchal. Many refugees suffer from broken family status. They also experience role reversals wherein the increased social and economic power of women and children (versus men and adults) disrupts the traditional family ethos. Finally, cultural conflicts often make communication between practitioners and clients difficult and obscure central issues in mental health treatment. Rather than treating symptoms alone, mental health workers should acknowledge the cultural, familial, and historical context of Vietnamese refugees.     

Selenium status and its correlates in a British national diet and nutrition survey: people aged 65 years and over.

Plasma selenium (Se) concentrations were measured in 1134 British people aged 65 years and over, living in mainland Britain during 1994-1995. Eight hundred and eighty-three lived in the community ("free-living"), while the remainder lived in institutions (residential and nursing homes). The overall mean plasma Se concentrations was 0.90 micromol/l (inner 95% range 0.50-1.36 micromol/l). Free-living people had significantly higher values than counterparts living in institutions, and there was an overall inverse correlation with age. Plasma Se varied with season (lower from October to December than at other times of the year), while values were higher in southern Britain than in the North. Socio-economic associations also existed (lower plasma Se in people receiving state benefits or with poorer educational attainment), while smokers had lower values than non-smokers. Several indices of poor health status or of medicine use were correlated with lower plasma Se, which was also predicted by several biochemical or haematological indices of infection or inflammation. Plasma Se was strongly and directly correlated with plasma albumin, zinc, cholesterol, vitamin C, several carotenoids, alpha-tocopherol, pyridoxal phosphate, and with blood haemoglobin and several anthropometric indices. All relationships were independent of age and gender, and are consistent with the view that plasma Se levels are higher in fit and well-nourished elderly people and lower in those who are frail, poorly-nourished and unwell. Whole-blood glutathione peroxidase generally did not share these relationships, was only very weakly correlated with plasma Se, and appeared to be less useful as a status indicator in this population group.     

The challenge of CT and MRI imaging of obese individuals who present to the emergency department: a national survey

The objective of this study was to estimate the availability of large weight capacity computed tomography (CT) and magnetic resonance imaging (MRI) equipment in US hospitals with emergency departments (EDs) and to evaluate animal facilities as alternate sources of imaging. We conducted a telephone survey of radiology technicians from a random sample of all the US hospitals with EDs (n = 262) and all 136 primary hospitals of academic EDs, 145 zoos, and 28 veterinary schools. We measured the prevalence of large weight capacity (>450 lb) CT and MRI, stratified by hospital characteristics. Response rates were 94-100% across samples. Nationally, 10% (95% confidence interval, 7-15) of hospitals with EDs had large weight capacity CT and 8% (95% confidence interval, 5-13) had large weight capacity MRI. In academic hospitals, access to large capacity equipment was better for CT (28%), but similar for MRI (10%) (P < 0.001 and 0.51, respectively). Few rural (5%) and critical-access hospitals (3%) had large capacity CT. In addition, 34% of trauma centers, 23% of stroke centers, and 21% of bariatric surgery centers of excellence had large capacity CT. Only two zoos (1%) had CT scanners; both would not image human patients. Among veterinary schools, 16 (57%) had large weight capacity CT equipment, but only 4 (14%) would consider imaging human patients. Further, 23 (82%) veterinary schools reported policies that specifically prohibited imaging humans. For patients who weigh >450 lb, access to emergent CT and MRI is limited, even at academic and bariatric surgery centers. Animal facilities are not a viable alternative for diagnostic imaging of human patients.     

Frequency of family dinner and adolescent body weight status: evidence from the national longitudinal survey of youth, 1997

Objective: To explore associations between overweight status and the frequency of family dinners (FFD) for adolescents and how those associations differ across race and ethnicity. Research Methods and Procedures: A sample of 5014 respondents between 12 and 15 years of age from the 1997 wave of the National Longitudinal Survey of Youth 1997 (NLSY97) was used. BMI was calculated using self‐reported height and weight; 13.3% of respondents qualified as overweight, 16.4% qualified as at‐risk‐of‐overweight, and 1.9% qualified as underweight. The remainder were normal weight. FFD was defined as the number of times respondents had dinner with their families in a typical week in the past year. Multinomial logistic regression models were estimated separately for non‐Hispanic whites vs. blacks and Hispanics for odds of belonging to the other weight categories compared with normal weight. A supplementary longitudinal analysis estimated the odds of change in overweight status between 1997 and 2000. Results: In 1997, the FFD distribution was as follows: 0, 8.3%; 1 or 2, 7.3%; 3 or 4, 13.4%; 5 or 6, 28.1%; 7, 42%. For whites, higher FFD was associated with reduced odds of being overweight in 1997, reduced odds of becoming overweight, and increased odds of ceasing to be overweight by 2000. No such associations were found for blacks and Hispanics. Discussion: Reasons for racial and ethnic differences in the relationship between FFD and overweight may include differences in the types and portions of food consumed at family meals. More research is needed to verify this.     

A national survey of complications associated with suction lipectomy: a comparative study

In March of 1988, a survey form was sent to all 2695 U.S. and Canadian members of the American Society of Plastic and Reconstructive Surgeons. Nine-hundred and thirty-five members responded, for a response rate of 34.7 percent. The purpose of the survey was to ascertain the total number of major liposuction, dermatolipectomy, and abdominoplasty procedures performed from January of 1984 to January of 1988 and to compare nine specific complications that are associated with these three procedures. The 935 surgeons reported a total of 112,756 procedures performed: major liposuction (75,591), dermatolipectomy (10,603), and abdominoplasty (26,562). Nine major complications were surveyed: mortality, myocardial infarction, cerebrovascular accident or transient ischemic attack, pulmonary thromboembolism, fat embolism, major skin loss, anesthesia complication, transfusion complications, and deep venous thrombosis. The findings in this survey showed, when comparing these three procedures and the nine types of complications, that the complication rate for major suction lipectomy was 0.1 percent, for dermatolipectomy 0.9 percent, and for abdominoplasty 2.0 percent. Fat emboli did not prove to be a significant factor associated with any of the three procedures. However, of the 15 reported deaths (major liposuction 2, dermatolipectomy 2, and abdominoplasty 11), pulmonary thromboembolism was the causative factor in 9 deaths (60 percent). Based on these analyzed data, we feel that major suction lipectomy has a low complication rate and is a reasonably safe procedure.     

Greater severity of new onset asthma in allergic subjects who smoke: a 10-year longitudinal study

Background

Little is known about the association between cigarette smoking and asthma severity. We assessed smoking as a determinant of disease severity and control in a cohort of clinic-referred allergic subjects who developed new onset asthma.

Methods

Allergic rhinitis subjects with no asthma (n = 371) were followed-up for 10 years and routinely examined for asthma diagnosis. In those who developed asthma (n = 152), clinical severity and levels of asthma control were determined. Among these subjects, 74 (48.7%) were current smokers, 17 (11.2%) former smokers, and 61 (40.1%) never smokers.

Results

When comparing current or past smokers to never smokers they had a higher risk of severe asthma in the univariate analysis, which became non-significant in the multivariate analysis. On the other hand, the categories of pack-years were significantly related to severe asthma in a dose response relationship in both the univariate and multivariate analysis: compared to 0 pack years, those who smoked 1-10 pack-years had an OR(95% CI) of 1.47(0.46-4.68), those who smoked 11-20 pack-years had an OR of 2.85(1.09-7.46) and those who smoked more than 20 pack-years had an OR of 5.59(1.44-21.67) to develop more severe asthma. Smokers with asthma were also more likely to have uncontrolled disease. A significant dose-response relationship was observed for pack-years and uncontrolled asthma. Compared to 0 pack years, those who smoked 1-10 pack-years had an OR of 5.51(1.73-17.54) and those who smoked more than 10 pack-years had an OR of 13.38(4.57-39.19) to have uncontrolled asthma.

Conclusions

The current findings support the hypothesis that cigarette smoking is an important predictor of asthma severity and poor asthma control.