Report of the Psychotherapy Task Force of the American Academy of Child and Adolescent Psychiatry.
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In this task force report, the authors define the field of child and adolescent psychotherapy; review the state of the field with respect to advocacy, training, research, and clinical practice; and recommend steps to ensure that psychotherapy remains a core competence of child and adolescent psychiatrists. (+info)
Childhood immunization coverage in zone 3 of Dhaka City: the challenge of reaching impoverished households in urban Bangladesh.
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A household survey of 651 children aged 12-23 months in Zone 3 of Dhaka City carried out in 1995 revealed that 51% of them had fully completed the series of childhood immunizations. Immunization coverage in slum households was only half that in non-slum households. Apart from residence in a slum household, other characteristics strongly associated with the completion of the entire series of childhood immunizations included the following: educational level of the mother, number of children in the family household, mother's employment status, distance from the nearest immunization site, and number of home visits from family-planning field workers. The findings point to the need to improve childhood immunization promotion and service delivery among slum populations. Two promising strategies for improving coverage are to reduce the number of missed opportunities for immunization promotion during encounters between health workers and clients, and to identify through visits to households those children who need additional immunizations. In the long run, increasing the educational level of women will provide a strong stimulus for improving childhood immunization coverage in the population. (+info)
Eradication of schistosomiasis in Guangxi, China. Part 3. Community diagnosis of the worst-affected areas and maintenance strategies for the future.
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Reported are the results of a community-based assessment of maintenance of schistosomiasis eradication in Guangxi, a large autonomous region of China with a population of 44 million. Eradication of the disease was achieved in 1989 in Guangxi but maintenance costs are rising. We focused on three counties that had the most intense transmission in the past: Binyang, Jingxi, and Yishan. Four instruments were used: in-depth interviews, focus group discussions, a knowledge, attitudes and practices survey, and subsequent community feedback. In the past, schistosomiasis had serious consequences in Guangxi, decreasing work capacity and restricting marriage and occupational mobility. Since its eradication there have been clear benefits in terms of increased agricultural output and improved farming conditions. Personal habits and traditional manual farming activities in Guangxi would continue to expose a large proportion of the population to environmental risk if the disease were to return. Ignorance about control programme achievements is increasing and is related to youth and inexperience. There was a universal desire in the study counties for more local education about the history of the programme and about the risk of schistosomiasis returning. Snail surveillance is considered important, but people are not willing to volunteer for such work. Our study methods were novel for Guangxi and community feedback was helpful. Snail checking procedures have been modified to make them more efficient and no snails have been found since 1992. The animal and human stool examinations have ceased and vigilance now concentrates on snails and children (skin tests). The long-term strategy is to make the population invulnerable to future schistosomiasis transmission if the snail vectors return. This means continuing education and making the former endemic counties a high priority for water and sanitation improvements. (+info)
Too far, too little, too late: a community-based case-control study of maternal mortality in rural west Maharashtra, India.
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A total of 121 maternal deaths, identified through multiple-source surveillance in 400 villages in Maharashtra, were prospectively enrolled during 1993-95 in a population-based case-control study, which compared deaths with the survivors of similar pregnancy complications. The cases took significantly longer to seek care and to make the first health contact after the decision to seek care was taken. They also travelled significantly greater distances through a greater number of health facilities before appropriate treatment was started. Multivariate analysis showed the negative effect of excessive referrals and the protective effect of the following: residing in and not away from the village; presence of a resident nurse in the village; having an educated husband and a trained attendant at delivery; and being at the woman's parents' home at the time of illness. Other significant findings showed that deaths due to domestic violence were the second-largest cause of deaths in pregnancy, that more than two-thirds of maternal deaths were underreported in official records, and that liveborn infants of maternal deaths had a markedly higher risk of dying in the first year of life. This study points to the need for information-education-communication (IEC) efforts to increase family (especially male) preparedness for emergencies, decentralized obstetric management with effective triage, and a restructuring of the referral system. (+info)
Tuberculin skin testing among economically disadvantaged youth in a federally funded job training program.
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Low income, medically underserved communities are at increased risk for tuberculosis. Limited population-based national data are available about tuberculous infection in young people from such backgrounds. To determine the prevalence of a positive tuberculin skin test among economically disadvantaged youth in a federally funded job training program during 1995 and 1996, the authors evaluated data from medical records of 22,565 randomly selected students from over 100 job training centers throughout the United States. An estimated 5.6% of students had a documented positive skin test or history of active tuberculosis. Rates were highest among those who were racial/ethnic minorities, foreign born, and (among foreign-born students) older in age (p < 0.001). Weighted rates (adjusting for sampling) were 1.3% for white, 2.2% for Native American, 4.0% for black, 9.6% for Hispanic, and 40.7% for Asian/Pacific Islander students; rates were 2.4% for US-born and 32.7% for foreign-born students. Differences by geographic region of residence were not significant after adjusting for other demographic factors. Tuberculin screening of socioeconomically disadvantaged youth such as evaluated in this study provides important sentinel surveillance data concerning groups at risk for tuberculous infection and allows recommended public health interventions to be offered. (+info)
Inequalities in mortality according to educational level in two large Southern European cities.
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BACKGROUND: In Spain, studies on social inequalities in mortality based on individuals are few due to the poor quality of information on occupation in death certificates. This study looks at the differences in mortality according to educational level, using individual information obtained through the linkage between the Death Register and the Municipal Census, in the cities of Madrid and Barcelona, Spain. METHODS: The study populations were residents of Madrid and Barcelona aged >24 years, who died in 1993 and 1994. Indicators obtained for each city and educational level were: age- and sex-specific mortality rates, and life expectancy at 25 years. Poisson regression models were fitted to obtain the relative risk (RR) of death for each educational level with respect to the reference level (higher education completed), adjusted for age. RESULTS: The mortality rate was lower among individuals with higher educational levels, while life expectancy at 25 years was higher. In both cities men and women with no education showed the highest mortality in all age groups, with very high RR in the youngest age group (RR for men aged 25-34 years = 7.08 in Madrid and 6.02 in Barcelona, whereas in women these RR were 6.33 and 5.63 respectively). In Barcelona the greater part of the overall mortality difference for the group aged 25-34 years was due to AIDS (acquired deficiency syndrome, 33.4% in men and 59.3% in women). CONCLUSION: The present study has found higher mortality (mainly from AIDS) among individuals with no academic qualifications thus drawing attention to the need to implement policies aimed at reducing these inequalities. (+info)
Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission I. Description of study site, general methodology, and study population.
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A large-scale longitudinal cohort project was initiated in western Kenya in June 1992. The primary purpose of the project was to study Plasmodium falciparum malaria in a highly endemic area using a comprehensive and multidisciplinary approach, which included epidemiology, entomology, and immunology. Between June 1992 and July 1994, pregnant women living in 15 rural villages were identified during a monthly census and 1,164 were enrolled. The women were followed-up throughout their pregnancy and they, along with their newborn infants and direct siblings of the infants' less than 15 years of age, were monitored over time. As of May 1995, 1,017 infants had been born to these women. This paper presents the design and general methodology used in this study and describes the initial experience with intense monitoring of a large population over a prolonged period. (+info)
Impact of nativity and race on "Stroke Belt" mortality.
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The southeastern region of the United States has been recognized for 6 decades as an area of excess cerebrovascular mortality rates. While the reasons for the disease variation remain an enigma, South Carolina has consistently been the forerunner of the "Stroke Belt." To determine the effects of nativity (birthplace) on stroke mortality rates in South Carolina, proportional mortality ratios (PMRs) were calculated for stroke deaths in South Carolina during 1980-1996 according to birthplace and stratified by gender, race, age, and educational status. The analyses revealed a graded risk of stroke by birthplace, with the highest PMRs (95% CI) among individuals born in South Carolina (104.8 [103.4 to 106.3]), intermediate PMRs in those born in the Southeast other than South Carolina (92.5 [90.2 to 94.9]), and lowest PMRs for those born outside the Southeast (77.4 [74.9 to 80.1]). The lower stroke PMRs for individuals born outside the Southeast were more striking in blacks (51.8 [45.2 to 59.3]) than in whites (84.9 [82.0 to 88.0]) and for men (73.3 [69.5 to 77.3]) than women (83.5 [79.9 to 87.3]). The findings, particularly in blacks, were not explainable by gender, differences in age, and/or markers of educational and socioeconomic status. These findings suggest that nativity is a significant risk marker for the geographic variation in stroke mortality. Moreover, the regional disparities for nativity and subsequent stroke mortality appear to be greater in blacks than in whites and for men than for women. An understanding of factors linking birthplace to risk for cerebrovascular mortality could facilitate efforts directed at stroke prevention. (+info)