Screening for pediatric bipolar disorder in primary care

A child or adolescent with pediatric bipolar disorder (PBD) is at higher risk for suicide, violence, and impaired psychosocial functioning. The prevalence of diagnosed PBD has increased 40-fold in less than 2 decades, leading some to believe that PBD is inaccurately diagnosed. Complicating this issue, disagreements exist among clinicians as to the utility of current screening methods. The assessment picture is further muddied by the high rate of comorbid psychiatric conditions. A literature review was performed to describe the present understanding of PBD and identify current practices of screening for the disorder. Although screening tools are available, the literature suggests they lack validity. Awareness, a thorough interview, and expedient referral may assist clinicians in making a correct diagnosis. Accurate assessment will help ease the psychological and economic burden of PBD.     

The Effect of Mixing Events on the Dynamics of pH1N1 Outbreaks at Small Residential Colleges

Abstract Objective: The authors examine the dynamics and the impact of all-campus events on pH1N1 spread at Bates College in fall 2009, with comparisons to 3 other campuses. Participants: Students (N = 285) presented or called in to the Bates Health Center with symptoms consistent with influenza-like illness. Methods: Health Center staff at Bates collected data on the outbreak; data from other colleges are from Web sites and journal articles. Data were analyzed using a mathematical model for influenza. Results: Bates held 2 vaccine clinics mid-outbreak. The data are consistent with the hypothesis that the vaccine clinics may have altered routine student interactions, facilitating transmission of pH1N1 among students who otherwise might not have encountered each other. Conclusion: The vaccine clinics, held when vaccine became available, were too late to halt transmission. The disruptions to campus rhythms due to the vaccine clinics may instead have contributed to pH1N1 spread.     

Rural ageing in the United States: Trends and contexts

This paper examines rural population ageing in the United States with a particular focus on the contrasting contexts in which older rural residents live. We compare the characteristics of the older population by rural versus urban residence, and explore challenges and opportunities associated with the ageing of rural baby boomers. The United States is a vast territory, and rural areas in the US are diverse regionally, in poverty and income, principal forms of employment, proximity to metropolitan areas, population size, density and composition, the history of change in these parameters, and a number of other factors that affect the ageing process. Hence, the diversity across rural areas is an important consideration in what affects the well being of rural elderly individuals, as well as the community-level impacts of rural ageing. Further, the characteristics of the older rural population help shape community and rural development outcomes for diverse rural communities. We use data from various US Census Bureau sources, and cite other studies to provide a demographic overview of ageing in the rural United States, and to analyze how this situation differs in varying socio-demographic and regional contexts. In the concluding section, we focus on policy implications associated with rural ageing.     

Approaches used by employee assistance programs to address perpetration of intimate partner violence

Employee Assistance Programs (EAPs) are workplace resources available to employees with problems impacting work performance. EAPs are well-positioned to address intimate partner violence (IPV), a major public health problem with workplace impacts. A purposeful sample of 28 EAPs across the United States was surveyed to identify policies and programs to address IPV, including perpetration. Most EAPs did not report having standardized approaches for addressing IPV perpetration. EAPs also described significant barriers to identifying IPV perpetrators, with the majority relying on self-disclosure on the part of the perpetrator when contacting the EAP. These results suggest that many EAPs--even when interacting with employees who present with issues known to correlate with IPV--are missing a potential opportunity to assess and intervene with IPV perpetrators.     

Alzheimer's disease and euthanasia

Employing the tenets of philosophical materialism, this paper discusses the ethical debate surrounding assisted suicide for persons suffering end-stage Alzheimer's. It first presents a classification of the dissociative situations between "human individual" and "human person". It then moves on to discuss challenges to diagnosed persons and their caregivers in relation to the cardinal virtues of Spinozistic ethics - strength of character (fortitudo), firmness (animositas) and generosity (generositas). Finally, a number of ideas attached to the debate - "right of choice", "death with dignity", "quality of life" and "compassion in dying" - are discussed in order to clarify their foundations.     

On being unreasonable in modern society: are mental health problems special?

There are many grounds for arguing that people with a range of disabilities have more in common than they have differences. However, those grounds to date have not resulted in a unified social movement. This paper examines one possible reason for that lack of unity: the particular force of being unreasonable in modern society. However, being unreasonable is not limited to those with a psychiatric diagnosis, nor does a lack or loss of reason take a simple common form within that group: it is a highly nuanced and context-specific matter. This complexity is discussed in relation to a set of inter-related questions about legalism, morality and post-enlightenment concerns with order and rationality. The paper concludes with a discussion of scenarios available to new social movements concerned with disability.     

Electronic Play,Study, Communication,and Adolescent Achievement, 2003–2008

Adolescents’ time spent messaging, exploring websites, and studying on the computer increased between 2003 and 2008. Using data from the Panel Study of Income Dynamics Child Development Supplement, this study examines how such changes have influenced individual achievement and behavior from childhood to adolescence. Greater communications and Internet web time proved detrimental to vocabulary and reading whereas the increased use of computer games was associated with increased reading and problem‐solving scores, particularly for girls and minority children. Increased use of the computer for studying was associated with increased test scores for girls, but not boys. The consequences are more benign than many feared. Groups that have traditionally used the computer less (girls, minority children) appear to benefit from greater use.     

Motivators for Seeking Gambling-Related Treatment Among Ontario Problem Gamblers

A random digit dialing telephone survey was used to interview 8,467 adults in Ontario, Canada. The NODS-CLiP was used to identify a representative sample of 730 gamblers (54.3% male, mean age 45.3 years) with possible past year gambling problems in order to explore factors that might affect disordered gamblers’ motivators for seeking gambling-related help. A final sample of 526 gamblers provided useable data on possible reasons for and barriers to seeking help, awareness of services, self-perception of gambling problems and experience with help-seeking. Financial and relationship issues were the most frequently volunteered motivators. However, over two-thirds of the respondents could not think of a reason for seeking help. Gamblers who had self-admitted or more severe problems, who knew how to get help, who were employed and had more education, and who identified possible barriers to seeking help were more likely to suggest motivators, especially financial ones. More research is recommended on gamblers’ trajectory towards recognition of a gambling problem, the process of overcoming specific barriers to treatment, and the role of social advantage (e.g., education and employment), in order to devise educational campaigns that will encourage earlier help-seeking among disordered gamblers.