The position of the curator (abortion counsellor) in Sweden is discussed. The counselling is facultative before the 12th week of pregnancy and about 20% of abortion seekers go to curators for counselling. After the 12th week of pregnancy, counselling is mandatory; here the curator is intended to give support to the abortion seeker, and his evaluation of the case may be considered by the physicians in their approval of the abortion application. Abortion counselling is not meant to influence an abortion seeker, but to give her a chance to discuss and explore her decision to undergo abortion. Follow-up consultations after the abortion operation would be desirable, but are difficult to arrange.
The prevalence rate of allergic rhinitis and the consultation rate caused by this disease were studied in 131 general practices covering a population of 450,000 persons in Denmark. During a 1-year period starting June 1977 all consultations with or without symptoms were recorded. Allergic rhinitis was defined as paroxysmal sneezing and rhinorrhoea with or without conjunctivitis, and without signs of infection. Results are presented from three groups of practices classified by self-estimated completeness of reporting. 11--15 per thousand of the total population contacted a practice during the 1-year period (males: 12--17%, females: 10--13%). The highest prevalence rate occurred at 10--19 years of age, and allergic rhinitis was common from five to 44 years of age. The prevalence rate was higher among males up to the age of 30, after which age it was a little higher among females. About two-thirds of the patients consulting had at least one consultation per year with symptoms present. The number of contacts came to 4.4 per patient per year and 20--25% of these were with symptoms.
What kind of support can an affluent society as the Swedish offer dysfunctional parents in order to give the infants an optimal start in life? The purpose of the present study was to analyze the social situation in families precipitating the admission of infants to institutional care in 1970, 1975 and 1980. The results show that in 1980 more complex forms of parental dysfunction were common including mental disorders, criminality, abuse of alcohol and drug addiction. The reported incidence of domestic violence had increased significantly from 1970 to 1980 as well as the number of maltreated infants. The social welfare agencies had greater difficulties and to a larger extent lacked adequate methods of providing assistance to the dysfunctional parents in 1980 than in 1970.
To study differences in children's psychiatric symptoms and child mental health service use at three time points: 1989, 1999, and 2005.
Three cross-sectional representative samples of 8-year-old children were compared from southern Finland. The sampling, procedure, and methods were similar at all three time points. Information was gathered from parents and teachers using Rutter questionnaires and other related determinants of service use and from children using the Children's Depression Inventory. The participation rate at the three time points was 96% in 1989, 86% in 1999, and 84% in 2005.
Overall, parent and teacher reports of children's problems did not show a significant increase during the 16-year period. Parent reports of boys' conduct symptoms decreased from 1989 to 1999. However, self-reported depressive symptoms among girls increased from 1989 to 2005. Low parental education level, broken family, and negative life events were associated with depressive symptoms among girls. Although 4% of boys and 1% of girls had used child mental health services in 1989, the respective figures in 2005 were 12% and 4%. The majority of children who were screen positive on either parent or teacher ratings of emotional and behavioral problems using Rutter scales had received some educational support from school in 2005.
Reports of depressive symptoms increased among girls, and this finding merits further studies. Use of services has continuously increased. School services play an important role in providing support and early detection of children who need to be referred to child mental health services.
Patients accepted to chronic hemodialysis have changed. We analyzed these changes and survival, cause of death and other factors during 23 years at the Karolinska Hospital. Between 1965 and 1987, 274 patients were accepted: 60 are alive on dialysis, 75 died, 113 were transplanted, 25 sent to other units and one recovered renal function. The mean age increased from 44 to 55 years (p=0.001), the creatinine level at acceptance decreased from 1191 to 965 mumol/l (p = 0.001), the hemoglobin level rose from 70 to 85 g/l (p = 0.001) and the diastolic blood pressure decreased from 96 to 90 mmHg (p = 0.007). The number of co-morbid conditions increased from 1.2 to 1.4 (p less than 0.005). The diagnoses changed from over 90% primary renal disease to 20% systemic diseases such as nephrosclerosis and diabetes (p = 0.04). The chance of receiving a renal transplant decreased from 46 to 39% (p = 0.28). The transplanted patients were younger than the dialyzed patients 42 vs 47 years (p = 0.03) before 1980 and 49 vs. 56 years (p = 0.0001) after 1980. The cause of death changed. Withdrawal from dialysis increased from 5% of deaths before to 24% after 1980 (p = 0.047), cardiovascular deaths decreased from 85% to 55% (p = 0.01). Although the patients accepted for dialysis after 1980 had more serious renal disease and other degenerative diseases than those before, the mortality rate was reduced to only 1/4 to that before, in all age groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Child Psychiatry is now a well recognized and established sub-specialty in Canada. It has gone through a period of vigorous and healthy growth. Like psychiatry in general it now faces a number of challenges which provide potential threat but which may lead to better definition of priorities and of its most effective function. Other disciplines, medical and non-medical, increasingly compete for a place on the therapeutic spectrum. Within psychiatry the rhetoric between different schools of thought provides ammunition for those who have no use for any form of psychiatry however it may be provided. The challenge is to develop more effective ways of using the skills of the child psychiatrist within a recognition that the number of practitioners will never approach what would be required to have child psychiatry alone cover the treatment needs of children and adolescents. The field requires the adoption of a more flexible metaphor for training and practice with competence in the different schools of theory and of therapy. Attention needs to be paid to the consumer movement, to the impact of better informed parents and public and to the developing of a parsimonious and selective approach to the use of scarce professional time. The healthy growth of research in child psychiatry is a development long overdue and places the discipline on a scientific rather than a clinical practice base. At a time when funding and the cost of health care are crucial issues the development of a secure knowledge base, efficient methods of service delivery and the integration with other mental health care providers are opportunities and grounds for optimism about the future of the sub-specialty.
This essay discusses the position of child psychiatry as a subspecialty in Canada today. Proceeding from a review of a paper written by Dr. Quentin Rae-Grant in 1970 "Adult and Child Psychiatry--One or Two Nations?" the author, using the concept of a nation as a metaphor, explores the evolution of child psychiatry as a subspecialty in Canada. The history of child psychiatry in Canada is reviewed briefly; from its early beginnings to an increased understanding of its uniqueness as a subspecialty, finally through to the formation of the Canadian Academy of Child Psychiatry in 1980. The essay stresses the mutuality of our dependence on the Canadian Psychiatric Association. The author emphasizes our mutual dependence on the greater organizational body of psychiatrists, and encourages a greater participation of child psychiatrists within the Canadian Psychiatric Association. The author also emphasizes the need to have a closer relationship with the Canadian Paediatric Society. In addition, the author discusses in some detail the more complex and controversial relationship between child psychiatry and the Royal College of Physicians and Surgeons of Canada. Finally the author emphasizes the importance of a close working relationship with the American Academy of Child and Adolescent Psychiatry. All of these relationships are emphasized in terms of mutual dependence.
In 1991, money was granted by Nordisk Ministerråd to prepare a Nordic project concerning children at risk. Since then, preparations have gone forward to organize a project focussing on 10-year olds' experiences of risk and protective factors in their daily lives. The project combines data from fairly large cohorts or samples with in-depth studies concerning specific analyses of risk and protective factors, life events, children's experiences with various helping services and child welfare, children's school environment etc. A project group with participants from all the Nordic countries has been established, and three meetings have been arranged during 1992. The Nordic project as such aims to started fully 1993.