Social Work Today E-Zine

Asian American immigrants who came to the United States before they were 25 years old have poorer mental health than their compatriots who came when they were 25 or older, according to data from the first national mental health survey of Asian Americans.

The study is noteworthy because it shows that using traditional measures of socio-economic status—number of years of school and household income—to predict health outcomes is not accurate for individuals who immigrate when they are children or young adults, according to Janxin Leu, a University of Washington assistant professor of psychology and lead author of the study.

Immigrants who arrived in the United States before they were 25 attained higher levels of education and income than did older immigrants. However, 13% of the younger immigrants reported symptoms of an anxiety or depressive disorder in the previous 12 months compared with 9% of the over-25 group.

Leu and the other researchers found that what is called subjective social status was more accurate in predicting mental health outcomes than income or education. To calculate this, they told the people surveyed to imagine a ladder with 10 rungs containing individuals who had achieved the most on the top rung and those who were least successful on the bottom. Then they were asked to place themselves on the ladder in comparison with other people.

“The under-25 group experiences a lot of stress, the so called ‘long-reach of childhood’ that comes at a formative time of development,” Leu says. “It is important to understand the early development of mental health. Children who are bullied because they are immigrants, for example, may suffer long-term mental health consequences.”

— Source: University of Washington

While the 2008 summer Olympics in Beijing has elicited a rallying cry for human rights among high-profile activists and organizations outside China, ordinary Chinese citizens are mobilizing to fight for their rights inside the rapidly changing country, according to sociologist Ching Kwan Lee, PhD, a sociologist at the University of California-Los Angeles who studies rights activism in China and Chinese investments in Africa, in a recent issue of Contexts.

“Ordinary Chinese workers, homeowners, and farmers have emerged as unlikely activists in a quiet revolution that is filling the gaps between central government law-making and the rights violations and corruption of local governments,” says Lee. In contrast to traditional activism appealing to universal notions of human rights, this grassroots movement among everyday people in China invokes “the protection of lawful rights,” or weiquan. This activism focuses on specific rights prescribed by Chinese law, such as labor, property, and rural land rights.

According to Lee, growing unrest over social injustice, as well as wealth and power gaps in Chinese society—due to the country’s rapid economic development—has led to three decades of market reform and legal proliferation by the central government in Beijing.

“Today’s rights activism in China provides a look at the forces driving the near-total transformation of the most populace nation in the world,” Lee says. “Attention may shift away from China after the 2008 Olympic Games conclude, yet the struggles between economic growth and social stability; between authoritarian rule and a more responsive state and involved citizenry; and between local and central governments will continue to shape and define China for the long-term future.”

— Source: American Sociological Association

In one of the first studies to link molecular genetic variants to adolescent delinquency, sociological research published in a recent issue of the American Sociological Review identified three genetic predictors of delinquency that gain precision when considered together with social influences.

Sociologists from the University of North Carolina-Chapel Hill explored the interaction of genetics and social influences and identified three genetic polymorphisms that, when examined in the context of modulating social controls, are significant predictors of delinquency. These findings about gene–environment interactions suggest that certain genotypes and specific social control influences (eg, family characteristics and processes; popularity and friendship characteristics; school attendance factors) are mutually dependent on delinquency.

The present research is unique in that it systematically examines layers of social context simultaneously (ie, family dynamics, peer relations, and school-related variables) in relation to genetic factors. The study uses regression analysis to reveal nonintuitive and complex relations among the researched variables.

“While genetics appear to influence delinquency, social influences such as family, friends, and school seem to impact the expression of certain genetic variants,” says Guang Guo, PhD, the study’s lead author and a professor of sociology and faculty fellow at the University of North Carolina-Chapel Hill’s Carolina Population Center and Carolina Center for Genomic Sciences. “Positive social influences appear to reduce the delinquency-increasing effect of a genetic variant, whereas the effect of these genetic variants is amplified in the absence of social controls.”

“Our research confirms that genetic effects are not deterministic,” Guo says. “Gene expression may depend heavily on the environment.”

— Source: American Sociological Association

A different cutoff point on an existing mental function assessment may more effectively assess the risk of dementia in highly educated older adults, according to a report in a recent Archives of Neurology.

The most commonly administered screening test of cognitive function is known as the mini-mental state examination (MMSE). “The MMSE is used to screen patients for cognitive impairment, track changes in cognitive functioning over time and often to assess the effects of therapeutic agents on cognitive function,” the authors wrote. The maximum MMSE score is 30; a score of 24 or less is typically used to detect individuals with cognitive dysfunction.

Sid E. O’Bryant, PhD, of the Texas Tech University Health Sciences Center, and colleagues reviewed the MMSE scores of 1,141 participants (93% white, an average age of 75.9) in the Mayo Clinic Alzheimer Disease Research Center and Alzheimer Disease Patient Registry who reported having 16 or more years of education. These included 307 patients with dementia, 176 patients with mild cognitive impairment, and 658 control patients without dementia.

With the traditional cut score of 24 on the MMSE, 89% of the participants were accurately classified by dementia status. This score had a sensitivity of 66% and a specificity of 99% for the detection of dementia, meaning that an individual with a score of 23 or lower would be correctly identified as having dementia 66% of the time and an individual with score of 24 or higher would be correctly diagnosed as not having dementia 99% of the time. Raising the cut score to 27 changed the sensitivity to 89% and the specificity to 78%, correctly classifying 90% of the participants.

“Older patients who present with memory complaints (reported by themselves or others) who have attained a college degree or higher level of education and who score below 27 on the MMSE are at increased risk of cognitive dysfunction and dementia and should be referred for a comprehensive evaluation, including formal neuropsychological studies,” the authors wrote.

— Source: American Medical Association

Eighteen percent of school children who took part in two health surveys carried out a year apart admitted they had eating problems, according to research published in the latest Journal of Advanced Nursing.

Thirteen percent admitted eating problems in either the first or second survey and a further five percent reported problems in both surveys. Students who had ongoing eating problems were more likely to report multiple psychological problems and health complaints.

"For example we noticed that students who reported suffering from anxiety earlier in adolescence were 20 times more likely to have ongoing eating problems" says Lea Hautala from the Adolescent Psychiatry Clinic at the University of Turku, Finland. "And teenagers who were dissatisfied with their appearance only had recurring eating problems if they also reported anxiety earlier in adolescence."

Researchers from the University surveyed 372 students aged between 15 and 17, repeating the survey after one year with the same pupils; 57% were girls and 43% were boys. "A total of 66 students reported eating problems—23 only reported problems in the first survey, 24 only reported them in the second survey and 19 reported them in both surveys" she adds.

"Students who had previous problems with anxiety were much more likely to suffer sustained eating problems, while those who didn't have previous psychological problems only experienced temporary eating problems and dissatisfaction with their appearance.

"We also found that girls were twice as likely to report eating problems on one occasion than boys and five times more likely to have ongoing problems."

— Source: Journal of Advanced Nursing

The baby's smile that gladdens a mother's heart also lights up the reward centers of her brain, according to a Baylor College of Medicine (BCM) report that appeared in the journal Pediatrics.

The finding could help scientists figure out the special mother-infant bond and how it sometimes goes wrong, says Lane Strathearn, MBBS, an assistant professor of pediatrics at BCM and Texas Children's Hospital and a research associate in BCM's Human Neuroimaging Laboratory.

To study this relationship, Strathearn and his colleagues asked 28 first-time mothers with infants aged 5 to 10 months to watch photos of their own babies and other infants while they were in a functional magnetic resonance imaging scanner. In some of the photos, babies were smiling or happy. In others they were sad, and in some they had neutral expressions.

Researchers found that when the mothers saw their own infants' faces, key areas of the brain associated with reward lit up during the scans, signifying increased blood flow to that area. The areas stimulated by the sight of their own babies were those associated with the neurotransmitter dopamine. Specifically, the areas associated included the ventral tegmental area/substantia nigra regions, the striatum, and frontal lobe regions involved in emotion processing, cognition and motor/behavioral outputs.

"These are areas that have been activated in other experiments associated with drug addiction," says Strathearn. "It may be that seeing your own baby's smiling face is like a 'natural high.' Understanding how a mother responds uniquely to her own infant, when smiling or crying, may be the first step in understanding the neural basis of mother-infant attachment."

— Source: Baylor College of Medicine

Common genetic variations affecting nicotine receptors in the nervous system can significantly increase the chance that European Americans who begin smoking by the age of 17 will struggle with lifelong nicotine addiction, according to a study published in a recent issue of PLoS Genetics. The study highlights the importance of public health efforts to reduce the number of youths who begin smoking.

The researchers studied 2,827 long-term European American smokers. They assessed the level of nicotine dependence for all smokers, and recorded the age they began daily smoking, the number of years they smoked, and the average number of cigarettes smoked per day. DNA samples were taken from all smokers, and the researchers recorded the occurrence of common gene variations, grouped into four haplotypes, which had been identified earlier in a subset of participants.

They found that people who began smoking before the age of 17 and possessed two copies of the high-risk haplotype had a 1.6-fold to almost 5-fold increase in risk of heavy smoking as an adult. For people who began smoking at the age of 17 or older, presence of the high-risk haplotype did not significantly influence their risk of later addiction. The high-risk haplotype is common in the three study populations, and European American populations in general, ranging in frequency from 38% to 41%.

Although the authors caution that different haplotype frequencies would likely be observed in different ethnic populations, Robert Weiss, PhD, professor of human genetics at the University of Utah and lead author of the study explains, “We know that people who begin smoking at a young age are more likely to face severe nicotine dependence later in life. This finding suggests that genetic influences expressed during adolescence contribute to the risk of lifetime addiction severity produced from the early onset of tobacco use.”

— Source: University of Utah Health Sciences

Pediatricians can help prevent future violent behaviors in their patients with a brief, one-time office intervention during a routine exam, according to a new study published in a recent issue of Pediatrics. The study involved 5,000 families with children aged 2 to 11 and more than 200 providers at 137 practices.

"This concept of anticipatory guidance—that pediatricians can have a public health impact through a brief, one-time office intervention—is key," says Shari Barkin, MD, director of the division of general pediatrics at the Monroe Carell Jr. Children's Hospital at Vanderbilt, who designed and implemented the study with coauthors.

The research was based on changing factors previously shown to impact the risk of future violent behavior, such as: excessive media time (computer games and television often depicting violence), access to unsafely stored firearms, and corporal punishment. One group of parents received specific violence-prevention intervention; the other group received only printed literature on literacy promotion and no information related to violence prevention.

After six months, there was a significant increase in the number of caregivers limiting their children’s media time to fewer than two hours per day, with intervention group families watching, on average, 45 minutes less of media per day. Additionally, firearm owners exposed to the intervention in the study were twice as likely to store their firearms more safely. Use of time-outs was not significantly affected, but there was a decrease in families who reported corporal punishment, more in the intervention group than the control group.

"We showed that this type of dialogue between the pediatrician and the family, which only lasts three to four minutes, can motivate change," Barkin says.

— Source: Vanderbilt University Medical Center

The reported death of a woman at King's County Hospital in Brooklyn, NY, illustrates the dire need for more public services for individuals with mental illness, according to the American Psychiatric Association (APA).

According to news reports, a woman who was suffering from agitation and psychosis, was kept waiting in the emergency room for almost 24 hours because the hospital did not have a bed available for psychiatric patients. She collapsed onto the floor and then lay there for approximately one hour before emergency room personnel tried to revive her. Tragically, she died.

"The question is how and why hospital personnel could ignore a person who fell to the floor in an emergency room and stood by or walked around her while she died," says APA President Nada Stotland, MD. "Still, the lack of emergency services for psychiatric patients is only one part of an overall healthcare crisis, which extends to and includes mental health services.

A lack of funding has led to an ongoing shrinkage of the number of hospital beds for these individuals. At the same time, many times hospitals have no emergency room physician on duty that is qualified to handle mental health problems. The difficulty of accessing needed services may only intensify the sense of stigma many patients feel in seeking help for a psychiatric problem in the first place.

"The time to intervene is long before a person finds herself in the position of needing emergency help from a hospital that is ill-equipped to care for her," Stotland says. "The tragedy is that we know how to help these individuals recover and remain productive members of society; this suffering is needless and ends up costing society as much or more than adequate care would cost. Our society is failing to provide the most basic safety net for our most vulnerable citizens."

— Source: American Psychiatric Association

Pregnancy alone does not appear to be associated with an increased risk of the most prevalent mental disorders, according to a report in a recent issue of Archives of General Psychiatry. However, postpartum women may have a higher risk of major depressive disorder.

Oriana Vesga-López, MD, of New York State Psychiatric Institute, and colleagues analyzed data from interviews of 43,093 individuals who participated in a survey on alcohol, disorders, and related conditions. Of these, 14,549 were women (aged 18 to 50) who had been pregnant within the past year. Participants reported psychiatric disorders, substance use, and whether they had sought treatment.

Women who were pregnant at the time of the study had a lower risk of having any mood disorder, except major depression, than nonpregnant women. “Age, marital status, health status, stressful life events and history of traumatic experiences were all significantly associated with higher risk of psychiatric disorders in pregnant and post-partum women.” Women who had been pregnant within the past year had lower treatment-seeking rates for any psychiatric disorder within the past year and within their lifetime. “Most women with a current psychiatric disorder did not receive any mental health care in the 12 months prior to the survey regardless of pregnancy status,” the authors wrote.

Although pregnancy alone is not associated with an increased risk of the most common mental disorders, “groups of pregnant women with particularly high prevalence of psychiatric disorders were identified,” the authors wrote. These groups included women aged 18 to 25 living without a partner, widowed, separated, divorced, or never married and women who experienced pregnancy complications or stressful life events. “Given the critical importance of this life period for mothers and their offspring, urgent action is needed to increase detection and treatment of psychiatric disorders among pregnant and post-partum women in the United States.”

— Source: American Medical Association

A class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) appear to be associated with bleeding in the upper gastrointestinal (GI) tract, according to a report in a recent issue of Archives of General Psychiatry. The effects appear increased when antidepressants are combined with other stomach-harming medications and decreased when acid-suppressing agents are used.

Francisco J. de Abajo, MD, MPH, PhD, of the Spanish Agency for Medicines and Healthcare Products, and Luis A. García-Rodríguez, MD, MSc, of the Spanish Centre for Pharmacoepidemiologic Research, Madrid, Spain, studied 1,321 patients who had been referred to a specialist or hospitalized for upper GI bleeding between 2001 and 2005. These cases were compared with 10,000 control subjects who were the same age and sex but did not have upper GI bleeding.

Individuals with upper GI bleeding were significantly more likely than controls to be taking SSRIs (5.3% vs. 3.0%) or venlafaxine (1.1% vs. 0.3%). The risk of bleeding appeared to be increased further among those taking both SSRIs and other drugs known to be harmful to the GI tract, including nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. However, acid-suppressing agents were associated with a reduced risk of upper GI bleeding in those taking SSRIs or venlafaxine.

The researchers estimate that in patients not taking acid-suppressing agents, one individual per year would develop upper GI tract bleeding for every 2,000 patients taking these antidepressants. “When both SRIs [SSRIs and venlafaxine] and NSAIDs are concomitantly used, it would be sufficient to treat 250 patients per year for one case of upper GI tract bleeding to be attributed to such combination, and 500 patients per year if SRIs are concomitantly used with antiplatelet drugs,” the authors wrote.

— Source: American Medical Association

Vietnam veterans who experienced posttraumatic stress disorder (PTSD) were twice as likely to die from heart disease as veterans without PTSD, a new Geisinger study finds. In the study, published in a recent issue of Psychosomatic Medicine, Geisinger senior investigator Joseph Boscarino, PhD, MPH, examined the prevalence of heart disease, PTSD, and other problems in more than 4,000 Vietnam veterans.

The more severe the PTSD diagnosis, the greater the likelihood of death from heart disease, the study showed. Vietnam veterans with PTSD-—like chronic smokers—are at higher risk of early death from heart disease, Boscarino concluded. He equated PTSD to smoking two to three packs of cigarettes per day for more than 20 years.

PTSD causes the body to release stress hormones, which leads to the inflammation and damage to the arteries and cardiovascular system damage. Stress hormones also tend to reduce the amount of inflammation-reducing cortisol in the body—though researchers aren’t sure why. “Increased levels of stress hormones and less cortisol from PTSD are a bad combination,” Boscarino explains. “Basically, PTSD just cooks your arteries in this situation.”

Boscarino previously found that people with PTSD had dramatically higher rates of chronic health problems such as psoriasis, arthritis, and other inflammatory diseases. “The science is conclusively showing that if you suffer psychological trauma, it’s going to take a toll on your physical health,” Boscarino says. “Getting counseling today is critical to avoiding a related problem tomorrow.”

— Source: Geisinger Health System

How children respond to the smell of alcoholic beverages is related to their mothers’ reasons for drinking, according to a new study from the Monell Chemical Senses Center. When asked to smell both the odor of beer and an unpleasant odor and then indicate which they liked better, children of mothers classified as ‘Escape drinkers’ were more likely than children of Nonescape drinkers to select the unpleasant odor over beer.

“Children’s responses to odors provide us with a window into their emotions,” says study lead author Julie Mennella, PhD, a Monell biopsychologist. “When given a choice between beer and pyridine—the smell of rotten eggs—children of mothers who drink to relieve tension and worry choose pyridine as smelling better. That’s pretty powerful.”

In the study, which appears in the journal Alcohol, 145 aged 5 to 8 were presented with seven pairs of odors. One of the odors was always beer; the others were bubblegum, chocolate, cola, coffee, green tea, pyridine, and cigarette smoke. For each pair, the children indicated which odor they liked better.

Mennella notes that because odor information travels directly to areas of the brain that deal with nonverbal aspects of emotion and memory, studying children’s responses to odors provides insights into their emotional worlds.

Mennella comments that additional research is needed to determine whether children who dislike the odor of alcohol and experience it in a negative emotional context are more or less likely as adolescents or adults to seek out alcohol when stressed.

— Source: Monell Chemical Senses Center

A team of researchers at Northeastern University’s Institute on Race and Justice, in collaboration with Arizona State University and Sam Houston State University, has issued a report, titled “Understanding and Improving Law Enforcement Responses to Human Trafficking,” about the incidence of and response to human trafficking in the United States.

Lead by principal investigators Amy Farrell, PhD, an assistant professor and the associate director of the Institute on Race and Justice, and Jack McDevitt, associate dean for Research and Graduate Studies in the College of Criminal Justice, the researchers conducted a random survey of law enforcement agencies throughout the United States to better understand how agencies identify and respond to suspected cases of human trafficking. This survey provides the first comprehensive national look at how local, state, and county law enforcement agencies respond to human trafficking.

The first part of the report details how law enforcement agencies perceive human trafficking and how they investigate such cases. The survey was sent to a random sample of approximately 3,000 state, county, and municipal law enforcement agencies in the United States. The results indicate that all types of law enforcement agencies have investigated at least one case of human trafficking, but local law enforcement agencies perceive human trafficking as rare or nonexistent in their jurisdiction. In addition, agencies in larger jurisdictions are more likely to distinguish human trafficking as a problem in their area, as evidenced by the fact that more than one half of the agencies serving large jurisdictions have investigated human trafficking cases.

The study also looked at the multiagency human trafficking task forces to better understand how the federal government is working to bring together federal, state, county and local law enforcement agencies to combat human trafficking. There are currently 39 task forces functioning nationally with a focus on a victim-centered response. The study found that when a task force is involved, a case of human trafficking is more likely to be investigated, resulting in higher rates of arrests and federal charges than nontask force agency human trafficking reported cases.

The data show some common obstacles among multiagency task forces, including defining and identifying human trafficking victims and a lack of communication among task force group members. Other issues that arose were how to align common goals when certain members have other responsibilities, as well as the complexity and length of time that is involved with human trafficking cases.

— Source: Northeastern University

The National Association of Social Workers (NASW) has elected Jim Kelly, PhD, ACSW, LCSW as its president. He brings more than 25 years of social work education experience to the NASW presidency. Kelly is the provost and executive vice president of Menlo College in Atherton, CA. He is a tenured social work educator, having worked for many years in the California State University system most recently as a professor, associate vice president of continuing and international education, and interim provost at California State University, East Bay.

“Dr. Kelly brings a wealth of talent and experience to the leadership of NASW. His diverse background and widespread experience as a social work educator will be a great benefit to the progress of NASW,” says Elizabeth J. Clark, PhD, ACSW, MPH, executive director of NASW.

Kelly has been actively involved with NASW serving as president of NASW's California Chapter, and has been active in the Tennessee, Massachusetts, and Hawaii chapters. In 1987, he was named NASW's Social Worker of the Year.

“NASW's most important function is to advocate for the social work profession on behalf of our clients. As a community, we must continue to attain the highest professional standards, protect client and practitioner rights, and improve health and human service systems of care.” says Kelly. “I hope that as president of NASW I can work with all social workers to advance the profession and to provide more for individuals, families, and communities.”

— Source: National Association of Social Workers

Gun-related homicide among young men rose sharply in the United States in recent years even though the nation’s overall homicide rate remained flat, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health. Between 1999 and 2005, homicide involving firearms increased 31% among black males aged 25 to 44 and 12% among white males of the same age. The study is published online in the Journal of Urban Health.

“The recent flatness of the U.S. homicide rate obscures the large increases in firearm death among males ages 25 to 44, especially black males,” says Susan Baker, MPH, coauthor of the study and a professor with the Bloomberg School’s Center for Injury Research and Policy.

For the study, Baker and her colleagues analyzed data from the Web-based Injury Statistics Query and Reporting System, which includes information on injury-related deaths and mortality rates per 100,000 population from 1981 to 2005. Mortality data by urbanization level was obtained through the Wonder System at the Centers for Disease Control and Prevention.

According to the study, the overall homicide rate remained between 6.0 and 6.1 deaths per 100,000 from 1999 to 2005, except for an increase in 2001 attributed to the terrorist attacks of September 11. The researchers found significant increases in the rate of firearm homicide for white males aged 25 to 34 and for black males aged 25 to 44.

The increase in firearm homicide for males aged 25 to 44 was not distributed evenly throughout the country. The most significant increases occurred in Alabama, California, Michigan, Minnesota, Nebraska, Nevada, New Jersey, Ohio, Pennsylvania, Texas, and Washington. The other states did not see significant change. Additionally, most of the increases occurred in and around large metropolitan areas.

— Source: Johns Hopkins Bloomberg School of Public Health

Pregnant women who receive treatment for substance abuse early in their pregnancy can achieve the same health outcomes as pregnant women with no substance abuse, according to a Kaiser Permanente study published online in the Journal of Perinatology.

“This program can happen everywhere and should become the gold standard for women who are pregnant and using cigarettes, alcohol, or other drugs,” says study lead author Nancy C. Goler, MD, an OB/GYN and Kaiser Permanente regional medical director of the Early Start Program for the organization’s Northern California operations. “The study’s big finding was that study participants treated in the Early Start program had outcomes similar to our control group, women who had no evidence of substance abuse.”

The study compared 2,073 pregnant women who were screened, assessed, and received ongoing intervention during pregnancy through the Early Start program from 1999 to 2003 to women in three other groups: 156 women who were screened but did not accept assessment or treatment; 1,203 women were screened, assessed, and received brief intervention only; and a control group of 46,553 women who showed no evidence of substance abuse.

The study found the risk of stillborn, placental abruption (when the placental lining separates from the mother’s uterus), preterm delivery, low birth weight, and neonatal ventilation were dramatically higher for the 156 untreated substance abusers than the 2,073 women in the Early Start program

“The sooner women ask for help, the better the health outcomes will be for themselves, and their babies. My message to all pregnant women, as well as women who are trying to conceive, is to stop all alcohol, cigarette, and drug use,” says Goler.

— Source: Kaiser Permanente

More than one half of older adults complain about having difficulties sleeping. Most don't bother seeking treatment. Those who do usually turn either to medications, which can lead to other health problems, or behavior therapies, which are costly and often not available close to home. Now, University of California, Los Angeles (UCLA) researchers report in the journal Sleep that practicing tai chi chih promotes sleep quality in older adults with moderate sleep complaints.

In the study, 112 healthy adults ranging in age from 59 to 86 were randomly assigned to one of two groups for a 25-week period: The first group practiced 20 simple tai chi chih moves; the other participated in health education classes that included advice on stress management, diet, and sleep habits.

The study found that the tai chi chih group showed improved sleep quality and a remission of clinical impairments, such as drowsiness during the day and inability to concentrate, compared with those receiving health education. The tai chi chih participants showed improvements in their own self-rating of sleep quality, sleep duration, and sleep disturbance.

The lead study author, Michael Irwin, MD, the Norman Cousins Professor of psychiatry and biobehavioral sciences at the David Geffen School of Medicine at UCLA and director of the UCLA Cousins Center for Psychoneuroimmunology, notes that 58% of adults aged 59 and older report having difficulty sleeping at least a few nights each week. "Poor sleeping constitutes one of the most common difficulties facing older adults," says Irwin.

— Source: University of California, Los Angeles

Expansion of Medicaid's Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program in California has significantly improved children's access to mental health services, reports a study in a recent issue of Medical Care.

The gains appear greatest in rural communities and areas with historically low levels of state funding for mental health services, where children living in poverty have high rates of mental health issues that are not appropriately treated. The lead author was Lonnie R. Snowden, PhD, of University of California, Berkeley.

Under a 1995 expansion of the EPSDT program, mental health benefits were "carved out" from other EPSDT benefits and assigned to California county mental health plans. Mental health benefits paid by Medi-Cal (the California Medicaid program) increased sharply after the expansion—from $121 million in 1994 to 1995 to $446 million in 1999 to 2000—with increased use of outpatient treatment and reduced use of crisis services.

The current study focused on how the changes affected children's access to mental health services—a major goal of the EPSDT expansion. The analysis included data from 53 county mental health plans from 1992-93 to 2001-02.

— Source: Wolters Kluwer Health: Lippincott Williams & Wilkins

Hearing loss is about twice as common in adults with diabetes compared with those who do not have the disease, according to a new study funded by the National Institutes of Health (NIH) that was published in the Annals of Internal Medicine.

"Hearing loss may be an under-recognized complication of diabetes. As diabetes becomes more common, the disease may become a more significant contributor to hearing loss," says senior author Catherine Cowie, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), who suggested that people with diabetes should consider having their hearing tested. "Our study found a strong and consistent link between hearing impairment and diabetes using a number of different outcomes."

The researchers discovered the higher rate of hearing loss in those with diabetes after analyzing the results of hearing tests given to a nationally representative sample of adults in the United States. The test measured participants' ability to hear low, middle, and high frequency sounds in both ears. The link between diabetes and hearing loss was evident across all frequencies, with a stronger association in the high frequency range. Mild or greater hearing impairment of low- or mid-frequency sounds in the worse ear was about 21% in 399 adults with diabetes compared with about 9% in 4,741 adults without diabetes. For high frequency sounds, mild or greater hearing impairment in the worse ear was 54% in those with diabetes compared with 32% in those who did not have the disease.

"The link between diabetes and hearing loss has been debated since the 1960s or before, and our results show that a relationship exists even when we account for the major factors known to affect hearing, such as age, race, ethnicity, income level, noise exposure, and the use of certain medications," notes Kathleen Bainbridge, PhD, of Social & Scientific Systems, Inc.

— Source: National Institutes of Health

The American Psychiatric Association (APA) applauds House passage of the Medicare Improvements for Patients and Providers Act, which overhauls key features in Medicare coverage of treatment for mental health, most notably by reducing the discriminatory 50% coinsurance patients must pay for outpatient mental health services to the same 20% copayment charged for all other Medicare Part B services. The House passed HR 6331 by a vote of 355 to 59.

In addition to ending the disparity with mental health care out-of-pocket costs, HR 6331 includes numerous provisions that will strengthen the Medicare program, and block a scheduled 10.6% cut in payments to physicians and other health professionals through 2009.

Since the Medicare program was established some 40 years ago, enrollees using outpatient psychiatric services have by law had to pay an effective copayment of 50%—two-and-a-half times the customary 20% copayment paid for other Medicare Part B services.

"The House showed great foresight in taking steps to finally end 40 years of discrimination against patients just because they need mental health treatments," says Nada Stotland, MD, MPH. "It is unconscionable to require the elderly and disabled to pay half the cost of their mental health care out of pocket. This change makes social and economic sense. The APA will continue to advocate for this legislation until it becomes law."

Action now shifts back to the Senate, which has yet to reach agreement on a bill of its own.

— Source: American Psychiatric Association

Young children show evidence of smart and flexible behavior early in life—even though they don’t really know what they’re doing, new research suggests. The study appears in a recent issue of the journal Child Development.

In a series of experiments, scientists tested how well 4- and 5-year-olds were able to rely on different types of information to choose objects in a group. In some situations, they were asked to choose objects based on color and in some cases based on shape. Results showed children could be trained to choose correctly, but still didn’t know why shape or color was the right answer in any particular context.

“Children have more powerful learning skills than it was thought previously,” Vladimir Sloutsky, coauthor of the study and a professor of psychology and human development and the director of the Center for Cognitive Science at Ohio State, says. “They can show evidence of flexible learning abilities without conceptual knowledge and without being aware of what they learned.”

Sloutsky says, “these children were not aware of what they learned. They didn’t know how they were making the correct choices.” The findings have implications for theories of how children learn and develop their cognitive abilities, he says.

“Children learn implicitly. They don’t need complex conceptual knowledge to show evidence of smart, flexible behavior.”

— Source: Ohio State University

A survey conducted by the World Health Organization (WHO) research consortium looked at patterns in the use of alcohol, tobacco, cannabis, and cocaine in 17 countries representing all six WHO regions (the Americas, Europe, Asia, the Middle East, Africa, and Oceania).

"These findings add to our understanding of substance abuse world-wide, and suggest that drug use is still a major problem in this country, pointing to the need for more effective prevention interventions," says Elias A. Zerhouni, MD, NIH director.

Among the significant findings of this study were:

• Across countries and across the drug types in this survey, drug use is becoming more common over time.

• Males were more likely than females to have used all drug types in all countries and all age groups.

• Younger adults were more likely than older adults to have used these substances.

• Those with higher incomes were more likely to have used legal and illegal drugs.

• Alcohol had been used by the vast majority of survey participants in the Americas, Europe, Japan, and New Zealand, compared to smaller proportions in the Middle East, Africa and China.

• Alcohol use by age 15 was far more common in European countries than in the Middle East or Africa.

• Lifetime tobacco use was most common in the United States (74%), Lebanon (67%), Mexico (60%), and the Ukraine (61%), followed by the Netherlands (58%).

— Source: National Institute on Drug Abuse

Psychosocial influences such as stress, depression, and trauma have been neglected in biomedical and treatment studies involving people infected with HIV, yet they are now known to have significant health impacts on such individuals and the spread of AIDS, according to a University of North Carolina (UNC) at Chapel Hill scientist.

Now, a comprehensive update on those influences in the current issue of the journal Psychosomatic Medicine offers a wake-up call and should give infectious disease physicians and other healthcare practitioners working with HIV-infected persons information to improve patient outcomes, says Jane Leserman, PhD, a sociologist, a professor of psychiatry in the UNC School of Medicine and coeditor of the special journal issue.

“A huge amount of research has been done in our field around these psychosocial influences, yet we felt not all medical professionals working with HIV-infected persons were aware of this body of knowledge,” Leserman says. “We hope this special issue will serve as a catalyst for healthcare providers to address these problems as part of standard HIV care, and to stimulate collaborations between biomedical and biobehavioral clinicians and researchers working as a team to address the quantity and quality of life for these patients.”

Recent large, long-term studies show that HIV and AIDS patients with chronic depression and trauma are about twice as likely to die from AIDS-related causes, Leserman says.

“No one argues about the importance of following the numbers—immune cell counts and levels of the virus in the blood—nor should they,” Leserman says. “But there is substantial and consistent evidence that depression, stressful life events, and trauma account for some of the variability in HIV disease course. That can’t be ignored.”

— Source: University of North Carolina at Chapel Hill School of Medicine

According to a new study in a recent issue of the Journal of Applied Social Psychology, if someone have a tendency to become upset while driving, they’re more likely to be the kind of parent who explodes in anger at their kids’ sports matches.

Research by kinesiology PhD student Jay Goldstein of the University of Maryland School of Public Health found that ego defensiveness, one of the triggers that ignites road rage, also kicks off parental “sideline rage,” and that a parent with a control-oriented personality is more likely to react to that trigger by becoming angry and aggressive.

By surveying parents at youth soccer games in suburban Washington, DC, Goldstein found that parents became angry when their ego got in the way. “When they perceived something that happened during the game to be personally directed at them or their child, they got angry.” says Goldstein. “That’s consistent with findings on road rage.”

And the parents who Goldstein defines as control-oriented were far more likely to take something personally and flare up at referees, opposing players, and even their own kids, than autonomy-oriented parents, who take greater responsibility for their own behavior.

“In general, control-oriented people are the kind who try to ‘keep up with the Joneses,’” Goldstein says. “They have a harder time controlling their reactions. They more quickly become one of ‘those’ parents than the parents who are able to separate their ego from their kids and events on the field.”

However, Goldstein says, even autonomy-oriented parents get angry, and when they do, ego defensiveness is the trigger. “While they’re more able to control it, once they react to the psychological trigger, the train has already left the station.”

— Source: University of Maryland, College Park

To accelerate the translation of basic discoveries about HIV into advances in vaccine design and evaluation, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has formed a new Vaccine Discovery Branch within the Vaccine Research Program in the Division of AIDS (DAIDS).

"There is broad scientific consensus that designing a safe and effective vaccine to prevent HIV infection will require enormous advances beyond present-day knowledge," says NIAID Director Anthony S. Fauci, MD. "The NIAID Vaccine Discovery Branch will help remove fundamental obstacles to achieving this goal by focusing intensively on the development and sharing of new knowledge critical to vaccine development."

The new branch is dedicated to monitoring scientific developments in multiple fields related to HIV vaccine discovery, building more bridges between basic researchers and HIV vaccine designers, identifying gaps in knowledge pertinent to a preventive HIV vaccine, and promoting research to fill those gaps.

"Cross-fertilization of HIV/AIDS research with the fields of genetics, structural biology, systems biology, and others could open up new perspectives on how to overcome major obstacles to HIV vaccine design," says DAIDS Director Carl W. Dieffenbach, PhD. "The Vaccine Discovery Branch will be in an ideal position to spot these opportunities, promote the translation of new knowledge about HIV and foster fruitful research collaborations."

— Source: National Institutes of Health