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Rett syndrome (RTT) is a neurodevelopmental disorder, including autonomic nervous system dysfunctions and severe communication impairment with an extremely limited ability to use verbal language. These individuals are therefore dependent on the capacity of caregivers to observe and interpret communicative signals, including emotional expressions. People in general, including therapists tend to focus on changes in facial expressions to interpret a person's emotional state or choices, but with this population it is difficult to know if the interpretations are correct. The aims of this study were to investigate if the Facial Action Coding System (FACS) could be used to identify facial expressions, and differentiate between those that expressed emotions and those that were elicited by abnormal brainstem activation in RTT. The sample comprised 29 participants with RTT and 11 children with a normal developmental pattern, exposed to six different musical stimuli during non-invasive registration of autonomic brainstem functions. The results indicate that FACS makes it possible both to identify facial expressions and to differentiate between those that stem from emotions and those caused by abnormal brainstem activation. This knowledge may be a great help to an uninitiated observer, who otherwise might incorrectly interpret the latter as an expression of emotion. (Contains 5 tables.)

Highlights: [•] Physiological and emotional output initiated by music in people with Rett syndrome. [•] Neurophysiological brainstem assessment combined with Facial Action Coding System. [•] It is easy to misinterpret facial expressions in people with Rett syndrome. [•] Initial expressions sometimes change after some time due to brainstem immaturity. [•] The part of the brain which receives and processes music may remain intact. [Copyright &y& Elsevier]

A study was conducted on utilization of and satisfaction with the health care and medical services among 527 Scandinavian children (aged 4-18) with myelomeningocele (MMC). Data were collected from two sources: a questionnaire distributed to parents in 1984, and patients' medical records. Comparisons were made with a control group comprised of 7,792 children. Over a period of one year, 52% of the MMC group and 6% of the controls were hospitalized. Over 3 months, children with MMC had more contact with specialist care services than had the controls, while contact with primary health care was the same for both groups. Continuity of care and satisfaction with time spent with the physician were both greater among children with MMC than in the control group. Dissatisfaction with medical services was expressed by approximately 10% of the parents of both categories. Such dissatisfaction was found significantly more frequently among Danish parents and well educated mothers. Dissatisfaction with care was not related to either the child's age or the severity of its disability. Danish children with MMC received treatment relatively more frequently from primary care physicians than from specialists. In Sweden, where satisfaction was the greatest, families with children with MMC were supported by local habilitation teams. [ABSTRACT FROM PUBLISHER]

The Adolescence Medical Group in Sweden has performed a questionnaire every second year since 1990. The questionnaire is performed during school hours in seventh and ninth grade and also in the second grade in the upper secondary school (gymnasium). The questionnaire is completed anonymously. The schools are not chosen by statistical methods, but more depending on youth-health-iterested school doctors and nurses who have interest in these studies. The result of these studies has been used locally in each community, but also been reported for example i Acta Pediatrica. After the war in Bosnia there has been different projects to help to build up the countries health system, for example in psychiatry. The question was laso raised how the youth health was in Bosnia. Representatives from the Adolescence section in Sweden were invited to Bosnia to introduce the questionnaire and also to help in analysing the results. We were also in Bosnia to present results to local authorities and those who performed the study locally.

In summary it seems reasonable to state that around 5000 individual service users are visiting the CMHCs in Bosnia and Herzegovina during one week. Approximately 60% of them have mental health problems, around 25% come for non mental medical disorders and around 15% are healthy and come for check ups or certificates. The average CMHC cater for about 65,000 inhabitants with a staff of one psychiatrist, three nurses and 0.7 psychologist and social worker respectively. Most of them have training for tasks within mental health services. The progress of the mental health reform is positive with more CMHCs opened, and basically staffed with trained personnel. They offer a variety of services practiced with a modern strategy. Most personnel has changed their attitudes to mental health itself and the relevant service provision and hence devoted to implement the mental health reform. They would like to have more influence on decision making and present constructive suggestions for future service and policy improvements. The service users are almost all of them very satisfied with the service provided.