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Objectives: To examine the relationship of childhood physical and sexual abuse with reported parenting satisfaction and parenting role impairment later in life among American Indians (AIs). Methods: AIs from Southwest and Northern Plains tribes who participated in a large-scale community-based study (n=3,084) were asked about traumatic events and family history; those with children were asked questions about their parenting experiences. Regression models estimated the relationships between childhood abuse and parenting satisfaction or parenting role impairment, and tested for mediation by depression or substance use disorders. Results: Lifetime substance use disorder fully mediated the relationship between childhood physical abuse and both parenting satisfaction and parenting role impairment in the Northern Plains tribe. There was only partial mediation between childhood sexual abuse and parenting role impairment in the Southwest. In both tribes, lifetime depression did not meet the criteria for mediation of the relationship between childhood abuse and the two parenting outcomes. Instrumental and perceived social support significantly enhanced parenting satisfaction; negative social support reduced satisfaction and increased the likelihood of parenting role impairment. Exposure to parental violence while growing up had deleterious effects on parenting outcomes. Mothers and fathers did not differ significantly in the relation of childhood abuse experience and later parenting outcomes. Conclusions: Strong effects of social support and mediation of substance abuse disorders in the Northern Plains offer direct ways in which childhood victims of abuse could be helped to avoid negative attributes of parenting that could put their own children at risk. Practice implications: Mothers were not significantly different from fathers in the relation of abusive childhood experiences and later parenting outcomes, indicating both are candidates for interventions. Strong effects ofsocial support offer avenues for interventions to parents. The prevalence of substance use disorders and their role as a mediator of two parenting outcomes in the Northern Plains should focus special attention on substance use treatment, especially among those who experienced childhood victimization. These factors offer direct ways in which childhood victims of abuse can be helped to avoid negative attributes of parenting that could put their own children at risk of violence.

The association of intakes of omega-3 and omega-6 fatty acids with the development of islet autoimmunity (IA) in children is examined. Dietary intake of omega 3 fatty acids is found linked with reduced risk of IA in children and increased genetic risk of type 1 diabetes.

We used data on a national sample of children involved with child welfare systems to compare American Indian caregivers with White, Black, and Hispanic caregivers in their need for, and receipt of, specialty alcohol, drug, and mental health treatment. American Indian caregivers were significantly less likely to receive services than were Hispanic caregivers (P doi:10.2105/AJPH.2004.059436)

A random clinical trial is conducted among adolescents with co-occurring major depression and substance use disorder to study adolescents for whom the onset of depression is first as compared to those for whom the onset of substance use disorder is first or in the same year as depression. Results reveal some differences in the developmental path towards co-occurring depression and substance use disorder but measures of dependence and severity show remarkable similarity.

Objective: The purpose of this study was to examine the relationship of childhood physical and sexual abuse to subsequent lifetime alcohol or drug use disorders among American Indians (AIs) by using cross-sectional and retrospective data collected from a structured epidemiological interview. Method: A sample of 3,084 AIs from two tribal population--Southwest and Northern Plains participated in a large-scale, community-based study. Participants were asked about traumatic events and family history and were administered standard diagnostic measures of substance use disorders. Results: Prevalence of childhood physical abuse was approximately 7% for both tribes, and childhood sexual abuse was 4%-5%, much higher for females. The Northern Plains tribe had higher prevalences of substance use disorders. Childhood physical abuse had a significant main effect in bivariate models of substance dependence, but remained significant only in the multivariate models of substance dependence for the Northern Plains tribe. Correlates of disorder were psychiatric and medical comorbidity, parental alcohol problems and adult experience of physical attacks. Conclusions: Childhood physical abuse had a stronger effect than childhood sexual abuse on lifetime substance dependence. Childhood sexual abuse, on the other hand, was more associated with lifetime substance abuse. Females more commonly experienced childhood abuse but were less likely than males to develop substance use disorders. Although additional covariates reduced the main effect on disorder, results provide clinical guidance to constellations of risk factors and expand the population at risk to include males. (J. Stud. Alcohol 65: 74-83, 2004), CHILDHOOD PHYSICAL and sexual abuse and substance use disorders are known to co-occur for many people, although the precise nature of the relationship has yet to be established empirically. The [...]

Objectives. To estimate the effect of early childhood abuse (ie, inflicted injury) on medical costs of head trauma. Methods. Abstracts of patient records were drawn from the annual 1993-2000 Colorado state-mandated hospital discharge database maintained by the Colorado Hospital Association. The 2 dependent variables were total charges (TC) and length of stay. Our key independent variable was the nature of injury, ie, inflicted or unintentional; other independent variables were age, severity level, death, and trauma designation of the hospital. Comparisons of variables between patients with inflicted and unintentional head trauma were performed using Student's t tests or [chi square] statistics. Ordinary least squares regression was used to estimate the marginal and total effects of inflicted injury on TC and LOS. Results. Of the 1097 head trauma patients Conclusions. The findings from multivariate models of TC and length of stay corroborate the simpler univariate findings of earlier studies. By focusing on the impact of those cases of child abuse that lead to a specific, severe clinical entity (traumatic brain injury), we isolated a significant economic impact of abuse on health care expenditures for injury., ABBREVIATIONS. APR-DRG, All Patient-Refined Diagnosis-Related Groups; CC, complications and comorbidities; CHA, Colorado Hospital Association; EM, expectation maximization; ICD-9, International Classification of Diseases Coding Manual, Volume 9; LOS, length of stay; [...]

The authors' reply to a letter to the editor in response to the article "Alcohol, drug, and mental health specialty treatment services and race/ethnicity: a national study of children and families involved with child welfare," by A. M. Libby, H. D. Orton, and colleagues is presented.

Objetivo: En octubre de 2003 la Food and Drug Administration (FDA) emitió un comunicado de salud pública sobre el riesgo de suicidio en los pacientes pediátricos que tomaban antidepresivos y aconsejó mantener una «supervisión estrecha» de este tipo de pacientes. En este estudio, los autores compararon las tendencias en la frecuencia de contacto de los pacientes con depresión con los profesionales sanitarios, antes y después de la emisión del comunicado. Método: Se crearon cohortes retrospectivas de niños (n = 27.370) y adultos (n = 193.151) con nuevos episodios de depresión tratados con antidepresivos, a partir de una base de datos de reclamaciones de seguros de planes de atención gestionada (1998-2005) de ámbito nacional. Para determinar la monitorización de los pacientes se emplearon dos estándares: el criterio de calidad de la atención del Health Plan Employer Data and Information Set (HEDIS), que recomienda tres contactos en 3 meses, y la agenda de contactos recomendada por la FDA, que consiste en siete visitas en 3 meses. Se emplearon modelos de series temporales para comparar las tendencias posteriores al comunicado con la tendencia esperada basada en medidas anteriores al comunicado. Resultados: Antes del comunicado, menos del 5 % de los pacientes cumplieron las recomendaciones de contactos de la FDA, y este índice no varió después del comunicado. Una proporción mayor de pacientes cumplió los criterios de contacto de HEDIS antes del comunicado (60 % para los niños y 40 % para los adultos) y el índice no varió después del comunicado. Una mayor proporción de pacientes pediátricos visitados por un psiquiatra (80 %) cumplió los criterios de HEDIS frente a los que fueron visitados por un pediatra (60 %) o por un médico de atención primaria no pediatra (54 %), y frente a los adultos visitados por un psiquiatra (65 %) o por un médico de atención primaria (37 %). Las proporciones de pacientes pediátricos que cumplieron las recomendaciones de la FDA no presentaron diferencias según la especialidad. Conclusiones: Contrariamente a lo esperado, la frecuencia de visitas realizadas por pacientes con nuevos episodios de depresión tratados con antidepresivos no aumentó después de la emisión del comunicado de la FDA de octubre de 2003. [ABSTRACT FROM AUTHOR]

Objetivo: En octubre de 2003, la Food and Drug Administration (FDA) emitió un comunicado de salud pública sobre el riesgo de suicidio en pacientes pediátricos que reciben inhibidores selectivos de la recaptación de serotonina (ISRS) como tratamiento de la depresión. Este estudio empleó datos de una gran cohorte pediátrica de ámbito nacional para examinar los patrones de diagnóstico de la depresión, de prescripción de antidepresivos, de prescripción de alternativas farmacológicas a los antidepresivos y del uso de la atención psicosocial antes y después de la emisión del comunicado de la FDA. Método: Se creó una cohorte pediátrica de gran tamaño con episodios de depresión de diagnóstico reciente a partir una base de datos integrada de ámbito nacional de peticiones de planes de asistencia gestionada desde octubre de 1998 a septiembre de 2005 (n = 65.349). Se emplearon modelos de series temporales para comparar las tendencias en los diagnósticos y las prescripciones durante los 2 años posteriores al comunicado de la FDA y las tendencias esperadas basadas en los datos del período de 5 años anteriores al comunicado. Resultados: Entre 1999 y 2004, los diagnósticos pediátricos de depresión aumentaron de 3 a 5 por 1.000. Después del comunicado de la FDA, el índice nacional descendió a los niveles de 1999, lo que supone una desviación significativa de la tendencia histórica. Los pediatras y los médicos de atención primaria no pediatras fueron responsables de las mayores reducciones de nuevos diagnósticos. Entre los pacientes con depresión, la proporción que no recibió ningún antidepresivo aumentó hasta el triple del índice previsto por la tendencia. No hubo pruebas de un aumento significativo del uso de alternativas terapéuticas (psicoterapia, antipsicóticos atípicos y ansiolíticos). Conclusiones: El comunicado de la FDA se asoció con reducciones significativas en los índices generales de diagnóstico y tratamiento de la depresión pediátrica. [ABSTRACT FROM AUTHOR]