BMJ No 7144 Volume 316
Press Releases Saturday 23 May 1998
(1) THE RIGHTS AND WRONGS OF COVERT VIDEO SURVEILLANCE
(2) NOT ENOUGH ATTENTION IS GIVEN TO ATTENTION DEFICIT HYPERACTIVITY DISORDER
(3) CHILDREN OF SINGLE PARENT FAMILIES
HAVE MORE ACCIDENTS, MORE HOME VISITS
AND LESS
IMMUNISATION
(4) PSYCHOLOGICAL SUPPORT CAN HELP DEPRESSED YOUNGSTERS
(5) HOW CAN PARENTS TREAT COLIC IN THEIR BABIES?
(6) GP ADVICE CAN IMPROVE SAFETY IN THE HOME
(7) DOCTORS SHOULD BE HELPED TO DO MORE
TO HELP
CHILDREN IN
CONFLICT
(1) THE RIGHTS AND WRONGS OF COVERT VIDEO SURVEILLANCE
(Concerns about using and interpreting covert video surveillance)
http://www.bmj.com/cgi/content/full/316/7144/1603
(Commentary: Covert video surveillance is acceptable - but only
with a
rigorous protocol)
http://www.bmj.com/cgi/content/full/316/7144/1603#resp1
Covert video surveillance is an infringement of the liberty of the parent
and child and should be undertaken only as a last resort, writes Professor
Colin Morley from Addenbrooke's Hospital in this week's BMJ.
He argues
that the scenes witnessed by observers are open to
misinterpretation; for example, playing with the child by putting
a hand
over its face, making it difficult for the parent to defend himself
or
herself.
In an accompanying commentary, Professor Alan Craft from the University
of
Newcastle upon Tyne argues that the perceived infringement of the civil
liberty of the parent is no greater than the massive amount of video
surveillance to which the public in general is subjected in an attempt
to
prevent crime. Craft says that the needs of the child are paramount
and
the surveillance procedure is intended only as a safeguard for children
and
their siblings. Craft concludes that children have a right to
protection
from abuse and ill treatment and that covert video surveillance is
an
important tool to help professionals make the correct decision on behalf
of
children.
Contact:
Professor Colin Morley, Neonatal Intensive Care Unit, Royal Women's
Hospital, Melbourne, Australia
email: morleyc@crytic.rch.unimelb.edu.au
Professor Alan Craft, Sir James Spence Professor of Child Health,
Department of Child Health, University of Newcastle upon Tyne
email: a.w.craft{at}ncl.ac.uk
(2) NOT ENOUGH ATTENTION IS GIVEN TO ATTENTION DEFICIT HYPERACTIVITY DISORDER
(Personal paper: Attention deficit hyperactivity disorder is under-
diagnosed and under-treated in Britain)
http://www.bmj.com/cgi/content/full/316/7144/1594
Attention Deficit Hyperactivity Disorder is a condition of brain
dysfunction with associated educational and behavioural difficulties,
that
is misunderstood and under-recognised in Britain, says Dr Geoffrey
Kewley
from the Learning Assessment Centre in Horsham, in this week's BMJ.
The
author argues that there is much myth and misinformation about the
condition, which has tended to be seen in the UK - in contrast to many
other countries - as a purely psychosocial problem caused by poor
parenting, with overemphasis on the presence of hyperactivity for
diagnosis. There is widespread ignorance, even in severe cases,
about the
need for medication as a component of the management of what is a very
treatable condition.
The disorder is characterised by excessive inattentiveness, impulsiveness
or hyperactivity that significantly interferes with everyday life.
It is a
very variable condition with a number of potential complications.
Rather
than outgrowing the condition, about 60 per cent of sufferers have
persisting difficulties into adulthood. Unrecognised and untreated,
it
predisposes to educational, social and psychiatric difficulties, and
those
with associated Conduct Disorder have a much higher risk of turning
to
criminal activity.
Contact:
Geoffrey Kewley, Consultant Paediatrician, Learning Assessment Centre,
Horsham, West Sussex
email: achorsham{at}aol.com
(3) CHILDREN OF SINGLE PARENT FAMILIES HAVE MORE
ACCIDENTS,
MORE HOME VISITS AND LESS IMMUNISATION
(Morbidity and healthcare utilisation of children in households with
one
adult: comparative observational study)
http://www.bmj.com/cgi/content/full/316/7144/1572
Changes in lifestyles over recent years have resulted in a rapidly
increasing number of children brought up in single parent households
(numbers have increased fivefold from 1961 to 1994). In 1991,
nearly a
fifth of children were living in a one parent family, mostly with their
mother.
In a paper in this week's BMJ Douglas Fleming from the Royal College
of
General Practitioners and John Charlton from the Office for National
Statistics found that children in households with one adult visit their
doctor more frequently and receive more home visits. Of particular
concern
is that they reported more accidents and that the children received
fewer
immunisations. They observe that when there is no-one with
whom to share
the responsibility of bringing up a child, obtaining appropriate health
care can be more difficult.
Fleming and Charlton conclude that these children need to be targeted
by
GPs and other primary healthcare workers to reduce the risk of accidents
and ensure adequate immunisation.
Contact:
Dr Douglas Fleming, Director, Birmingham Research Unit, Royal College
of
General Practitioners, Birmingham
email: Bill{at}rcgp-bru.demon.co.uk
(4) PSYCHOLOGICAL SUPPORT CAN HELP DEPRESSED YOUNGSTERS
(Systematic review of efficacy of cognitive behaviour therapies in
childhood and adolescent depressive disorder)
http://www.bmj.com/cgi/content/full/316/7144/1559
Until recently it was widely believed that depression was rare in children,
but over the last 15 years there has been increasing recognition that
some
children suffer from the same symptoms as adults. In this week's
BMJ,
Professor Richard Harrington et al from the Royal Manchester Children's
Hospital and the Hope Hospital in Salford, consider ways of treating
child
sufferers based on a study of youngsters aged eight to 19 years old.
They
report that previous studies found no proof that antidepressant medication
relieves symptoms, but their study has found that psychological treatment,
in the form of cognitive behaviour therapy, is effective in treating
moderate depression. However, the authors conclude by noting
that their
study is based on a small number of trials and therefore wider research
should now be undertaken.
Contact:
Professor Richard Harrington, Department of Child and Adolescent
Psychiatry, Royal Manchester Children's Hospital, Manchester
(5) HOW CAN PARENTS TREAT COLIC IN THEIR BABIES?
(Effectiveness of treatments for infantile colic: systematic review)
http://www.bmj.com/cgi/content/full/316/7144/1563
Infantile colic - excessive crying in healthy, thriving infants - is
a
self-limiting condition which is usually resolved by the time a baby
reaches three or four months; however the condition can cause
a great deal
of distress for the family. The cause of colic is still far from
clear,
but several biological and social factors have been suggested, such
as an
allergy to cows' milk. In this week's
BMJ Dr Lucassen et al from the Netherlands report that attempts to treat
infantile colic should begin by substituting cows' milk with hypoallergenic
formula milks. This combined with behavioural interventions,
such as
teaching parents to be more appropriately responsive to their infants
and
more effectively soothing, may help reduce crying. The authors
argue
strongly that drug treatment of infantile colic has no place in primary
care because of the serious potential side effects that the drugs could
pose.
Contact:
Dr Peter Lucassen, General Practitioner in Private Practice, Amsterdam
Dr Willem Assendelft, General Practitioner, Institute of Research in
Extramural Medicine, Free University, Amsterdam, Netherlands
email: p.assendelft.EMGO{at}med.vu.nl
(Initiative to improve childhood immunisation uptake: a randomised
controlled trial)
http://www.bmj.com/cgi/content/full/316/7144/1569
Childhood immunisation coverage in the UK is good, but maintaining high
coverage levels is increasingly proving difficult. Mrs Maria
Morgan and Dr
Meirion Evans from the Bro Taf Health Authority in South Wales have
tested
the effectiveness of two interventions to improve uptake and their
findings
are published in this week's BMJ. They discovered that neither
prompting
the child's health visitor by telephone nor a direct mail reminder
to
parents achieved any significant improvement in uptake.
The authors conclude that district wide initiatives are unlikely to
be
successful and that effort should be concentrated on opportunistic
and
domiciliary immunisation activities at the primary healthcare team
level.
Contact:
Dr Meirion Evans, Consultant in Communicable Disease Control, Public
Health
Directorate, Bro Taf Health Authority, Temple of Peace and Health,
Cardiff
email: mre{at}abton4.demon.co.uk
(6) GP ADVICE CAN IMPROVE SAFETY IN THE HOME
(A randomised controlled trial of general practitioner safety advice
for
families with children under five years)
http://www.bmj.com/cgi/content/full/316/7144/1576
The Government's Health of the Nation report suggests that primary
healthcare teams should provide safety advice to parents during child
health surveillance programmes; advise on and provide access
to safety
equipment; check and advise on hazards in the home; provide
advice on
first aid and advise the community on safety. In a paper in this
week's
BMJ, Dr Margaret Clamp and Dr Denise Kendrick from Nottingham assess
the
effectiveness of general practice advice about child safety, on safe
practices in the home and, in particular, the provision of low cost
safety
equipment to low income families. The authors found that GP intervention
increased safe behaviour and the use of safety equipment in all families.
Contact:
Dr Denise Kendrick, Senior Lecturer, Division of General Practice,
University of Nottingham Medical School, Queen's Medical Centre, Nottingham
email: Denise.Kendrick{at}nottingham.ac.uk
(Administration of medicines in school: who is responsible?)
http://www.bmj.com/cgi/content/full/316/7144/1591
Chronic illnesses, such as asthma, epilepsy and diabetes, are relatively
common in schoolchildren and often require treatment during school
hours.
In this week's BMJ Dr M Bannon from Northwick Park Hospital highlights
the
continuing debate about who should be responsible for the administration
of
medicines to children while they are at school. There is no legal
requirement for schoolteachers to administer medicine, notes the author,
yet some parents hold the view that teachers act in loco parentis and
this
role should include medicine administration. Parents argue that
if they
can learn to deliver drugs effectively to children, so can teachers.
On the other hand many teachers understandably express anxiety about
accepting liability for something in which they have received
little or no
training. Storage of medicines at schools is also fraught with
difficulty.
Bannon concludes that four measures must now be taken: health
professionals should arrange training events for teachers; local
education
authorities should ensure that each school has general policies in
place
with respect to the administration of medicines to children;
teachers must
continue to respond as positively as they can when they encounter a
child
with medical needs and, finally, parents must acknowledge that they
hold
the prime responsibility for their children's welfare and that
accountability for the administration of medicines must be negotiated
with,
rather than demanded of, school staff.
Contact:
Dr M Bannon, Consultant Paediatrician, Paediatric Directorate, Northwick
Park and St Mark's NHS Trust, Northwick Park Hospital, Harrow
(7) DOCTORS SHOULD BE HELPED TO DO MORE TO HELP
CHILDREN IN CONFLICT
(Protecting children from armed conflict)
http://www.bmj.com/cgi/content/full/316/7144/1549
Doctors should do more to protect children in conflict, write Professor
David Southall from North Staffordshire Hospital and Dr Kamran Abbasi
of
the BMJ, in this week's BMJ. They argue that doctors should lobby
for the
development of a UN force which goes beyond peacekeeping and is designed
to
protect children.
In 1996 there were 31armed conflicts around the world and 24 of these
were
in countries with child (under five years) mortality rates of five
per cent
or more. Armed groups frequently and deliberately manipulate
food supplies
and target hospitals, health centres and health professionals.
Over the
past ten years, 90 per cent of casualties in armed conflicts have been
civilians. Ten million children have been killed and four to
five million
seriously injured (usually without the use of analgesia, anaesthesia
or
surgical facilities to treat them). Twelve million children have
been made
homeless, more than one million orphaned and countless psychologically
traumatised (during the Rwandan genocide, almost every girl aged over
eight
years was raped).
The authors suggest that doctors could develop long-term links
with
colleagues in disadvantaged countries and that study leave or early
retirement would enable them to provide hands-on aid, educational
materials, medical equipment and moral support. They believe
that these
doctors should be supported by both employers and colleagues.
Contact:
Dr Kamran Abbasi, Editorial Registrar, BMJ, Tavistock Square, London
or
Professor David Southall, Professor of Paediatrics, Academic Department
of
Paediatrics, North Staffordshire Hospital Centre, Stoke on Trent
email: cai_uk{at}compuserve.com
FOR ACCREDITED JOURNALISTS
Embargoed press releases:
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(contact Jill Shepherd;jshepher{at}bma.org.uk)
and from:
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Advancement of Science (http://www.eurekalert.org)
Please remember to credit the BMJ as source when publicising an article
and to inform your readers that they can read its full text on the
journal's web site (http://www.bmj.com).
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