HEALTH CARE COSTS HIGHER FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS

CHICAGO—Although children with special health care needs comprised less than 16 percent of the child population, they had health care expenditures three times higher than other children, according to an article in the January issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

According to background information in the article, children with special health care needs (CSHCN) are defined as "those children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally." Compared to other children, CSHCN use more health care services and thus have higher health care costs.

Paul W. Newacheck, Dr.P.H., from the Institute for Health Policy Studies, University of California, San Francisco, and colleagues used data from the 2000 Medical Expenditure Panel Survey (MEPS) in order to examine health care expenditures of CSHCN. A total of 6,965 children under the age of 18 were included in the survey, with 949 (15.6 percent) identified as CSHCN. From these data the number of CSHCN in the U.S. was estimated at 11 million.

In 2000, CSHCN had an average health care expenditure of $2,099, compared to children without special health care needs who had an average expenditure of $628. CSHCN accounted for 42.1 percent of total medical care costs (excluding dental costs) and 33.6 percent of total health care costs (including dental costs) for children. These children also had more than twice as many physician visits and seven times as many non-physician visits than other children, and had average out-of-pocket costs (for all health care) twice that of other children ($352 vs. $174). Average annual expenditures on prescribed medications were ten times higher ($340 vs. $34) for CSHCN.

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To contact J. David Hawkins, Ph.D., call Joel Schwarz at 206-543-2580.

SOCIAL DEVELOPMENT PROGRAM IN CHILDHOOD AIDS IN POSITIVE FUNCTIONING AS AN ADULT

CHICAGO—Young adults who participated in a social development training program in elementary school reported greater job stability, less incidence of drug use, and greater overall emotional well being compared with a control group, according to an article in the January issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

"The transition to early adulthood is a challenging time for many young people," background information in the article states. Young adults are vulnerable to emotional and mental health problems, involvement in crime, and growing problems with drugs and alcohol. Studies have shown the effectiveness of selective interventions in children from families in poverty in encouraging positive adolescent and adult outcomes.

J. David Hawkins, Ph.D., from the Social Development Research Group, School of Social Work, University of Washington, Seattle, and colleagues examined the long-term effects of the Seattle Social Development Project (SSDP) in participants at 21 years of age. The project included teacher training, child social and emotional skill development, and parent training. The full-intervention group (n = 156) consisted of children who received an average of 4.13 years of intervention during grades one through six. The late-intervention group (n = 267) received an average of 1.65 years of intervention, during grades five and six only. The control group (n = 220) received no intervention.

Compared to the control group, students in the full-intervention group were more likely to have graduated from high school (91 percent vs. 81 percent) and to have completed two or more years of college (14 percent vs. 6 percent). Full-intervention students reported having stayed at their current job longer than the control group (4.96 years vs. 3.85 years), and reported significantly fewer symptoms of social phobia and fewer suicidal thoughts. The arrest rate for men in the full-intervention group was significantly lower than men in the control group (14 percent vs. 23 percent). The full-intervention group was also less likely to be involved in crime, to have sold illegal drugs in the past year, and to have an official lifetime court record.

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To contact David C. Henderson, M.D., call Julie Bergan at 617-726-0274.

TWO ATYPICAL ANTI-PSYCHOTIC DRUGS MAY BE ASSOCIATED WITH AN INCREASED RISK OF DIABETES FOR PATIENTS WITH SCHIZOPHRENIA

CHICAGO—Patients treated with the atypical anti-psychotic agents clozapine and olanzapine may be at an increased risk for insulin resistance, which is a major risk factor for diabetes mellitus, according to a study in the January issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

"Compared with the general population, life expectancy in patients with schizophrenia is shorter by as much as 20 percent, attributable to higher rates of suicide, accidental deaths, and natural causes such as cardiovascular disease, infectious disease, and endocrine disorders," according to background information in the article. "Recently, the newer 'atypical' antipsychotic agents have been linked to several forms of morbidity, including obesity; hyperlipidemia; type 2 diabetes mellitus; and diabetic ketoacidosis [a severe complication of diabetes]."

David C. Henderson, M.D., from Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues, evaluated 36 non-obese outpatients with schizophrenia or schizoaffective disorder who were treated with clozapine, olanzapine, or another medication, risperidone. Participants were given a diet to follow to maintain body weight and were told to fast for 12 hours prior to undergoing a frequently sampled intravenous glucose tolerance test.

"Both nonobese clozapine- and olanzapine-treated groups displayed significant insulin resistance and impairment of glucose effectiveness compared with risperidone-treated subjects," the researchers found.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JANUARY 3, 2005
To contact Marco Battaglia, M.D., e-mail: marco.battaglia{at}hsr.it.

VERY SHY CHILDREN MAY PROCESS SOME FACIAL EXPRESSIONS DIFFERENTLY

CHICAGO—Children who appear to have higher levels of shyness, or a particular gene, appear to have a different pattern of processing the signals of interpersonal hostility, according to a study in the January issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

According to background information in the article, "Neuroimaging studies are beginning to clarify the relationship between the brain's cortical and subcortical activity in regulating the emotional and cognitive functions of behavior." … "A temperamental disposition toward the avoidance of novel and uncertain situations together with a set of behaviors that indicate shyness and discomfort in social interactions are comprehensively named childhood shyness, or behavioral inhibition (BI). Children with high indexes of shyness-BI are at a heightened risk of developing anxiety disorders, in particular social phobia."

Marco Battaglia, M.D., from the Istituto Scientifico San Raffaele, Milan, Italy, and colleagues analyzed the responses of 49 third- and fourth-grade schoolchildren (characterized as shy) to different emotional facial expressions. The researchers showed the study participants pictures of boys and girls with facial expressions that depicted joy, neutrality, and anger. The study participants were assessed through questionnaires and responses were also recorded with electrodes measuring brain wave activity.