This study investigated the effects of early institutional care on memory and executive functioning. Subjects were participants in the Bucharest Early Intervention Project (BEIP) and included institutionalized children, children with a history of institutionalization who were assigned to a foster care intervention, and community children in Bucharest, Romania. Memory and executive functioning were assessed at the age of 8 years using the Cambridge Neuropsychological Test and Automated Battery (CANTAB). As expected, children with a history of early institutional care performed worse on measures of both visual memory and executive functioning compared to their peers without a history of institutional care. In comparing children randomly assigned to the foster care intervention with their peers who had continued care in the institution, initial comparisons did not show significant differences on any of the memory or executive functioning outcomes. However, for one of the measures of executive functioning, after controlling for birth weight, head circumference, and duration of time spent in early institutional care, the foster care intervention was a significant predictor of scores. These results support and extend previous findings of deficits in memory and executive functioning among school-age children with a history of early deprivation due to institutional care. This study has implications for the millions of children who continue to experience the psychosocial deprivation associated with early institutional care.
Children raised in institutions, considered an extreme example of social deprivation, are one group through which we can better understand the impact of neglect on child health and development. The Bucharest Early Intervention Project (BEIP) is the first randomized, controlled trial of foster care as an intervention for institutionalized children. In this review we describe the mental health outcomes from the BEIP. Specifically, we report findings on attachment styles, attachment disorders, emotional reactivity, and psychiatric symptomatology for children in the BEIP. We describe the impact of the foster care intervention on these outcomes and also describe how outcomes differ by gender and by length of time spent in the institution. In addition, we explore the influence of genetic variation on individual outcomes and recovery from early severe social deprivation, as well as the role of differences in brain development in mediating later psychiatric morbidity. The results from the BEIP confirm and extend the previous findings on the negative sequelae of early institutional care on mental health. The results also underscore the benefit of early family placement for children living in institutions.
Children raised in institutions frequently suffer from a variety of behavioral, emotional, and neuropsychological sequelae, including deficits in attention, executive functions, disorders of attachment and in some cases a syndrome that mimics autism. The extent and severity of these disorders appears to be mediated, in part, by the age at which the child entered and, in some cases, left the institution. Here we review the neurobiological literature on early institutionalization that may account for the psychological and neurological sequelae discussed in other chapters in this volume.
Because many disenfranchised Americans use the ED as a regular source of health care, increased attention to smoking in the ED setting holds tremendous public health potential. This study's results reinforce the validity of the stage-of-change model within the ED setting. Developers of ED-initiated interventions will have to consider the heterogeneity in stage of change when designing their treatments.
Objectives: As an initial step in disseminating an emergency department (ED)-based quality improvement program (QIP) to improve antibiotic prescribing for patients with acute respiratory infections, the authors conducted a nationwide survey to assess the value and feasibility of the QIP. Methods: Directors of EDs at 119 Veterans Administration hospitals and 160 non-Veterans Administration hospitals (identified based on the existence of accredited emergency medicine training programs and/or participation in an existing ED-based research network) were surveyed. The survey included questions on the current existence of an antibiotic QIP in the ED, enthusiasm for an antibiotic QIP program, and the existence of physical features in the ED that would support the QIP intervention. Results: Overall, 77% of ED directors reported they did not have an existing antibiotic QIP and 84% reported they would benefit from having such a program (either new or in addition to their current program). In addition, 63% of respondents indicated that improving antibiotic prescribing was an intermediate to high priority in the ED. Forty-five percent reported that they did not have a suitable location for a key component of the intervention (an interactive computer kiosk), and 26% reported that they could not display educational posters on the walls of the examination room. Conclusions: Many EDs identify barriers to implementing an antibiotic QIP. Perceived and real barriers are important factors to consider in translating successful QIPs into routine clinical practice. Key words: emergency medical services; data collection; quality improvement. ACADEMIC EMERGENCY MEDICINE 2005; 12:667-670. Over the past several years, there has been a substantial growth in quality improvement research.1 However, such research is often conducted in settings where the perceived value of the intervention is high and the practical barriers to implementation are low. As a result, successful quality improvement programs (QIPs) may have limited applicability to other clinical sites and may be poorly reproducible. 2Emergency departments (EDs) are an important setting for testing and disseminating QIPs.3 One area that has been relatively ignored in these ED-based QIPs is the overuse of antibiotic drugs for the management of patients with acute respiratory tract infections. The aim of this study was to describe the perceived benefits and feasibility of an ED-based antibiotic QIP across a national sample of hospital sites, both as a first step to identify sites for a randomized trial of the antibiotic QIP and as a means of estimating the acceptability of the program across a broad range of potential sites. METHODSStudy Design. We conducted a cross-sectional study of hospital EDs and urgent care centers in August 2003. This study was approved by the institutional review board at each of the authors' institutions.Survey Content and Administration. Our questionnaire was developed to measure two domains: 1) the perceived benefit of an antibiotic QIP improveme...
Because many disenfranchised Americans use the ED as a regular source of health care, increased attention to smoking in the ED setting holds tremendous public health potential. This study's results reinforce the validity of the stage-of-change model within the ED setting. Developers of ED-initiated interventions will have to consider the heterogeneity in stage of change when designing their treatments.
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