Recent studies indicate that antiviral treatment with pegylated interferon alfa and ribavirin for hepatitis C can be individualized based on viral and host characteristics and the pattern of virologic response during the initial months of antiviral treatment. Patients with a low initial viral load who demonstrate a rapid virologic response to antiviral therapy may be treated with a shorter duration of therapy and are less sensitive to reduced dosing of ribavirin. Patients with delayed virologic response will require a longer duration of therapy - up to 72 weeks for patients with genotype 1 - in order to optimize chances of a sustained virologic response. Patients who were nonresponders or relapsed after an acceptable course of antiviral therapy may be retreated using a more intensive regimen and/or a longer duration of therapy. Previous nonresponders to pegylated interferon alfa and ribavirin are less likely to respond to retreatment unless they demonstrate a virologic response within the first three months of retreatment, lack advanced fibrosis, and can tolerate a more intensive and/or lengthier treatment. Individualized treatment based on viral genotype, viral load, the presence of advanced fibrosis, and initial virologic response can improve therapy for some patients and save resources in others.
Fibrosis ; Genotype ; Hepatitis C ; Humans ; Interferon-alpha ; Interferons ; Retreatment ; Ribavirin ; Viral Load

This research was aimed at developing a model for school mental health service. Subjects were students at two elementary schools located in an urban community. The goals of the study included, 1) early detection and intervation in children with mental health problems, 2) developing educational programs for parents and teachers ; 3) developing programs linking mental health resources in the community with the school system(school consultation, telephone counselling, and group activities for high risk-students). Subjects wars 1,732 students at 2 primary schools in a community of Seoul. Problem children were selected through screening with CBCL and were examined by psychiatrists. The results were as follows: 1) Of 1,732 students, nearly 8% had mental health problems. The parents of the students with mental health problems were urged to seek psychiatric care. However, only 8% of them had a positive response. On the other hand, telephone counselling was preferred and 40% of them said they had visited a psychiatric clinic. 2) Regarding the education of parents, they preferred telephone counselling and written information to direct counselling or participating in education programs. In most cases, they avoided talking about their children's problems. 3) Teachers showed a good sense for ducting children's mental health problems, but they suffered from a fueling of helplessness because of lack of knowledge and skills. 4) Special education programs were needed f)r students with serious behavior problems. Group activities, which were directed by college student volunteers, had been proved to be effective in helping children with high risks. 5) This suggests that the stigma for mental disorder is still an obstacle in mental health service and that fechers need on-going systemic education on children's mental health since college period. Based on these study results, the authors suggest a model of school mental health service linking the school system, family(parents) and professional mental health resources in the community.
Child ; Education ; Education, Special ; Hand ; Humans ; Mass Screening ; Mental Disorders ; Mental Health Services* ; Mental Health* ; Parents ; Psychiatry ; Seoul ; Telephone ; Volunteers

As an initial step for promoting a mental health service for elementary school children, a school-based epidemiologic study on children's mental problems and their social background was conducted. The subjects were 3,021 students from 20 elementary schools in a rural community in Korea. The epidemiologic study consisted of two stages, initial screening using the Child Behavior Check List(CBCL) and a structured psychiatric evaluation. After the study, we received feedback from teachers and parents. The results were as follows: 1) Initially, 251(8.3%) students with total CBCL score higher than 54 were selected as problem children. Among the 251 students, only 31 had completed a structured psychiatric evaluation, and 71%(22 students) of them met the DSM-III-R citeria of psychiatric disorders. 2) Attention deficit hyperactivity disorder was the most common problem in both sexes, followed by oppositional defiant disorder in males and depression and anxiety disorder in females. Other students also had borderline intellectual functioning, learning disorders, somatoform disorder, sleep disorder and obsessive-compulsive disorder 3) The socio-environmental factors that were significantly related with mental health problems were poor economic status and little education in parents, no family religion, and children living with their maternal grandmother or with a single parent. Students who had mental problems also showed low levels of social competence. 4) The feedback from parents and teachers showed that the stigma of mental disorders, limitations of available time, and a poor understanding and lack of knowledge on the par of parents and teachers were the major obstacles in mental health service. Based on these results, the future direction of research and practice of school mental health was discussed.
Anxiety Disorders ; Attention Deficit and Disruptive Behavior Disorders ; Attention Deficit Disorder with Hyperactivity ; Child ; Child Behavior ; Depression ; Education ; Epidemiologic Studies ; Female ; Humans ; Korea ; Learning Disorders ; Male ; Mass Screening ; Mental Competency ; Mental Disorders ; Mental Health Services* ; Mental Health* ; Obsessive-Compulsive Disorder ; Parents ; Rural Population ; Single Parent ; Somatoform Disorders