The principles and practice of a Behavior Modification Unit in a psychiatric hospital are described. A simple but consistent program of rewards related to privileges is employed together with attention to individual counseling and family therapy. A consecutive series of 56 patients is reported. They had a high frequency of personality disorders, behaviour disorders and past psychiatric treatment irrespective of diagnosis. Improvement was measured in terms of success, three months after discharge, in staying out of hospital and maintaining an independent existence in the community. By this criterion 42 out of 56 patients (75%) were improved. Patients who improved had had less past treatment of various types and this relationship was highly significant. The justification for this type of program is briefly discussed.
In contrast to most pediatric cancers, there is a growing body of literature, nationally and internationally, that has implicated the role of several environmental indoor and outdoor hazards in the etiology of childhood leukemia. For example, exposures to solvents, traffic, pesticides, and tobacco smoke have consistently demonstrated positive associations with the risk of developing childhood leukemia. Intake of vitamins and folate supplementation during the preconception period or pregnancy has been demonstrated to have a protective effect. Despite the strength of these findings, the dissemination of this knowledge to clinicians has been limited. Some children may be more vulnerable than others as documented by the high and increasing incidence of childhood leukemia in Hispanics. To protect children's health, it is prudent to establish programs to alter exposure to those factors with well-established associations with leukemia risk rather than to suspend judgment until no uncertainty remains. This is particularly true because other serious health outcomes (both negative and positive) have been associated with the same exposures. We draw from historical examples to put in perspective the arguments of association versus causation, as well as to discuss benefits versus risks of immediate and long-term preventive actions.
