西安地区118例哮喘患儿家长行为调查及其干预效果分析

【目的】 了解西安地区儿童哮喘患儿家长对哮喘认知水平和行为现状,采取有针对性的行为干预措施,并分析其效果,为哮喘规范治疗和管理提供依据。 【方法】 采用问卷形式进行调查,选取本院儿童哮喘门诊就诊且哮喘规范化治疗超过6个月的哮喘患儿。 【结果】 118例问卷显示:1)患儿一般情况:患儿首次喘息发病年龄平均为(5.1±3.7)岁,首次喘息发作距确诊哮喘时间为(2.3±1.6)年;患儿中有50.8%合并过敏性鼻炎、50.6％有湿疹、28.8％有哮喘家族史; 2)哮喘患儿家长行为:56.6%知道在哮喘急性发作时应该吸入速效β2受体激动剂治疗,96.6%在哮喘没有症状时会坚持用药。在选择哮喘长期治疗药物种类时,有51.7%选择吸入激素与长效β2受体激动剂联合制剂、39.6%单独吸入激素、20.6%口服白三烯拮抗剂、13.7%使用抗过敏药物。家长不愿意给患儿使用长期控制哮喘药物原因,60.3%是担心对生长发育产生影响、22.4%是担心对药物产生依赖;3)给予哮喘知识和行为低于平均得分的46例进行干预,干预后家长哮喘知识、态度和行为得分明显提高(P>0.01)。 【结论】 今后应做好哮喘患儿及家长的管理和宣教工作,提高家长的哮喘知识,改善其态度和行为水平,促进患儿的干预效果。     

School Age Workaholic Children: Type A Behaviors, Self-esteem, Anxiety and Locus of Control

The relationships between childhood workaholism and Type A behaviors among school-age children were examined in terms of their self-esteem, anxiety, and locus of control. A total of 40 elementary-school children, their parents, and teachers took a battery of tests. No relationships were found between child Type A behaviors as rated by parents and children's self-perceived workaholism, self-esteem, anxiety, and locus of control. There was no relationship between parental workaholism and any of the child instrument scores. Teachers' competitiveness ratings of children were positively related to children's internal locus of control and social self-esteem. Teachers' impatience ratings of children were negatively related to children's school self-esteem. Workaholism among the children was positively related to their anxiety and inversely related to their self-esteem and internal locus of control. Child anxiety also was inversely related to childhood self-esteem and internal locus of control.     

Can children teach their parents about asthma?

The Open Airways for Schools (OAS) program has been shown to improve the self-management skills and health outcomes of students with asthma in Grades 3 to 5. This report examines the impact of OAS on students' parents. Because pilot studies showed that parental attendance at school-based sessions was low, the authors held six sessions at school for children and gave children homework assignments to complete with parents at home to teach parents about asthma and build support for children's self-management efforts. Analysis of 1-year follow-up data showed that children's participation in OAS was a significant predictor of parental self-management skills (p <.03) and that OAS children's communication was more strongly associated than controls' with parents' self-management (p = .05). The findings show that health education activities brought home from school by children can positively influence parents' self-management of a complex chronic disease such as asthma.     

Family-Based Treatment for Pediatric Overweight: Parental Weight Loss as a Predictor of Children's Treatment Success

This study examined the relative influence of nutrition and exercise education, behavioral therapy, and parental weight loss on children's weight-related treatment outcomes. Participants included 65 children and their parents who were participating in an evidence-based multicomponential pediatric overweight intervention program. After accounting for age and sex, children's attendance at group treatment and change in health knowledge predicted 9.7% and 5.8% of the variance in children's weight change, respectively. However, the single greatest predictor of change in children's body mass index was parent weight loss, which accounted for 18.8% of the variance in the model. Findings suggest that although nutrition-exercise education and group therapy are beneficial, parental weight loss best predicts children's treatment outcomes.     

社区儿童健康管理规范实施前后家长育儿的知信行调查

目的 调查社区儿童健康管理规范实施以来试点区0~3岁儿童家长育儿知信行变化趋势及影响因素。方法 2007年和2010年分别收集试点区按照社区0~36个月儿童健康管理规范管理的791名和747名儿童家长调查问卷。采用χ2检验分析规范实施前后试点区0~3岁儿童家长育儿知识、态度、行为的变化,采用Logistic分析其影响因素。 结果 规范实施后,儿童家长对“补铁预防贫血”、“吃肝脏补铁”的知晓率明显提高,儿童家长愿意每次体检找同一个医生有所提高,家长给儿童口腔护理的行为有所改善(P均<0.05);规范实施、文化程度、户口、参加儿童保健是影响儿童家长育儿知识的主要因素;规范实施、户口、系统儿童保健机构是影响儿童家长育儿行为的主要因素。 结论 社区0~3岁儿童健康管理规范的实施在一定程度上提高儿童家长育儿知识,增强利用服务的意识,改善育儿行为。     

Predictors of psychological adjustment,experienced parenting burden and chronic sorrow symptoms in parents of children with cerebral palsy

Aim To investigate the role of child behaviour, parental coping and experiential avoidance in predicting the psychological outcomes of: (i) psychological symptoms; (ii) chronic sorrow symptoms; and (iii) experienced parenting burden in parents of children with cerebral palsy (CP). Method This study is a cross‐sectional, correlational study. Ninety‐four parents of children (aged 2–12 years) with CP (various levels of motor functioning GMFCS I–V) participated. Results Together, the three predictors of child behaviour, parental coping and experiential avoidance explained 36.8% of the variance in psychological symptoms with child behavioural problems and experiential avoidance as significant unique predictors. In addition, 15.8% of the variance in chronic sorrow symptoms was explained by the three predictors with experiential avoidance alone as a significant unique predictor. Lastly, the predictors together explained 24.3% of the variance in experienced parenting burden with child behavioural problems and experiential avoidance as significant unique predictors. Conclusions This study demonstrates a relationship between child behavioural problems and parental psychological symptoms and experienced parenting burden as well as a relationship between experiential avoidance and parental psychological symptoms, experienced parenting burden and chronic sorrow symptoms.     

Parenting Stress, Difficult Child Behavior, and Use of Routines in Relation to Adherence in Pediatric Asthma

The main purpose of this study was to evaluate the role of child behavior problems, parenting distress, and child routines in relation to children's adherence to daily medication in pediatric asthma. Participants included 45 asthmatic children and their families. Assessment included questionnaires, a medication dose-count monitor, and a brief telephone interview with the parent. Significant negative correlations were found between child care routines and both parenting distress and difficult child behavior. Medication adherence was significantly and positively correlated with both parental distress and difficult child behavior but was not significantly related to parent use of routines.     

Limited english proficiency, primary language at home, and disparities in children's health care: how language barriers are measured matters

BACKGROUND: Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. OBJECTIVES: Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. METHODS: We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. RESULTS: Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. "Dose-response" relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar "dose-response" relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. CONCLUSIONS: Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP categories are associated with different risks of adverse outcomes in children's health and health care. Consistent data collection on parental English proficiency and referral of LEP parents to English classes by pediatric providers have the potential to contribute toward reduction and elimination of health care disparities for children of LEP parents.     

Psychological distress among parents of children with mental retardation in the United Arab Emirates

This study was designed to identify predictors of parental stress and psychological distress among parents of children with mental retardation in the United Arab Emirates. It examined the relative contributions of child characteristics, parents' sociodemographics, and family environment to parental stress and psychological distress. Participants were parents of 225 mentally retarded children, of whom 113 were fathers and 112 were mothers. Measures of parental stress (QRS-F), psychiatric symptom index (PSI) and family environment scale (FES) were administered in an interview format. Hierarchical multiple regression was used to predict parental stress and psychological distress. The results indicate that the model containing all three predictor blocks, child characteristics, parents' sociodemographics, and family environment, accounted for 36.3% and 22.5% of parental stress and parents' psychiatric symptomatology variance, respectively. The age of the child was significantly associated with parents' feelings of distress and psychiatric symptom status, and parental stress was less when the child was older. Parents reported more psychiatric symptomatology when the child showed a high level of dysfunction. Fathers' work appeared to be a significant predictor of parental stress, indicating that for fathers who were not working the level of stress was higher than fathers who were working. Lower socioeconomic level was associated with greater symptom rates of cognitive disturbance, depression, anxiety, and despair among parents. Among the family environment variables, only the personal growth dimension stood out as a predictor of parental stress. An orientation toward recreational and religious pursuits, high independence, and intellectual and recreational orientations were associated with lower levels of parental stress. On the other hand, parents in achievement-oriented families showed elevated levels of parental stress. Implications for prevention, and intervention as well as parent training and system-oriented counseling programs are discussed.     

The Asthma Therapy Assessment Questionnaire (ATAQ) for children and adolescents.

The Asthma Therapy Assessment Questionnaire (ATAQ) for children and adolescents was developed to assist clinicians and health plans to identify children at risk for adverse outcomes of asthma. ATAQ is a brief, 20-item parent-completed questionnaire that generates indicators of potential care problems in several categories, including symptom control, behavior and attitude barriers, self-efficacy barriers, and communication gaps. This paper describes testing of the internal consistency and construct validity of the instrument. A cross-sectional mail survey with telephone follow-up was conducted with parents of 434 children aged 5-17 years being treated for asthma and enrolled in three managed care organizations in the Midwestern and Northeastern United States. ATAQ scales were evaluated using correlations with measures of health status, asthma impact, and healthcare utilization. ATAQ demonstrated good internal consistency and the hypothesized relationships to corresponding measures from existing instruments. Asthma control was significantly associated with measures of physical health, psychosocial health, resource use, and family impact. "Shared decision making," an indicator of patient-provider communication and involvement of the parent and child in developing asthma management plans, was significantly and positively associated with symptoms and parental satisfaction. Other ATAQ components showed similar associations. ATAQ appears to have satisfactory measurement properties and is ready for use to identify patients who might benefit from further disease management efforts or medical attention.     

Educational program on self-management for asthmatic school children

This study was conducted to improve asthmatic school children's knowledge, belief and behavior related to asthma in order to improve their control of the disease. A total of 54 school children suffering from moderate or severe asthma who are attending the allergy center affiliated to school Students' Hospital of Alexandria were enrolled in the present study. An educational intervention was provided to these asthmatic children, each one was accompanied by one of his/her parents. It consisted of two components: classes conducted in group settings and individualized monthly visits. The intervention continued for a 6-month period. An interview questionnaire was used to assess both children's and parent's knowledge and beliefs related to asthma before and after the intervention. The children's inhaler use technique was also assessed twice by an observational check list. The study revealed significant improvement in both children's and parent's knowledge and beliefs concerning asthma inhaler use technique which significantly improved and positive behavioral changes were reported. The frequency of emergency room visits (ERV) due to asthma over a 6-month period after the initial assessment was substantially less than in the prior 6-month period (p<0.05). It could be concluded that patient education can significantly affect asthmatic's knowledge and behavior and consequently morbidity as revealed by reduction of frequency of ERV. It should be considered one of the major components of asthma care.     

Self-Esteem, Health Locus of Control, and Health Attitudes Among Native American Children

Self-esteem and health locus of control have been postulated as predictors of attitudes and behaviors related to child health. The association among these variables has not been assessed adequately among Native American children. This study measured the relationship among self-esteem, health locus of control, and health attitudes of Native American fourth, fifth, and sixth grade students. A statistically significant relationship was found between self-esteem and positive attitudes toward health. Self-esteem was a modest predictor of health attitudes and health behavioral intentions among Navajo and Pueblo children.     

The usefulness of a condition-specific measure (child-report) for the evaluation of the adaptation of children with asthma

The goal of this study was to identify the distinctive contribution of the assessment of children´s asthma-specific quality of life. Children's generic quality of life, temperament, parental perception of asthma management, and the children’s perceived impact of asthma were assessed. The sample group comprised 81 children (aged between 8 and 12 years, diagnosed with asthma) and their parents. The results showed that the asthma module assesses unique aspects of living with asthma and is more sensitive to asthma severity. It also evidences stronger associations with predictors of child adaptation to asthma than the generic module, showing its usefulness in clinical practice.     

Perceived parental burden and service use for child and adolescent psychiatric disorders.

OBJECTIVES: Pediatric chronic physical illness and adult psychiatric disorders are substantial sources of burden for family care-takers, but little attention has been paid to parental burden resulting from children's or adolescents' psychiatric disorders. This paper describes the predictors of perceived parental burden and its impact on the use of specialty mental health and school services. METHODS: A representative general population sample of 1015 9-, 11-, and 13-year-olds and their parents completed structured psychiatric diagnostic interviews and the Child and Adolescent Burden Assessment. RESULTS: Weighted estimates indicated that 10.7% of parents in the general population perceived burden resulting from their children's symptomatology. Significant predictors of perceived burden were levels of child symptomatology and impairment and parental mental health problems. Children's depressive and anxiety disorders were associated with less burden than other diagnoses. The effects of child disorder severity on specialty mental health service use appeared to be mediated by the level of burden induced. CONCLUSIONS: Substantial levels of parental burden resulted from child psychiatric disorders and were a major reason for specialist mental health service use.     

Physicians' attention to parents' concerns about the psychosocial functioning of their children.

BACKGROUND: Epidemiological data indicate that approximately 20% of children have psychosocial problems, yet less than 2% of children are seen by mental health specialists each year. Primary care physicians tend to identify children with psychosocial problems when parents discuss concerns with them. OBJECTIVE: To examine factors related to physicians' attention to parental disclosures. DESIGN: Parents reported the psychosocial functioning of themselves and their children. Physicians reported the psychosocial functioning of 75 children and whether the parent disclosed psychosocial concerns to them. SETTING: Ambulatory care clinic of a community-based, university-affiliated, residency training program. PARTICIPANTS: Seventy-five parents of children aged 2 to 16 years who presented for routine primary care, and 26 physicians. MAIN OUTCOME MEASURES: Beck Depression Inventory (parental distress), Eyberg Child Behavior Inventory (child behavior problems), physician and parent report. RESULTS: Physicians identified 50.0% of children with clinically significant behavior problems. Logistic regression indicated that parental disclosure was the only significant predictor of physician identification (P < .002). When children had clinically significant behavior problems, physicians were more likely to report disclosures by parents (45.0% vs 5.7% for parents of children with and without behavior problems, respectively). Physicians were more likely to report parental disclosure when parents reported personal psychosocial distress (38.9% for distressed vs 5.7% nondistressed parents). CONCLUSIONS: Parental disclosure of concerns was a better predictor of physician identification of child psychosocial problems than was the presence of child behavior problems. Physicians responded more frequently to the disclosures of potential problems by parents of children with clinically significant psychosocial problems. They also attended more frequently to disclosures about behavior problems when the parent was also experiencing psychosocial distress.     

A Comparison of Knowledge about Asthma Between Asians and Non-Asians at Two Pediatric Clinics

Little is known about the relative knowledge of asthma in recent immigrant Asian populations in the United States (US). To comparatively assess asthma knowledge for Asian and non-Asian populations, 333 parents and children were surveyed at two geographically close urban clinics that had a large percentage of Asian patients, most of whom were Chinese. The Asian respondents scored lower compared to the non-Asian respondents on 4 of the 6 knowledge questions (p < 0.001). Subcategories of non-Asians (white, African-American, Hispanic) were more similar to each other than they were to Asians. In multivariate analysis we found that SES (measured as parental occupation) and being Asian were independent predictors of less asthma knowledge. Having family members with asthma did not improve knowledge scores. A single focus group of Cantonese-speaking parents of asthmatic children suggested that a combination of cultural factors and lack of knowledge contribute to lower knowledge scores in this Asian population. Asthma education programs need to be developed, tailored to recent Asian immigrants and tested for efficacy.     

Childhood asthma and environmental interventions

BACKGROUND: Contaminants encountered in many households, such as environmental tobacco smoke, house dust mite, cockroach, cat and dog dander, and mold, are risk factors in asthma. Young children are a particularly vulnerable subpopulation for environmentally mediated asthma, and the economic burden associated with this disease is substantial. Certain mechanical interventions are effective both in reducing allergen loads in the home and in improving asthmatic children's respiratory health. RESULTS: Combinations of interventions including the use of dust mite-impermeable bedding covers, improved cleaning practices, high-efficiency particulate air vacuum cleaners, mechanical ventilation, and parental education are associated with both asthma trigger reduction and improved health outcomes for asthmatic children. Compared with valuated health benefits, these combinations of interventions have proven cost effective in studies that have employed them. Education alone has not proven effective in changing parental behaviors such as smoking in the home. CONCLUSIONS: Future research should focus on improving the effectiveness of education on home asthma triggers, and understanding long-term children's health effects of the interventions that have proven effective in reducing asthma triggers.     

An Evaluation of the Effects of INSIGHTS on the Behavior of Inner City Primary School Children

A prevention trial was conducted to evaluate a temperament-based intervention (INSIGHTS into Children's Temperament) as compared to a Read Aloud attention control condition in reducing behavior problems among inner city children. The participants were 148 inner-city first and second grade children, their parents, and their 46 teachers who were from six schools in a Northeastern city. Parents were interviewed on the Parent Daily Report at baseline and every two weeks until the completion of the intervention phase to assess the extent of child problem behaviors in the home. The parents also were interviewed at baseline with the Disruptive Module of the Diagnostic Interview for Children and completed the Brief Symptom Index to assess parental depression. A repeated measures multivariate analysis of covariance with parental depression as a covariate was conducted to examine the children's behavior over the course of the intervention. In order to test the impact of INSIGHTS for the overall sample and to determine whether the intervention was differentially effective for children diagnosed with a disruptive disorder versus those who did not receive a diagnosis, two and three-way interactions were examined and found to be significant. The INSIGHTS intervention was more effective than Read Aloud in reducing children's problem behaviors at home across both the diagnosed and non-diagnosed groups, but demonstrated a significantly greater efficacy among children who were at diagnostic levels compared to those who were within normal levels. Editors' Strategic Implications: The authors describe the promising practice of instructing parents and teachers on how to adapt their behavior management strategies to fit each child's temperament. Replication with a longitudinal follow-up will be necessary to determine whether program effects persist.     

Transferring a Clinic-based Health Education Program for Children with Asthma to a School Setting

Open Airways is a clinic-based health education program for low income, inner city families of children with asthma. The program was transferred to the public schools to test it in a setting more representative of school-age children with asthma, and to provide health education for families not receiving medical care for asthma. During the transfer, the program changed from placing primary responsibility for management on parents to a child-centered program independent of direct parental involvement. Children's attendance increased greatly and a significant number of families not receiving regular medical care for asthma enrolled. Preliminary analysis showed the child-centered program improved children's school performance and asthma management skills. The findings of this study suggest health education programs designed for medical care settings can be adapted successfully for use in the schools and reach new populations of children with chronic diseases.     

中小班学龄前儿童父母亲职压力与儿童心理状况的影响因素研究

目的 了解中小班学龄前儿童父母亲职压力状况及其与儿童心理状况的关系,以期为幼儿教育和心理工作的拓展提供依据。方法 采用横断面调查研究,收集上海某幼儿园学龄前儿童51名,采用亲职压力量表(PSI)和长处与困难问卷(SDQ)对其父母进行评定。结果 1)学龄前男童、女童在PSI儿童适应性(t=2.376,P<0.05)、接受度(t=2.517,P<0.05)、儿童总分(t=2.104,P<0.05)差异有统计学意义;2)学龄前男童、女童在SDQ行为问题因子分(t=2.064,P<0.05)和社交行为因子分(t=-2.743,P<0.01)的差异有统计学意义;3)SDQ困难总分与PSI总分显著正相关(P<0.01),SDQ各因子与PSI多个因子分相关(P均<0.05);4)半年后随访,PSI总分及儿童注意不能多动、适应性、要求、心境、接受度,父母竞争性、依恋性较基线时升高(P均<0.05)。结论 健康学龄前女童行为问题少于男童,社交行为优于男童。健康学龄前女童家长感受到的亲职压力较男童家长少。亲职压力与儿童行为表现相关,学龄前期随着儿童年龄的增长家长感受到的亲职压力也有所增长。