Medical management of asthma and folk medicine in a Hispanic community

OBJECTIVE: To describe beliefs about asthma and asthma treatment in a Hispanic (Dominican-American) community to determine how alternative belief systems affect compliance with medical regimens. METHOD: Twenty-five mothers of children with asthma were interviewed in their homes, in their primary language, Spanish. Mothers were questioned about their beliefs regarding asthma etiology, treatment, prevention of acute episodes, and use of prescribed medications. RESULTS: Most mothers (72%) said that they did not use prescribed medicines for the prevention of asthma; instead, they substituted folk remedies called "zumos." The home remedies were derived from their folk beliefs about health and illness. Most mothers (60%) thought that their child did not have asthma in the absence of an acute episode. Eighty-eight percent said that medications are overused in this country and that physicians hide therapeutic information from them. CONCLUSIONS: Mothers' reliance on home remedies for asthma prevention leads to a high rate of noncompliance with prescribed regimens. Yet they perceive themselves as compliant with an effective regimen that differs from standard medical practice. Further studies should explore ways of promoting physician/patient communication in order to find ways of coordinating medical and folk beliefs to enhance compliance with medically prescribed regimens.     

An attempt to reconstruct children's donor concept: a comparison between children's and lesbian parents' attitudes towards donor anonymity

BACKGROUND: This study investigated the donor concept of children who were born by means of donor insemination (DI), and their lesbian parents. METHODS: A total of 41 children aged between 7 and 17 years, and 45 parents, took part in the follow-up study. In-depth topic interviews were used to reconstruct how DI children and their mothers perceived the donor. Data were collected about the birth story, about children's conversations with their mothers concerning donor characteristics and about children's and parents' attitudes towards the status of the donor. RESULTS: 54% of these children preferred donor anonymity at this point in their life, whereas 46% wanted to know more about the donor. The majority of the latter group would have liked to know the donor's identity, with boys outnumbering girls. The remaining children of this group were content with non-identifying information. Children wanted to know more about the donors whereas the majority of the mothers preferred the donor to remain anonymous. CONCLUSIONS: Our results suggest that among DI children in general and among members of the same family, unit opinions differ on the status of the donor. A flexible system offering different types of donors seems to be necessary in order to meet the needs of each family.     

Maternal determinants of pediatric preventive care utilization among blacks and whites

OBJECTIVE: We assessed maternal characteristics that were predictive of preventive care utilization among children 0-5 years and compared black-white differences in preventive care usage. METHOD: We used the 1996-2000 series of public use files from the Medical Expenditure Panel Survey (MEPS). Receipt of preventive care was defined as up-to-date immunization coverage of the child and at least one dental visit during the year. RESULTS: A total of 10,525 children were analyzed consisting of 2,090 blacks (19.9%) and 8,435 whites (80.1%). Black mothers were in general older and less educated. Black households were larger in size and contained a greater number of children. Black mothers earned, on average, much less than their white counterparts even though they tended to be more frequently employed than whites. Despite similar levels of insurance coverage for both racial groups, the overwhelming majority of white mothers were privately insured (73.2%), in contrast to only about half of blacks with private insurance coverage [54.3% (p < 0.0001)]. Overall, the level of pediatric preventive services utilization was a paltry 15.4%. Children of black mothers were significantly less likely to receive preventive care than whites (OR = 0.78; 95% CI = 0.64-0.94). Other determinants of preventive care use were maternal age, insurance coverage, education and family size. Older, educated mothers with insurance coverage and reduced family size were more likely to have their children immunized and have dental visits. CONCLUSION: Maternal characteristics are important markers that indicate the risk for underutilization of pediatric preventive care. A particularly important finding with policy implication is the observation that maternal insurance coverage enhances pediatric preventive care use. Health policy planners may consider parallel insurance coverage of both the child and the mother in order to enhance receipt of preventive health services by the child.     

Validation of the Spanish and English versions of the asthma portion of the Brief Pediatric Asthma Screen Plus among Hispanics.

BACKGROUND: The health and health care needs of non-English-speaking Hispanic families with children are poorly understood, in part because they are often excluded from research owing to language barriers. Instruments that are valid in English and Spanish are necessary to accurately evaluate the magnitude of asthma prevalence and morbidity among Hispanics. OBJECTIVE: To establish the sensitivity and specificity of the English and Spanish versions of the asthma portion of the Brief Pediatric Asthma Screen Plus (BPAS+) in a low-income Hispanic population. METHODS: The validation sample consisted of 145 children whose parents completed the BPAS+ in Spanish and 78 whose parents completed it in English. Bilingual clinicians conducted the examinations on which the clinical assessments were based. We compared the BPAS+ results with the clinical assessment findings to determine the sensitivity and specificity of the BPAS + among Hispanics in terms of identifying children who warrant further medical evaluation for asthma. RESULTS: The sensitivity and specificity of the asthma portion of the Spanish BPAS+ were 74% and 86%, respectively. The sensitivity and specificity of the asthma portion of the English BPAS+ were 61% and 83%, respectively. CONCLUSIONS: The asthma portion of the BPAS+, a valid screen for identifying children who are in need of further evaluation for potentially undiagnosed asthma, is valid for low-income Hispanics in Spanish and English. As the Hispanic population continues to grow, it is imperative that researchers have English and Spanish instruments that are valid for this population.     

Parent-child factors and their effect on communicating BRCA1/2 test results to children

The purpose of the present study was to evaluate the likelihood and the effect of parent-child factors on communicating about maternal genetic test results for breast/ovarian cancer risk. Subjects were 42 mothers enrolled in a hereditary breast cancer research program who reported on their interactions with 68 target children. Predictor variables (demographic, clinical, and psychological) were assessed at baseline after mothers participated in a comprehensive genetic counseling/education session and provided a blood sample for BRCA1/2 mutation analysis. Maternal communication of test results to children was assessed 1 month after mothers learned their mutation status. The rate of disclosure to pediatric-age children was 53%. Older children were more likely to be informed of their mothers' test results than were younger children. Maternal disclosure of genetic test results to children was also more likely to occur in the presence of more open parent-child communication styles, though the act of disclosing did not appear to impact communication style. These findings suggest that in addition to developmental phase, family behavioral interactions and communication styles are strongly predictive of whether or not mothers choose to share cancer genetic risk information with their children.     

Factors influencing African-American mothers' concerns about immunization safety: a summary of focus group findings

OBJECTIVE: To examine the vaccine safety concerns of African-American mothers who, despite concerns, have their children immunized. METHODS: Six focus groups of Atlanta-area African-American mothers who were very concerned about vaccine safety but whose children were fully vaccinated were conducted. RESULTS: Major factors influencing participants' concerns about immunizations included: lack of information and mistrust of the medical community and government. Factors that convinced parents to have their child immunized despite their concerns included social norms and/or laws supporting immunization and fear of the consequences of not immunizing. Suggestions given to reduce concerns included improving available information that addressed their concerns and provider-patient communication. CONCLUSIONS: Addressing mothers' concerns about immunization is important both from an ethical perspective, in assuring that they are fully informed of the risks and benefits of immunizations, as well as from a practical one, in reducing the possibility that they will decide not to immunize their child. Changes in the childhood immunization process should be made to reduce parental concern about vaccine safety. Some changes that may be considered include improved provider communication about immunizations and additional tailored information about the necessity and safety of vaccines.     

Levels of aspiration of parents for their asthmatic, diabetic, and healthy children

This study employed a modified Rotter Level of Aspiration (LOA) task to assess parents' goal setting for their children. The sample of 64 children (ages 6 to 13) and their 128 parents contained 16 triads from each of four groups: Asthmatic, asthma sibling, diabetic, and normal. Parents indicated their own goals for their children and could influence the goals that the children set for themselves. Aspects of general family functioning also were assessed. Mothers of asthmatic children showed no significant goal setting differences from comparison mothers. These mothers were less, rather than more, controlling, and there was no support for the theory that mothers of asthmatic children are narcissistically overcontrolling. Fathers of asthmatics were more rigid and less accommodating in their goal setting, and fathers of all chronically ill children had higher LOAs than did control fathers.     

The effect of cigarette smoke from the mother on bronchial responsiveness and severity of symptoms in children with asthma

The effect of parental smoking was assessed in 94 consecutively observed children, aged 7 to 17 years, who had a history of asthmatic wheezing. The 24 children whose mothers smoked, when they were compared with children whose mothers did not smoke, had 47% more symptoms, a 13% lower mean FEV1 percent, a 23% lower mean FEF25-75%, and fourfold greater responsiveness to aerosolized histamine. A dose response was evident. There was a highly significant correlation between the results of the tests and the number of cigarettes the mother smoked while she was in the house. The differences between the children of smoking and nonsmoking mothers were greater in older than in younger subjects. The smoking habits of the father were not correlated with the severity of the child's asthma.     

Mothers' Adult Attachment Interview ratings predict preschool children's IQ following domestic violence exposure

This study examined links between mothers' Adult Attachment Interview ratings (AAI; Main, Goldwyn, & Hesse, 2003) and their preschool children's IQ among 70 families who had experienced domestic violence. As predicted, children displayed significantly stronger verbal and perceptual-organizational abilities when their mothers exhibited more secure, i.e. coherent, states of mind regarding attachment. Mothers' coherence of mind on the AAI explained 18% of the variance in children's Verbal IQ and 12% of the variance in children's Performance IQ, after controlling for maternal education. Mothers' attachment security also was related to children's total IQ score, but this association was accounted for by effects on children's Verbal IQ. Children whose mothers were rated as unclassifiable on the AAI and those whose mothers were unresolved/insecure had lower IQ scores. Although mothers who appeared more secure on the AAI were more sensitively responsive toward their children, mediational analyses suggested that there was a direct link between mothers' security and children's IQ that was not explained by sensitive parenting. This suggests that clinical interventions for children exposed to domestic violence should include helping their mothers achieve coherent ways of thinking about their own childhood experiences, including past trauma.     

Fears and anxiety in children with long-QT syndrome compared to children with asthma

OBJECTIVE: To compare children with asthma to children with long-QT syndrome (LQTS) in terms of anxiety and medical fears. METHOD: Forty children (25 males/15 females) with asthma and their mothers participated, along with seven children with LQTS (four males/three females) and their mothers. RESULTS: Children with asthma had significantly more medical fears, fear of danger/death, and fear of minor injury and small animals compared to children with LQTS. Children with LQTS tended to have more fear of failure and criticism, and tended to keep their feelings to themselves and minimize their real feelings of anxiety. Children with LQTS had significantly more internalizing problems, and their mothers had significantly higher anxiety. CONCLUSION: Fear and uncertainty can be overwhelming in LQTS. Children with LQTS do not seem to be able to share their feelings openly. Examining the psychosocial adjustment of affected children may assist professionals to help families to cope more effectively.     

All in the family: evaluation of the process and content of sisters' communication about BRCA1 and BRCA2 genetic test results.

Despite the potential importance of family communication, little is known about the process and content of communicating BRCA1/2 test results to relatives. The objectives of this observational study were to describe the process and content of communicating BRCA1/2 test results to sisters, and to evaluate whether the proband's carrier status influenced communication outcomes. Participants were 43 women who were the first family member to have genetic testing (probands). Probands reported on communication outcomes for 81 sisters. Process and content variables were evaluated 1-month after receipt of BRCA1/2 test results using the Family Communication Questionnaire (FCQ). Overall, BRCA1/2 test results were communicated to 85% of sisters, and carriers communicated their results to significantly more sisters compared to uninformative (96% vs. 76%, FET = 0.02). The most important reason for communicating results was to provide genetic risk information; however, compared to uninformatives, carriers communicated their results to significantly more sisters to obtain emotional support (74%) and to get advice about medical decisions (42%) (FET = 0.001). Carriers also discussed the possibility of discrimination and recommendations for cancer management with significantly more sisters. Among sisters to whom BRCA1/2 test results were not communicated, the most important reason for not sharing test results was because of emotionally distant relationships. The results of this study suggest that probands are likely to quickly communicate their BRCA1/2 test results to relatives and that although needs for social support may motivate family communication, emotionally distant relationships may be a barrier to communication with relatives.     

Psychiatric intervention in primary care for mothers whose schoolchildren have psychiatric disorder.

BACKGROUND. Psychiatric disorder in schoolchildren has been linked to increased general practice attendance rates. This increase may, in part, be a result of maternal stress focused on the disturbed child, and of a decrease in confidence in parenting. AIM. A study was undertaken to pilot the feasibility of a single session, psychiatric intervention in primary care for mothers of disturbed children and to examine uptake rates and reported immediate and long-term effects. METHOD. Single psychiatric sessions by a child psychiatrist in general practice were offered to mothers of 26 schoolchildren. The schoolchildren (age range 7-12 years, mean nine years) were frequent attenders in general practice with physical symptoms, and were identified from research interviews carried out with a parent (usually their mother) as psychiatrically disordered. The main outcome measures were the mothers' ratings of helpfulness of the intervention; degree of behavioural, emotional or health problems in their children and confidence in managing them; the Rutter A parental behaviour questionnaire; and children's yearly general practice attendance rates. RESULTS. Sixteen mothers (62%) who were offered appointments attended for the intervention. Nine of the 14 who responded at three-month follow up (64%) reported that the intervention had been markedly or extremely helpful. The main areas of perceived improvement at both three months and at 18-24 months were in the child's behaviour, emotional and health problems, and in the mother's confidence in dealing with these. Mothers also found the specific advice discussed and the ability to talk to somebody about the problems helpful. Mothers were less likely to find the intervention extremely or markedly useful where the child had had previous psychiatric intervention. The mean yearly attendance rate for the whole group of 23 children (data missing for three) decreased from 6.5 consultations before the intervention to 2.8 afterwards; there was a non-significant trend for the drop in attendance to be more marked in the group whose mothers attended the intervention and who felt helped by it, than among the group of children whose mothers only reported finding the intervention slightly useful. CONCLUSION. Standardized child psychiatric interventions which may be used in the primary care setting appear acceptable and may be helpful to mothers in addressing psychiatric disorders associated with somatic presentation in their schoolchildren.     

Association of allergic symptoms in children with those in their parents

This study investigated the association of asthma, allergic rhinitis, and eczema in United Arab Emirates (UAE) schoolchildren with allergic conditions in their parents. A cross-sectional, population-based study among schoolchildren aged 6–14 years was conducted in Al-Ain City, UAE. The field survey was conducted from October 1992 to May 1993. A questionnaire was distributed to 850 UAE government school students from representative, randomly selected schools with a majority of UAE nationals. The student and both or either of the parents were present during the interview. A detailed clinical history of asthma and wheezing in the target children and a history of asthma and allergic rhinitis in their parents and siblings were obtained. It was found that 13.1% of asthmatic children had mothers with asthma (relative risk (RR) = 2.67; 95% confidence intervals (CI)= 1.65–4.35), and 15.2% had fathers who were asthmatic (RR = 2.85; 95% CI = 1.81–4.49). This contrasted with 4.4% of nonasthmatic children who had fathers with asthma, and 4.1% who had mothers with asthma. A similar pattern was seen with symptoms of allergic rhinitis when it was found that 34.3% of children who had asthma had mothers with allergic rhinitis (RR: 2.74; 95% CI: 1.90–3.94). The corresponding figure for fathers was 12.7% (RR: 0.92; 95% CI: 0.5–1.7). The frequency of either parent of the asthmatic children having allergic rhinitis was 28.6%; for both parents, it was 14.5%. It was also found that asthmatic children had 12.5% of their fathers, 32.8% of their mothers, 26.4% of either of their parents, and 33.3% of both their parents suffering from allergic rhinitis. Siblings of the asthmatic children were also studied to establish the relationship between allergic conditions in the siblings and asthma in the study sample. It was found that in the asthmatic study population the frequency of siblings having asthma was 31.9%; of those having allergic rhinitis, 21.3%; and of those having eczema, 16.1%. Twenty-nine percent of either of the parents of the children with eczema had the same condition, and the corresponding figure for allergic rhinitis was 36.5%. The prevalence rate of asthma in the schoolchildren studied increased dramatically to 22% when wheeze, asthma, or nocturnal cough were grouped together. When eczema and allergic rhinitis were also considered together along with the above, the rate increased to 31%. The size of the family did not seem to affect the parent/child association of allergic symptoms. Our findings indicate that there is a strong association between respiratory allergies and eczema in parents and in their asthmatic children, thereby indicating a strong genetic basis for the occurrence of asthma in particular and atopy in general.     

影响精神发育迟滞儿童母亲心理健康的主要因素

目的探讨影响MR儿童母亲心理健康的主要因素。方法采用症状自评量表、家庭环境量表中文版和自编的一般状况调查表对263例MR儿童的母亲进行调查。结果MR儿童母亲在SCL-90中除恐怖因子外其他因子均显著高于对照组,差异具有统计学意义（P〈0.01）,家庭经济水平、母亲文化程度、家庭环境中的矛盾性、娱乐性是主要影响因素。结论MR儿童母亲心理健康问题应受到关注。     

Mothers' intentions and the immunization of their infants

One hundred and seventy-eight mothers who had recently been delivered were interviewed before discharge from hospital to ascertain their initial intentions about vaccination of their children. Nine months later the behaviour of 154 mothers was checked from health service records; 24 were lost to follow-up.

One hundred and forty-one (92 per cent) of the infants had received at least one dose of vaccine against polio, diphtheria and tetanus. Eighty-five infants (63 per cent of 135) had received at least one dose of vaccine against whooping-cough; 19 mothers had been advised against the vaccine. Failure to have their children vaccinated against whooping-cough correlated with the mothers' initial intentions, although a high proportion of mothers who were initially against the vaccine had started vaccination by the time their child was nine months old. Mothers attending general practitioners were more likely to have their infants vaccinated against whooping-cough than those attending community health clinics, and this difference was not explained by the social characteristics of the mothers nor by more positive early intentions among the mothers who attended general practitioners.

     

Mothers’ Intentions to Support Children’s Physical Activity Related to Attention and Implicit Agreement with Advertisements

Background

ParticipACTION’s Think Again campaign targeted mothers who think their children are sufficiently active, yet whose children do not achieve recommended amounts of physical activity.

Purpose

This research examined the relationship of mothers’ intentions to support children’s physical activity with explicit believability and implicit agreement with the Think Again campaign message, attention paid to the advertisement, involvement with the issue, concern regarding children’s inactivity, and attitudes.

Method

Participants were mothers from Edmonton, Canada (N?=?102) who viewed one Think Again advertisement then completed a measure of implicit agreement with the campaign message and questionnaires.

Results

The mothers who paid attention to the message and were concerned for their own children were more likely to intend to act on campaign messages. The majority of participants implicitly agreed that children’s physical inactivity was a problem, but there was less agreement that physical inactivity was a problem for their own children.

Conclusion

Participants automatically tended to agree with campaign messages when the focus was on children in general, but there was greater disagreement when asked about participant’s own children. Why most mothers were not in agreement with the reality of how much physical activity their children needs remains to be determined.     

Developmental and Family Correlates of Children's Knowledge and Attitudes Regarding AIDS

Assessed developmental and family variables associated withchildren's knowledge of and emotional attitudes toward AIDS.Participants included 65 first to sixth graders from two privateelementary schools and their mothers. Between-groups comparisonsshowed that children knowledgeable about AIDS were older andhad more mature illness concepts than children who were notknowledgeable. Among children who were knowledgeable about AIDS,a relatively negative attitude toward AIDS was associated witha negative attitude toward illness in general. Moreover, thechildren's attitude toward AIDS was more negative than theirattitudes toward other serious illnesses. Family relations andmaternal AIDS-related knowledge and attitudes were linked withneither children's knowledge nor their attitudes.     

The impact of family asthma management on biology: a longitudinal investigation of youth with asthma

This study examined longitudinal associations of asthma management-related beliefs and behaviors with changes in asthma-relevant biological markers in a sample of 43 children with asthma. Children (M age = 12.4, 75% male) and parents were interviewed about asthma management beliefs and behaviors. Asthma outcomes included lung function (FEV₁%), eosinophil counts, and daily cortisol measured at two time points, 18 months apart. Children with a less sophisticated disease belief (termed the “no symptoms, no asthma” belief) displayed eosinophil counts that increased over time, controlling for baseline levels. Poorer family asthma management was associated with increasing eosinophil counts over time. Poorer child asthma management was associated with cortisol output that declined over time. Further, families who reported poorer collaboration with their physician had children who displayed worsening lung function over time. These findings suggest that interventions aimed at teaching families better asthma management approaches and more accurate disease beliefs may have the potential to alter biological profiles in children with asthma.     

Gene-Environment Interaction in Adults’ IQ Scores: Measures of Past and Present Environment

Gene-environment interaction was studied in a sample of young (mean age 26 years, N = 385) and older (mean age 49 years, N = 370) adult males and females. Full scale IQ scores (FSIQ) were analyzed using biometric models in which additive genetic (A), common environmental (C), and unique environmental (E) effects were allowed to depend on environmental measures. Moderators under study were parental and partner educational level, as well as urbanization level and mean real estate price of the participants' residential area. Mean effects were observed for parental education, partner education and urbanization level. On average, FSIQ scores were roughly 5 points higher in participants with highly educated parents, compared to participants whose parents were less well educated. In older participants, IQ scores were about 2 points higher when their partners were highly educated. In younger males, higher urbanization levels were associated with slightly higher FSIQ scores. Our analyses also showed increased common environmental variation in older males whose parents were more highly educated, and increased unique environmental effects in older males living in more affluent areas. Contrary to studies in children, however, the variance attributable to additive genetic effects was stable across all levels of the moderators under study. Most results were replicated for VIQ and PIQ.     

Does the pill make a difference? Previous maternal use of contraceptive pills and allergic diseases among offspring

BACKGROUND: Maternal use of oral contraceptive pills (OCPs) might increase the prevalence of allergic diseases among offspring. The aim of the study was to clarify if there are differences between OCP types in this association. METHODS: Primary outcomes were asthma, allergic rhinitis and atopic eczema among 1182 children (618 asthmatic and 564 controls) aged 5-6 years. RESULTS: Maternal previous use of desogestrel, gestodene or cyproterone acetate before pregnancy, each combined with ethinyloestradiol (EO), increased the risk of allergic rhinitis among offspring compared with those children whose mothers had not used OCPs (OR 1.67, 95% CI 1.07-2.59, P < 0.024), and this risk was increased mainly in those children with parental allergy (OR 1.78, 95% CI 1.11-2.86, P < 0.018), especially in boys (OR 2.12, 95% CI 1.17-3.84, P < 0.014). No associations were observed between maternal use of OCPs before pregnancy and asthma or atopic eczema among offspring. The association between the previous use of OCPs and allergic rhinitis was not mediated through maternal sex steroid levels during early pregnancy, but women who had used more androgenic types of progestin formulas had higher serum levels of progesterone during early pregnancy. CONCLUSION: Maternal previous use of desogestrel, gestodene or cyproterone acetate before pregnancy, each combined with EO, increased the risk of allergic rhinitis among offspring compared with those children whose mothers had not used OCPs and this risk was detected mainly in boys and in children with parental allergy.