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1.
BACKGROUND: This study used household survey data on the prevalence of child, parent and family variables to establish potential targets for a population-level intervention to strengthen parenting skills in the community. The goals of the intervention include decreasing child conduct problems, increasing parental self-efficacy, use of positive parenting strategies, decreasing coercive parenting and increasing help-seeking, social support and participation in positive parenting programmes. METHODS: A total of 4010 parents with a child under the age of 12 years completed a statewide telephone survey on parenting. RESULTS: One in three parents reported that their child had a behavioural or emotional problem in the previous 6 months. Furthermore, 9% of children aged 2-12 years meet criteria for oppositional defiant disorder. Parents who reported their child's behaviour to be difficult were more likely to perceive parenting as a negative experience (i.e. demanding, stressful and depressing). Parents with greatest difficulties were mothers without partners and who had low levels of confidence in their parenting roles. About 20% of parents reported being stressed and 5% reported being depressed in the 2 weeks prior to the survey. Parents with personal adjustment problems had lower levels of parenting confidence and their child was more difficult to manage. Only one in four parents had participated in a parent education programme. CONCLUSIONS: Implications for the setting of population-level goals and targets for strengthening parenting skills are discussed.  相似文献   

2.
OBJECTIVE: To assess personal autonomy of long-stay psychiatric inpatients, to identify those patients who could be discharged and to evaluate the impact of sociodemographic variables, social functioning, and physical disabilities on their autonomy was also assessed. METHODS: A total of 584 long-stay individuals of a psychiatric hospital (96% of the hospital population) in Southern Brazil was assessed between July and August 2002. The following instruments, adapted to the Brazilian reality, were used: independent living skills survey, social behavioral schedule, and questionnaire for assessing physical disability. RESULTS: Patients showed severe impairment of their personal autonomy, especially concerning money management, work-related skills and leisure, food preparation, and use of transportation. Autonomy deterioration was associated with length of stay (OR=1.02), greater physical disability (OR=1.54; p=0.01), and male gender (OR=3.11; p<0.001). The risk estimate of autonomy deterioration was 23 times greater among those individuals with severe impairment of social functioning (95% CI: 10.67-49.24). CONCLUSIONS: In-patients studied showed serious impairment of autonomy. While planning these patients' discharge their deficits should be taken into consideration. Assessment of patients' ability to function and to be autonomous helps in identifying their needs for care and to evaluate their actual possibilities of social reinsertion.  相似文献   

3.
BACKGROUND: Urinary tract infection (UTI) in childhood can be diagnosed in 5% of febrile infants. Renal scarring is associated with increasing numbers of UTI episodes, and the incidence of renal scarring rises with each urinary infection. High levels of awareness of childhood UTI are important among both professionals and parents. Whilst problems for professionals in making the diagnosis have been explored, few data exist concerning parental understanding and perspectives. OBJECTIVES: The purpose of this study was to assess parental understanding of UTI in their child and identify any delay perceived in the diagnosis, along with identifying how helpful parents had found any information that they had been given. METHODS: Subjects were the parents of children aged <2 years being investigated in one out-patient department following proven UTI. A semi-structured questionnaire was given to parents at first attendance (quantitative data) and content analysis of qualitative data was carried out. RESULTS: Fifty-two out of 84 parents responded (response rate 64%), of whom 45 (86.5%) felt that they had been given a full explanation of the significance of UTI in childhood. Forty percent felt that clean catch was the easiest method of obtaining a urine sample from their child. Although the quantitative data were positive, several themes were identified in the qualitative data, relating to lack of awareness, delay in investigation by health professionals and issues regarding the information that had been imparted to parents. Parents would like more information about the illness that affects their child, and many would like this in leaflet form. CONCLUSIONS: Parents perceive low awareness levels and delays in investigation of UTI in childhood amongst health professionals. Increasing awareness about the importance of UTI in childhood, its incidence and management should be generated amongst health professionals who deal with young children. Parents need and would like more information about the disease and how to identify it, with guidance on urine collection. Further research is needed into whether educational strategies for either parents or health professionals are effective in identifying UTI earlier, and what the best methods of implementing these would be.  相似文献   

4.
OBJECTIVES: The principal aim was to assess the psychiatric topics that doctors and students considered most important for undergraduate teaching. Differences between doctors and students, men and women, physicians/students with or without an interest in psychiatry were examined. DESIGN: A mailed questionnaire was used concerning the knowledge and skills of psychological/psychiatric medi- cine considered to be needed in medical practice. SETTING: The Medical School of the University of Geneva. SUBJECTS: Doctors and undergraduate medical students in their last 2 years of medical training. RESULTS: Both doctors and students agreed on most topics, even though the students tended to give all items a higher rating. Both groups agreed on the importance of the following main topics: the doctor-patient relationship, identification and management of the principal psychiatric disorders and their associated risks and problems of a psychosocial nature. Those doctors showing an interest in psychiatry tended to accentuate the importance attached to interpersonal skills. The male and female doctors and students expressed very similar opinions. The female doctors, however, tended to attach greater importance to relational-emotional aspects and to disorders affecting children and adolescents than did their male colleagues, which is probably a reflection of the specific role that women still play within our society. When asked to assess the current teaching they received in medical school, the students considered that certain important aspects of psychiatry were insufficiently taught. CONCLUSION: These results confirm the importance of teaching psychiatry with an emphasis on problems encountered in general practice.  相似文献   

5.
BACKGROUND: Doctors develop the skills needed to interview parents and children in paediatric settings by practice and by receiving feedback during their medical training. Interviewed parents are ideally placed to provide evaluations of these skills. If parents, as consumers of health care services, are to be consulted, it is important to determine whether factors other than interview skills affect their evaluations. OBJECTIVES: Our aim was to examine the relationship between maternal satisfaction ratings of student doctor interviews, and maternal and child characteristics. METHODS: Sixty mothers of children attending the paediatric medical out-patient clinic at the Women's and Children's Hospital, South Australia were allocated randomly to rate one of four video-taped final year student doctor interviews (15 mothers per interview). The level of skills displayed by the student doctor differed in each interview. Maternal satisfaction was measured using the Medical Interview Satisfaction Scale (MISS) and the Interpersonal Skills Rating Scale (IPS), and interview ratings were compared for a number of maternal and child characteristics. RESULTS: No significant associations were observed between maternal satisfaction ratings and any maternal or child characteristics other than lower satisfaction associated with previous experience of a real student doctor interview (P <0.01). The interview seen by mothers predicted 53% (MISS) and 65% (IPS) of the variance in maternal satisfaction ratings. After controlling for the interview type, the maternal and child characteristics studied predicted 17% additional variance in MISS scores and 7% in IPS scores. CONCLUSION: The quality of the interview skills demonstrated was the principle determinant of maternal satisfaction ratings.  相似文献   

6.
BACKGROUND: Despite the availability of effective screening measures, physicians fail to identify and manage many children with psychosocial problems. Physicians are most likely to identify children with psychosocial problems when parents voice concerns about their child's functioning. However, few parents express concerns to their child's physician, and children's perspectives of their own functioning are rarely considered. This study evaluated the potential utility of children's reports of their own functioning. METHODS: The Child Functioning Scale (CFS) was completed by 107 parents and children and compared with the Pediatric Symptom Checklist (PSC) and physician reports on the psychosocial status of each child. RESULTS: Physicians identified 20% of the children identified by the PSC. Children's self-reported problems on the CFS would have identified 53.3% of these children. Additionally, 11.2% of children who did not meet criteria on the PSC self-reported problems in daily functioning. CONCLUSION: Collecting information about children's perceptions of their own daily functioning could provide physicians with an additional tool for the assessment of psychosocial problems.  相似文献   

7.
BACKGROUND: Recognizing patient expectation is considered as an important objective for primary care physicians. A number of studies suggest that failure to identify patient expectations can lead to patient dissatisfaction with care, lack of compliance and inappropriate use of medical resources. It has been suggested that identifying patient expectations in multicultural contexts can be especially challenging. OBJECTIVES: The aim of the study was to compare health care expectations of Swiss and immigrant patients attending the out-patient clinic of a Swiss university hospital and to assess physicians' ability to identify their patients' expectations. METHODS: Over a 3-month period, all patients attending the out-patient clinic at a Swiss university hospital were requested to complete pre-consultation surveys. Their physicians were requested to complete post-consultation surveys. Outcome measures were patients' self-rated health, resort to prior home treatment, patients' expectations of the consultation, physicians' perception of their patients' expectations and agreement between patients and physicians. RESULTS: We analysed 343 questionnaires completed by patients prior to their consultation (> 50% immigrants) and 333 questionnaires completed by their physicians after the consultation. Most expectations were shared by all patients. Physicians had inaccurate perceptions of their patients' expectations, regardless of patients' origin. CONCLUSIONS: Our study found no evidence that immigrant patients' expectations differed from those of Swiss patients, nor that physicians had more difficulty identifying expectations of immigrant patients. However, physicians in our study were generally poor at identifying patients' expectations, and therefore inter-group differences may be difficult to detect. Our results point to the need to strengthen physicians' general communication skills which should then serve as a foundation for more specific, cross-cultural communication training.  相似文献   

8.
End-of-life decisions for terminally-ill newborn infants are usually made with the consent of parents as well as physicians, but may occasionally involve disagreement about which decision is in the best interest of the child. Paediatricians, while acting in accordance with the principle of respecting the autonomy of the parents, may collide with their own motive of avoiding pointless suffering of the infant. Based on their religious beliefs Islamic parents may not consent to an end-of-life decision. Three newborn girls who eventually died had been suffering from a skeletal dysplasia and a serious bronchopulmonary dysplasia, serious intractable deterioration after surgery for necrotising enterocolitis, and trisomy 18 respectively. In the first two cases there was no preceding consensus between parents and physicians and the girls died after more suffering than the paediatrician found acceptable. The physicians should aspire to prevent conflict situations by paying sufficient attention to the differences in beliefs. This demands that physicians understand and respect different beliefs and that they are able to communicate on the subject of these differences. It is important to Islamic parents that the natural course allows Allah to exercise his authority over life and death, and human dignity. Doing the best for the child is often more important than respect for patient or parent autonomy.  相似文献   

9.
INTRODUCTION: Uneven increases in mammography utilization rates call for methods to efficiently target educational interventions to women who do not regularly use mammography and physicians who do not adhere to national guidelines for breast cancer screening. This paper discusses a method for identifying physicians who are nonadherers to breast cancer screening guidelines or in need of continuing medical education (CME) in this area. METHODS: A 1995 community-based telephone survey of randomly selected women aged 50-80, residing in four Long Island, NY, townships was used to identify women who underuse mammography and their regular physicians. Community-based surveys of physicians permitted identification of nonadherent providers. Nonadherence to breast cancer screening recommendations was the primary criterion, but because of anticipated physician reluctance to self report nonadherence with screening guidelines, additional criteria were developed to identify physicians with educational needs relating to breast cancer screening. These criteria included lack of office reminder systems and knowledge relating to breast cancer screening, and lack of confidence in patient counseling and clinical breast examination skills. RESULTS: Overall response rates were 77% for women's survey, and 66% for the physician survey. 3427 women were classified as underusers (38.5%) and 87% of underusers provided the name and address of their regular physicians. By physician self report, 45% of physicians were classified as nonadherers and 42% were identified as having related educational needs. CONCLUSION: A feasible method for identifying physicians who are nonadherers to breast cancer screening recommendations or in need of CME about this is described, permitting efficient targeting of educational interventions to those with patients who underuse mammography. The method is not dependent on access to a specific provider or patient population.  相似文献   

10.
OBJECTIVE: To better understand differences among parents in their attitudes, beliefs, and behaviors regarding childhood immunizations and health-related issues. METHODS: Forty-four survey variables assessing attitudes and beliefs about immunizations and health were analyzed. The K-means clusters technique was used to identify homogeneous groups of parents based upon their responses to the questions. RESULTS: Five clusters were identified: Immunization Advocates (33.0%), Go Along to Get Alongs (26.4%), Health Advocates (24.8%), Fencesitters (13.2%), and Worrieds (2.6%). CONCLUSIONS: Although only a small percentage of parents are seriously concerned, other parents who are generally supportive of immunizations for their child are also affected by immunization safety issues.  相似文献   

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