The pediatrician's role in encouraging parent-child communication about the acquired immunodeficiency syndrome.

OBJECTIVE--We explored whether communication from pediatrician to parent to child might assist in education about and prevention of human immunodeficiency virus (HIV) infection by comparing parents of children aged 10 through 17 years who did discuss acquired immunodeficiency syndrome (AIDS) with their children with parents of children aged 10 through 17 years who did not discuss AIDS with their children. RESEARCH DESIGN--Secondary analyses of the National Health Interview Survey, a general population survey with items on AIDS. We compared the relative importance of various characteristics in distinguishing parents who did discuss AIDS from those who did not. Variables included whether the parents had received an informational brochure about AIDS from a health care provider. RESULTS--Twenty percent of respondents had at least one child between ages 10 and 17 years; 62% of these parents had discussed AIDS with their children. This percentage was greater for parents living in metropolitan statistical areas with fewer than 100,000 persons compared with parents living in larger cities (73.6% vs 62.7%). Seventy-four percent of women (n = 4745) had spoken to their children about AIDS; only 49% of men (n = 3271) had done so. This gender difference was present in both one- and two-parent households. Hispanics were significantly less likely than non-Hispanics to have discussed AIDS with their children (men, 38.9% vs 49.9%; women, 62.6% vs 74.2%). Gender by far was most strongly associated with talking to children about AIDS, followed by self-assessed knowledge, knowing someone infected with the HIV, and actual knowledge about HIV and AIDS. Parents who reported reading an AIDS-related brochure were significantly more likely to have spoken with their children than were parents who had not read such a brochure (76.2% vs 57.4%). Thirty-seven percent of parents receiving a brochure received one from a health care provider. CONCLUSIONS--Pediatricians can assist in efforts to prevent HIV infection and AIDS by educating parents, especially mothers, about AIDS; by providing them with well-designed brochures about AIDS; and by encouraging them to discuss HIV with their children in a developmentally appropriate manner.     

Parent-adolescent communication about sex in Filipino American families: a demonstration of community-based participatory research.

OBJECTIVES: Pregnancy rates among Filipino American adolescents exceed those of other Asian and Pacific Islander adolescents. Strong parent-adolescent communication may promote healthy sexual development and protect against adolescent sexual risk behaviors. We explored communication barriers between Filipino American parents and adolescents. METHODS: Using community-based participatory research (CBPR), we collaborated with Filipino American community leaders, parents, and adolescents to design a focus-group study. Trained bilingual moderators conducted focus groups with 85 Filipino Americans (41 parents and grandparents and 44 adolescents aged 14-18 years) from various neighborhoods in Los Angeles. Sessions were recorded, transcribed, coded, and analyzed for themes. RESULTS: Focus-group participants appeared to divide sex information into 3 categories, which we termed facts, feelings, and values. Adolescents emphasized facts and feelings. Parents and grandparents emphasized facts and values. In general, facts were obtained through school, feelings through friends, and values through parents. The focus groups identified large barriers to value transmission, stemming from adolescent acculturation to the United States. Parents and grandparents felt that values were transmitted best through traditional Filipino respect for parents who often eschewed open discussion. Adolescents believed that open discussion was necessary for value transmission to occur. The result was bilateral withdrawal from family communication about sex. CONCLUSIONS: Our focus groups found that parent-child communication about sex, especially regarding values, was limited. Potential causes included conflicts between Filipino and US beliefs regarding respect for parents and open discussion. Our results raise important questions about the effect of acculturation on sex education for Filipino American adolescents and demonstrate potential advantages of CBPR.     

Quality of parent communication about sex and its relationship to risky sexual behavior among youth in psychiatric care: a pilot study

BACKGROUND: The number of HIV infections among adolescents is increasing, and youth in psychiatric care are at particular risk because of their high rates of risky sexual behavior. METHODS: As part of a larger longitudinal study examining AIDS-risk behavior among adolescents in psychiatric care, this pilot study investigated the relationship between parent communication about sex and sexual risk-taking among treatment-seeking adolescents. Adolescents reported their risky sexual behavior (e.g., inconsistent condom use, sex with multiple partners), and parents reported how frequently they bring up topics related to sex, HIV/AIDS, and birth control. Parents and adolescents participated together in videotaped discussions of fictional vignettes describing situations related to sex, birth control, and AIDS/HIV. Quality of the parent-teen discussions was coded based on a system developed by Whalen, Henker, Hollingshead, and Burgess (1996) to code AIDS-related discussions. RESULTS: Quality but not frequency of parent-teen communication was associated with adolescent sexual risk-taking, and ethnic differences in communication were found. CONCLUSIONS: Findings from this pilot investigation underscore the importance of studying the relationship between parent-teen communication and risky sexual behavior among troubled youth and provide direction for the development of family-based intervention programs that focus on parental behavior during conversations with teens.     

Implementation of a program to teach pediatric residents and faculty about domestic violence

OBJECTIVES: To obtain information about pediatric resident and staff knowledge, attitudes, and screening practices related to domestic violence (DV), to implement a domestic violence education program, and to evaluate whether the program resulted in changes in these 3 domains. DESIGN: Interventional with before and after survey evaluation. SETTING: A hospital-based, pediatric residency continuity clinic that serves families in Pittsburgh, Pa. PARTICIPANTS: Pediatric residents (n = 51), medicine-pediatric residents (n = 6), continuity clinic faculty (n = 22), and certified-registered nurse practitioners (n = 5). RESULTS: Prior to implementation of the DV education program, respondents correctly answered questions about the prevalence of DV (74 participants [90%]), the racial distribution of DV victims (66 participants [80%]), and the significant overlap between child abuse and DV (75 participants [91%]). Seventy-nine participants (96%) believed that screening for the presence of DV was part of their role as pediatric health care providers. At baseline, 17 (21%) of the 82 participants reported that they were routinely screening for signs of DV during well-child care visits compared with 39 (46%) after attending the education program (P =.005).Among participants who attended both educational session 25% (9/36) were routinely screening for the presence of DV prior to the intervention, compared with 46% (16/35) after the intervention (P =.008). At baseline, 33 (40%) of the 82 participants had identified at least 1 case of DV in the prior 6 months compared with 45 (53%) after training. Prior to training, 18 participants (22%) were aware of resources for DV victims compared with 45 (53%) after training (P<.001). CONCLUSIONS: To our knowledge, this is one of the first pediatric studies to demonstrate that using a short, multifaceted educational module, it is possible to change DV screening practices and to increase identification of DV victims among pediatric residents, continuity clinic faculty, and certified-registered nurse practitioners at a pediatric teaching hospital.     

Observation of parent-child interaction with two- to three-year-olds

A method of home observations of mother-child interaction is described. Its development is outlined in terms of the relevant conceptual and methodological issues, and the concomitant tactical decisions involved in development are discussed. The scheme focuses on parental responsivity, affect, social communication and social control, and a novel combination of time-interval and event-sequential recording is used to discriminate parental functioning in these areas. The measures have been shown to have a satisfactorily high level of reliability, and preliminary analysis indicates construct validity.     

Effectiveness of a computer skills program to improve written communication in children with Developmental Coordination Disorder

Word processing using a keyboard is an option for children with Developmental Coordination Disorder (DCD) who have printing/ handwriting difficulties. A five-replication single-subject ABA design was used to explore the ability of 6 children with DCD (entering Grades 3-5) experiencing problems with printing/handwriting to learn computer skills. Following a two-week intervention all children were familiar with basic computer functions and showed improved word processing skills. Touch-keyboarding speed increased for the five children entering Grades 4-5, but only one child acquired a speed (letters/minute) comparable to printing/ handwriting. Four children demonstrated increased text production when generating a story, but none achieved speeds comparable to printing/handwriting. Five-finger touch-keyboarding proficiency was better for children in Grades 4-5. Therapists observed improved legibility and increased motivation. Results suggest that the child's grade, program support, and program length should be considered when making decisions about keyboarding.     

Impact assessment of school-based sex education program amongst adolescents

This was a cross-sectional, interview-based study to assess the impact of sex education on the students and the feasibility of such a program. Study sample consisted of 189 students from two secondary schools of Surat city. Impact was assessed by “before and after” administration of questionnaires. Statistical analysis was done by Z tests for difference of means and proportions. Sex education influenced the need perception and the knowledge of the students. After the training, the preferred mean age to start sex education in the two sexes converged to be 15–16 years. Doctors remained the first choice to impart the sex education, followed by school teachers. Knowledge about the STDs and the method(s) of prevention improved significantly (more in boys). Optimum days for conception became known to more students after the training and the gain was more in girls. Increased awareness about the contraceptives (condoms) use was evident in boys and (oral pills and condoms) in girls. The training improved the participation of girls in the post-evaluation program. A positive attitudinal change was observed after the training, towards extra-marital sex. It also removed the myths associated with masturbation. All students were satisfied with the programme, however, two-third of boys considered the duration insufficient.     

Effect of patient priming and primary care provider prompting on adolescent-provider communication about alcohol

OBJECTIVE: To determine whether priming adolescent patients to discuss alcohol with their primary care providers and prompting providers to discuss alcohol increases adolescent-provider communication about alcohol. DESIGN: Randomized controlled trial. SETTING: Five managed care group practices in Washington, DC. PARTICIPANTS: Consecutive patients aged 12 to 17 years who were seeing primary care providers (n = 26) for health checkups. Of 892 eligible adolescents, 444 (50%) were randomized and completed data collection. Most adolescents (80%) were African American, 55% were male, and 17% currently drank alcohol. INTERVENTION: Usual care (group 1) vs adolescent priming with alcohol self-assessment and education just before their health checkups (group 2) vs adolescent priming and provider prompting with the adolescent's self-assessment and a patient education brochure (group 3). MAIN OUTCOME MEASURES: This exploratory substudy of a longitudinal study on adolescent alcohol behaviors examined adolescent-provider communication by adolescent exit survey, researcher observation, and audiotapes of a subsample of visits. RESULTS: More adolescents in group 3 (96%) than group 1 (87%) reported that their provider talked about alcohol (adjusted odds ratio [OR], 1.10; 95% confidence interval [CI], 1.04-1.17). More adolescents in group 3 (18%) than group 1 (10%) reported asking about alcohol (adjusted OR, 1.08; 95% CI, 1.00-1.16). The mean +/- SD number of minutes adolescents were with their providers without parents being present was greater for group 3 (10.8 +/- 7.6) than group 1 (8.8 +/- 8.0). Adolescents in group 2 spent more time with their provider and reported initiating more discussion not specific to alcohol than did group 1 adolescents. CONCLUSION: Adolescent priming and provider prompting increases adolescent-provider communication about alcohol.     

Hugs and kisses: HIV-infected parents' fears about contagion and the effects on parent-child interaction in a nationally representative sample

OBJECTIVES: To determine the effect of human immunodeficiency virus (HIV)-related fears on HIV-infected parents' interactions with their children and to identify parents who might be at greater risk of avoiding interactions because of these fears. PARTICIPANTS: In-person interviews with 344 parents from a nationally representative probability sample of adults receiving health care for HIV in the contiguous United States. MAIN OUTCOME MEASURES: Parents' fear of transmitting HIV to their children, fear of catching an illness or opportunistic infection from their children, and avoidance of 4 types of interactions (kissing on the lips, kissing on the cheeks, hugging, and sharing utensils) because of these fears. RESULTS: Forty-two percent of parents feared catching an infection from their children, and 36.1% of parents feared transmitting HIV to their children. Twenty-eight percent of parents avoided at least 1 type of interaction with their children "a lot" because they feared transmitting HIV or catching an opportunistic infection. When parents who avoided physical interactions "a little" are included, the overall avoidance rate rises to 39.5%. Hispanic parents were more likely than African American parents and parents who were white or of other races or ethnicities to avoid interactions. CONCLUSIONS: Although many parents feared transmitting HIV to their children or catching an infection from their children, few were avoiding the most routine forms of physical affection. They were much more likely to avoid interactions suggestive of fear of contagion through saliva. Clinicians may be able to provide education to HIV-infected parents and reassurance about HIV transmission and the safety of various activities.     

Teaching teachers about childhood cancer: the effects of a web-based training program

The purpose of this study was to examine the utility and acceptability of a modular computer-based training program on childhood cancer (eg, acute and late effects of treatment, intervention strategies) for teachers. A within-subjects design was implemented with 41 teachers and teachers in training. Participants completed tests of childhood cancer knowledge and application skills both before and after completing the web-based training. An acceptability questionnaire was completed after the training. Results indicated significant gains in knowledge and in case application, as well as high levels of acceptability of the training. It seems that a web-based training program can be accessed by teachers and in 2 to 4 hours can significantly increase cancer knowledge in an acceptable manner.     

Comparison of generic tacrolimus and Prograf drug levels in a pediatric kidney transplant program: Brief communication

Abdulnour HA, Araya CE, Dharnidharka VR. Comparison of generic tacrolimus and Prograf drug levels in a pediatric kidney transplant program: Brief communication.
Pediatr Transplantation 2010: 14:1007–1011. © 2010 John Wiley & Sons A/S. Abstract: A generic version of tacrolimus was approved for use in the USA in August 2009. These narrow therapeutic index generics are tested for bioequivalence only in adults. No data are available on generic tacrolimus levels in children with allografts. Four patients with stable renal allografts in our pediatric program were inadvertently switched to generic tacrolimus. We retrospectively analyzed pre‐ and post‐switch trough tacrolimus and serum creatinine levels. Twelve‐h trough tacrolimus levels (mean ± s.e.) were (i) patient 1 (12‐yr‐old girl): 7.0 ± 0.69 and 9.7 ± 3.5 (p = NS); (ii) patient 2 (eight‐yr‐old boy): 4.7 ± 0.68 and 3.4 ± 0.84 (p = 0.04); (iii) patient 3 (22‐yr‐old woman): 6.8 ± 0.17 and 6.6 ± 0.4 (p = NS); (iv) patient 4 (20‐yr‐old woman): 5.4 ± 0.25 and 4.9 ± 1.4 (p = NS). Creatinine levels were similar pre‐ and post‐switch (eGFR > 75 mL/min/1.73 m²) in the first three. Patient 4 experienced a biopsy proven acute rejection immediately after switching. Mean creatinine rose from 1.15 ± 0.05 to 2.168 ± 0.07 after switch (p < 0.001). Given our mixed picture with the early data, we suggest careful monitoring of pediatric patients who get switched to generic tacrolimus.     

Cortisol reactions in five-year-olds to parent-child interaction: the moderating role of ego-resiliency

BACKGROUND: This study with five-year-olds is the first to examine whether low-quality interactions with parents elicit physiological stress in children beyond toddlerhood, as evident from elevated cortisol levels in their saliva. It was hypothesised that particularly children with low levels of ego-resiliency -a personality construct reflecting the capacity to cope with stress - would show cortisol increases during low-quality parent-child interactions. METHOD: In a sample of 101 five-year-old children (62 boys), parent-child interaction was observed at home during parent-child discourse that involved the recollection and discussion of emotional events that happened to the child in the past. Saliva samples to assess cortisol levels were collected before and 20 minutes after the parent-child discourse task. The children's teacher rated child ego-resiliency using a Dutch translation of the California Child Q-set (CCQ; Block & Block, 1980). RESULTS: One of the two parent-child interaction factors that emerged from a principal component analysis, namely negative parent-child interactions, was significantly related to the children's cortisol reaction; more negative parent-child interactions elicited significantly stronger cortisol reactions. The other parent-child interaction factor that was found, i.e., effective guidance, was not significantly related to children's cortisol reaction. As predicted, children low on ego-resiliency showed increases in cortisol during negative interactions with their parents, whereas high ego-resilient children did not. CONCLUSIONS: The association between negative parent-child interactions and cortisol elevations in children may point to a likely mechanism through which negative parent-child interactions contribute to negative developmental outcomes as the repeated exposure to high levels of cortisol have earlier been found to negatively affect children's development and functioning in various areas.     

Effect of parent-child cooperative music therapy on children with autism spectrum disorder and their mothers: a prospective randomized controlled study北大核心CSCD

目的 探讨亲子合作式音乐疗法对孤独症谱系障碍（autism spectrum disorder,ASD）儿童的核心症状及其母亲的影响。 方法 前瞻性采用随机数字表法将112例ASD儿童及其母亲分为音乐疗法组和应用行为分析法（applied behavior analysis,ABA）组,每组各56例。ABA组采用ABA进行干预,音乐疗法组在ABA组基础上采用亲子合作式音乐疗法。2组干预时长均为8周。采用儿童孤独症评估量表（Childhood Autism Rating Scale,CARS）、儿童孤独症家长评定量表（Autism Behavior Checklist,ABC）、亲职压力简表（Parenting Stress Index-Short Form,PSI-SF）、家庭关怀度指数量表（Family APGAR Index,APGAR）和Herth希望量表（Herth Hope Index,HHI）,评估干预前和干预后ASD儿童的核心症状及其母亲的亲职压力、家庭关怀度和希望水平。 结果 共100对母子参与了全程研究（每组各50对）。干预后音乐疗法组ASD儿童ABC量表总分、感觉维度、社交维度、躯体运动维度得分,以及CARS量表总分低于ABA组（P<0.05）。干预后音乐疗法组母亲的PSI-SF总分、亲子互动失调维度得分,HHI量表总分和各维度得分,以及APGAR量表总分、合作度和亲密度得分均高于ABA组（P<0.05）。 结论 在ABA的基础上,加用亲子合作式音乐疗法可改善ASD儿童的核心症状,减轻母亲的亲职压力,提升其家庭关怀度指数和希望水平。 引用格式：中国当代儿科杂志,2022,24（5）：472-481     

Rise of pediatric surgery collaboratives to facilitate quality improvement

Broad changes in pediatric surgical care delivery are limited by the rarity of pediatric surgical diseases and the geographic dispersion of pediatric surgical care across different hospital types. Pediatric surgical collaboratives and consortiums can provide the patient sample size, research resources, and infrastructure to advance clinical care for children with who require surgery. Additionally, collaboratives can bring together experts and exemplar institutions to overcome barriers to pediatric surgical research to advance quality surgical care. Despite challenges to collaboration, many successful pediatric surgical collaboratives emerged in the last decade and continue to push the field forward towards high-quality, evidence-based care and improved outcomes. This review will discuss the need for continued research and quality improvement collaboratives in pediatric surgery, identify challenges faced when building collaboratives, and introduce future directions to expand impact.