Living with the unknown: Posttraumatic stress disorder in pediatric bone marrow transplantation survivors and their mothers

Bone marrow transplantation (BMT) is used to treat children with various hematologic, oncologic, and metabolic diseases. Although the treatment can be lifesaving, it is also physically and psychologically demanding for both the child and caregivers. In previous studies, BMT is found to be related with anxiety, posttraumatic stress disorder (PTSD), depression, and psychosocial problems both in children and parents. The aim of this study was to investigate PTSD in pediatric BMT survivors and their mothers compared with the healthy controls. Twenty-seven BMT survivors and their mothers and 28 healthy peers and their mothers were recruited as the study group and as the comparison group, respectively. All children were interviewed using Child Posttraumatic Stress Disorder—Reaction Index (CPTSD-RI) for assessing posttraumatic stress responses. As for mothers, Clinician-Administered PTSD Scale (CAPS) was used. In healthy children and mothers, instead of BMT, the most important traumatic event reported by them was included. All data were analyzed by a neutral statistician from the Department of Biostatistics of the university. The BMT group, both children and mothers, obtained significantly higher PTSD rates than the control group (66.5% and 17.8%, respectively, in children; 57.6% and 7%, respectively, in mothers). However, there was a weak correlation between survivors' and mothers' posttraumatic stress responses. These findings suggest that BMT is a significant stressor for both children and mothers. Clinicians should be aware of psychiatric symptoms of children who underwent such a life-threatening condition. Combination of medical treatment with psychosocial support is imperative.     

Impact of enuresis nocturna on health-related quality of life in children and their mothers

ObjectiveNocturnal enuresis (NE) is a common childhood disorder. As children age and NE persists, it may become more stressful for both them and their caregivers. The aim of the present study was to assess the impact of NE on the quality of life of children who were diagnosed with NE, and their mothers, and to compare the results with a healthy control group.Subjects and methodEighty-two children with NE, and their mothers, and 93 healthy children and their mothers were enrolled in the study. The sociodemographic data were evaluated. The Pediatric Quality of Life Inventory 4.0 Scales (PedsQL 4.0) were used to assess the children's health-related quality of life (HRQoL); and the World Health Organization Quality of Life Instrument; short form (WHOQOL-BREF) was used for the mothers' HRQoL.ResultsThe PedsQL 4.0 mean scores for the children with NE group were as follows: total score, 68.74; physical health score, 72.79; psychosocial health score, 66.56. The scores for the children in the control group were as follows: total score, 80.98; physical health score, 81.11; psychosocial health score, 80.88. The WHOQOL-BREF scores for the mothers of the children with NE were as follows: physical health score, 67.90; psychosocial health score, 62.66; social relationships score, 60.90; environmental area score, 61.04. The WHOQOL-BREF scores for the mothers in the control group were as follows: physical health score, 75.96; psychosocial health score, 72.39; social relationships score, 72.18; environmental area score, 67.44.ConclusionsNocturnal enuresis negatively affects the quality of life of both children and their mothers. Therefore, when physicians see children with enuresis, they should also be aware of the effect of NE on the mothers' quality of life.     

Health‐related quality of life (HRQoL) of children with type 1 diabetes mellitus (T1DM): self and parental perceptions

Kalyva E, Malakonaki E, Eiser C, Mamoulakis D. Health‐related quality of life (HRQoL) of children with type 1 diabetes mellitus (T1DM): self and parental perceptions. The aim of the study was to evaluate health‐related quality of life (HRQoL) in children and adolescents with type 1 diabetes mellitus (T1DM) in Greece compared with healthy controls and to identify the effect of age, gender, age of onset of disease, and metabolic control on perceptions of HRQoL. A total of 117 children and adolescents with T1DM aged 5–18, their parents, and 128 matched healthy children and adolescents participated. Children and adolescents completed PedsQL? 4.0 Generic Core Scales. Children and adolescents with T1DM also completed the PedsQL? 3.0 Diabetes Module, while their parents completed the proxy‐reports of both the PedsQL? 4.0 Generic Core Scales and the PedsQL? 3.0 Diabetes Module. The results demonstrated that children and adolescents with T1DM had lower general HRQoL compared with healthy matched children and adolescents. Parents of children and adolescents with diabetes reported that the illness has a greater affect on their children's lives than the children themselves. Finally, the results indicated that later age of onset of diabetes, less hyperglycemic episodes, lower glycosylated hemoglobin (HbA1c), older age, and male gender were associated with better general HRQoL and diabetes‐specific HRQoL. The findings have implications for designing effective therapeutic interventions aimed at improving the HRQoL of children and adolescents with T1DM.     

Maternal emotion coaching,adolescent anger regulation,and siblings’ externalizing symptoms

Background: Increases in externalizing behaviors during the transition to adolescence may put children at risk for developing mental disorders and related problems. Although children’s ability to regulate their emotions appears to be a key factor influencing risk for maladjustment, emotion processes during adolescence remain understudied. In this longitudinal study, we examined a multi‐level mediational model in which emotion coaching by parents was posited to influence the ability of adolescents to regulate their emotions, which in turn influences their expression of problem behaviors. Methods: We recruited a representative community sample of 244 families with biological sibling pairs comprising a child in late elementary school and a child in middle school. Maternal meta‐emotion interviews were coded for mother emotion coaching and adolescent difficulty with anger. Mothers also completed questionnaires on adolescent irritability. Ratings of adolescent problem behaviors were obtained from mother and teacher questionnaires completed at two time points. Using structural equation modeling, constructs were partitioned into components across older and younger siblings to examine shared and nonshared variance and contextual effects. Results: Cross‐sectional data indicated that mothers' emotion coaching of anger was related to better anger regulation in adolescent siblings, which was, in turn related to less externalizing behavior. Although support for mediational effects was limited in the longitudinal data, both older and younger siblings' difficulties in regulating anger predicted adolescent externalizing behavior three years later. Additional longitudinal predictors of externalizing behavior were observed for younger siblings. In particular, emotion coaching of anger by mothers was associated with decreased externalizing behavior, while conversely, older siblings' externalizing behavior was associated with increased externalizing behavior in the younger siblings over time. Conclusions: The findings highlight the importance of considering family emotion processes in understanding adolescent problem behavior. Both maternal emotion coaching of adolescent anger and adolescent difficulty in regulating anger influenced adolescent externalizing behavior. Emotion coaching interventions seem worthy of consideration for enhancing the impact of prevention and intervention programs targeting youth externalizing behaviors.     

Cost‐effectiveness of cognitive therapy as an early intervention for post‐traumatic stress disorder in children and adolescents: a trial based evaluation and model

Background

Untreated post‐traumatic stress disorder (PTSD) in children and adolescents is associated with a considerable economic burden on the health system, families and society. Recent research has demonstrated the potential efficacy of cognitive therapy as an early intervention for PTSD in children and adolescents. Children who experienced a single traumatic event in the previous two to six months and were randomized to cognitive therapy for PTSD (CT‐PTSD) were significantly more likely to be PTSD‐free compared to those randomized to usual care represented by waitlist control. The current study evaluated the economic impact of improvements in the treatment of PTSD in children and adolescents.

Methods

A cost‐effectiveness analysis was conducted from the national health service/personal social services perspective with outcomes expressed as quality‐adjusted life years (QALYs). Patient level costs and outcomes were collected during the 11 week clinical trial and extrapolated to a three year time horizon using economic modelling methods. Uncertainty was estimated using probabilistic sensitivity analysis and assumptions were tested using one way sensitivity analysis.

Results

The incremental cost‐effectiveness ratio at 3 years was £2,205 per QALY with a 60%–69% probability of CT‐PTSD being cost‐effective compared to usual care at the UK £20,000 to £30,000 per QALY decision threshold.

Conclusions

This study provides preliminary evidence for the cost‐effectiveness of cognitive therapy in this treatment population. Larger pragmatic trials with longer follow‐up are indicated.     

Follow‐up results on monitoring and discussing health‐related quality of life in adolescent diabetes care: benefits do not sustain in routine practice

de Wit M, Delemarre‐Van de Waal HA, Bokma JA, Haasnoot K, Houdijk MC, Gemke RJ, Snoek FJ. Follow‐up results on monitoring and discussing health‐related quality of life in adolescent diabetes care: benefits do not sustain in routine practice. Objective: We previously demonstrated that adding monitoring and discussion of health‐related quality of life (HRQoL) of adolescents with type 1 diabetes to routine periodic consultations positively impacts psychosocial well‐being and satisfaction with care. The current study examines whether these positive effects are maintained 1 year after the intervention was terminated and patients received regular care again, with no formal HRQoL assessment. Patients and methods: Forty‐one adolescents with type 1 diabetes were followed for 1 year after the initial HRQoL intervention, in which their HRQoL had been assessed and discussed as part of period consultations using the PedsQL. Changes in physical and psychosocial well‐being [Child Health Questionnaire‐Child Form 87 (CHQ‐CF87), diabetes family conflict scale (DFCS), Center for Epidemiological Studies scale for Depression (CES‐D)], satisfaction with care [Patients' Evaluation of the Quality of Diabetes (PEQ‐D) care], and glycemic control (HbA_1c) were determined 12 months after the HRQoL intervention had ended. Results: One year after the HRQoL intervention, mean scores on CHQ subscales: behavior (p = 0.001), mental health (p = 0.004), and self‐esteem (p < 0.001) had decreased, whereas the family activities subscale remained stable. Adolescents were less satisfied with their care (p = 0.012), and HbA_1c values had increased significantly 12 months postintervention (p = 0.002). Conclusions: The beneficial effects of an office‐based HRQoL intervention in adolescents with diabetes largely disappear 1 year after withdrawing the HRQoL assessment procedure. This finding underscores the importance of integrating standardized evaluation and discussion of HRQoL in routine care for adolescents with diabetes.     

Reduced quality of life in children with Gastro‐oesophageal reflux disease

Aim: To assess self‐reported Quality of life (QoL) in children with Gastro‐oesophageal reflux disease (GORD) aged 5–18 and compare this with both disease and healthy control children in a prospective consecutive sample. Methods: All children attending a tertiary paediatric gastroenterology clinic from February 2009 to May 2009 with GORD, chronic constipation and inflammatory bowel disease (IBD) were asked to complete the validated PedsQL generic QoL assessment (self‐report) at their clinic appointment. The PedsQL considers physical, emotional, social and school domains and is scored from 0 to 100. Healthy children were also recruited from the same site. Groups were compared using the independent samples Student’s t‐test. Results: A total of 184 children completed the assessment [103 (56%) male, mean age 10.7 years ± 3.3] including 40 children with GORD, 44 with chronic constipation, 59 with IBD and 41 healthy children. QoL was significantly lower in the GORD group compared with both children with IBD (74 vs. 82) and healthy children (74 vs. 84), and was comparable to that of children with chronic constipation (74 vs. 74). Conclusions: Self‐reported QoL in children with GORD attending a tertiary paediatric gastroenterology clinic is significantly reduced compared with both healthy children and children with IBD.     

Judgements about emotional events in children and adolescents with post-traumatic stress disorder and controls

Research with clinically anxious adults has revealed that they estimate future negative events as far more likely to occur, relative to healthy controls. In addition, anxious adults estimate that such events are more likely to happen to themselves than to others. Previous research with anxious children and adolescents, in contrast, has revealed no increased probability estimates for negative events, relative to controls, and the events were rated as more likely to happen to others than to the self. The present study followed up these discrepant findings by investigating probability judgements concerning future negative events generated by children and adolescents who had actually experienced an extreme negative event and who met criteria for a diagnosis of Post-traumatic Stress Disorder (PTSD). Control groups comprised a group of healthy participants, and a group of healthy participants whose parents had experienced a trauma and who met criteria for PTSD. The results revealed no overall differences between the clinical group and the controls. However, children and adolescents with PTSD estimated all negative events as significantly more likely to happen to others than to themselves, with this other-referent bias being strongest for events matched to their trauma. In contrast, the two control groups exhibited an other-referent bias for physically threatening events but not for socially threatening ones. Developmental analyses indicated that the strength of the relationship between anxiety and elevated judgements about future negative events declined with age in the control participants but that there was no significant relationship in the groups who had been exposed to trauma. The findings are discussed in the context of the literature on information processing biases and PTSD.     

Incidence and associations of parental and child posttraumatic stress symptoms in pediatric patients

BACKGROUND: Previous studies consistently found remarkable prevalence rates of posttraumatic stress symptoms (PTSS) and posttraumatic stress disorders (PTSD) in pediatric patients and their parents. Findings suggest a significant association between child and parent PTSS. The present study examined, in a sample of pediatric patients with different conditions, incidence rates and determinants of PTSS and PTSD in the patients, and their mothers and fathers. Also, associations of maternal, paternal and child PTSS and PTSD were analyzed. METHOD: Two hundred and nine children (aged 6.5-14.5 years) were interviewed 5-6 weeks after an accident or a new diagnosis of cancer or diabetes mellitus type 1 by means of the Child PTSD Reaction Index. Their mothers (n = 180) and fathers (n = 175) were assessed with the Posttraumatic Diagnostic Scale. RESULTS: Children reported PTSS levels in the mild range. Sixteen percent of the fathers and 23.9% of the mothers met full DSM-IV diagnostic criteria for current PTSD. Type of trauma impacted differently on parents and children. In children, accident-related injury was associated with higher PTSS scores. Conversely, in parents, diagnosis of cancer in their child was associated with more symptoms. Functional status of the child was also found to be an important predictor of PTSS in children and parents. PTSS scores of mothers and fathers were significantly correlated with each other. However, child PTSS were not significantly related to PTSS of mothers and fathers. This was true for total scores as well as for DSM-IV symptom clusters. CONCLUSIONS: There is a need for careful evaluation of PTSS and PTSD in pediatric patients with accidental injuries or sudden onset of severe chronic diseases and in their respective parents. Importantly, children, their mothers, and their fathers should be assessed separately, because a significant association between child and parental PTSS may not exist.     

Health-related quality of life in paediatric patients with inflammatory bowel disease related to disease activity

Aim: Impaired health‐related quality of life (HRQoL) and an increased risk of psychosocial problems may encounter children and adolescents with inflammatory bowel disease (IBD). Generic HRQoL questionnaires, 15D designed for subjects over 16 years of age, 16D for adolescents aged 12–15 and 17D for younger children, allow comparison to healthy peers and have not been used in children with IBD before. Further, in paediatric IBD patients, HRQoL has not been related to disease activity. We evaluated the applicability of 15D, 16D and 17D questionnaires in the paediatric IBD population and examined how HRQoL is influenced by changes in clinical activity of IBD. Methods: The study subjects recruited at their scheduled, routine appointment in the outpatient clinic of the children's hospital completed the HRQoL questionnaire at baseline and again after 3–5 months. Disease activity was estimated by a three‐level scale. The HRQoL of the study population was compared with that of the age‐standardised general population. Results: Fifty‐five children, aged 7–19 years, were recruited. The HRQoL scores strongly correlated with the activity of the disease (P < 0.001). The two oldest age groups with IBD had lower HRQoL scores than age‐standardised peers (P= 0.001/0.04). There was no gender difference in HRQoL scores. Conclusions: IBD has a considerable impact on the HRQoL of children and adolescents. The generic HRQoL instruments used appeared to be promising tools for examining HRQoL in paediatric IBD patients in different age groups, but larger studies to establish their usefulness in the follow‐up of young patients are still warranted.     

Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial

Background: The evidence base for trauma‐focused cognitive behavioral therapy (TF‐CBT) to treat posttraumatic stress disorder (PTSD) in youth is compelling, but the number of controlled trials in very young children is few and limited to sexual abuse victims. These considerations plus theoretical limitations have led to doubts about the feasibility of TF‐CBT techniques in very young children. This study examined the efficacy and feasibility of TF‐CBT for treating PTSD in three‐ through six‐year‐old children exposed to heterogeneous types of traumas. Methods: Procedures and feasibilities of the protocol were refined in Phase 1 with 11 children. Then 64 children were randomly assigned in Phase 2 to either 12‐session manualized TF‐CBT or 12‐weeks wait list. Results: In the randomized design the intervention group improved significantly more on symptoms of PTSD, but not on depression, separation anxiety, oppositional defiant, or attention deficit/hyperactivity disorders. After the waiting period, all participants were offered treatment. Effect sizes were large for PTSD, depression, separation anxiety, and oppositional defiant disorders, but not attention‐deficit/hyperactivity disorder. At six‐month follow‐up, the effect size increased for PTSD, while remaining fairly constant for the comorbid disorders. The frequencies with which children were able to understand and complete specific techniques documented the feasibility of TF‐CBT across this age span. The majority were minority race (Black/African‐American) and without a biological father in the home, in contrast to most prior efficacy studies. Conclusions: These preliminary findings suggest that TF‐CBT is feasible and more effective than a wait list condition for PTSD symptoms, and the effect appears lasting. There may also be benefits for reducing symptoms of several comorbid disorders. Multiple factors may explain the unusually high attrition, and future studies ought to oversample on these demographics to better understand this understudied population.     

Parent-proxy perception of overweight adolescents' health-related quality of life is different according to adolescent gender and age and parent gender

This study assessed health-related quality of life (HRQoL) reported by overweight adolescents and compared to their parent-proxy perception of HRQoL, according to adolescent gender, adolescent age, and parent gender. Patients and a total of 179 adolescents aged 10 to 18 years with excess weight were evaluated for perceived HRQoL prior to beginning a weight-loss intervention, using the Pediatric Quality of Life Inventory (PedsQL 4.0) questionnaire, estimating quality of life in the physical, emotional, social, and school domains, as well as index measures of psychosocial and overall quality of life. Parents completed the same questionnaire estimating his or her child's HRQoL. Compared to their child's self-report, parents underestimated all the domains of HRQoL except the school domain. Parents underestimated all the domains of HRQoL among boys; however, they only underestimated the physical domain among girls. Comparisons between parent-proxy perception and self-report of the adolescent according to adolescent's age revealed that parents underestimated their children's HRQoL in the younger adolescents (10 to 13 years) for all except for the school domain and underestimated only the physical domain in older adolescents (14 to 18 years). The same comparison between parent-proxy perception and their child's self-report of HRQoL according to parent gender showed that mothers underestimated HRQoL in all domains except for the school domain, while fathers only underestimated the school domain. Conclusion: The differences between self-report of overweight adolescent and perceptions of their parents about the HRQoL of their children are influenced by adolescent gender and age and parent gender.     

Health‐related quality of life after combined liver and kidney transplantation in children

While reduced HRQOL following isolated organ transplantation has been previously reported, there are no data in the context of children following CLKT. Twenty‐three children who underwent CLKT at our institution were included in the study. The indication for CLKT was PH1 in 13 patients and ARPKD in 10 patients. Quantification of HRQOL was facilitated through the use of the PedsQL 4.0 Generic Core Scale. The results of the study were compared to healthy children and published data of children who had undergone LTx or KTx. The CLKT samples' child self‐report showed good HRQOL. No statistically significant difference was found between the patients with PH1 and patients with ARPKD (P=.4). Compared to healthy children, a significant difference in the total scale score, the physical health score, and the school functioning was reported. HRQOL did not differ significantly when compared to patients following isolated LTx or KTx. To improve HRQOL after CLKT, a focus on patients' physical health, educational performances, and overall quality of life is crucial. Thus, coordinated medical care across disciplines and psychological and social support is essential to achieve this goal.     

Value conflicts in mothers' snack choice for their 2‐ to 7‐year‐old children

Value conflicts appear when people experience struggles, doubts, and feelings of guilt when making food choices. This study aims to provide insight into value conflicts, which mothers may experience while providing snacks to their young children. Mothers are mainly responsible for providing the snacks their young children eat, making it a big responsibility for them as children's dietary behaviour tracks into adulthood. Possible value conflicts Dutch mothers (n = 136) experience while providing snacks to their 2‐ to 7‐year‐old children were investigated using food and motivation diaries and semi‐structured interviews. Differences between mothers' educational level, first versus not‐first child, and the differences in age of the children were taken into account. Results showed that the younger the children, the more value conflicts the mothers experienced. Mothers experienced most value conflicts when they provided snacks perceived as unhealthy. Six main value conflicts are elicited by this study, namely, conflicts between healthy and unhealthy snacks; conflicts between healthy and convenient snacks; conflicts related to providing snacks just before dinner; conflicts related to influence of others; conflicts when the child asks but the mother says “no”; and conflicts related to many unhealthy snacks at parties or visits. The insights gained in this study can be used for interventions to promote a healthier lifestyle, support the design of new snack products, and can give guidance for marketing challenges in global snack markets.     

孤独症儿童父母心理健康状态的研究

目的：研究孤独症患儿家长的心理健康状态。方法：采用症状自评量表(SCL-90)对34名孤独症儿童和35名健康儿童的父母亲进行评分。结果：孤独症儿童父母亲SCL-90总分分别为162.5±34.0,175.1±51.0,均高于正常儿童的父母亲(分别为142.4±82.8,152.3±40.6;P<0.05)。孤独症儿童的父亲在强迫症状、忧郁、焦虑、偏执等4个因子上的分数高于健康儿童的父亲（P<0.05）;孤独症儿童的母亲在强迫症状、人际关系敏感、忧郁、焦虑、偏执、敌对性、精神病性和睡眠/饮食等8个因子的分数较正常儿童的母亲高（P<0.05）;在人际关系敏感、焦虑、精神病性症状因子上,孤独症儿童的母亲得分较父亲高（P<0.05）。结论：在对孤独症儿童给与关爱和治疗的同时,也要关注孤独症儿童父母的心理健康。［中国当代儿科杂志,2010,12(12)：947-949］     

Disclosure of sexual abuse, and personal and familial factors as predictors of post-traumatic stress disorder symptoms in school-aged girls

OBJECTIVE

The aim of the present study was to analyze predictive factors of post-traumatic stress disorder (PTSD) symptoms in school-aged girls.

METHODS

A group (n=67) of seven- to 12 year-old girls consulting a paediatric hospital following disclosure of sexual abuse were compared with a group (n=67) of nonabused girls. The girls answered questionnaires related to PTSD, coping, sense of hope, self-esteem, sibling relationships and perceived social support. Mothers answered questionnaires related to family relationships, family violence, perceived support given and psychological distress.

RESULTS

The mean ± SD age of the girls was 9±1.5 years. In the sexual abuse group, single-parent families were more frequent (53.7% versus 32.3%; P<0.01), mothers were less educated (10.8% versus 13.1%; P<0.0001) and socioeconomic level was lower (36.8% versus 47.9%; P<0.0001). A history of sexual abuse in childhood was reported by 50% of mothers of sexually abused children and 37% of mothers of the comparison group children. A higher prevalence of PTSD clinical scores was found for the girls reporting sexual abuse (46.3% versus 18.5%; P<0.001). Regression analyses controlling for parental education level and family structure revealed that group membership (sexual abuse group versus comparison group) was predictive of the level of PTSD symptoms. In addition, the mother’s level of support, the child’s perception of parental support and the child’s reliance on avoidance coping predicted PTSD symptoms. Sense of hope and the child witnessing interparental physical violence were marginally associated with the level of PTSD symptoms.

CONCLUSIONS

PTSD was common in the present study’s sample of sexually abused girls. Because predictive factors relate to both child-related variables and familial context, interventions for this population should target not only the child, but also the family.     

The impact of caregiver post‐traumatic stress and depressive symptoms on pediatric transplant outcomes

PTSS as well as symptoms of depression have been reported in children who experience a serious medical adversity as well as their caretakers. The adverse effects of PTSS, when experienced by the patients, on medical outcomes have been clearly documented. However, the impact of those symptoms, if any, when experienced by the caretakers on child outcomes has not been investigated prospectively. We evaluated whether caregiver PTSS and depression symptoms predict adherence to medications and medical outcomes in a prospective multisite study. Four hundred children participated in MALT. Caretaker PTSS were assessed by the IES and depressive symptoms by CES‐D. During 2 years of follow‐up, the MLVI was used to determine adherence. Centrally read, biopsy‐confirmed organ rejection was the primary medical outcome. IES scores were not associated with either adherence or rejection outcomes. In contrast, there were significant correlations between CES‐D (depression) scores and lower adherence, r = .13, P < .001, and a trend toward higher scores on the CES‐D among those whose children had experienced rejection, 12.4 (SD = 10.9) versus 9.1 (SD = 8.6), P = .077. Caregivers' PTSS were not a risk factor for poor child outcomes in this cohort, whereas depression symptoms were associated with non‐adherence and possibly increased rates of rejection. Further study can validate if caregivers' depression as opposed to PTSS confers greater risk and should be a focus during the clinical care of medically ill children.     

Long‐term effects of a healthy eating blog in mothers and children

In the context of low consumption of vegetables and fruits and milk and alternatives among Canadian mothers and children, novel strategies are needed to improve maternal and child nutrition. This study evaluated the long‐term effects of an evidence‐informed healthy eating blog on dietary intakes and food‐related behaviours of mothers and their child. The study presents a secondary outcome analysis of a randomised controlled trial in which 84 mothers (mean age of 37.6 ± 6.7 years) of 2‐ to 12‐year‐old children living in Quebec City, Canada, were randomly assigned to a dietary intervention delivered through a healthy eating blog written by a registered dietitian (RD; n = 42) or a control group (n = 42) during a period of 6 months. Dietary intakes, maternal eating behaviours, food parenting practices, and body weight were measured at baseline, 3 months, at the end of the intervention (6 months), and 6‐month post‐intervention (12 months). Differences between groups were assessed with mixed linear models. Globally, this study found no evidence of long‐term differences in mean dietary intakes in mothers exposed to the blog and their children as well as other food‐related outcomes and body weight compared with the control condition. Potential predictors of adherence to dietary recommendations in mothers and children (e.g., involvement of children in household food activities) were identified. In conclusion, a healthy eating blog written by an RD did not result in evidence of any long‐term differences in dietary intakes and food‐related behaviours in mothers and their children compared with the control condition.     

Mothers' depression and health‐related quality of life in neuromuscular diseases: Role of functional independence level of the children

Background: In the literature there have been studies about quality of life of parents who have children with chronic diseases. Most of these studies have focused on the stress of parents of children with neuromuscular disease (NMD), and there was no evidence to support hypothesized relationships between caregiving demands and health‐related quality of life (HRQOL). The aim of the present study was therefore to evaluate the relations between maternal depression and HRQOL and functional limitations of the children with NMD. Methods: Forty children with a diagnosis of NMD and their mothers were included in the study. HRQOL of the mothers was assessed on the Turkish version of the Nottingham Health Profile (NHP); potential cases of depressive illness were identified on Beck Depression Inventory (BDI); and Wee‐Functional Independence Measure (Wee‐FIM) was used to evaluate of functional independence level of the children. Results: It was found that mean total NHP score of the mothers was moderately correlated with the total FIM score and sphincter control of the child, and weakly correlated with the locomotion of the child (P < 0.001). There was moderate correlation between mothers' social isolation and children's sphincter control, social integration and total Wee‐FIM score and a weak correlation between mobility and communication scores (P < 0.001). In contrast there was no correlation between BDI scores of mothers and Wee‐FIM scores of children (P > 0.05). Conclusion: The functional level of children with NMD is one of the factors that affect the quality of life of mothers.     

Nutritional status and cognitive performance of mother–child pairs in Sidama,Southern Ethiopia

The purpose of this study was to assess the nutritional status and cognitive performance of women and their 5‐year‐old children using a cross‐sectional design. Cognitive performance of mothers and children was assessed with Raven's Colored Progressive Matrices (CPM) and Kaufman Assessment Battery for Children‐II (KABC‐II). Demographic characteristics, food consumption patterns and anthropometry were also measured. Four rural districts in Sidama, southern Ethiopia served as the setting for this study. Subjects were one hundred women and their 5‐year‐old children. Mean ± standard deviation age of the mothers was 29 ± 6 years and family size was 7.0 ± 2.6. Maternal body mass index (BMI) ranged from 15.3 to 29.0 with 14% of the mothers having BMI < 18.5. Anthropometric assessment of children revealed 29% to be stunted (height‐for‐age z‐score < ?2) and 12% to be underweight (weight‐for‐age z‐score < ?2). Mothers' education significantly contributed to prediction of both mothers' and children's cognitive test scores. There were significant differences in mean cognitive test scores between stunted and non‐stunted, and between underweight and normal‐weight children. Height‐for‐age z‐scores were correlated with scores for short‐term memory (r = 0.42, P < 0.001), and visual processing (r = 0.42, P < 0.001) indices and weight‐for‐age z‐scores were also correlated with scores of short‐term memory (r = 0.41, P < 0.001) and visual processing (r = 0.43, P < 0.001) indices. Malnutrition in the community likely contributed to the cognitive performance of the subjects. Performance on memory and visual processing tasks was significantly lower in children with growth deficits suggesting that efficient and cost effective methods to alleviate malnutrition and food insecurity would impact not only child health but also cognitive function.