Change Trajectories: Children’s Patterns of Improvement in Acute-Stay Inpatient Care

This study estimated classes of children’s acute-stay psychiatric acuity trajectories in terms of shape (i.e., linear, quadratic, cubic) and rate of change (slope). A total of 788 children served on three child units (ages 4–12) were studied. The Children’s Acuity of Psychiatric Illness (CAPI) was completed each weekday by trained frontline staff on the milieu. Latent class growth analysis was applied to the data, and seven acuity trajectory classes provided the most parsimonious fit. Four classes evidenced a significant quadratic term, one class a significant linear term, and two classes did not evidence a significant change in acuity. The classes varied in survival time to rehospitalization, in pre-treatment community service use and rates of seclusion, restraint, and emergency medications during the episode. Overall, the results suggest that acute-stay patients may have distinct and identifiable psychiatric acuity change patterns during their episodes and that some may experience non-linear (i.e., quadratic) acuity trajectories.     

Children’s Media Use and Self-Regulation Behavior: Longitudinal Associations in a Nationwide Japanese Study

Objective The effect of media use on child behavior has long been a concern. Although studies have shown robust cross-sectional relations between TV viewing and child behavior, longitudinal studies remain scarce. Methods We analyzed the Longitudinal Survey of Babies, conducted by Japan’s Ministry of Health, Labour and Welfare since 2001. Among 53,575 families, 47,010 responded to the baseline survey; they were followed up every year for 8 years. Complete data were available for longitudinal analysis among 32,439 participants. Daily media use (TV viewing and video game-playing hours at ages 3, 4, and 5 years) was used as the main exposure. We employed an index of the children’s self-regulatory behavior as the outcome variable. Odds ratios and 95 % confidence intervals (CIs) were estimated. Results Among boys, longer TV-viewing times at ages 4 and 5 were related to problematic self-regulatory behavior. Compared with boys who watched just 1–2 h of TV a day, those who watched it 4–5 h had a 1.79-fold greater risk (CI 1.22–2.64) of problematic self-regulatory behavior, according to parental report. Among girls, similar results were evident at ages 4 and 5 (e.g., adjusted odds ratios for 4–5 h daily viewing versus 1–2 h at age 4: 2.59; 95 % CI 1.59–4.22). Video games may have a protective effect on the risk of problematic self-regulatory behavior at ages 3 and 5. Conclusion Longer daily exposure to TV during early childhood (age 4–5) may be associated with subsequent problematic child self-regulatory behavior.     

Understanding Women’s Choices: How Women’s Perceptions of Quality of Care Influences Place of Delivery in a Rural Sub-County in Kenya. A Qualitative Study

Maternal and Child Health Journal - Maternal mortality is still unacceptably high in Kenya. The Kenyan Government introduced a free maternity service to overcome financial barriers to access. This...     

Family Organizations in Children’s Mental Health Systems of Care: the Challenge of Maintaining Financial Sustainability

The Journal of Behavioral Health Services & Research - Family-run organizations are an important source of support for families of children with serious emotional disturbance, yet little work...     

The Sustainability of Systems of Care for Children’s Mental Health: Lessons Learned

The federal Comprehensive Community Mental Health Services for Children and Their Families Program was initiated in 1992 to provide grants to states, communities, territories, and Indian tribes to develop systems of care to serve children and adolescents with or at risk for emotional disorders and their families. As part of the national evaluation of this program, a study was undertaken to assess the ability of funded sites to sustain their systems of care beyond the federal grant period. The study involved a web survey and telephone interviews with local and state respondents to examine the extent to which key components of systems of care were maintained during the period in which federal funds were phasing out and during the postgrant period. Study results demonstrate positive and negative changes that occurred in the communities which are included in the sample, with respect to maintaining the availability of each service included in the broad service array, the implementation of system of care principles, the system of care infrastructure, and the achievement of system of care goals. In addition, results identify factors that contribute to or impede the ability to sustain systems of care, and the effectiveness of various strategies for sustainability. Study findings offer guidance not only to federally funded system of care communities but also to nonfunded communities engaged in system of care development to enhance their ability to sustain systems of care for this population over time. Findings will also assist federal, state, and local policymakers, technical assistance providers, family members, advocates, and other key stakeholders to more effectively support the development of viable, sustainable systems of care.     

A Qualitative Study of Women’s Experiences of Communication in Antenatal Care: Identifying Areas for Action

To identify key features of communication across antenatal (prenatal) care that are evaluated positively or negatively by service users. Focus groups and semi-structured interviews were used to explore communication experiences of thirty pregnant women from diverse social and ethnic backgrounds affiliated to a large London hospital. Data were analysed using thematic analysis. Women reported a wide diversity of experiences. From the users’ perspective, constructive communication on the part of health care providers was characterised by an empathic conversational style, openness to questions, allowing sufficient time to talk through any concerns, and pro-active contact by providers (e.g. text message appointment reminders). These features created reassurance, facilitated information exchange, improved appointment attendance and fostered tolerance in stressful situations. Salient features of poor communication were a lack of information provision, especially about the overall arrangement and the purpose of antenatal care, insufficient discussion about possible problems with the pregnancy and discourteous styles of interaction. Poor communication led some women to become assertive to address their needs; others became reluctant to actively engage with providers. General Practitioners need to be better integrated into antenatal care, more information should be provided about the pattern and purpose of the care women receive during pregnancy, and new technologies should be used to facilitate interactions between women and their healthcare providers. Providers require communications training to encourage empathic interactions that promote constructive provider–user relationships and encourage women to engage effectively and access the care they need.     

Children’s Exposure to Metals: A Community-Initiated Study

In 2007, it was shown that the shipping of lead (Pb) through Esperance Port in Western Australia resulted in contamination and increased Pb concentrations in children. A clean-up strategy was implemented; however, little attention was given to other metals. In consultation with the community, a cross-sectional exposure study was designed. Thirty-nine children aged 1 to 12 years provided samples of hair, urine, drinking water, residential soil and dust. Concentrations of nickel (Ni) and Pb were low in biological and environmental samples. Hair aluminium (Al) (lower than the detection limit [DL] to 251 μg/g) and copper (Cu) (7 to 415 μg/g), as well as urinary Al (<DL to 210 μg/L), manganese (Mn) (<DL to 550 μg/L), and Cu (<DL to 87 μg/L), were increased for a small number of participants. Concentrations of nickel (Ni) in urine, soil, and dust decreased with increasing distance from the port, as did soil Pb concentrations. The results suggest exposure to Ni and Pb was limited in children at the time of sampling in 2009. Further investigation is required to determine the source(s) and significance of other increased metals concentrations.     

A National Perspective on Exploring Correlates of Accreditation in Children’s Mental Health Care

This study is the first to explore national accreditation rates and the relationship between accreditation status and organizational characteristics and quality indicators in children’s mental health. Data from the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey of Mental Health Treatment Facilities (NSMHTF) were used from 8,247 facilities that serve children and/or adolescents. Nearly 60% (n=4,925) of the facilities were accredited by the Council on Accreditation (COA), the Commission on Accreditation of Rehabilitation Facilities (CARF), or The Joint Commission (TJC). Chi-square analyses were conducted to explore relationships. Compared to non-accredited facilities, more accredited facilities reported greater number of admissions, acceptance of government funding and client funds, and implementation of several quality indicators. Policies with incentives for accreditation could influence accreditation rates, and accreditation could influence quality indicators. These results set the foundation for future research about the drivers of the accreditation phenomenon and its impact on children’s mental health outcomes.     

Choice of Care for Minor Trauma: Hospital or General Practice?

This paper analyses the question whether minor trauma shouldbe treated in hospital or general practice. It shows what kindof data are necessary and that this data can be obtained fromdifferent countries, with basic similarities in their healthcare system. In a period of tight budgets there is a tendencyto focus on a narrow economic analysis. This article, however,shows the complexity of the simple question of where minor traumashould be treated and stresses other important aspects whichshould supplement an economic analysis. These aspects are illustratedwith data from different investigations in Denmark and the UnitedKingdom.     

Interviewer Variability – Quality Aspects in a Case–Control Study

Quality assurance and quality control are important for the reliability of case–control studies. Here we describe the procedures used in a previously published study, with emphasis on interviewer variability. To evaluate risk factors for acute pancreatitis, information including previous diagnoses and medication was collected from medical records and by telephone interviews from 462 cases and 1781 controls. Quality assurance procedures included education and training of interviewers and data validity checks. Quality control included a classification test, annual test interviews, expert case validation, and database validation. We found pronounced variations between interviewers. The maximal number of interviews per day varied from 3 to 9. The adjusted average (95% CI) number of diagnoses captured per interview of cases was 4.1 (3.8–4.3) and of controls 3.5 (3.4–3.7) (excluding one deviating interviewer). For drugs, the average (95% CI) number per interview was 3.9 (3.7–4.1) for cases and 3.3 (3.2–3.4) for controls (excluding one deviating interviewer). One of the fourteen interviewers deviated significantly from the others, and more so for controls than for cases. This interviewer’s data `were excluded. Nonetheless, data concerning controls more frequently needed correction and supplementation than for cases. Erroneous coding of diagnoses and medication was also more frequent among controls. Thus, a system for quality control of coding practices is crucial. Variability in interviewers’ ability to ascertain information is a possible source of bias in interview-based case–control studies when “blinding” cannot be achieved. Bengt-Erik Wiholm unexpectedly died on 30th July 2005 after an auto accident. He was specialist in internal medicine as well as in clinical pharmacology, he has been a leader in the field of Drug Safety and Pharmacoepidemiology. He started his carrier in pharmacology and epidemiology at Karolinska Institute in Stockholm Sweden and later on as head for the Pharmacoepidemiology Unit at the Swedish Medical Products Agency in Sweden. Since the last four years he has been employed as Senior Director, Epidemiology at Merck Research and Laboratories in US.     

Children’s perceptions of live arts performances: a longitudinal study

‘Children’s Voices’ is a longitudinal research project to document and understand children’s perceptions of live arts performance and the impact on their teachers and school communities. The research conducted in South Australia with 135 5–12‐year‐olds in four schools involves collaboration between the South Australian Department of Education and Children’s Services (DECS), Windmill Performing Arts and de Lissa Institute for Early Childhood and Family Studies, University of South Australia (UniSA). The children attend three arts performances per year at the Festival Theatre, Adelaide. This paper reports on children’s views after 12 months, their interest in various aspects of the arts and performance and the effects on teachers, parents and school communities.     

Primary Care Pediatrics and Public Health: Meeting the Needs of Today’s Children

The proportion of children suffering from chronic illnesses—such as asthma and obesity, which have significant environmental components—is increasing. Chronic disease states previously seen only in adulthood are emerging during childhood, and health inequalities by social class are increasing. Advocacy to ensure environmental health and to protect from the biological embedding of toxic stress has become a fundamental part of pediatrics. We have presented the rationale for addressing environmental and social determinants of children’s health, the epidemiology of issues facing children’s health, recent innovations in pediatric medical education that have incorporated public health principles, and policy opportunities that have arisen with the passage of the 2010 Patient Protection and Affordable Care Act.In pediatrics, the acknowledgment of child development as a transactional process and ultimate determinant of adult capacity has important implications for the development of systems, practice models, and training. If we are to ensure children’s health and, ultimately, overall population well-being, childhood service systems must become responsive and coordinated on many levels; practitioners must develop multiple skills outside the traditional medical model; and training strategies must become innovative. Promoting access to effective health and health-related services is essential for achieving Healthy People 2020 objectives (the US Department of Health and Human Services’ set of health-promotion and disease-prevention goals to be achieved nationwide by 2020). There are many examples of shortfalls in adequacy of available services, effectiveness of care provided, organization of services, and focus on primary prevention. Up to 50% of developmental problems in children are not identified until school entry,1 more than 8 million children remain without health care coverage in the United States, and a much larger number have no regular source of health care except in emergencies.2 In addition to inadequate funding for appropriate services, the network of programs serving children is increasingly fragmented, difficult to navigate, and unresponsive.A major challenge for children’s and youths’ services is to develop more effective and efficient service integration models. In the present system, pediatricians tend to avoid asking parents about matters for which they feel inadequately trained and for which they are not aware of patient resources, including child development, obesity, breastfeeding, family violence, environmental health, and mental health. The system will not respond without adequately prepared clinician–advocates who recognize and understand these issues and their relationship to ultimate outcomes.     

Children’s Receipt of Health Care Services and Family Health Insurance Patterns

PURPOSE Insured children in the United States have better access to health care services; less is known about how parental coverage affects children’s access to care. We examined the association between parent-child health insurance coverage patterns and children’s access to health care and preventive counseling services.METHODS We conducted secondary analyses of nationally representative, cross-sectional, pooled 2002–2006 data from children (n = 43,509), aged 2 to 17 years, in households responding to the Medical Expenditure Panel Survey (MEPS). We assessed 9 outcome measures pertaining to children’s unmet health care and preventive counseling needs.RESULTS Cross-sectionally, among US children (aged 2 to 17 years) living with at least 1 parent, 73.6% were insured with insured parents, 8.0% were uninsured with uninsured parents, and the remaining 18.4% had discordant family insurance coverage patterns. In multivariable analyses, insured children with uninsured parents had higher odds of an insurance coverage gap (odds ratio [OR] = 2.45; 95% confidence interval [CI], 2.02–2.97), no usual source of care (OR = 1.31; 95% CI, 1.10–1.56), unmet health care needs (OR = 1.11; 95% CI, 1.01–1.22), and having never received at least 1 preventive counseling service (OR = 1.20; 95% CI, 1.04–1.39) when compared with insured children with insured parents. Insured children with mixed parental insurance coverage had similar vulnerabilities.CONCLUSIONS Uninsured children had the highest rates of unmet needs overall, with fewer differences based on parental insurance status. For insured children, having uninsured parents was associated with higher odds of going without necessary services when compared with having insured parents.     

Patterns of Health Insurance Discontinuity and Children’s Access to Health Care

Objectives This study classified patterns of discontinuous health insurance coverage, including change in coverage type and gaps in coverage, and described their associations with children’s access to health care. Methods Using the 2011–2013 National Health Interview Survey data, we determined children’s insurance coverage over the past year, and whether children had a usual source of care, had to delay getting care, or had unmet health care needs. Using multivariable logistic regression, we compared measures of access to care across insurance coverage patterns, classified as continuous private coverage; continuous public coverage; continuous lack of coverage; change in coverage type (public versus private) without gaps in coverage; and any gap in coverage. A subgroup analysis repeated this comparison for children with a caregiver-reported chronic physical illness. Results The analysis included 34,105 children, of whom 7% had a gap in coverage and 1% had a change in coverage type. On multivariable analysis, gaps in coverage were associated with increased likelihood of unmet health care needs, compared to continuous private (OR 6.9; 95% CI 5.9, 8.0) or continuous public coverage (OR 5.1; 95% CI 4.4, 6.0). Seamless changes in coverage were also associated with greater likelihood of unmet health care needs [OR vs. private: 3.8 (95% CI 2.3, 6.1); OR vs. public: 2.8 (95% CI 1.8, 4.6); all p < 0.001]. Results were similar for other study outcomes, and among children with chronic physical illness. Conclusions for Practice Both gaps in coverage and seamless changes between coverage types were associated with limited health care access for children.

     

Children’s choice: motivation after successful completion of a mathematics task

The purpose of this study was to examine kindergarten children’s motivation choice after successfully completing a mathematical task. Three succeeding measurements took place in two-week intervals. In each measurement a different choice dyad was presented to participating children. After the successful completion of a mathematical activity, participants were asked to make one choice from among three dyads: social reward-tangible reward, social reward-harder task and tangible reward-harder task. Results revealed that children preferred the tangible reward (candy) over other choices and the social reward over the harder task. Logistic regression analyses revealed that children’s choice of a tangible reward cannot be predicted by their mothers’ and fathers’ education and income levels, their mathematical level or their teachers’ reward practices. Educators should be aware of practices that would harm the learner’s inner process in order to avoid those applications in their classroom.     

Annals Journal Club: Prognosis of Abdominal Pain in Children in Primary Care—A Prospective Cohort Study

PURPOSE

Abdominal pain is a common complaint in children. Because few data exist on its natural history, we wanted to investigate the prognosis of abdominal pain in children in general practice.

METHODS

In a prospective cohort study of children (aged 4 to 17 years) complaining of abdominal pain, follow-up was at 3, 6, 9, and 12 months using standardized questionnaires. The primary outcome measure was chronic abdominal pain: abdominal pain at least 1 time a month during at least 3 consecutive months that had an impact on daily activities. Prevalence, incidence, and duration of chronic abdominal pain were assessed.

RESULTS

Three hundred five children (116 boys, 189 girls), with a median age of 7.8 years (interquartile range [IQR] = 5.7–10.5 years) were included. Chronic abdominal pain was present in 142 (46.6%) children at an initial visit to the primary care physician for this complaint. During follow-up, 78.7% fulfilled the criteria for chronic abdominal pain at 1 or more follow-up points. Among 163 children at risk for developing chronic abdominal pain, the cumulative incidence of chronic abdominal pain was 60.1% (95% CI, 52.1%–67.7%) and was higher in girls than in boys (RR = 1.23; 95% CI, 0.94–1.61). Median duration of abdominal pain was 7.5 months (IQR = 4.5–12.0 months). Children aged 10 to 17 years had the longest duration of abdominal pain (median = 9.0 months; IQR = 7.5–12.4 months). Children with symptoms of irritable bowel syndrome seemed to have a less favorable prognosis compared with children with symptoms of functional dyspepsia or functional abdominal pain.

CONCLUSIONS

The presence and development of chronic abdominal pain is common and of long duration among children consulting in primary care for abdominal pain. These poor outcome data warrant follow-up.     

Exploring Children’s Perceptions of Two School-Based Social Inclusion Programs: A Pilot Study

Background

Although social exclusion among typically developing school-aged children has been well explored, it is under-researched for children with disabilities even though they are at a higher risk for being excluded. While there are a number of different programs available to improve social inclusion at school, the appeal of these programs to children remains unknown.

Objective

The objective of this pilot study was to elicit children’s perceptions of the desirable components of two commonly used social inclusion programs in Ontario, Canada.

Methods

An exploratory mixed methods design (group discussion, observation notes, and a brief questionnaire) was used to provide an in-depth understanding of children’s perceptions of two social inclusion programs: A group-based game (n = 87) and a puppet show (n = 78).

Results

Children in each program reported that several aspects of the content appealed to them including learning about (1) bullying; (2) disability; (3) building friendships and encouraging social inclusion; (4) preventing social exclusion. The desirable aspects related to the format of the game and puppet show included (1) the interactive components; (2) the relevant topics and characters; (3) the length of the programs.

Conclusions

Children’s insights about social inclusion programs should be considered in development and improvements of future programs.