The impact of childhood conditions and concurrent morbidities on child health and well-being

Background   Understanding the impact of illnesses and morbidities experienced by children and adolescents is essential to clinical and population health programme decision making and intervention research. This study sought to: (1) examine the population prevalence of physical and mental health conditions for children and quantify their impact on multiple dimensions of children's health and well-being; and (2) examine the cumulative effect of concurrent conditions.
Methods   We conducted a cross-sectional school-based epidemiological study of 5414 children and adolescents aged 5–18 years, and examined parental reports of child health and well-being using the parent-report Child Health Questionnaire (CHQ) PF50 13 scales are scored on a 0–100 pt scale with clinically meaningful differences of five points and the presence of childhood conditions (illnesses and health problems).
Results   Asthma, dental, vision and allergies are the most commonly identified health problems for children and adolescents, followed by attention- and behaviour-related problems (asthma 17.9–23.2%, dental 11.9–22.7%, vision 7.2–14.7%, chronic allergies 8.8–13.9%, attention problems 5.1–13.8% and behaviour problems 5.7–12.0%). As the number of concurrent health problems increase, overall health and well-being decreases substantively with mean differences in CHQ scale scores of 14 points (−7.69 to −21.51) for physical health conditions, and 28 points (−5.15 to −33.81) for mental health conditions.
Conclusions   Children's health and well-being decreases linearly with increasing presence and frequency of health problems. Having three or more conditions concurrently significantly burdens children's health and well-being, particularly for family-related CHQ domains, with a greater burden experienced for mental health conditions than physical health conditions.     

SCHIP Directors' Perception of Schools Assisting Students in Obtaining Public Health Insurance

Background:  Health insurance coverage increases access to health care. There has been an erosion of employer-based health insurance and a concomitant rise in children covered by public health insurance programs, yet more than 8 million children are still without health insurance coverage.
Methods:  This study was a national survey to assess the perceptions of State Child Health Insurance Program (SCHIP) directors (N = 51) regarding schools assisting students in obtaining public health insurance. This study examined the perceived benefits of and barriers to working with school systems and the perceived benefits to schools in assisting students to enroll in SCHIPs and what SCHIP activities were actually being conducted with school systems.
Results:  The majority (78%) of SCHIPs had been working with school systems for more than a year. Perceived benefits of working with schools were greater access to SCHIP-eligible children (75%), assistance with meeting mandates to cover all SCHIP-eligible children (65%), and greater ability of state agencies to identify SCHIP-eligible children (58%). A majority of the directors did not identify any of the potential barrier items. The directors cited the following benefits to schools in helping enroll students in public health insurance programs: reduces the number of students with untreated health problems (80%), reduces student absenteeism rates (68%), improves student attention and concentration during school (58%), and reduces the number of students being held back in school because of health problems (53%).
Discussion:  The perceived benefits derived from schools assisting in enrolling eligible students into SCHIPs are congruent with the mission of schools. Schools need to become proactive in helping to establish a healthy student body, which is more likely to be an academically successful body.     

Understanding the medically unexplained: emotional and familial influences on children's somatic functioning

Background   Many youth experience impairing, unexplained somatic complaints. Psychosocial models of child somatization have primarily focused on parent somatic functioning. Although helpful in understanding child somatization, this narrow focus on parental factors leaves a large proportion of the variance unaccounted for when explaining children's general somatic functioning. The goal of this investigation is to extend current models of child somatization by collectively examining the influence of parent somatization and child emotional functioning.
Methods   Forty-two children (50% male; M age = 9.11) reported on their somatic symptoms, emotion awareness skills, and negative affect. Parents reported on their own somatic symptoms and their child's somatic symptoms and emotion regulation skills.
Results   Regression analyses indicated that poor awareness of emotional experiences and frequency of negative effect predicted child-reported somatic symptoms. Parental somatic symptoms and parent reports of children's emotion regulation difficulties predicted mother-reported child somatic symptoms. Only parental somatic symptoms significantly predicted father-reported child somatic symptoms.
Conclusions   These results suggest that models of child somatization should consider both family – (e.g. parent somatization) and child-level (e.g. emotional functioning) variables. The discrepancies between parent and child report of youth somatic symptoms underscore the importance of including multiple reporters on symptomatology in research and clinical settings. Suggestions for future research are provided.     

Stress in mothers of preterm infants in Bangladesh: associations with family, child and maternal factors and children's neuro-development

Background   The aim of this paper was to ascertain stress experienced by mothers of prospectively followed up preterm infants, and associations with family, child and maternal factors and children's neuro-development.
Methods   Within a follow-up study of preterm infants <33 weeks gestational age at a Child Development Center in Dhaka Shishu Hospital, mothers were interviewed with the Self-Report Questionnaire (SRQ) at each visit. Association between SRQ scores and child, family and maternal variables at first and final visit and children's neuro-developmental outcomes was determined.
Results   Low income mothers were more compliant (54%) compared with the defaulters (31%) ( P  = 0.0001) among the 159 mothers enrolled. Of the 88 mothers who were followed up until a mean age of 22 months of their child, 29.3% were at high risk for psychiatric morbidity at first visit compared with 23.9% on their last visit. Use of abortifacients ( P  = 0.026) and higher maternal age ( P  = 0.040) were significantly associated with maternal stress at first visit; while at last follow-up, total number of visits had the most significant association ( P  = 0.041). Twenty-five per cent and 19% of mothers were at risk for psychiatric morbidity in children developing normally and those with neuro-developmental impairments respectively.
Conclusions   Mothers at risk for psychiatric morbidity can be helped through follow-up support within public hospitals close to their homes, which is most availed by low income families. Neuro-developmental monitoring of high-risk infants closer to homes may be more feasible in resource poor countries than reliance on hospital visits, which increase stress. Biological markers of stress and coping strategies need further research.     

Directly observed physical activity levels in preschool children

Background:  Millions of young children attend preschools and other structured child development programs, but little is known about their physical activity levels while in those settings. The purpose of this study was to describe the physical activity levels and demographic and school-related correlates of physical activity in children attending preschools, using a direct observation measurement system.
Methods:  The Observational System for Recording Physical Activity in Children-Preschool Version was used to measure physical activity levels and related factors in four hundred ninety-three 3- to 5-year-old children in 24 preschools. A minimum of six hundred 30-second observation intervals were recorded for each child. Physical (height/weight) and demographic data also were collected.
Results:  Children engaged in moderate-to-vigorous physical activity (MVPA) during less than 3% of the observation intervals and were sedentary during more than 80% of the observation intervals. Boys were more likely than girls to engage in MVPA (p = .01), and 3-year-old boys were more active than 4- and 5-year-old boys (p = .01). The preschool that a child attended explained 27% of the variance in activity levels.
Conclusions:  The study indicates that young children are physically inactive during most of their time in preschool. The preschool that a child attended was a stronger predictor of physical activity level than any other factor examined. Additional research is needed to identify the characteristics of preschools in which children are more active.     

Promoting Community-Based Maternal and Child Health Services: A University-Health Department Partnership

Objectives: Funded by the Federal Maternal and Child Health Bureau, a partnership between the Johns Hopkins University School of Public Health, Department of Maternal and Child Health (JHU), and the Baltimore City Health Department (BCHD) identifies maternal and child health problems, and develops appropriate interventions. This paper presents the organization and activities of the JHU/BCHD Maternal and Child Community Health Science Consortium as a result of overcoming traditional barriers to collaborative efforts, and discusses what role the Consortium has had in its own collaborative success. Method: A review of the literature uncovered a number of barriers to productive interaction. A number of factors contributing to overcoming the barriers was also revealed. The organization and activities of the work of the JHU/BCHD Maternal and Child Community Health Science Consortium has been applied to these barriers and associated factors, and discussed in context of implications for future collaborative efforts. Results: The Consortium has developed a fully integrated administrative structure bridging both the BCHD and JHU. The mission of the Consortium has been translated into four categories of work, each one designed to complement, extend, and augment the other. The infrastructure established in Baltimore, as a direct result of this partnership, has served to overcome traditional barriers to productive academic/agency collaboration, while promoting organizational productivity. This outcome is a result of overcoming the recognized barriers to collaboration. Conclusions: Health agencies and university public health programs must link resources and collaborate to address public health issues. Commitment to a collaborative approach to the public's health will determine its future.     

Model Programs Addressing Perinatal Drug Exposure and Human Immunodeficiency Virus Infection: Integrating Women's and Children's Needs

Many of the efforts to address perinatal drug exposure and human immunodeficiency virus infection have been influenced by a perspective of conflict between the interests of mother and infant. This article highlights several programs that integrate women''s and children''s services while dealing with these health issues. It discusses the challenges encountered by these programs, such as funding restrictions, institutional barriers, professional attitudes, regulatory constraints, and local political issues. It presents strategies for overcoming these barriers including the creative coordination of funding streams, innovative relationships with child protective agencies, effective collaboration with other agencies, and advocacy on behalf of clients and programs, and makes recommendations for certain policy changes, which could foster the development of programs that serve women and children together.     

Linkage, coordination and integration: Evidence from rural palliative care

Objective:  Review the findings from the evaluations of three rural palliative care programs.
Design:  Review by the authors of the original material from each evaluation. The conceptual framework for the review was provided by the work of Leutz, including his distinction between linkage, coordination and full integration.
Setting:  Community-based palliative care in rural Australia.
Interventions:  Fifteen projects across all six states of Australia that focused on integration between general practitioners and other community-based health providers.
Results:  The projects set out to improve networking and collaboration between providers; improve coordination and integration of care for patients; reduce duplication of services; and achieve a multidisciplinary, collaborative approach to palliative care. The most common interventions were establishment of formal governance structures, provision of education programs, case conferencing, dissemination of information, development of formal arrangements, development of protocols and use of common clinical assessment tools. The terms 'integration' and 'coordination' were used frequently but without clear definitions. Coordination required someone specifically designated to do the coordinating, usually a nurse. Formal arrangements to improve linkage and coordination were difficult to maintain. The main mechanism to achieve full integration was the development of common clinical information systems.
Conclusions:  The 'laws' proposed by Leutz and the concepts of linkage, coordination and full integration provide a useful framework to understand the barriers to integrating GPs and other health providers. It is important to be clear on what level of integration is required. Improving links might be sufficient (and realistic), rather than striving for full integration.     

Stress and help-seeking for drought-stricken citrus growers in the Riverland of South Australia

Objective:  To explore the psychological impact of a problematic industrial climate for citrus growers, their help-seeking behaviour and perspectives on ways to encourage better use of rural mental health services.
Design:  Thematic analysis of in-depth interviews.
Setting:  The Riverland of South Australia.
Participants:  Sixteen citrus growers (12 male, 4 female) from eight Riverland towns.
Main outcome measures:  Citrus growers' perceived factors relating to psychological stress, coping behaviours, impact of stress on well-being, help-seeking behaviours, barriers to help-seeking and ways to encourage better use of rural mental health services.
Results:  Work-related stresses grouped under broad themes, including 'Uncontrollable events', 'Financial hardship' and 'Pressure', had negative effects on participants' well-being. Furthermore, it was found that significant difficulties arise because many of the stresses which growers endure are not controllable, and that the alleviation of strain with the help of mental health professionals is uncommon because of barriers preventing help-seeking. Five broad themes of barriers to help-seeking were extracted from the data: 'Self-reliance', 'Social image', 'Lack of knowledge', 'Negative perceptions of health professionals' efficacy' and 'Restrictive lifestyle factors'. A specialised model of occupational health for citrus growers was proposed.
Conclusions:  These results highlight the practical need to address the identified issues in delivery and promotion of health services when facilitating help-seeking within this group. The findings also add to our knowledge of occupational health psychology broadly.     

Chronic illnesses in Canadian children: what is the effect of illness on academic achievement,and anxiety and emotional disorders?

Background   Survival rates of children with a chronic illness is at an all-time high. Up to 98% of children suffering from a chronic illness, which may have been considered fatal in the past, now reach early adulthood. It is estimated that as many as 30% of school-aged children are affected by a chronic illness. For this population of children, the prevalence of educational and psychological problems is nearly double in comparison with the general population.
Methods   This study investigated the educational and psychological effects of childhood chronic illness among 1512 Canadian children (ages 10–15 years). This was a retrospective analysis using data from the National Longitudinal Survey of Children and Youth, taking a cross-sectional look at the relationships between childhood chronic illnesses, performance on a Mathematics Computation Exercise (MCE) and ratings on an Anxiety and Emotional Disorder (AED) scale.
Results   When AED ratings and educational handicaps were controlled for, children identified with chronic illnesses still had weaker performance on the MCE. Chronic illness did not appear to have a relationship with children's AED ratings. The regression analysis indicated that community type and illness were the strongest predictors of MCE scores.
Conclusions   The core research implications of this study concern measurement issues that need to be addressed in future large-scale studies. Clinical implications of this research concern the need for co-ordinated services between the home, hospital and school settings so that services and programmes focus on the ecology of the child who is ill.     

母亲教养压力与小学一年级学生睡眠问题的关系

  目的  了解北京市6~8岁小学一年级儿童睡眠现状,探索母亲教养压力与儿童睡眠之间的关系,为减少儿童睡眠问题的发生提供科学依据。  方法  对北京儿童生长与健康队列(PROC)的参与者开展线上调查。由家长完成儿童睡眠习惯问卷(CSHQ)和父母教养压力问卷(PSI-SF),纳入同时完成两份问卷且父母教养压力问卷由母亲回答的1 136对小学一年级学龄儿童及其母亲作为研究对象。采用Logistic回归分析母亲教养压力与儿童睡眠之间的关联。  结果  小学一年级学生睡眠问题发生率为78.52%,有睡眠问题儿童的母亲教养压力问卷得分(86.66±17.31)高于无睡眠问题儿童的母亲(78.59±17.75)(t=6.42,P < 0.01)。在调整混杂因素后,多因素Logistic回归结果显示,与没有教养压力的母亲相比,母亲有教养压力时儿童存在睡眠问题的风险增加(OR=2.52,95%CI=1.55~4.11,P < 0.01);在以PSI-SF中3个维度为自变量进一步分析时,结果显示, 相比母亲在育儿压力、困难儿童2个维度没有压力的小学生,母亲有压力的小学生存在睡眠问题的风险增加(OR值分别为1.66,1.76,P值均 < 0.05)。  结论  小学一年级学生普遍存在不同程度的睡眠问题,为母亲提供心理支持以减少母亲教养压力的发生,可以减少儿童睡眠问题。     

Racial, Ethnic, and Sex Differences in the Associations Between Violence and Self-Reported Health Among US High School Students

BACKGROUND:  Involvement in interpersonal violence or suicidal behaviors can have a significant impact on an adolescent's physical health. Similarly, previous research has suggested that lived experiences, more than the presence or absence of physical ailments, can significantly influence self-assessed health status among adolescents. The purpose of this study was to examine the cross-sectional associations between involvement in violence and poor or fair self-reported health among US high school students.
METHODS:  Data were obtained from the 2005 national Youth Risk Behavior Survey (n = 13,953). Logistic regression analyses were conducted to determine the associations between violence-related measures and self-reported health while controlling for demographic characteristics and potential confounders. Analyses are presented for students overall and stratified by sex and race/ethnicity.
RESULTS:  Overall, 7.2% of students reported fair or poor self-rated health. Having been in a physical fight, having been injured in a physical fight, having attempted suicide, and having not gone to school because of safety concerns were significantly associated with fair or poor self-rated health after controlling for demographic characteristics and other potential confounders. Differences associated with race/ethnicity and sex are identified.
CONCLUSIONS:  Four of the 5 violence-related measures included in these analyses were significantly associated with fair or poor self-rated health. Future studies should consider the impact of involvement in violent behaviors and perceptions of both physical and mental well-being.     

Parental discipline behaviours and beliefs about their child: associations with child internalizing and mediation relationships

Introduction   Internalizing disorders of childhood are a common and disabling problem, with sufferers at increased risk of subsequent psychiatric morbidity. Several studies have found associations between parenting styles and children's internalizing, although few have considered the role of parental discipline. Parental discipline style may exert an effect on children's internalizing symptoms. Anxiety and depression are reliably found to run in families and parental anxiety has been shown to effect parenting behaviour. This study set out to examine the links between parental anxiety, parental discipline style and child internalizing symptoms.
Method   Eighty-eight parents of children aged 4–10 years were recruited through primary schools. All parents completed questionnaires including measures relating to: adult anxiety (State-Trait Anxiety Inventory – Trait version, Penn State Worry Questionnaire), parental depression (Beck Depression Inventory – Fastscreen), parental discipline (The Parenting Scale), parenting-related attributions (Parenting Attitudes, Beliefs and Cognitions Scale) and child psychological morbidity (Child Behaviour Checklist 4–18 version).
Results   Significant correlations were found between both parental anxiety and child internalizing symptoms with ineffective discipline and negative beliefs about parenting. Particularly strong correlations were found between parental anxiety and child internalizing symptoms with harsh discipline. Parents of anxious/withdrawn children were more likely to hold negative beliefs about their child. The link between parental anxiety and child internalizing symptoms was mediated by harsh discipline. The link between parental anxiety and harsh discipline was mediated by parental beliefs about the child.
Conclusion   Discipline style may be an important factor in the relationship between parent anxiety and child internalizing symptoms.     

Movement skills proficiency and physical activity: A case for Engaging and Coaching for Health (EACH)–Child

Background/aim:  Supporting children's participation in health-enhancing physical activities is an important occupational goal for therapists. Fundamental movement skills (FMS) are thought to underpin and enable many activity options. This study had two goals: first, to examine the relationship between fundamental movement skills (FMS) and physical activity, and second, to use this and existing evidence to inform strategies whereby children's motivation for and engagement in physical activity can be supported.
Methods:  A cross-sectional investigation of 124 children, aged 6–12 years, was undertaken. FMS were assessed using the Movement Assessment Battery for Children (M-ABC) and physical activity by pedometer step counts.
Results:  A weak but significant association was found between weekend physical activity and balance skills for girls. Correlations between physical activity and ball skills or manual dexterity were not significant for either gender, however, having age appropriate ball skills did result in greater but not significant levels of physical activity for all children when grouped together.
Conclusions:  Findings from this study question the magnitude of the relationship between children's FMS and physical activity as measured by pedometers. If the goal of health enhancement through physical activity engagement is to be realised, it is proposed that community, occupation-based approaches may offer more potential than skills-based interventions at increasing activity participation. The concept of Engaging and Coaching for Health (EACH)-Child is introduced to this end. Occupational therapists are encouraged to work collaboratively with school and community organisations to assist children to find the physical activities that best accommodate their interests, abilities and offer opportunities for lifelong engagement.     

Family-centred care and health-related quality of life of patients in paediatric neurosciences

Background   Little is known about the influence of contextual factors such as health services characteristics on health-related quality of life (HRQL) for children with a neurological condition. To address this gap, we conducted an exploratory study of the relationship between family-centred care (FCC) and HRQL outcomes in children from neurosciences clinics in a large acute care hospital.
Methods   A total of 187 family caregivers completed questionnaires regarding their socio-demographic status, the severity of their children's condition (FIM™), perceptions of their children's HRQL (PedsQL 4.0) and their experiences of FCC (MPOC-20). Hierarchical regression analyses explored the hypothesis that FCC is a significant predictor of children's HRQL, independent of illness severity.
Results   Illness severity and FCC jointly explained one-third of the variance in children's total HRQL. When FCC was controlled for illness severity, it remained a significant predictor of physical, psychosocial and total HRQL scores.
Conclusions   This study provides evidence that the level of FCC is positively related to paediatric HRQL independent of neurological illness severity. The implication is that the uptake of FCC practices by service providers can positively impact the quality of life of children with neurological disorders.     

Reliability of the School Food Checklist for in-school audits and photograph analysis of children's packed lunches

Background:  Assessment of children's diets is problematic, typically relying on error-prone parent or child recall or reporting, or resource intensive direct observation. The School Food Checklist (SFC) is an objective instrument comprising of 20 food and beverage categories designed to measure the foods contained in children's packed lunches. The present study aimed to assess intra-rater and inter-rater reliability of each of the food and beverage categories of the SFC for both in-school audits and photograph analysis of children's school lunches.
Methods:  Participants comprised 176 children aged 5–8 years from five primary schools in Northern Metropolitan Melbourne. The SFC was used to measure the foods contained in children's packed lunches in the school setting and using photographs. Photograph analysis was conducted by the auditors 2–3 months after completion of in-school audits.
Results:  Both intra-rater [intra-class correlation coefficient (ICC) = 0.78–1] and inter-rater (ICC = 0.50–0.95) reliability analysis indicated strong agreement for in-school auditing. With the exception of the food category titled 'leftovers', there was strong intra-rater reliability for auditors' live audits and their analysis of photographs [ICC = 0.57–0.98 (Auditor 1); ICC = 0.72–0.90 (Auditor 2)], and strong inter-rater reliability for photograph analysis (ICC = 0.68–0.92).
Conclusions:  The SFC is a reliable method of measuring the foods and beverages contained in children's packed lunches when used in the school setting or for photograph analysis. This finding has broad implications, particularly for the use of photograph analysis, because this approach offers a convenient and cost effective method of measuring what food and beverages children bring to school in home packed lunches.     

Assistive devices and cerebral palsy: factors influencing the use of assistive devices at home by children with cerebral palsy

Background   There is a growing awareness of the significance of gaining insights into device users' needs in their everyday usage in order to maximize the potential of assistive device intervention. However, current studies in this field are likely to focus more upon adult users' or adult carers' perspectives and, accordingly, the opinions of young users seem to be overlooked. In order to take the gap into consideration, this study aimed to explore the usability of assistive devices at home by children with cerebral palsy and consider the underlying factors related to the device usage in this setting mainly from the children's perspectives.
Methods   Semi-structured interviews were adopted as the main data collection instrument. A total of 30 participants were involved in the study, including 15 Taiwanese children with cerebral palsy and 15 mothers.
Results   The results showed a low frequency of device use at home by the participating children. Four factors leading to low device use at home were identified, including children's reluctance, mothers' perspectives, physical environmental barriers and device-related barriers.
Conclusions   The results highlight the need, when considering the usability of assistive devices, to take into account three interactive factors, namely, the personal, device and environmental factors. They also demonstrate the importance of taking children's different developmental stages and unique personal experiences into consideration in understanding the influence of assistive device intervention for children with cerebral palsy.     

Predictors of undergraduates' intention to incorporate glycaemic index into dietary behaviour

Aim:  The present study used an extension of the theory of planned behaviour to analyse undergraduates' intention to perform behaviour related to the glycaemic index of food. The extended model incorporated measures of past behaviour and pre-existing knowledge about glycaemic index.
Methods:  Seventy-two participants read an academic journal article about glycaemic index and completed questionnaires measuring predictor components of the theory of planned behaviour model.
Results:  Subjective norm and attitude were generally observed to be the best predictors of intention. Pre-existing knowledge about glycaemic index and attitude towards restrained eating were generally found to be poor predictors of intention. Past behaviour exhibited a positive relationship with intention.
Conclusions:  Interventions that focus on dietary behaviour related to the glycaemic index of food should involve individuals who have relationships of influence with the target demographic, such as friends and family, and will need to address modifying ingrained patterns of behaviour.