Survey of parents, nurses, and school principals on their perceptions of the controversial role of schools in health promotion

BACKGROUND: The aim of this paper was to study the perceptions of parents, nurses, and school principals of the role of the health services in elementary schools. METHODS: A questionnaire was distributed to the heads of parents' committees, school nurses, and school principals of 35 randomly selected elementary public schools in Israel. Respondents were asked to qualify the degree of importance of the traditional and contemporary roles of the school health-care team. RESULTS: Response rates were 80.0% for parents, 100% for nurses, and 97.1% for principals. All respondents agreed that both the traditional and new roles are very important. Nurses rated three interconnected roles significantly lower than parents and school principals: 'Evaluation of students with behavioral problems', 'Evaluation of students with low academic performance', and 'Follow up and care of students with behavioral problems and low performance'. CONCLUSIONS: Nurses, parents and school principals in Israel agree that the traditional roles of health teams in elementary schools, that is, providing first aid and ensuring school hygiene, are very important. Most are ready to accept a move from an illness-based to a social-based model, with less time spent on screening and surveillance and more on identifying and managing special needs of children and staff.     

Transition Care: Future Directions in Education,Health Policy,and Outcomes Research

All youth must transition from pediatric to adult-centered medical care. This process is especially difficult for youth with special health care needs. Many youth do not receive the age-appropriate medical care they need and are at risk during this vulnerable time. Previous research has identified barriers that may prevent effective transition, and protocols have been developed to improve the process. Health outcomes related to successful transition have yet to be fully defined.Health care transition can also be influenced by education of providers, but there are gaps in medical education at the undergraduate, graduate, and postgraduate levels. Current changes in federal health policy allow improved health care coverage, provide some new financial incentives, and test new structures for transitional care, including the evolution of accountable care organizations (ACO). Future work must test how these systems changes will affect quality of care. Finally, transition protocols exist in various medical subspecialties; however, national survey results show no improvement in transition readiness, and there are no consistent measures of what constitutes transition success.In order to advance the field of transition, research must be done to integrate transition curricula at the undergraduate, graduate, and postgraduate levels; to provide advance financial incentives and pilot the ACO model in centers providing care to youth during transition; to define outcome measures of importance to transition; and to study the effectiveness of current transition tools on improving these outcomes.     

Sleep,Physical Activity,and General Health Status: US Pediatricians and the General US Adult Population

Objective

To examine US pediatricians and US adults on 3 self-reported health measures (sleep, physical activity, and general health status) and to assess factors related to these measures for each group.

Waiting times for cancer care in Canadian children: impact of distance, clinical, and demographic factors

BACKGROUND: The objective of this study was to evaluate the impact of distance from residence to pediatric oncology centers on waiting times to diagnostic assessment and treatment in Canadian children with cancer. PROCEDURE: Two thousand three hundred sixteen children (< 15 years of age) captured by the Canadian Childhood Cancer Surveillance and Control Program's (CCCSCP) Treatment and Outcome Surveillance (TOS) system were included in the analysis. The number of days between onset of symptoms and first anti-cancer therapy was compared for those living less than 25, 25-99, and more than 100 kilometers from their treating center. For each time period, the adjusted odds of falling into the longest time quartiles were estimated using logistic regression analysis. RESULTS: Thirty-four percent (n = 786) of children lived more than 100 kilometers from their treating center. There were no significant differences in age at diagnosis (P = 0.33), sex (P = 0.68), or ICCC diagnosis (P = 0.02) by distance from center, though there was a significant difference in region of residence (P < 0.01) and the first health care professional contacted (P < 0.01). Except for waiting time from first health care contact to first assessment by treating oncologist which increased with increasing distance (P < 0.01), there were no significant differences in waiting times by distance. When adjusted for important demographic and clinical characteristics, distance to center did not affect the odds of waiting longer for any event. CONCLUSIONS: Distance to treating center had no significant impact on waiting times for important diagnostic and treatment events, when adjusted for age at diagnosis, diagnosis, region, and first health care professional seen.     

The Transition Readiness Assessment Questionnaire (TRAQ): Its Factor Structure,Reliability, and Validity

ObjectiveNational consensus statements recommend that providers regularly assess the transition readiness skills of adolescent and young adults (AYA). In 2010 we developed a 29-item version of Transition Readiness Assessment Questionnaire (TRAQ). We reevaluated item performance and factor structure, and reassessed the TRAQ's reliability and validity.MethodsWe surveyed youth from 3 academic clinics in Jacksonville, Florida; Chapel Hill, North Carolina; and Boston, Massachusetts. Participants were AYA with special health care needs aged 14 to 21 years. From a convenience sample of 306 patients, we conducted item reduction strategies and exploratory factor analysis (EFA). On a second convenience sample of 221 patients, we conducted confirmatory factor analysis (CFA). Internal reliability was assessed by Cronbach's alpha and criterion validity. Analyses were conducted by the Wilcoxon rank sum test and mixed linear models.ResultsThe item reduction and EFA resulted in a 20-item scale with 5 identified subscales. The CFA conducted on a second sample provided a good fit to the data. The overall scale has high reliability overall (Cronbach's alpha = .94) and good reliability for 4 of the 5 subscales (Cronbach's alpha ranging from .90 to .77 in the pooled sample). Each of the 5 subscale scores were significantly higher for adolescents aged 18 years and older versus those younger than 18 (P < .0001) in both univariate and multivariate analyses.ConclusionsThe 20-item, 5-factor structure for the TRAQ is supported by EFA and CFA on independent samples and has good internal reliability and criterion validity. Additional work is needed to expand or revise the TRAQ subscales and test their predictive validity.     

Toxicity and feasibility of vincristine,etoposide, and carboplatin alternating with vincristine,doxorubicin, and cyclophosphamide in children with advanced retinoblastoma in Guatemala

Retinoblastoma is highly curable, with event-free survival (EFS) of greater than 95% in high-income countries. However, in lower middle-income countries, outcomes of EFS are 30%–60% due to delayed diagnosis and lack of resources resulting in extra-ocular disease. We report the toxicity profile and outcomes of intensified therapy for advanced retinoblastoma: vincristine, etoposide, carboplatin (VEC) alternating with vincristine, doxorubicin, and cyclophosphamide (VDoCx) in Guatemala. Compared to VEC alone, similar rates of neutropenia, anemia, and thrombocytopenia were seen, with no toxic deaths. Although survival was not a primary objective, a modest survival benefit supports further investigation of VEC+VDoCx for advanced retinoblastoma.     

Unsettled infant behaviour and health service use: a cross-sectional community survey in Melbourne, Australia

Aims: To investigate factors associated with health service use by women and their infants in Victoria, Australia. Methods: Cross‐sectional screening survey of 875 women with 4‐month‐old infants attending immunisation clinics in five local government areas in Melbourne between May 2007 and August 2008. The self‐report instrument assessed socio‐demographic characteristics, unsettled infant behaviour, maternal mood (Edinburgh Postnatal Depression Scale) and, the outcome, health service use during the first 4 months post‐partum. Results: Mothers and their infants used on average 2.8 different health services in the first 4 months post‐partum (range 0–8). After adjustment for other factors, high health service use (defined as >3 different services) was more common in mothers whose infants were unsettled with persistent crying, resistance to soothing and poor sleep. A one‐point increase on the unsettled infant behaviour measure was associated with an 8% (2–14%) increase in the use of >3 services, 9% (3–16%) in use of emergency departments, 7% (2–13%) in use of telephone helplines and 9% (3–14%) of parenting services. Poorer maternal mental health was also implicated with a one‐point increase on the Edinburgh Postnatal Depression Scale associated with a 4% (0.4–8%) increase in the likelihood of using more than three services. Conclusions: Unsettled infant behaviour is associated with increased use of multiple health services. The high use of emergency departments by families with unsettled infants found in this study suggests that enhancement of primary health‐care capacity might be required.     

Maternal Health, Breast-Feeding and Infant Nutrition in Australian Aborigines

Undernutrition is widespread in Australian Aboriginal infants and children and is associated with high rates of infections, particularly of the respiratory and gastrointestinal systems. Maternal ill health and under nutrition seem to be neglected factors which contribute to the high incidence of low birth weight in Aboriginal babies and to their poor growth in the first five years of life. More effective preventive programmes are needed to help overcome these problems.     

Behavior problems and mental health contacts in adopted, foster, and nonadopted children

The implications of adoption for the emotional and behavioral adjustment of children have been an issue in child welfare for many years. Past research has suggested that adopted children are over-represented in mental health settings. In addition, some studies have suggested that adopted and nonadopted children differ on measures of social, emotional, behavioral, and cognitive functioning. The current study used data from a large, representative sample in the United States to examine whether adopted children are more likely to have had mental health contacts or emotional or behavioral problems than nonadopted children. Age of placement in the adoptive home was examined as a variable contributing to the adjustment of adopted children. Results suggest that adopted and foster children are more likely to have mental health contacts than nonadopted children. Results are mixed regarding whether adopted and foster children have more behavior problems than nonadopted children. However, significant differences between adopted, foster, and nonadopted children disappeared when a small group of influential cases were removed. This suggests that the differences seen between the groups reflect a small number of cases and are not representative of the groups of adoptees and foster children as a whole. The vast majority of adopted children showed patterns of behavior problems similar to those of nonadopted children. These results are discussed in relation to the past literature and areas for future research.     

Nature,severity and correlates of psychological distress in women admitted to a private mother-baby unit

OBJECTIVE: To characterize psychological distress of women admitted with their infants to a private hospital mother-baby unit. METHODS: A cross-sectional self-report survey including standardized psychometric questionnaires of consecutive admissions to Masada Private Hospital Mother-Baby Unit, Melbourne between 1 June and 30 November 1997. Scores on the Profile of Mood States, Edinburgh Postnatal Depression Scale, Intimate Bonds Measure, Parental Bonding Instrument, Social Support Questionnaire, Vulnerable Personality Scale self-report instruments and responses to a structured self-report questionnaire. Of the women admitted, 109 out of 146 participated in the survey. RESULTS: Clinically significant fatigue was almost universal in this cohort. Psychological distress clustered into three distinct groups: (i) probable depression; (ii) fatigue and distress; and (iii) fatigue only. It may be more accurate to conceptualise postpartum psychological distress either as a continuum, or as a wide range of distinct states, rather than as a dichotomous condition in which individuals are categorized as being or not being cases. In this cohort, the severity of distress was associated most consistently with the quality of a woman's relationship with her partner and with infants who were difficult to settle. CONCLUSIONS: It appears that some cases of psychological distress in women following childbirth may be inaccurately conceptualised as depression. Clinically significant fatigue and moderate distress are distinguishable from depression, and warrant specifically tailored assessment strategies and treatments. Following the birth of a baby, the partner of a mother has a strong influence on her emotional health and should be included in any assessment and intervention.     

青少年心理病理症状及应对方式与童年期反复躯体和情感虐待经历的相关性研究

目的分析青少年心理问题、应对方式与童年期反复严重躯体虐待、中度躯体虐待及情感虐待经历的关联强度。方法5141名中学生以自愿、无记名方式填写调查表的形式调查童年期经历父母或其他监护人的严重和中度躯体虐待及情感虐待情况。以在小学年龄阶段,3类共24项虐待行为中至少1项平均1年发生3次以上,界定为有该项童年期反复虐待经历。用症状自评量表（SCLOO）评定总心理问题、心理病理症状阳性项目数和9种心理病理症状,运用特质性应对方式问卷评定青少年积极和消极应对方式。结果青少年总心理问题检出率为9．1％,其中躯体化、强迫、人际关系敏感、抑郁、焦虑、敌对、恐惧、偏执、精神病性症状检出率分别为1．3％、3．6％、3．6％、2．8％、2．2％、4．0％、2．1％、2．8％、1．6％。总心理问题检出率、9种心理病理症状检出率和阳性项目数与3类童年期反复虐待经历的数量呈剂量-反应趋势。有童年期反复虐待经历的青少年,消极应对评分高于无童年期反复虐待经历者,且消极评分越高,其总心理问题检出率和阳性项目数增加。以青少年和父母的人口统计学变量为协变量,多项式Logistic回归分析表明,积极应对评分不影响3类童年期反复虐待经历与总心理问题的比值比（OR）,但消极应对降低童年期反复虐待经历与总心理问题及9种心理病理症状的OR值。结论不同种类和数量的童年期反复躯体虐待、情感虐待经历对青少年心理健康产生负面影响,消极应对方式可能参与调节了童年期虐待经历与青少年心理问题的联系。     

Child health services in transition: I. Theories, methods and launching

AIM: To describe an evidence-based model for preventive child health care and present some findings from baseline measurements. METHODS: The model includes: parent education; methods for interaction and language training; follow-up of low birthweight children; identification and treatment of postnatal depression, interaction difficulties, motor problems, parenthood stress, and psychosocial problems. After baseline measurements at 18 mo (cohort I), the intervention was tested on children from 0 to 18 mo at 18 child health centres in Uppsala County (cohort II). Eighteen centres in other counties served as controls. Two centres from a privileged area were included in the baseline measurements as a "contrasting" sample. Data are derived from health records and questionnaires to nurses and mothers. RESULTS: Baseline experiment (n = 457) and control mothers (n = 510) were largely comparable in a number of respects. Experiment parents were of higher educational and occupational status, and were more frequently of non-Nordic ethnicity. Mothers in the privileged area (n = 72) differed from other mothers in several respects. Experiment nurses devoted considerably fewer hours per week to child health services and to child patients than did control nurses. CONCLUSIONS: Despite certain differences, experiment and control samples appeared comparable enough to permit, in a second step, conclusions about the effectiveness of the intervention.     

Demographic characteristics and needs of families at an urban,low-income,multicultural paediatric clinic

OBJECTIVES:

To describe the demographic characteristics and identify the needs of a population attending an urban, low-income area, multicultural paediatric clinic.

METHODS:

Surveys were distributed to caregivers of children zero to 16 years of age (n=299).

RESULTS:

Of the children attending appointments, 55% were female and 51% were five years of age or younger. Of the caregivers, 29.5% were born outside of Canada and 25% reported that their primary spoken language was not English. Sixty-six per cent of families had been living in Edmonton for more than three years, with two-thirds of respondents living in Edmonton’s second-lowest average household income region. Seventy-six per cent of respondents lived in households with four or more persons.

CONCLUSIONS:

Challenges facing individuals attending an urban, low-income area, paediatric clinic include language barriers, lower household income and larger family size. Immigrants living outside of major Canadian cities are under-represented and may have different needs compared with their counterparts in ‘gateway’ cities. More studies are needed to determine their needs, and will ultimately lead to the provision of culturally competent care.