A randomized intervention study of sun protection promotion in well-child care

BACKGROUND: This study evaluated the behavioral impact of a skin cancer prevention program in which health care providers delivered advice and materials to parents of infants over a 3-year period from 1998 to 2001. METHODS: Fourteen offices of a large managed care organization in Colorado were randomly assigned to the intervention or control groups. 728 infants and their parents were recruited within 6 months of birth. At intervention offices, health care providers attended orientation sessions, prompts for delivering sun protection advice were placed in medical records, and parents received sun protection packets at each well-child visit between 2 and 36 months of age. RESULTS: Based on provider self-report and exit interviews of parents, providers in the intervention group delivered approximately twice as much sun protection advice as providers in the control group. Annual telephone interviews of parents indicated small but statistically significant differences in parent sun protection practices favoring the intervention. Skin exams revealed no significant differences in tanning, freckling, or number of nevi. Behavioral differences between groups appeared to grow over the 3 years of follow-up. CONCLUSIONS: This intervention strategy was successful in increasing the delivery of sun protection advice by health care providers and resulted in changes in parents' behaviors. While the behavioral effect was probably not strong enough to reduce risk for skin cancer, the effect may increase as children age and have more opportunities for overexposure to the sun.     

Children's Admissions to the Intensive Care Unit: Parents' Attitudes and Expectations of Outcome

A reliable instrument based on the Expectancy-Value Model of Attitude was developed using responses of 30 parents to assess parental attitudes toward the intensive care unit admission of children. The instrument was then administered to 50 parents whose children were in the intensive care unit to examine relationships between parents' previous experiences/knowledge and their attitudes/expectations about their child's critical illness outcome. Qualitative and quantitative data analysis demonstrated that parents' attitudes toward the event of their child's admission and parents' expectations for their child's illness outcome were influenced by previous knowledge of similar situations, previous exposure to intensive care units, and previous knowledge of similar illnesses. Knowledge of factors associated with the development of parental attitude is essential to the development of models that can be tested for predictive validity. Such models may eventually assist in identifying parents who are at risk and in need of intervention. Further studies to assess the reliability and validity of the instrument in other populations is warranted.     

Communication and the Appraisal of Uncertainty: Exploring Parents’ Communication with Credible Authorities in the Context of Chronic Childhood Illness

Individuals with chronic illnesses must manage long-term uncertainty as they cope with the ways the illness influences their lives. In the context of pediatric illnesses, parents must manage uncertainty during the diagnosis and treatment of their child’s illness. It is common for children with complex chronic illnesses to see multiple specialists for the treatment of their condition. While previous research has explored parents’ uncertainty during a child’s diagnosis and during end-of-life care, less is known about these experiences when the child is referred to a team of specialists for treatment. The aim of the current study was to explore how specialists, as credible authorities, influence parents’ uncertainty during parents’ first visit to a multidisciplinary clinic for the care of their child’s complex chronic illness. Data were collected through semi-structured interviews with 29 parents after their child’s first visit to a vascular anomaly clinic at a large Midwestern children’s hospital. The results suggest parents’ communication with credible authorities facilitates effective uncertainty management primarily through the mechanism of uncertainty reappraisal. The results also suggest that specialists, as credible authorities, are a key mechanism in the appraisal of uncertainty for conditions that are often misdiagnosed and mismanaged.     

Whose power/authority/knowledge? Conundrums in the experiences of parents whose children have cancer

This paper is based on data collected from two different studies of parents (76 mothers and 14 fathers) whose children had been diagnosed with cancer. Although the goal of the first study, to describe parental experiences when their children have cancer, was different than the goal of the second study, to describe the home health care work done by parents whose children had cancer, the themes outlined here were reiterated from study to study. In both sets of data conflicts in the dynamics of power, authority and knowledge were pivotal to the dilemmas experienced by parents in their interactions with health care staff both during the time of diagnosis and later during the treatments when their children had cancer. The paper points to the significance of fundamental social processes such as power, authority and knowledge in understanding and ameliorating parental experiences when a child has cancer.     

Family‐centred care: a qualitative study of Chinese and South Asian immigrant parents' experiences of care in paediatric oncology

Background Over the past two decades, there is increasing emphasis being placed upon providing family‐centred care (FCC) in paediatric oncology settings. However, there is a lack of knowledge of FCC in paediatric oncology from the perspectives of immigrant parents. The purpose of this paper is to describe Chinese and South Asian immigrant parents' experiences of FCC in paediatric oncology settings in Canada. Methods This study adopted a constructivist grounded theory approach. Fifty first generation Chinese and South Asian parents of children with cancer who were at least 6 months post‐diagnosis were recruited from six Canadian paediatric oncology centres. Interviews were conducted in English, Cantonese, Mandarin, Urdu, Punjabi or Hindi, and transcribed into English. Analysis involved line‐by‐line, focused and theoretical coding, and the use of the constant comparison method. Results Findings indicated that overall parents were highly satisfied with the care and services they received, and their experiences were reflective of the key elements of FCC. However, there were some areas of concern identified by participants: parents not perceiving themselves as a member of the medical team; inconsistency in the quality and co‐ordination of services among healthcare providers; disrespectful and mechanical manner of a few healthcare providers; and parents' discomfort with healthcare providers communicating sensitive health‐related information directly with their child. Conclusions In order to successfully provide family‐centred services to immigrant parents of children with cancer, better communication of the elements of FCC between healthcare staff and families is needed to negotiate a clear role for the parents as partners of the healthcare team. Moreover, a better understanding of how family relationships are structured in immigrant families will assist healthcare providers to balance the best interests of the child with that of the family as a unit.     

Medical care experiences of children with autism and their parents: A scoping review

Children with autism spectrum disorder (ASD) and their families may benefit from the provision of additional supports in health care settings, particularly when preparing for and attending medical appointments. This review examined literature that describes experiences in medical care settings from the perspective of patients under age 18 with ASD and their caregivers. A scoping review was conducted to examine the experiences of children with ASD and their families in medical care settings. Twenty‐nine studies meeting inclusion criteria were identified and reviewed. The review indicated a number of challenges (e.g., parent‐reported problems in parent‐provider communication and overwhelming environments) as well as factors that facilitate positive experiences (e.g., providing positive reinforcement and explaining exam steps) during medical appointments. Children with ASD and their families are faced with many challenges while receiving care in medical settings. The present review identified many challenges families face, as well as facilitators of positive experiences. Understanding the unique experiences of patients with ASD and their parents will help to improve experiences in medical care settings for children, caregivers, and health care providers.     

What do foster parents think of the natural parents? A comparative study

By means of standardized case vignettes and rating scales, this study compared attitudes of short-term foster parents, professional social workers and parents in the general population respectively towards birth parents of abused children received into foster care. Significant differences arose between the foster parents and comparison groups on dimensions about issues relating to the desirability of foster care, restrictions on contact with birth parents and conditions under which the abused child might return to its family. Wide variation occurred both between individual foster parents and also in the degree of correspondence of views between the foster parents and each of the comparison groups on individual dimensions. Such an anomalous position, if unacknowledged, might affect outcomes of individual foster placements and hold implications for the recruitment, training and support of foster parents.     

A comparison of the childhood health status of normal birth weight and low birth weight infants

We analyzed previously unavailable data to describe the national health status in 1981 of noninstitutionalized children who were low birth weight infants. They were compared with normal birth weight children. All data contained in the analysis were based on weighted national estimates. Low birth weight children in general were found to have more chronic conditions, more hospitalizations, more days in bed because of illness, more limitations of activity, poorer health status as perceived by parents, and more school days lost because of illness. However, numbers of physician visits were not different even for low birth weight children younger than 2 years, which is inconsistent with the higher proportions of multiple hospitalizations, chronic conditions, and other illness measures. The proportions of children in the younger age groups at risk for health problems associated with low birth weight should be increasing. The proportion of very low birth weight children in the younger age groups with higher excessive morbidity measures tends to support the possibility. The increased survival of high-risk infants raises concern about their future requirements for special medical and educational services, and about the resulting stress on their families. Normal birth weight children were found to make a major contribution to the prevalence of morbidity. It is not the children identified as at risk as a result of low birth weight that comprise most of those with illnesses. The physical, social, and psychological environment after birth probably has the largest impact on the health status of our children. The attributable risk of excessive morbidity associated with low birth weight and very low birth weight reinforces the concept that while the overall impact is not large, the consistent pattern of poorer health for children born with low birth weight, compared to those of normal birth weight, shown in this analysis, is striking. The pattern reinforces concerns with the many factors associated with low birth weight and their effects on the present and future health of the population.     

Predicting Parental Attitudes Toward the Helpfulness of Postoperative Analgesic Medication

This study examined explanatory variables that could predict parent attitudes concerning the helpfulness of pain medication for their postoperative child. Predictor variables included beliefs underlying attitudes, prior medical experiences of the child and parent, and parental goals for pain relief. Data were provided by 236 parents of children undergoing day surgery and were analyzed using a multiple regression model. Although beliefs were significant predictors, parents' own experiences with surgery were stronger predictors of attitudes toward the helpfulness of pain medication for their children. Identifying parents' personal adverse experiences with surgery may assist in improving the care they provide to their child after surgery.     

慢性病儿童父母情绪障碍及影响因素分析

目的 探讨慢性病对患儿家长心理和情绪的影响.方法 采用医院焦虑抑郁量表,对72例慢病组和59例正常对照组儿童的父亲和/或母亲的抑郁和焦虑情绪进行调查和比较,并收集患儿及父母基本信息,进行单因素和Logistic多元回归分析.结果 慢病组父母在焦虑(A分值)、抑郁(D分值)得分和总分(T分值)均显著高于正常对照组(P＜0.01);慢性病组儿童父亲和母亲医院焦虑抑郁量表评分比较其3个分值均无显著性差异(P＞0.05);多因素非条件Logistic回归分析显示:与父母医院焦虑抑郁量表得分相关联的变量为:患病年限(OR=1.339)、疾病状况(OR=1.494)和亲友帮助(OR=7.269).结论 慢性病儿童父母有更多的焦虑和抑郁情绪.在治疗患儿躯体疾病的同时,对慢性病患儿及家庭进行针对性的、有效的社会心理干预非常必要.     

Child for child in Zaire: school children in the service of health

In Gecamines, Zaire, a coordination unit examines ways to introduce medical education in 90 business schools in order to promote and protect health with and through children and in favor of the community. Its activities include analyses of the causes of failure to implement medical education in the past; proposing solutions and strategies allowing the unit to succeed at proposed activities; initiating a training program for physicians, teachers, social workers, and all persons promoting the program; introducing the child-to-child pedagogy at schools and for health education for children; informing teachers about screening methods for certain abnormalities and early detection of illnesses; and helping teachers control the vaccination status of children and participate in increasing vaccination coverage. School-based activities are personal hygiene; general cleanliness of class rooms, halls, and rest rooms; screening for illnesses, especially sight, hearing, and walking anomalies; children-organized health education conferences; and transmission of health education messages via drama, songs, conferences, and drawings. Out-of-school activities include relay of new health information to families and the community through children and surveillance of schools to prevent window thefts (source of air currents leading to upper and lower respiratory infections). The oldest children care for the health of other children, especially those who live near them; inform their parents about community health resources; serve as health volunteers (e.g., growth monitoring); and actively help control and evaluate the progress of health activities in their neighborhoods. After one year of primary health care coordination activities, the results are encouraging. Children play a substantial role favoring the promotion and protection of health. They can give life to prevention activities and even care for the youngest children. They can be excellent health volunteers in their community. They influence adults and other children.     

Birth defects among children born to a population occupationally exposed to pesticides in Colombia

A case-referent study of birth defects was nested in a prevalence survey of adverse reproductive outcomes carried out among 8867 floriculture workers in Bogotá, Colombia. A total of 535 children born to these workers and reported by their parents as malformed and 1070 children selected at random as referents were invited to a medical examination including consultation with a geneticist and a clinical teratologist and a review of the medical records. Seventy-six percent of both groups attended the examination. Of 403 children reported as malformed, a birth defect was confirmed for only 154 (38%). On the other hand, of the 817 children reported as normal, 735 (90%) were normal, but 68 had a birth defect and 14 had other conditions. A case-referent analysis was then carried out including 222 children with birth defects and 443 referents. An increased risk was found only for birthmarks, and specifically for hemangiomas, for children with parents exposed to pesticides in the floriculture industry.     

学龄前儿童家长对其情感暴力行为调查研究

目的 了解家长对学龄前儿童情感暴力行为的发生情况,探讨家长对学龄前儿童情感暴力行为的影响因素。方法 采用无记名自填式问卷方法,对北京市西城区5所幼儿园842名学龄前儿童家长进行了问卷调查。结果 被调查的842名学龄前儿童家长中,在最近一年里, 15.9%的家长对子女实施过至少一项情感暴力;有童年期受虐待经历的父母对子女的情感暴力行为明显高于童年期无受虐待经历的父母(P<0.001)。结论 被调查地区家长对学龄前儿童情感暴力行为存在一定比例;父母童年期受过虐待可能为学龄前儿童情感暴力的危险因素。     

Health care of children: a continuing struggle

During the past century, research in the fields of medicine, psychology and child development has resulted in significant changes in the style of medical care provided to children. Nursing care for hospitalized children reflects many of these changes. It has become more individualized, more flexible, more responsive and more family centered. Some recent developments indicative of these changes are play rooms and play therapists for younger children, special adolescent units to meet the unique needs of hospitalized youth, prepared programs designed to educate young patients prior to hospital admission, and rooming-in for parents, to permit children to experience the support of parents while hospitalized. Continued research into the special health needs of children is needed to assure improvement in physical and emotional care of children.     

衡阳市211例唇腭裂分析与相关致畸因素研究

目的通过调查衡阳市唇腭裂患儿及父母家庭情况,了解衡阳市唇腭裂发病情况并探讨相关致畸因素,为有效进行早期干预提供科学依据。方法 2009-2012年期间,选取医院唇腭裂患儿收集个案资料,并对患儿的父母进行面谈完成调查问卷,了解其父母孕前孕期基本情况,采用χ2检验进行单因素分析,追踪患儿的可能致畸因素。结果不同性别间各年龄组患儿间单发与综合征型唇腭裂比较差异具有统计学意义(χ2=58.90,P0.01),前5位父母职业比较差异具有统计学意义(χ2=55.294,P0.01),妊娠期母亲有无呕吐服药经χ2检验差异具有统计学意义(χ2=14.45,P0.01),父、母亲是否因病服药两者比较差异具有统计学意义(χ2=39.51,P0.01),饮酒母亲与不饮酒母亲比较差别具有统计学意义(χ2=8.00,P0.05)。结论衡阳市唇腭裂患病受环境、父母生活方式、职业、遗传等多因素影响。预防的办法首先做好孕前保健、孕期保健,对高危孕妇给予产前诊断、唇腭裂患儿早期干预非常必要。     

小学生父母躯体虐待状况及其影响因素分析

目的了解小学生父母近1a来对子女躯体虐待行为的发生情况及其影响因素,为制定干预策略提供科学依据。方法采用自填式问卷,对某小学185名家长对子女躯体虐待的行为进行不记名调查。结果在被调查的185名小学生父母中,在最近1a里,有97人(52.4%)曾对子女实施过下列躯体虐待行为:用力徒手打(51.9%)、用物品打(10.8%)、罚跪(5.4%)、罚不让吃饭(3.2%)、曾使孩子窒息或烧烫或用利器刺伤(1.1%)。有童年期被家长躯体虐待经历的父母对子女实施躯体虐待行为的相对危险性,是无此经历父母的5.32倍。与女童比较,男童更容易受到家长的躯体虐待。父母对子女的躯体虐待行为与其受教育程度无明显关联,与家长的性别及年龄无明显关联。结论家长对儿童躯体虐待问题较为普遍。童年期受家长躯体虐待经历是导致家长对儿童躯体虐待的危险因素。     

AIDS in the family and community: The impact on child health in Malawi

Pediatric HIV infections jeopardize children’s health and survival. Much less is known about how the experiences of being orphaned, living with chronically ill parents, or living in a severely affected community impact child health. Our study responds by examining which HIV/AIDS-related experiences place children at greatest risk for poor health. Data from the 2004–2005 Malawi Integrated Household Survey were analyzed using logistic multilevel modeling to examine whether HIV/AIDS-related experiences within the family and community predicted reported health status among children age 6–17 years. We found higher burdens of acute and chronic morbidity for children whose parents have an AIDS-related illness. No other AIDS-related exposure, including orphanhood and recent household deaths, demonstrated a clear relationship with health status. Children living with sick parents may be at increased risk due to the spread of infectious disease and receiving limited adult care. Community home-based care programs are best situated to identify children in these difficult circumstances and to mitigate their disadvantage.     

A case-control study of testicular cancer using Connecticut tumour registry data

This case-control study was designed to determine whether males who were exposed to diethylstilboestrol (DES) in utero are at increased risk of testicular cancer. Questionnaires were completed for 79 residents of Connecticut, who were diagnosed with primary cancer of the testes between 1945 and approximately six months into 1980. An equal number of matched controls drawn from birth certificate records available from the Connecticut State Department of Health Services also submitted questionnaires. Information included data on past medical conditions of subjects and obstetrical history of mothers. The major finding of this study was a statistically significant elevated risk for premature birth for the testicular cancer cases. The study failed to show that DES increased the risk for testicular cancer. However, in view of the findings from previous human and animal studies of such abnormalities as undescended and hypoplastic testes as well as the consideration that only the earliest exposed birth cohort has reached the age of substantial cancer risk, it would seem prudent for any male who has been prenatally exposed to DES to seek medical follow-up.     

Group day care and the risk of serious infectious illnesses

Group day care attendance has been associated with an increased risk of infectious illnesses. With the exception of illnesses caused by Haemophilus influenzae type b (H. influenzae) and Neisseria Meningitidis (N. meningitidis), most studies have examined relatively mild illnesses. A matched case-control study was conducted to study the association between group day care attendance and serious infectious illnesses (requiring hospitalization). Cases were children aged 3 months to 59 months hospitalized for an infectious illness at Yale-New Haven Hospital from June 1984 through November 1986. Each case was matched to a control by date of birth and regular pediatrician, and their parents were interviewed. Data from 193 matched pairs were analyzed using conditional logistic regression. The matched odds ratio (OR) for the association between group day care attendance and serious infectious illness was 1.39 (95% confidence interval (CI) 0.87-2.20). For pairs in which the case had an H. influenzae infection (n = 46), the odds ratio was 8.00 (95% CI 1.00-63.85), and for N. meningitidis (n = 9) the odds ratio was 2.00 (95% CI 0.39-10.27). In the remaining 138 pairs, the odds ratio was 1.27 (95% CI 0.76-2.12). In infants less than 12 months of age (n = 64) the odds ratio for group day care and illnesses (excluding H. influenzae and N. meningitidis) was 1.66 (95% CI 0.73-3.80) and it was 1.06 (95% CI 0.55-2.05) for older children (n = 74). The data suggested an association between day care attendance and invasive bacterial infections other than H. influenza and N. meningitidis, OR = 2.00 (95% CI 0.81-4.94) but not for local bacterial infections, OR = 1.00 (95% CI 0.25-4.00) or infections of presumed viral etiology, OR = 1.00 (95% CI 0.49-2.05). Important predictors of serious infections (excluding H. influenzae and N. meningitidis) were passive smoking (OR = 3.96, 95% CI 2.16-7.24) and sharing a bedroom (OR = 2.31, 95% CI 1.23-4.33). These findings do not suggest that group day care attendance poses a large risk of serious infections (other than H. influenzae or N. meningitidis) to young children; however, at least one preventable factor, passive smoking, may.     

Health and mortality of migrant farm children

This research examines preventive medical care, morbidity and mortality among children of migrant agricultural workers using a representative sample of migrant families in Wisconsin. Our findings support the view that this group is at substantially greater risk of health problems and early mortality than the general population. Fewer than half of migrant children under age 16 received the recommended annual physical checkup. Only one-third of migrant children under age 16 had received an annual dental checkup compared to 50% of children in the total population. A rough comparison between levels of chronic health conditions for migrant children and those reported for children in a national survey suggest that the incidence of chronic conditions is several times greater among migrant children. Childhood mortality appears to be 1.6 times higher than in the U.S. population. In analyzing variation in preventive care for migrant children, younger children are more likely to receive checkups, while older children are more likely to receive immunizations. In interpreting this finding, we suggest distinguishing between two types of preventive care: one under the direct control of the family, and the other controlled by the schools. Since immunizations are given to migrant children in schools, the older or school-age children are more likely to be immunized. In assessing reports of chronic conditions, we noted that mothers who spoke English were more likely to report that a child had a chronic condition. One possible interpretation is that women who do not speak English may not label various childhood conditions as chronic illnesses. Since a large proportion of women spoke only Spanish, the chronic conditions may be substantially under-reported among migrant children. The analysis of childhood mortality shows the level of mortality to be proportionally lower among women who spoke English, and higher among those who gave birth to a low birth weight child. But surprisingly, the most important characteristic related to loss of children was whether or not a mother smoked. Using smoking as one example of high risk behavior, we suggest that future studies should give closer attention to the impact of parental risk-taking behaviors on childhood morbidity and mortality experiences.