Survival Against Drugs: Education for School-Age Children

PROBLEM: Alcohol and drug use of young school-age children continue to escalate. Comprehensive, effective interventions are needed to treat and prevent future alcohol and drug use. METHODS: The alcohol and drug use of 69 school-age children participating in afterschool programs was explored; parents completed a family climate scale. An investigator-developed educational program was evaluated for its effect on self-efficacy of the children to prevent drug and alcohol use. FINDINGS: Although family climate scales indicated functioning families, 25% of the children indicated they have used drugs or alcohol and 49% indicated a possible problem with alcohol or drugs being used at home by parents. A significant correlation with a child's self-efficacy and drug use was found. CONCLUSIONS: The educational program taught children survival skills to resist the use of alcohol and drugs. Children with a plan to resist the use of drugs were more likely not to use drugs.     

Distances to Emergency Department and to Primary Care Provider's Office Affect Emergency Department Use in Children

Objectives:  Patients of all ages use emergency departments (EDs) for primary care. Several studies have evaluated patient and system characteristics that influence pediatric ED use. However, the issue of proximity as a predictor of ED use has not been well studied. The authors sought to determine whether ED use by pediatric Medicaid enrollees was associated with the distance to their primary care providers (PCPs), distance to the nearest ED, and distance to the nearest children's hospital.
Methods:  This historical cohort study included 26,038 children age 18 and under, assigned to 332 primary care practices affiliated with a Medicaid health maintenance organization (HMO). Predictor variables were distance from the child's home to his or her PCP site, distance from home to the nearest ED, and distance from home to the nearest children's hospital. The outcome variable was each child's ED use. A negative binomial model was used to determine the association between distance variables and ED use, adjusted for age, sex, and race, plus medical and primary care site characteristics previously found to influence ED use. Distance variables were divided into quartiles to test for nonlinear associations.
Results:  On average, children made 0.31 ED visits/person/year. In the multivariable model, children living greater than 1.19 miles from the nearest ED had 11% lower ED use than those living within 0.5 miles of the nearest ED (risk ratio [RR] = 0.89, 95% CI = 0.81 to 0.99). Children living between 1.54 and 3.13 miles from their PCPs had 13% greater ED use (RR = 1.13, 95% CI = 1.03 to 1.24) than those who lived within 0.7 miles of their PCP.
Conclusions:  Geographical variables play a significant role in ED utilization in children, confirming the importance of system-level determinants of ED use and creating the opportunity for interventions to reduce geographical barriers to primary care.     

Understanding caregivers' help-seeking for Latino children's mental health care use

BACKGROUND: Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers' decisions about whether to use mental health care for their children can help explain why. OBJECTIVE: The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users. SUBJECTS: Data were collected from a random Puerto Rican community sample of caregiver-child dyads. MEASURES: Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems. STATISTICAL METHODS: The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers' decision-making around taking children for mental health care and the setting for care. RESULTS: The classification model of use versus no use of mental health service suggested 3 significant predictors: child's level of impairment, parental concern, and child's difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified 1 significant predictor, any disruptive disorder diagnosis. CONCLUSION:: Assisting caregivers in linking a child's impairment with need for mental health care might be a mechanism to reduce children's unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need.     

Breast cancer risk factors in Korean women: a literature review

Aim:  To compile a complete list of risk factors from the Korean breast cancer studies to obtain relevant predictor information essential in developing a predictive model for breast cancer.
Background:  Breast cancer is the most commonly diagnosed female cancer in Korea. However, the breast cancer-screening rate in Korea is relatively low compared with that in other countries. In order to promote early health screening, there is a need to identify those individuals who are most likely to develop breast cancer by using an accurate predictive model.
Methods:  Thirty-four breast cancer studies were selected from MEDLINE and two Korean literature databases. Two researchers summarized the risk factors and their effects in each article using a checklist.
Findings:  Most of the studies were case–control studies conducted after 2000. In 34 articles, a total of 84 risk factors for breast cancer in Korean women were identified; of these, 58 factors were determined as statistically significant factors. The factors identified most often were body mass index, menarche, menopause, family history, pregnancy and delivery, breastfeeding, alcohol use, smoking habits, diet, education and use of oral contraceptives. None of 34 studies looked at stress as a risk factor of which influence on cancer has been reported in other populations.
Conclusion:  The next steps will be to construct a questionnaire consisting of relevant variables based on these study results and to develop a predictive model. This would be used to encourage those Koreans who are more likely to develop breast cancer to have early check-ups.     

Chronic sorrow in parents of children with type 1 diabetes

Title.  Chronic sorrow in parents of children with type 1 diabetes.
Aim.  This paper reports on a study exploring parents' longer-term experiences of having a child with type 1 diabetes.
Background.  Parents of children with type 1 diabetes may experience a grief reaction at diagnosis similar to that normally associated with bereavement, but little is known about their long-term emotional adaptation. Chronic sorrow, a sustained but intermittent grief reaction, is identified in adults with diabetes but has not previously been explored in relation to parents.
Methodology.  In-depth interviews were conducted in 2007 with a convenience sample of 17 parents of children with type 1 diabetes 7–10 years after diagnosis. Data were explored within a theoretical framework of grief, loss, adaptation, and change.
Findings.  Parents had adapted to the needs of diabetes management but most had not 'come to terms' with the diagnosis. They experienced a resurgence of grief at critical times during their child's development and some, particularly mothers, became upset during their interviews, even though these took place 7–10 years after their child's diagnosis. Mothers elaborated more on their emotions than fathers, but continuing feelings associated with grief, such as anger and guilt, were expressed by both fathers and mothers.
Conclusion.  Greater understanding of parents' long-term emotional responses and recognition that grief may never resolve in these parents may enable healthcare professionals to provide appropriate and timely support at critical times.     

Obsessive-compulsive disorder in children: The role of nurse practitioners

Purpose: To review the characteristics of obsessive-compulsive disorder (OCD) in children, differential diagnoses, screening and assessment tools, interventions, and outcomes. The role of nurse practitioners (NPs) in caring for children with OCD and the need for more research are discussed.
Data sources: Review of published literature on the topic.
Conclusions: OCD is now recognized as a common psychiatric disorder that may go unrecognized during childhood, leading to interference with a child's development and daily functioning. Early identification and treatment of OCD are crucial for a child's psychosocial functioning and quality of life.
Implications for practice: NPs familiar with OCD in children can identify patients and make informed judgments about assessment, treatment, and referral.     

Culture BoundAnxiety Disorder in Adolescence: A Case Study

TOPIC:  There are a number of culture-bound syndromes in the literature that may directly impact on clients' systems of meaning and, thus, the clinician's ability to effectively intervene. This applies to Hispanic/Latino children, particularly those who present with anxiety and somatic symptoms.
PURPOSE:  This case study deals with a 14-year-old Hispanic girl who presented at a behavioral health clinic with anxiety behaviors.
SOURCES:  Review of the literature and case example from practice.
CONCLUSION:  Since culture can have a profound influence on a child's thoughts, emotions, and behaviors, nurses' cultural understanding is critical in psychiatric diagnostic evaluation and treatment.     

Early intervention and the influence of the occupational therapist on the parent-child relationship

The child's development and the parent-child relationship reflect two interdependent processes. Several factors influence the occupational behavior of the child and the adult. In this paper, the ways in which occupational therapists can influence both the child and the parent-child relationship are identified. The parents' occupational behavior is influenced by their knowledge of their children and their attitudes regarding the parenting role. The occupational therapist is part of the social support system and can work with the parents to enlarge their feelings of social embeddedness and support. In addition, the occupational therapist can influence the parent-child relationship by fostering the child's development and helping the parents learn techniques to deal with their child's undesirable characteristics, such as excessive irritability. Knowledge of the different avenues of influence helps the occupational therapist in planning and evaluating treatment in early intervention.     

Primary Child Health Care Nurses' assessment of health risks in children of foreign origin and their parents – a theoretical model

Background:  According to recent studies, intercultural interaction in health care between clients and care-givers seems to be problematic. A recent Swedish study revealed that a majority of Primary Child Health Care Nurses (PCHNurses) experienced difficulties in their interaction with children and parents of foreign origin. As every third child in the Primary Child Heath Care (PCHC) services is of foreign origin it seem to be of utmost importance to examine in depth how these difficulties could be understood and explained.
Aim:  The present study aimed at a theoretical explanation of the core problem concerning PCHNurses' interaction with children and parents of foreign origin, as experienced by the PCHNurses.
Methods:  Fifteen PCHNurses working in the PCHC services were interviewed. Grounded Theory was used as research methodology because focus is on social interactions and the aim is to theoretically explain unarticulated social processes.
Results:  Anxiety about missing children, exposed to risks of ill-health, due to various conditions in the child's home environment, turned out to be the PCHNurses' main concern. An assessment of health risks was initiated, when PCHNurses thought that psychosocial conditions in the child's environment might cause ill health. Some of the psychosocial conditions were difficult to assess, as they were unfamiliar and not understood by the PCHNurses. In such difficult-to-assess cases, when the PCHNurses considered the possibility of undefined risk to the child's health they held on to the assessment of the cases and worked out strategies to learn and understand more about the child and the child's home environment. A theoretical model grounded in data was created accounting for the variation in the assessment process and the different strategies used. Implications are discussed and recommendations for improvements are given.     

Alcohol Use among Subcritically Injured Emergency Department Patients

Objectives: To determine the incidence of alcohol use in subcritically injured patients presenting to the ED, by using a saliva alcohol test (SAT) at ED triage during the ED initial assessment; to compare the incidence of alcohol use revealed by the SAT with documentation of alcohol use by ED nurses and emergency physicians (EPs) blinded to the SAT results; and to describe the demographics of the SAT-positive, subcritically injured population.
Methods: A blinded, prospective, observational evaluation of ED patients presenting with subcritical injuries was performed. The patients were tested for alcohol use with an SAT, and a subsequent record review was conducted for extraction of demographic data and evidence of documentation of alcohol use by ED nurses and EPs blinded to the SAT results.
Results: During the study. 791 subcritically injured patients had SATs performed. Twenty-one percent of these patients were found to be alcohol-positive by SAT. Either the ED nurse or the EP documented a clinical impression of alcohol use for 52% of the SAT-positive patients. There were higher SAT-positive rates among men (24%), victims of assault (47%), and patients arriving at night (41%).
Conclusions: While the SAT identified 21% of the subcritically injured patient population as alcohol-positive, ED nurse and EP documentation did not identify half of these alcohol-positive patients. Many of these patients may be at risk for additional injuries related to their drinking behavior.     

Participation of the child with cerebral palsy in the home, school, and community: A review of the literature

Improving participation of children with cerebral palsy is an important outcome in the practice of pediatric rehabilitation. Current knowledge of how a child's interactions with various environments influence participation can affect care provision to children with cerebral palsy. The literature was searched using electronic databases and reference lists from 1991 to 2008. Studies included reports on one or more factors influencing a child's participation. Using the International Classification of Function, Disability, and Health (ICF) as a framework, factors that influence participation are summarized.     

Predictors of the Transition From Experimental to Daily Smoking Among Adolescents in the United States

PURPOSE.  This study examined factors affecting the transition from experimental smoking at baseline to two types of daily smoking, temporary daily smoking, and continued daily smoking, at 1-year follow-up.
DESIGN AND METHODS.  This study analyzed data from the National Longitudinal Study of Adolescent Health ( n  = 4,903 U.S. adolescents). Baseline predictors were selected based on Problem Behavior Theory.
RESULTS.  Important problem behavior theory-related predictors of smoking were the number of friends who smoke, academic performance, and alcohol, marijuana, and other illicit drug use. Other significant predictors were age, gender, race, depression, perceived general health, and cigarette availability at home.
PRACTICE IMPLICATIONS.  To prevent teens from progressing to daily smoking, nursing professionals should consider multifaceted factors based on multiple theories.     

Antibiotics for nasopharyngitis are associated with a lower risk of office-based physician visit for acute otitis media within 14 days for 3- to 6-year-old children

Objectives  This study was designed to analyse factors potentially influencing children's return visits to physicians for symptoms of acute otitis media (AOM) within 14 days after being diagnosed with nasopharyngitis (NP), and the impact of recent antibiotic use.
Design  A controlled population-based pharmaco-epidemiological trial in 3- to 6-year-old children conducted from January to May 2000.
Setting  Three different geographical regions in France.
Participants  Among 2507 eligible children, 2456 could be analysed and 505 children had 634 office-based physician visits (OBPV) for NP symptoms.
Interventions  The statistical associations between antibiotics prescribed for NP and an OBPV for AOM within 14 days in a population-based study were analysed along with risk factors of AOM.
Main outcomes measure  Clinical events and antibiotic use.
Results  During the 2 weeks following physician-diagnosed NP, antibiotic use, especially a beta-lactam, significantly decreased the risk of OBPV for AOM in children (odds ratio = 0.2; 95% confidence interval = 0.09–0.7; P  = 0.002).
Conclusion  Antibiotics prescribed to children for NP seem to protect during the following 2 weeks against the risk of OBPV for AOM. It remains to be determined whether a subgroup at high risk of developing AOM after a viral infection exists and what might be the best strategy to adopt for NP in a national programme of optimal antibiotic use.     

Psychosocial Experiences of Parents of a Child With Imperforate Anus

PURPOSE.  This study aims to examine the psychosocial experiences of parents of children with imperforate anus (IA) and to describe their potential positive experiences.
DESIGN AND METHODS.  Parents of IA children and a comparison group answered a questionnaire, which was analyzed quantitatively and with manifest content analysis.
RESULTS.  Social relationships and respect for the child's will were more affected among IA mothers. Positive experiences were revealed in relation to the child, the parent, and the family.
PRACTICE IMPLICATIONS.  Support to parents in caring for a child with IA should be individualized and occasionally undertaken through collaboration with experts from child and adolescent psychiatry.     

Home Asthma Management for Rural Families

ISSUES AND PURPOSE. To assess home asthma management among rural families with a school-age child who has asthma.
DESIGN AND METHODS. Exploratory analysis of baseline data of a tri-ethnic sample of rural families with school-age children who have asthma.
RESULTS. Parents and children enact a moderate amount of asthma management behaviors. Preventive behaviors were correlated with the Asthma Behavior Inventory and treatment behaviors were correlated with the child's asthma severity. Factors that could affect asthma management include no insurance, no visits to providers in 12 months, or no asthma medications.
PRACTICE IMPLICATIONS. Nurses must use every contact with families to assess their asthma management and availability of resources, and to determine the fit between asthma severity and the asthma management plan.