Social/economic costs and health-related quality of life in patients with cystic fibrosis in Europe

Objectives

Our goal was to provide data on the economic burden and health-related quality of life (HRQOL) of patients with cystic fibrosis (CF) and their caregivers in Europe.

Methods

A cross-sectional study was carried out on adults and children with CF in eight European countries. Patients completed an anonymous questionnaire regarding their socio-demographic characteristics, use of healthcare services and presence of a caregiver. Costs were calculated with a bottom-up approach using unit costs from each participating country, and HRQOL was assessed using EQ-5D. The principal caregiver also answered a questionnaire on their characteristics, HRQOL and burden.

Results

A total of 905 patients with CF was included (399 adults and 506 children). The total average annual cost per patient varied from €21,144 in Bulgaria to €53,256 in Germany. Adults had higher direct healthcare costs than children, but children had much higher informal care costs (P < 0.0001). Total costs increased with patients’ level of dependence. In adults, mean utility fell between 0.640 and 0.870, and the visual analogue scale ranged from 46.0 to 69.7. There was no difference in caregiver HRQOL regardless of whether they cared for an adult or a child. However, caregivers who looked after a child had a significantly higher burden (P = 0.0013).

Conclusions

Our study highlights the burden of CF in terms of costs and decreased HRQOL for both patients and their caregivers throughout Europe.

     

Eating Competence Among Caregivers of Toddlers: Associations With Caregiver and Child Overweight/Obesity

ObjectiveTo examine the association between caregiver eating competence and child overweight/obesity and caregiver obesity.DesignLongitudinal cohort.SettingA large US children's hospital.ParticipantsCaregiver–child dyads (n = 288 with complete data at 2 time points) were sampled in 2017–2019 from those who received care at Nationwide Children's Hospital.Main Outcome Measure(s)Child overweight/obesity at 24 months of age (body mass index [BMI]) z-score >2 per World Health Organization standards and caregiver weight status (underweight/healthy [BMI < 25 kg/m²], overweight [BMI ≥ 25 and < 30 kg/m²], or obese [BMI ≥ 30 kg/m²]).AnalysisLog-binomial models examined the relationship between caregiver eating competence (ecSatter Inventory) at 18 months and child overweight/obesity at 24 months of age. Proportional odds models investigated the relationship between caregivers’ eating competence and weight status.ResultsEating competent caregivers had more than twice the odds (odds ratio, 2.11; 95% confidence interval, 1.30–3.42) of having a lower BMI category and had lower average BMI than noneating competent caregivers. Child overweight/obesity at 24 months did not differ by caregiver eating competence.Conclusions and ImplicationsAlthough child overweight/obesity did not vary by caregiver eating competence, caregiver eating competence was related to their weight status. Longer-term studies are needed to clarify the role of caregiver eating competence as children develop. Promoting caregivers’ eating competence may translate into healthier behaviors and skills for caregivers and their children long term.     

Overweight and obesity in primary school: native children versus migrant children

Aim

To compare the means of body mass index (BMI) and the prevalences of overweight and obesity between native Dutch and migrant primary school children and to assess to what degree differences between these children could be explained by socioeconomic position and BMI of the mother and the father.

Subjects and methods

A cross-sectional survey was performed among children at the age of 8–9 years old. Subjects were a total of 1,943 children and their primary caregiver. Outcome measures were BMIs and the prevalence of overweight, including obesity. Main independent variables were migrant background, based on country of birth of the parents, socioeconomic status, as indicated by educational level, and parental BMI. Other independent variables were the age and sex of the child.

Results

Overall, our findings show that overweight and obesity are significantly more prevalent among migrant children of non-Western descent as compared to native children and children of Western descent.

Conclusion

Parental BMI is an important predictor of a child’s BMI. However, socioeconomic position is not. Because children of non-Western migrant origin are at higher risk for overweight and obesity, insight into differences in both physical activity and energy intake as well as how these behaviors relate to cultural contrasts in parental beliefs and practices is needed.     

Improving weight status in childhood: results from the eat well be active community programs

Objectives

The eat well be active Community Programs (ewba) aimed to prevent obesity among children aged 0–18 years in two Australian communities from 2006 to 2010.

Methods

ewba was a multi-strategy intervention in children’s settings. The evaluation was quasi-experimental, including a before and after survey with intervention (INT) and non-randomised comparison (COMP) communities. Outcome measures included BMI-z score (zBMI) and overweight/obesity prevalence in children aged 4–5 years; and zBMI, waist circumference (WC) z-score and overweight/obesity prevalence in children aged10–12 years.

Results

After 3 years, among the 4–5 years old, mean zBMI was significantly lower in both INT (?0.20, p < 0.05) and COMP (?0.15, p < 0.05), however, changes were not significantly different between INT and COMP. There was a larger reduction in overweight/obesity prevalence in INT (?6.3 %) compared to COMP (?3.7 %) (p < 0.05, χ ² test). In the 10–12 years old, mean zBMI did not change significantly in INT or COMP. There was a significant reduction in WC z-score in INT (?0.17, p < 0.05) but not in COMP (?0.10, p = NS), although not significantly different between INT and COMP (p = 0.092).

Conclusions

These findings suggest that the ewba community intervention had a moderate impact, showing modest improvements in weight status at 3-year follow-up.     

Effects of the Caregiver Interaction Profile Training on Caregiver–Child Interactions in Dutch Child Care Centers: A Randomized Controlled Trial

Background

Previous studies underscore the need to improve caregiver–child interactions in early child care centers.

Objective

In this study we used a randomized controlled trial to examine whether a 5-week video feedback training can improve six key interactive skills of caregivers in early child care centers: Sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions.

Method

A total of 139 caregivers from 68 early child care groups for 0- to 4-year-old children in Dutch child care centers participated in this RCT, 69 in the intervention condition and 70 in the control condition. Caregiver interactive skills during everyday interactions with the children were rated from videotape using the Caregiver Interaction Profile (CIP) scales at pretest, posttest, and follow-up 3 months after the posttest.

Results

Results at posttest indicate a significant positive training effect on all six caregiver interactive skills. Effect sizes of the CIP training range between d = 0.35 and d = 0.79. Three months after the posttest, caregivers in the intervention group still scored significantly higher on sensitive responsiveness, respect for autonomy, verbal communication, and fostering positive peer interactions than caregivers in the control group with effect sizes ranging between d = 0.47 and d = 0.70.

Conclusions

This study shows that the quality of caregiver–child interactions can be improved for all six important caregiver skills, with a relatively short training program. Possible ways to further improve the training and to implement it in practice and education are discussed.

     

Caregiver Perspectives During the Post Inpatient Hospital Transition: A Mixed Methods Approach

Background

Knowledge of caregiver perspectives of their psychosocial resources and needs during the post inpatient psychiatric hospitalization is limited. Examining caregivers’ perspectives of the transition period may be a critical step in improving the transition success of children with emotional and behavioral disorders. Using quantitative and qualitative methods, we investigated the psychosocial resources and needs of caregivers after a child inpatient hospitalization.

Objective

This study sought to examine the psychosocial resources of caregivers of children leaving intensive psychiatric care and participating in a post-inpatient transition program, and to describe their reported needs at home and school.

Methods

Forty-four caregivers were recruited from the child and adolescent psychiatric inpatient units of two hospitals (one urban, one suburban). We utilized a partially mixed concurrent equal status design for mixed-methods analysis. Qualitative data were analyzed using consensual qualitative research methodology.

Results

Caregivers reported high levels of strain, child symptomatology, and low levels of empowerment and social support. Their satisfaction with school and mental health services were mixed. Caregivers identified a need for increased knowledge of behavior management strategies, improved caregiver/child relationship, more emotional support, and increased access to services for their children. Areas of concern in the school setting included social–emotional functioning, learning, access to school services, and advocacy.

Conclusion

These findings expand our knowledge of caregivers’ psychosocial resources and needs during their children’s inpatient psychiatric hospitalization and subsequent transition to home and school. As research in this area develops, we suggest that incorporating caregivers’ needs into transition planning may result in more effective and acceptable interventions for families.

     

Health and educational status of children raised by a caregiver with a disability

Background

Research on children raised by adults with disability is limited. Our goal was to provide a profile of the health and educational status of children raised by a caregiver with disability.

Methods

In 2007-2008, 4571 adults completed the North Carolina Behavior Risk Factor Surveillance System (BRFSS) and Child Health Assessment Monitoring Program (CHAMP) surveys. Analyses using weighted data provided population-based health/educational status comparisons of children (0 to 17 years old) raised by caregivers with and without disability.

Results

Twenty-three percent of caregivers reported disability. Rates of insurance coverage and preventive care did not differ by caregiver disability status, although children of caregivers with disability were more likely to have publicly funded insurance. The majority of children of caregivers with disability were in excellent/very good health (70%), healthy weight (58%), and making above-average grades (74%). Nonetheless, children raised by caregivers with disability appear to be at disproportionately higher risk for overall poorer outcomes. Children raised by caregivers with disability were more likely to be in fair/poor health (adjusted odds ratio [aOR] 2.2; 95% confidence interval [CI] 1.3 to 3.6), overweight/obese (aOR = 1.5, 95% CI 1.1-2.0), need medical/educational services (aOR = 2.0, 95% CI 1.5-2.6), have lower grades (aOR = 1.9, 95% CI 1.4-2.5), and higher rates of school absenteeism (aOR = 2.4, 95% CI 1.8-3.4), compared to children of caregivers without disability.

Conclusion

Children raised by a caregiver with disability show good overall wellness; however, caregiver disability status was found to be associated with an increased risk for poor child health and educational outcomes. Future research is needed to clarify the causes of these disparities and inform policies to alleviate them.     

Randomized Video-Feedback Intervention in Home-Based Childcare: Improvement of Children’s Wellbeing Dependent on Time Spent with Trusted Caregiver

Background

The childcare environment offers a wide array of developmental opportunities for children. Providing children with a feeling of security to explore this environment is one of the most fundamental goals of childcare.

Objective

In the current study the effectiveness of Video-feedback Intervention to promote Positive Parenting-Child Care (VIPP-CC) was tested on children’s wellbeing in home-based childcare in a randomized controlled trial.

Methods

Forty-seven children and their caregivers were randomly assigned to the intervention group or control group. Children’s wellbeing, caregiver sensitivity, and global childcare quality were observed during a pretest and a posttest.

Results

We did not find an overall intervention effect on child wellbeing, but a significant interaction effect with months spent with a trusted caregiver was present. Children who were less familiar with the caregiver showed an increase in wellbeing scores in both the intervention and control group, but for the group of children who were more familiar with the caregiver, wellbeing increased only in the intervention group.

Conclusions

Although there was no overall effect of the VIPP-CC on children’s wellbeing, the VIPP-CC seems effective in children who have been cared for by the same trusted caregiver for a longer period of time.

     

The Influence of Maternal Acculturation on Child Body Mass Index at Age 24 Months

Objective

Obesity rates in preschool-aged children are greatest among Latinos. Studies of the relationship of acculturation to obesity among Latino immigrants have primarily focused on adults and adolescents. We examined the influence of maternal acculturation on child body mass index (BMI) at age 24 and 36 months among predominantly Latino, low-income mother-child pairs enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children.

Design and methods

Maternal characteristics were obtained from interviewer-administered surveys conducted in English or Spanish at 6 to 20 weeks postpartum among 679 participants in a randomized controlled trial of a health promotion intervention in two urban areas in the Northeast. Acculturation measures included: nativity (born in the United States vs foreign born), parents' nativity, years of US residence (<8 years vs ≥8 years), and exclusive use of native language vs nonexclusive use (mixed or English only). Following repeated mailings and telephone calls requesting permission to obtain their child's height and weight from Special Supplemental Nutrition Program for Women, Infants, and Children records, informed consent was obtained from 108 mothers. Multivariable linear regression models of maternal acculturation and child BMI z score at age 24 months and age 36 months were estimated among all mother-child pairs and within immigrant-only mother-child pairs, adjusting for relevant maternal characteristics.

Results

At age 24 months, children of mothers with exclusive use of native language had higher BMI z scores compared to children of mothers with nonexclusive use among 91 mother-child pairs (β=.74, P=0.02) and within 63 immigrant-only mother-child pairs (β=.92, P=0.009).

Conclusions

Exclusive use of native language was associated with greater BMI in children as young as age 24 months. Future research should examine the mechanisms by which mothers' language acculturation may affect proximal determinants of energy balance in preschool children, including breastfeeding practices, dietary intake, and physical activity.     

Optimism and the Socioeconomic Status Gradient in Adolescent Adiposity

Purpose

To assess whether dispositional optimism is associated with adiposity and to explore whether dispositional optimism mediates the relationship between parent education and adiposity (body mass index [BMI] z-score).

Methods

Multivariate regression analyses of data were collected from 1,298 non-Hispanic black and white adolescents aged 12–19 years from a single Midwestern public school district.

Results

Less optimistic adolescents had higher BMI z-scores (r = −.09, p < .001). Addition of dispositional optimism to the regression model caused an approximately 10% attenuation of the parent education and BMI z-score relationship. Sobel tests confirmed that this attenuation indicated partial mediation.

Conclusion

Lower dispositional optimism is associated with higher adiposity and this association accounts for some of the influence of parent education on adolescent adiposity.     

Feasibility of a Multimedia Program for Parentally Bereaved Children

Background

Self-directed multimedia resources that provide psycho-educational information to selected populations have been supported in child health related areas including parenting skills in adults and literacy in children. Comparable programs for use with bereaved children and families have not been adequately developed or empirically examined. Examining usability and satisfaction with such materials is critical, especially when dealing with bereavement.

Objective

This study evaluated the feasibility of the multimedia kit “Talk, Listen, Connect III: When Families Grieve? (TLC III)” for use with caregivers and their parentally bereaved children (ages 2–16 years). Primary outcomes included the utilization and overall satisfaction with the TLC III kit and the kit’s impact on caregiver–child communication. Secondary outcomes, engagement, family coping, and caregiver and child grief also were examined.

Participants

Ninety-three caregivers completed pre- and post-viewing questionnaires (59 in the TLC III group, 34 in the comparison group).

Results

Caregiver’s who viewed the TLC III kit materials reported greater satisfaction with kit materials and greater impact on family coping with death than did caregivers who viewed the Ready kit. No significant differences were found with regard to pre- to post-test changes on any of the primary or secondary outcome measures after controlling for pretest scores.

Conclusions

Multimedia programs should be considered as adjuncts or alternatives to traditional therapies and further evaluated for use with parental bereavement; particularly among inaccessible segments of the population. Future studies should consider innovative approaches to examining the effects of such programs on complex problems faced by children.     

The relationship between child and parent food hedonics and parent and child food group intake in children with overweight/obesity

Many factors influence children's dietary intake, including children's and parents' food hedonics (liking), and parent intake. This secondary data analysis studied the relationship between child and parent liking, and parent intake and child intake of fruits, vegetables, low-fat dairy, snack foods, and sweetened beverages in 4- to 9-year-old overweight/obese (body mass index ≥85th percentile) children presenting for obesity treatment (September 2005 to September 2007) in Providence, RI. One hundred thirty-five parent-child pairs, with complete baseline dietary (3-day food record) and food group hedonic data were included. Hedonic ratings were mean ratings using a 5-point Likert scale (lower scores represented greater liking of a food group). Children were aged 7.2±1.6 years, 63.0% girls, 12.6% African American, and 17.8% Hispanic, with a mean body mass index z score of 2.3±0.6. Total servings consumed by children over 3 days were: fruits 2.7±3.2, vegetables 3.4±2.5, low-fat dairy 2.4±2.1, snack foods 5.9±4.2, and sweetened beverages 2.7±3.1. After demographic and anthropometric variables were controlled, parent intake was positively related (P<0.05) to child intake of all food groups except sweetened beverages. Child liking was only significantly (P<0.05) related to child intake of vegetables. In young children with obesity/overweight, parent intake was consistently related to child intake. Changing parent intake may be important in helping to change the dietary intake of young children with overweight/obesity.     

Nutrient Adequacy and Diet Quality in Non-Overweight and Overweight Hispanic Children of Low Socioeconomic Status: The Viva la Familia Study

Objective

The role of diet quality and nutrient adequacy in the etiology of childhood obesity is poorly understood. The specific aims of these analyses were to assess overall diet quality and nutrient adequacy, and test for association between weight status and diet in children from low socioeconomic status (SES) Hispanic families at high risk for obesity.

Design

A cross-sectional study design was used to assess dietary intake in low-SES Hispanic children with and without overweight who were enrolled in the Viva la Familia Study. Multiple-pass 24-hour dietary recalls were recorded on two random, weekday occasions. Diet quality was evaluated according to the Dietary Guidelines for Americans. Nutrient adequacy was assessed using z scores based on estimated average requirement or adequate intake.

Subjects/setting

The study included 1,030 Hispanic children and adolescents, aged 4 to 19 years, in Houston, TX, who participated between November 2000 and August 2004.

Statistical analysis

STATA software (version 9.1, 2006, STATA Corp, College Station, TX) was used for generalized estimating equations and random effects regression.

Results

Diet quality did not adhere to the Dietary Guidelines for Americans for fat, cholesterol, saturated fatty acids, fiber, added sugar, and sodium. Although energy intake was significantly higher in children with overweight, food sources, diet quality, macro- and micronutrient composition were similar between non-overweight and overweight children. Relative to estimated average requirements or adequate intake levels, mean nutrient intakes were adequate (70% to 98% probability) in the children without and with overweight, except for vitamins D and E, pantothenic acid, calcium, and potassium, for which z scores cannot be interpreted given the uncertainty of their adequate intake levels.

Conclusions

Whereas the diets of low-SES Hispanic children with and without overweight were adequate in most essential nutrients, other components of a healthful diet, which promote long-term health, were suboptimal. Knowledge of the diets of high-risk Hispanic children will inform nutritional interventions and policy.     

Low recognition of childhood overweight and disease risk among Native-American caregivers

OBJECTIVES: Pediatric obesity is a significant and increasing problem in Native-American communities. The aim of this study was to determine whether parents and other caregivers from three Wisconsin tribes recognized overweight children. We also assessed caregiver attributes associated with levels of concern for risk of future overweight and chronic disease. RESEARCH METHODS AND PROCEDURES: Data were obtained from child health screenings and caregiver surveys. Participants included 366 kindergarten-through-second grade child-caregiver dyads. Children's BMI percentiles were calculated and compared with caregiver responses. We assessed the relationships between predictors of caregiver concern for health risk factors and recognition of overweight. RESULTS: Twenty-six percent of children were overweight (>or=95th percentile), and 19% were at risk for being overweight (>or=85th to <95th percentile) using Centers for Disease Control standards. Caregivers recognized only 15.1% of overweight children. Factors predictive of child overweight recognition included a child BMI >99th percentile and grandmother as caregiver. Overall, caregivers were more concerned about diabetes and cardiovascular disease than obesity. Parents with diabetes and heart disease were more concerned than others about risk for these diseases; however, only diabetic parents made a connection between child weight status and future risk of obesity-related disease. Child sex, child age, and parental education level were not significant predictors for caregiver recognition of an overweight child. DISCUSSION: Most caregivers did not recognize overweight children or associate excess weight with increased risk of disease. When designing community interventions, it is crucial to incorporate caregivers' attitudes and beliefs regarding childhood overweight and risk of future disease.     

Childhood obesity and prevention in different socio-economic contexts

Objective

To assess recent trends in obesity, health beliefs, and lifestyles in Swedish schoolchildren, with focus on socioeconomic disparities.

Method

The study was conducted in two areas with high and low socioeconomic status (SES). 340 11–12 year olds participated in three cross-sectional surveys assessing food-related behaviours, physical activity and health beliefs, together with anthropometric examinations. Comparisons were made before and after a community-based intervention (2003 versus 2008) within the low-SES school, and between the low and high-SES school (2008 only).

Results

In the low-SES school BMI z-score decreased over 5 years (0.80 vs 0.46) as did the percentage of children frequently consuming sweet drinks (43.5 vs 26.8%), statistically significant in girls only (p < 0.05). Children increasingly perceived benefits of healthy life-styles (37 vs 55%). In 2008, consumption of breakfast, vegetables, sweets and sweet drinks differed between schools, as did screen-time and physical activity, all in favour of the high SES-school where the obesity-prevalence was significantly lower (0.8 vs 6.7%).

Conclusion

Positive changes in diet and weight status were observed, especially in girls, within a low-income multi-ethnic community undergoing a health promotion intervention. Our results underscore the multifactorial etiology of childhood obesity and the importance of continuing tailored, gender-sensitive prevention efforts.     

Do Maternal Caregiver Perceptions of Childhood Obesity Risk Factors and Obesity Complications Predict Support for Prevention Initiatives Among African Americans?

Objectives African American maternal caregiver support for prevention of childhood obesity may be a factor in implementing, monitoring, and sustaining children’s positive health behaviors. However, little is known about how perceptions of childhood obesity risk factors and health complications influence caregivers’ support of childhood obesity prevention strategies. The objective of this study was to determine if childhood obesity risk factors and health complications were associated with maternal caregivers’ support for prevention initiatives. Methods A convenience sample of maternal caregivers (N?=?129, ages 22–65 years) completed the childhood obesity perceptions (COP) survey. A linear regression was conducted to determine whether perceptions about childhood obesity risk factors and subsequent health complications influenced caregivers’ support for prevention strategies. Results Caregivers’ perceptions of childhood obesity risk factors were moderate (M?=?3.4; SD?=?0.64), as were their perceptions of obesity-related health complications (M?=?3.3; SD?=?0.75); however, they perceived a high level of support for prevention strategies (M?=?4.2; SD?=?0.74). In the regression model, only health complications were significantly associated with caregiver support (β?=?0.348; p?<?0.004). Conclusions Childhood obesity prevention efforts should emphasize health complications by providing education and strategies that promote self-efficacy and outcome expectations among maternal caregivers.     

Psychosocial outcomes of Lunch is in the Bag, a parent program for packing healthful lunches for preschool children

Objective

This pilot study evaluated effects of Lunch is in the Bag on behavioral constructs and their predictive relationship to lunch-packing behaviors of parents of young children.

Methods

Six child care centers were pair-matched and randomly assigned to intervention (n = 3) and comparison (n = 3) groups. Parent/child dyads participated. Constructs of knowledge, outcome expectations, perceived control, subjective norms, and intentions were measured by a pre/post questionnaire. Hierarchical linear regression was used, and P < .05 was considered significant.

Results

There were significant increases in knowledge (P = .01); outcome expectations for whole grains (P < .001); and subjective norms for fruit (P = .002), vegetables (P = .046), and whole grains (P = .02). Perceived control, outcome expectations, and intentions significantly predicted packing vegetables and knowledge predicted whole grains.

Conclusions and Implications

Lunch is in the Bag is a feasible intervention to improve the lunch-packing behaviors of parents of preschool-aged children.     

Immigrant Caregivers of Young Children: Oral Health Beliefs,Attitudes, and Early Childhood Caries Knowledge

The incidence of early childhood caries (ECC) is a global public health concern. The oral health knowledge of a caregiver can affect a child’s risk for developing ECC. An exploratory study of the oral health knowledge and behaviors among caregivers of children 6 years of age and younger was conducted with a convenience sample of adults (n = 114) enrolled in English language or high school equivalency examination courses. The majority of study participants were born in Asia (47 %). Other birth regions included South America (16 %), Caribbean (16 %), Africa (10 %), and Central America (6 %). Study findings showed caregivers with low oral health knowledge were more likely to engage in behaviors that increase a child’s risk for developing ECC. A statistically significant relationship was found between participants’ rating of their child’s dental health as poor and the belief that children should not be weaned from the nursing bottle by 12 months of age (P = 0.002), brushing should not begin upon tooth eruption (P = 0.01), and fluoride does not strengthen teeth and prevent dental caries (P = 0.005). Subjects who pre-chewed their child’s food also exhibited behaviors including sharing eating utensils or a toothbrush with their child (P < 0.001). Additional caregiver behaviors included providing their child with a bottle containing cariogenic liquids in a crib (P < 0.001). As a result of this research, it is pertinent that culturally sensitive oral health promotion programs are developed and implemented to raise awareness and reduce the risk of dental disease among immigrant populations.